As the COVID-19 pandemic has stretched on, the American health care system has depended on the tireless efforts of nurses to care for the ill, tend to the dying, and stop the illness from seeping outside hospital doors. But despite all of these nurses’ dedication, they themselves have been let down—not only by state and local governments, but by the health care system as a whole, says Bonnie Castillo, a registered nurse and executive director of National Nurses United and the California Nurses Association.

Castillo, who was recognized for her advocacy work as a member of the 2020 TIME100 list of the most influential people in the world, has been calling attention to shortages of personal protective equipment to protect health care workers for at least six months. But as she told Senior TIME Correspondent Alice Park in a TIME100 Talks discussion, the U.S. is still coming up short on essential items like N95 face masks, leaving nurses unable to protect themselves, the public or their patients. To make up for these shortfalls, Castillo feels that the U.S. must enact the Defense Production Act, which some critics feel the federal government has not employed aggressively enough to provide enough masks for health care workers.

“It’s very frustrating because we know what we need,” says Castillo, noting that countries like South Korea have successfully produced their own personal protective equipment. “While we say the virus is novel, the science of infectious control and protection isn’t, and so we know that we could have done better, and we need to still do better.”

Castillo says that nurses have been left to fend for themselves to get through the pandemic. She notes that nurses have had to bring their own personal protective equipment to work, and even rely on friends to borrow N95 asks. In turn, unions have also had to fight for nurses, to make sure that they get the personal protective equipment that they need. However, it hasn’t been enough to protect some nurses; 11 members of National Nurses United alone have died.

“For us, it’s been a matter of life and death,” says Castillo. “If we had not been out there and collectively advocating and fighting, tooth and nail, for every single N95 and every single protection, we would have lost many more.”

In Castillo’s opinion, Americans have suffered due to a lack of leadership in the fight against COVID-19. To begin to turn the country’s trajectory, she says, the United States must finally enact a coordinated national response.

However, Castillo says, the country must also address one of the root problems that is making the COVID-19 pandemic so painful: a health care system that doesn’t put people before profit. In her opinion, that would be through a “Medicare For All” program.

“We have seen this system function under a pandemic,” Castillo says. “And it has been an utter failure.”