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Hold It. Stop. And Wait Just a Dog-Gone Minute.
It should be expected that many would berate President Trump and Jared Kushner for their comments yesterday concerning the federal stockpile of medical equipment. While no expert, my life experiences do include 36 years of direct patient care, state legislative responsibilities that included Health Policy/Finance and a specific role in strengthening my state’s laws concerning response to things like a pandemic. Here is some of what I think I know:
When it comes to the Federal stockpile of medical supplies, Trump, Kushner, and others in the Administration are correct, the Feds were never supposed to be the supplier of first resort. The Bush Administration’s planning documents published in 2005, as a result of the fear of SARS and avian flu threats, clearly outlined the shared responsibility of all levels of government.
States, their Public Health agencies at the state and local levels, and hospital systems have been encouraged since to plan and prepare for what was deemed the inevitable future pandemic.
Much of that preparation seems to be bearing fruit as you notice hospital systems across the country not yet feeling the CoVid-19 brunt to be in similar situations. Low census, overstaffing, impending lay-offs, and eerily quiet and near-empty rooms and hallways are the result of the implementation of plans that readies the facilities for a quick influx of patients. Where many have fallen short, however, was arrangements to have an adequate supply of vital medical equipment. Personal Protection Equipment (PPE’s) is one of the best examples.
What most do not know is that in normal situations, hospitals will burn through thousands of these items (whether singly or in combination) per week. Supply chains that are based on just-in-time inventory simply cannot quickly meet demands placed on them in events such as a pandemic. This is why stockpiles at local and state levels were always stressed as an integral part of planning.
It would be hard to overstate the burn-rate of these items. Hospitals cannot be expected to have warehoused enough PPE’s to see them through to the end of this. They were, however, expected to be able to face an initial onslaught. Many (most?) have failed.
But the hospitals et al are not running for re-election, are they?
Thank you. My sister tells me they run out of things all the time. They do disaster drills, but those do not include how many supplies they have.
In a rare event, it should be expected and allowed that norms are no longer the playbook. We still have the ability to respond quickly, with free and private initiative to get back to normal. In a country where private property rights are important, being unable to keep your property secure has high importance.
VDH once said something like, the reason democracies fight furious is because they have an investment to get back to. Democracies rarely fight each other.
Haven’t I heard that New York had a procurement process underway to purchase ventilators for stockpiling when Andrew Cuomo became Governor and a decision was made not to purchase. Am I making this up or something?
I will also add that it isn’t just medical that may be short of on had supplies and equipment. With the advent of two day shipping internet sales, I haven’t been able to buy plotter paper locally for years.
‘Just-in-time’ supply management works better for a nation in a situation like we are facing if your hand is on the production point. We outsourced much of ours and now we pay the price. This medical crisis shows just how right President Trump has been all along on trade issues. Free trade is a valid point-of-view but it comes after national security.
I’ve heard that as well, but to be fair, a relatively small number of these ventilators are manufactured a year. To build up a significant stockpile takes years.
And the states had years but didn’t take advantage of the time.
Yes. I doubt that our military will be out-sourcing munitions manufacturing to China any time soon.
What about medicine and medical equipment?
It takes a long time to get a contract though DoD and even longer to change one. Barriers. Barriers. Always barriers.
That’s going to have to change.
You are being mislead by an inaccurate statement by Pres. Trump in the Fox News Town Hall.
https://www.factcheck.org/2020/03/trumps-misleading-ventilator-counter-punch-at-cuomo/
I read that and it really looks as if Cuomo is of two minds when it comes to ventilators, one in normal times when pondering guidelines for a pandemic, and another when faced with actual deaths that must be faced through triage in a pandemic.
Industry has been working for decades to reduce idle inventory. Even ten years ago I toured an automobile assembly plant that had on-site only enough parts on site to keep the assembly line running for a couple of hours. The plant depended on a regular flow of trucks delivering parts and subassemblies.
I assume hospitals read the same studies. Why take up valuable space in the hospital storing two weeks’ worth of supplies. Store two days’ worth and get a delivery every day or two. Use the storage space for a higher value activity, like something directly affecting patient care.
In the current pandemic we seem to be focusing on ventilators. But it seems to me that the next pandemic might strain the supply of a different type of equipment or supply. Was it really all that clear years ago that ventilators were going to be the critical tool?