Foraging for Healthcare Supplies in a Western Economy

Yesterday I spoke with a procurement executive at a major hospital in the Northeast.  This is someone that I know and respect, and who is considered a highly proactive and informed individual.  He is deploying advanced procurement technology in his hospital, and has been on the front lines of the COVID crisis.  In our discussion, he mentioned that “I’m able to get a lot of my PPE through the Canadian border.  We know the people up there quite well, and if there are problems, I can get some of the military people who work for me to go up there and influence them in a positive manner to get material through.  However, we are still short of N95 masks.   No one can get those anywhere.  The federal government bought a ton of other stuff like ventilators and other material, but N95’s are still on everyone’s short list.”

Is this what we’ve come to?  Really?

It is incredible to me that in one of the most sophisticated healthcare systems in the world, in a country with the most esteemed schools and advanced economies, that we are forced to scrounge and forage for personal protective equipment and masks to keep our healthcare workers safe.  Everyone now seems to have been numbed to this fact, but I can assure you, that it is not at all normal, nor should it ever be considered “okay” to have our procurement and supply chain executives reduced to this.  We can do better.

If you have been watching or reading the news since February you are probably keenly aware of the term “Personal Protective Equipment” or PPE, especially as it applies to the fight against COVID-19. Healthcare and supply chain personnel and systems have been struggling under the strain of insufficient available stock since the pandemic began. While everyone was aware of the shortage during the early months of the pandemic, not many people are aware that this shortage was never really solved, and that shortages are worse than ever in the summer of 2020.

You may also be wondering how there can be so many disparate story lines regarding PPE coming from federal and state administrations, agencies, hospitals and front-line medical workers. I’ve been working with a team of experts and advisors supporting the federal supply chain task force efforts noticed early on that the supply of PPE necessary to combat COVID for the near, intermediate and long haul was woefully insufficient. The protective personal equipment most in demand includes face protection (goggles, shields, N95 respirators, surgical masks etc.), body protection (gowns, coveralls, aprons etc.) and hand protection (gloves and sanitizer). Despite our early insights into this issue and our early warnings we still have not solved the issue. Reporting by Andrew Jacobs of the New York times shows that nursing home and professional medical associations like the Good Samaritan Society, American Medical Association and National Nurses United report medical practitioners at all levels feeling the sting of PPE scarcity. Many report having to reuse disposable masks and gloves. These practitioners admit that, though the FDA has provided emergency use authorization for ultraviolet PPE decontamination, using decontamination procedures on disposable items is not ideal. Dr. Susan Bailey of the American Medical Association is quoted in Jacobs’ article pointing to the frustration in the government’s early focus on ventilators when there was, and is, an ongoing need for PPE. Again, our team pointed this out early in the pandemic but there seemed to be a momentum around certain items that was not easy to shift.

How did we get here?

The federal government and the president have largely dismissed claims of a PPE shortage, despite the evidence to the contrary.  On April 26, President Trump deemed PPE shortages “fake news”.[1]  On May 4, he publicly disagreed with the president of the American Association of Nurse Practitioners, who in a visit to the White House noted that PPE had sporadic supply, stating “I have heard we have tremendous supply to almost all places, tremendous supply.”[2]  On July 20, the American Federal of Teachers ran a public ad in response to President Trump’s press conference comment “Something’s going on. Where are the masks going? Are they going out the back door?”  In the ad, several different nurses respond, with one saying, “President Trump suggested that nurses like me are possibly stealing masks.”[3]  Some members of Congress have finally admitted that the PPE situation has been dire throughout the pandemic.  At a virtual Congressional hearing Wednesday, Illinois Gov. JB Pritzker criticized the federal government for leaving it up to states to compete for personal protective equipment, or PPE, saying, “in the midst of a global pandemic, states were forced to play some sort of sick ‘Hunger Games’ game show to save the lives of our people.”

Despite these shortages, government agencies were slow to respond, and were fearful of admitting indeed that a problem existed.  For instance, FEMA guidelines[1] advocated that hospitals reach out to their state emergency office, and before reaching out to FEMA, explore alternatives for re-using PPE, explore all use reduction strategies, and provide justification for the shortage and the timeline it is needed for.  (State offices were typically unable to get masks either)[2]. In essence, this emergency response government resource is doing everything possible to avoid having to provide masks – because they don’t have any in stock (essentially).  For weeks prior to April, nurses and other employees at Veterans Affairs hospitals have said they were working with inadequate protective gear. VA officials denied it.  Finally on April 25, Richard Stone, executive in charge of the sprawling Veterans Health Administration, reluctantly admitted that he had been forced to move to “austerity” levels at some hospitals, and that the four week supply of masks was almost gone.[3]  A large survey in April indicated that of 47 institutions in Massachusetts, half had less than a week’s supply of N95 masks left, with another 23% having none at all. In California, of 120 institutions, 41% had a week or less left of N95 masks, and 12% had none left. In Florida, of 50 institutions, 40% had a week or less left of N95 masks, and 24% had none at all.[4]

In effect, there is a significant disparity between the claims of the President, FEMA, DHS, and the VA about adequate PPE that do not reflect the truth “on the front lines”.  This is mystifying – why would government healthcare agencies not admit there is a shortage of materials?  Why would this be the case?  Is it a political issue, or is there a legitimate belief that there is enough PPE to go around in the minds of these government officials?

These are questions which federal agencies need to come together and work on…

[1] https://www.fema.gov/news-release/2020/04/22/coronavirus-covid-19-pandemic-addressing-ppe-needs-non-healthcare-setting

[2] https://www.fema.gov/news-release/2020/04/22/coronavirus-covid-19-pandemic-addressing-ppe-needs-non-healthcare-setting

[3] https://www.washingtonpost.com/politics/va-health-chief-acknowledges-a-shortage-of-protective-gear-for-its-hospital-workers/2020/04/24/4c1bcd5e-84bf-11ea-ae26-989cfce1c7c7_story.html

[4] https://time.com/5823983/coronavirus-ppe-shortage/

[1] https://www.politico.com/news/2020/04/26/trump-ppe-fake-news-207523

[2] https://www.forbes.com/sites/mattperez/2020/05/06/president-trump-disagrees-with-nurse-who-says-ppe-supplies-have-been-sporadic/#77301d862a75

[3] https://www.nbcnews.com/politics/meet-the-press/blog/meet-press-blog-latest-news-analysis-data-driving-political-discussion-n988541/ncrd1183416#blogHeader