COMMENTARY: What US leaders must do to protect health workers amid COVID-19 supply shortages – CIDRAP

March 26, 2020




Dr. Goodman is a professor medicine and infectious diseases at Georgetown University and is a former chief scientist of the US Food and Drug Administration. Dr. Lurie served as assistant secretary for preparedness and response at the US Department of Health and Human Services from 2009 to 2017 and is now the strategic advisor to the CEO of the Coalition for Epidemic Preparedness Initiatives (CEPI).

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Doctors, nurses, first responders, and housekeeping staff are caring for COVID- 19 patients without assurance they can safely do their jobs. Many are jury-rigging homemade masks and respirators or using unproven, possibly unsafe methods to wash and reuse them (prompting a recent European Safety Federation warning), while at the same time we learn about infected healthcare workers becoming patients on ventilators.

These drastic shortages are in large part due to a long-term under-investment in preparedness at all levels, from federal to states to health systems. Many healthcare institutions themselves had not maintained or rebuilt adequate stockpiles after the 2009 H1N1 flu and 2014-16 Ebola crises and maintained dependence on personal protective equipment (PPE) from overseas.

As many frontline providers are already doing, the healthcare system, whether in hospitals, clinics, or urgent care settings, can and must adapt best practices to conserve PPE and other supplies, including implementing administrative controls and workflows. Such conservation and stewardship measures are fundamental pillars of crisis standards of care.

Given the crisis we are now in, however, governors and hospital CEOs should not be left to try to find PPE supplies on their own. The federal government also can do more, and while enhanced production is critically needed, improving the visibility, distribution, and need-based access to what exists in—and enters—the supply chain can play a helpful temporizing role.

Step 1: Complete an online inventory

First, the federal government must identify the full inventory of critical supplies that are now in and soon will be in both stockpiles and throughout the entire national supply chain.

To do that, the federal government can set up a website to which all manufacturers and distributors, as well as healthcare facilities and state and local health departments, are expected to confidentially report their inventories.

This can be voluntary and done without invoking the Defense Production Act (DPA). But, if good cooperation is not achieved, the President can and should use DPA authorities to mandate such action.

Step 2: Consolidate data across agencies

Additionally, the federal government should consolidate information about all of its own orders and stockpiles—across every department and agency. Since all federal agencies must have pandemic plans, and many call for stockpiling PPE, it is quite possible that significant inventories still exist that may not be urgently needed by their holders.

Since federal orders are usually prioritized by manufacturers, it is important to identify all PPE within the federal system, including the Veterans Administration, Department of Defense health systems, Department of Homeland Security, Department of Transportation, and other departments and agencies with public-facing responsibilities. Alternative products and production, such as industrial-use respirators, must also now all be located and included as part of that inventory.

This does not mean that the federal government must necessarily distribute products or take over manufacturing. A strong federal role in facilitating need-based access to supplies in short demand, including vaccines, syringes, and needles, was part of the 2009 pandemic flu response and helped make distribution more efficient and equitable, while largely using commercial distribution capabilities. It also inhibited entities from bidding against one another. The need for such supply chain visibility was foreseen and is included in pandemic and other disaster preparedness plans.

Step 3: Fill in the gaps

Then, the federal government, with the Federal Emergency Management Agency (FEMA) and the Department of Health and Human Services (HHS) as the key collaborators, can help identify duplicate orders and where critical orders are not being filled. The federal response can also encourage voluntary and equitable redistribution as a way to efficiently apportion and allocate available supplies, including reserves, as needed, from the Strategic National Stockpile.

Data and modeling can be used to identify areas and facilities in greatest need, maximizing our ability to protect those in the highest risk settings where intense transmission is going on right now, and to adapt quickly as things change.

The time for federal leadership is now

It cannot continue to be left to hospitals and healthcare providers to call everywhere looking for supplies. Or to have multiple manufacturers and distributors each doing the best they can to figure out who needs how much of what and when.

They cannot assess needs at a national level nor the relative merit of innumerable requests. They have sick patients to care for, healthcare workers to keep safe, and lifesaving products to make and deliver.

While the PPE crisis is upon us now, the ventilator crisis is next, and shortages of other related supplies and medicines may follow soon. A similar inventory and tracking system for these is critical, and should include, for example, all working and repairable ventilators, ventilator tubing and other essential supplies such as endotracheal tubes.

A voluntary and confidential system would permit the federal government to identify where there is a true need, whether across the nation, or even across a city. If needed, numerous just-in-time private-sector supply chain and distribution systems can be enlisted to help.

If we can ship cell phones and televisions for same-day delivery across the country, surely we can rise to the challenge for PPE and ventilators. This is exactly what the federal emergency response system is for; this is what its scientists, emergency response officials, and logisticians can help do; this is what industry and the healthcare system will support.

We are all in this together and must act in the most coordinated, efficient way possible. The confidence and lives of the public and healthcare workers are on the line.