“The pace and rapid spread of COVID-19 will likely surpass local response capacity and existing resources in many countries that are important to U.S. interests,” the document asserts. “Depending on the severity in each country, COVID-19 is expected to cause significant economic and social disruption.”

The document, labeled “sensitive but unclassified,” adds that “longer-term impacts could reverse valuable economic and development gains made over many years, which could slow a country’s Journey to Self-Reliance and undermine billions of dollars of investments by American taxpayers that have resulted in tremendous health gains.”

But the United States faces criticism that its behavior during the pandemic is simply making the global situation worse.

Multiple reports emerged this week in which foreign officials accused Americans — including U.S. government representatives — of essentially commandeering shipments of medical supplies meant for other countries, among them generally well-off U.S. allies in Europe.

In one case, according to a report in The Guardian, American buyers managed to “wrest control” of a shipment of masks from China that was supposed to go to France by offering three times the selling price. In another report, a German official accused the U.S. of an “act of modern piracy” after a shipment of masks from China that was meant for Berlin were seized and diverted to the U.S. while en route in Thailand. Similar reports emerged from Brazil, where a top official said China had set aside his country’s orders for equipment after the U.S. sent some 20 planes to pick up materials for itself.

It wasn’t always clear whether the U.S. government had authorized such diversions of goods. In a statement to POLITICO, a senior Trump administration official asserted that the reports of U.S. malfeasance are “completely false.”

“The United States government has not confiscated or taken any masks intended for delivery to or ordered by any other country,” the official said. “We are producing vast quantities of materials domestically and are working through the appropriate channels to purchase supplies from other nations to meet our needs.”

But there’s no question the U.S. is trying to procure as much medical equipment as it possibly can.

One company caught in the middle is U.S.-based manufacturer 3M. Trump on Thursday invoked the Defense Production Act to demand more N95 respirators from 3M, and the company has been the target of a threatening tweet from the president.

In a statement Friday, 3M expressed concern that the Trump administration had asked it to stop exporting certain respirators to Canada and Latin America and instead respond to growing demand in the United States.

“There are … significant humanitarian implications of ceasing respirator supplies to health care workers in Canada and Latin America, where we are a critical supplier of respirators,” the company said.

It also argued that other countries could retaliate by halting exports of crucial materials to the United States. That’s a key point that aid experts make as they try to predict the future; some note that the fight for medical equipment now could evolve into a battle for the elements that make therapeutics and vaccines.

Trump’s pressure on 3M prompted a rebuke from Canadian Prime Minister Justin Trudeau, who noted that U.S.-Canadian trade goes both ways.

“These are things that Americans rely on and it would be a mistake to create blockages or reduce the amount of back-and-forth trade of essential goods and services, including medical goods, across our border,” he said.

Still, there are signs that imposing controls on what the U.S. sends overseas will have bipartisan support in Washington.

House Foreign Affairs Chairman Eliot Engel. | J. Scott Applewhite/AP Photo

Prior to Trump’s announcement Friday that he would use the Defense Production Act to limit medical exports, House Foreign Affairs Chairman Eliot Engel (D-N.Y.) called for such a move.

“There is mounting evidence that the critical shortages of surgical masks and other personal protective equipment are being exacerbated by the unregulated export of such medical supplies from the United States,” Engel wrote to Vice President Mike Pence, who leads the administration’s coronavirus task force.

And the United States isn’t the only one imposing export restrictions due to the virus; the European Union did so weeks ago, while countries within the bloc have squabbled over supplies.

There already are more than 1 million confirmed cases of coronavirus worldwide, with more than 58,000 deaths. But the epicenters of the disease have primarily been in better-off countries — China, the United States, Spain and Italy.

U.S. officials, global health analysts and others say the worst may be yet to come, in less-well off places like India, Nigeria, Bangladesh and parts of Latin America. The health infrastructure in many of these countries is already weak, and sparse in rural areas in particular. Some of them also have large, densely concentrated urban populations that make it hard to exercise “social distancing” rules.

Yet these countries are caught up in the global competition for medical supplies even though they have less cash to spread around.

Earlier this week, tech entrepreneur Elon Musk, a founder of Tesla, tweeted that the car company has “extra FDA-approved ventilators. Will ship to hospitals worldwide within Tesla delivery regions. Device & shipping cost are free.”

One respondent was Bashir Ahmad, a top aide to the president of Nigeria, who wrote to Musk: “Nigeria, my dear country is in need. Kindly send 100s here, we really need them, thanks!”

The State Department and USAID have been caught in the middle, grappling with what often feel like contradictory impulses by the Trump administration.

One impulse is characterized by the “America First” philosophy, which says the U.S. must put its needs ahead of other countries and that other governments should share more of the global burden of humanitarian aid. The other is the desire to project continued U.S. dominance worldwide — the notion that America remains indispensable to any global effort.

On the one hand, the U.S. is trumpeting that it has made available some $274 million worth of aid to help other countries afflicted by the coronavirus. Those aid announcements come as U.S. adversary China, the original epicenter of the illness, has been on a public relations spree touting the expertise and equipment it is sending to other countries to help them battle the virus.

On the other, as POLITICO first reported earlier this week, the vice president’s office has ordered a review of U.S. assistance to ensure that personal protective equipment needed in America isn’t heading to other countries — at least not so long as there’s need in the U.S.

Aid experts gave some leeway to the Trump administration’s approach.

They noted that such a worldwide crisis was highly unusual, not least because the U.S. itself is one of the hardest-hit zones. The idea that the U.S. is in crisis — with official projections of 100,000 to 240,000 dead — is hard to digest for aid workers who are used to viewing America as a safe harbor.

“I would really doubt that any other administration would be different about prioritizing American needs when they’re looking at a quarter of a million people dying in the next few months,” said Nicole Widdersheim, a former National Security Council official with expertise in Africa.

Nongovernmental aid groups also are caught in the competition for medical supplies.

Chris Skopec, a top official with Project HOPE, said his group recently put in a $500,000 order for 200,000 masks from a Chinese manufacturer. The masks were going to be sent to countries like Colombia, Ethiopia and the Philippines. But word soon came that the manufacturer had taken another order from another source for 20 million masks to be sent to the U.S. and Europe, Skopec said.

“So our modest order got sidelined and deprioritized,” he said. Project HOPE managed to find another manufacturer.

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On March 27, USAID issued an extraordinary “urgent request” asking aid groups around the world to see if they have personal protective gear and other medical supplies that could be given to the United States.

In a note to the organizations, a USAID official attached a spreadsheet in which they could tabulate the items they could spare, including endotracheal tubes, biohazard bags and nasal cannula. NBC News first reported the request. USAID officials did not immediately respond to a request for comment.

U.S. officials and health experts say it’s likely the Trump administration will focus more on what it can do for other countries once it feels it has the situation in the United States under control.

A senior State Department official said that’s definitely the plan as far as donating PPE to other countries. “This is a global challenge, and we have to respond globally as well,” the official said. “We’re not going to just fix it at home and then seal the borders.”

The problem with that, others say, is that by the time America’s health crisis is under control, its economy might be in such poor shape that giving aid to other countries would be even less politically palatable than it is now.

And besides, it might be too late for many less developed countries.

Some poorer countries are trying to impose social distancing and other measures to prevent the virus from gaining too big a foothold. India, which has more than 1 billion residents, on March 24 announced a three-week nationwide lockdown. The number of confirmed cases in neighboring Pakistan has ticked past 2,600.

Still, with densely packed areas and limited access to health care, it’s hard to tell how truly widespread the infection already is in many of those countries. By the time enough equipment arrives from overseas, the death tolls could be staggering.

All that means it will be even more likely the virus could find its way back to the United States and other countries that thought they had brought it under control.

“If there are countries that are raging fires, and we’ve still got kindling at home, then we’ve still got a problem,” Konyndyk said.