As Alabama braces for an expected surge in COVID-19 cases, its hospitals are competing with hospitals across the country in a medical arms race to acquire equipment needed to fight the deadly virus that threatens to exhaust in a matter of days what has already been stored.

And Alabama has only itself to lean on.

"As you know, states have been told we are on our own in terms of finding this equipment," Dr. Scott Harris, state health officer, said Monday. "So everyone is competing with each other trying to find sources that can provide those materials."

The scramble to secure masks, gowns, goggles, respirators and other equipment considered absolute necessities to treat patients stricken with the novel coronavirus that originated in China has even led Alabama to, well, China.

David Spillers, CEO of Huntsville Hospital, said his hospital has taken what might seem as a most unorthodox step to get some COVID-19 ammo.

"We're not getting extra unless we go outside our typical supply chain and go direct to a vendor or somebody in China," he said Monday. "Believe it or not, they still manufacture a lot of stuff there. That's where it comes from. We've reached out and taken that chance to do that and hopefully it will get here on a boat."

It’s a jarring reality that led governors across the country to speak out in protest and concern over the policy of President Donald Trump, who has said he is leaving it up to the states to fend for themselves while the federal government will be there “should you fail” in a Twitter message on Saturday.

.@JBPritzker, Governor of Illinois, and a very small group of certain other Governors, together with Fake News @CNN & Concast (MSDNC), shouldn’t be blaming the Federal Government for their own shortcomings. We are there to back you up should you fail, and always will be! — Donald J. Trump (@realDonaldTrump) March 22, 2020

But just as states have long competed in the economic marketplace – jostling to win this giant automaker plant promising thousands of jobs or that convention filling thousands of rooms at hotels and tables at restaurants – the fight now is for who can be the best to take care of its people amid the spread of a virus without a cure.

It’s a scramble, a competition, unlike any Dr. Don Williamson, president of the Alabama Hospital Association, said he has seen. Then again, the COVID-19 threat is unlike any he has seen as well.

Williamson served as Alabama's health officer for 23 years before joining the hospital association.

“We went through our share of disasters,” he said in an interview with AL.com Monday. “Admittedly, we never went through anything like this. But that was never the approach during my time. The H1N1 (virus in 2009) being the best example, the feds had resources and they allocated them to states.”

The COVID-19 crisis, though, is so unique that Williamson said maybe precedent cases don’t apply.

"It may be, in fairness, it is simply such a large challenge that there is no other way to do that," he said. "And how big a challenge is that going to be? I simply don’t know."

It is the unknown that is perhaps the scariest aspect for health officials. Spillers, for example, said his hospital system is well stocked at this moment. But all planning is based on an anticipated spike of cases that require hospitalization.

That's why Spillers said the Huntsville Hospital System – which includes medical facilities throughout north Alabama – has worked to trim its inpatient load to clear bed space and preserve resources. So far, he said the hospital has been able to free up about 350 beds through discharging patients.

It’s perhaps not unlike staring at the horizon, watching the storm clouds grow darker and more menacing. As of Monday, the Huntsville Hospital System had admitted only three COVID-19 patients, Spillers said.

"All of our work right now is to acquire and store as much supplies as possible, we're doing that to prepare for an influx of inpatients if and when they come," he said.

Williamson said there are methods by which hospitals can seek needed equipment even as he describes the process as "imperfect."

One avenue is shared resources among hospitals. Spillers said that Huntsville Hospital has loaned respirators to East Alabama Medical Center for its inpatient COVID-19 cases.

"But that's obviously not a long-term solution because folks are going to need those ventilators back as their issues rise," Williamson said.

Another avenue is through traditional supply chains that hospitals rely upon on an everyday basis – not just during a pandemic.

"That's not going to be enough is my guess," Williamson said.

Still another avenue is to request equipment from the Strategic National Stockpile, a federal reserve that works to fill needs across the country. Williamson said a shipment last week provided hospitals some N95 masks and other personal protective equipment for healthcare workers and that another request had already been submitted for more respirators.

“The state of Alabama asked for 200 ventilators,” Williamson said. “Depending on how bad the epidemic gets, we may need not 200 but we need 2,000. If we need 2,000 ventilators, that may be more than we can ever get out of the Strategic National Stockpile and we have to find another source.”

Finally, there is the open marketplace.

"The states are now having to go out and compete against each other on the marketplace to try to find increasingly scarce resources," Williamson said.

He also commended Gov. Kay Ivey for creating a task force who work to identify sources of equipment and then allocating it to the hospitals. Ivey’s office deferred comment on the equipment competition to the Alabama Department of Public Health.

“When ADPH has PPE resources available, we utilize either the Alabama Incident Management System (AIMS) or an automated program, ReadyOps, to collect the needs from medical facilities,” said Arrol Sheehan, spokesperson for the ADPH. "The available resources are then allocated based upon the request received.

“These are then distributed via UPS or the Strategic National Stockpile (SNS) distribution network with county emergency management agencies.”

With necessity being the mother of invention, a new avenue is emerging for securing hospital equipment: The community the hospital serves.

Hospitals have not been reluctant to seek out equipment from local businesses, Williamson said. Athens-Limestone Hospital said it was “urgently appealing” to the community for help in a Sunday Facebook post. The Huntsville Hospital Foundation has received pledges of more than $52,000 toward a $150,000 goal for an “emergency assistance fund.”

The webpage said the money will "support the growing and rapidly changing needs of our hospitals and staff who are on the front lines, at ground-zero of this crisis."

"There was something on social media about Huntsville Hospital asking people to donate supplies," Spillers said. "And somehow, that got twisted into a bad thing."

In fact, hospital requests to the community underscore the tenuous situation of being prepared for that surge of patients.

"We have an adequate amount of supplies today," Spillers said. "What we are worried about is a week or 10 days from now, if we have a huge influx of patients, and the concern is that the supply chain that is feeding us supplies today somehow gets cut off because everybody in the country has a huge spike.

"We're more than willing to accept N95 masks, gowns, goggles, what people have that they are not going to use, put them in our stockpile in the event that we need them and in the event that our supply line does get cut off for some reason or supplies become short."

Huntsville Mayor Tommy Battle lauded the grass-roots support.

"At this point, we are very fortunate to have this community that almost overruns you with people wanting to help," he said.

That help stretches across the state, perhaps best epitomized by groups banding together to sew masks for healthcare workers in the case of a shortage or to preserve the stockpile. Still, Harris, the state health officer, dismissed the homemade masks as not effective despite the heartfelt effort put into making them.

Nevertheless, Harris urged the community to keep working.

"We would certainly encourage those in the private sector who have access to (equipment) to think about donating that to your hospital to protect your healthcare providers," he said.

And, in fact, Ivey said in a Twitter message Monday that an anonymous donation of 100,000 masks/PPEs had been made to the state.

A donor (who wishes to remain anonymous) has donated 100,000 masks/ PPE’s to our state. We are working to provide resources to our healthcare workers who are on the frontlines of #COVID19 It truly takes a team effort as we seek to flatten the curve! #alpolitics — Governor Kay Ivey (@GovernorKayIvey) March 23, 2020

In sum, though, Williamson said of the community supply line of donated equipment: "That's not a long-term solution."

And that’s the enormity of fighting COVID-19, a crisis that has seen the number of cases in Alabama almost double since Friday despite limited testing, more than 500 people have died nationwide and more than 16,500 people worldwide.

“We’re not where we would like to be, I can assure you,” Williamson said of equipment. "However, at least there is a path to get things. It’s not as smooth as we would like.

“As imperfect as the systems are with the knowledge of the demand is almost always going to exceed the supply, we at least have a process in place to try to meet that need. How successful we will be is unclear but we at least have a process in place to try to meet that need.”

So if there is a competition to get medical equipment, it begs the question: Is Alabama winning?

There’s not simply a “yes” or “no” answer. Logic would dictate that areas of the country hit hardest so far -- such as Seattle and New York -- would get an outsized supply of equipment, Williamson said.

“On the other hand,” he said, “you can also make the argument that they are in the throes of their outbreak now. We know, barring some miracle, we’re going to deal with that same thing over the next few weeks. We need more than our fair share right now to be positioned to deal with the tsunami when it hits us.”