Virtually every U.S. healthcare organization is struggling with a flood of patients with COVID-19. Clinicians are getting the virus, some have died, and patients are suffering. While most facilities have lived through and handled a variety of crises, this one is unusual.

“What makes this situation different than other [crises] in the past is the wholesale decrease in manufacturing production and export levels coupled together with increased global demand, which has led to severe shortages of PPE, including N95, surgical, ear loop, and face shield masks, gowns, gloves and pharmaceutical supplies,” said Michael Schiller, CMRP, senior director, American Hospital Association and Association for Health Care Resource & Materials Management (AHRMM). “AHRMM is actively working with health care leaders, associations, suppliers, and distributors from across the healthcare field, sharing information and solutions around resource allocation, conservation, supply continuity and availability."

On March 31, The Forum at the Harvard T.H. Chan School of Public Health and The World co-presented a live, online Q&A titled “The Coronavirus Pandemic: Addressing Weaknesses in the Medical Supply Chain.” Dr. Michael Mina, assistant professor, associate medical director of the clinical microbiology laboratory, and director of molecular virology diagnostics at the hospital, shared his insight.

Unlike some of the other countries battling coronavirus, Mina said, “We have no way to centralize things in this country short of declaring martial law and giving a tremendous amount of power to the federal government. There’s little ability for a central command unit to pool all resources from around the country, and you don’t have one major warehouse or lab type of thing where you could say, Wisconsin, Ohio, New York and Pennsylvania — everyone send their supplies and equipment here and really bank on the economy of scale. We’re very fragmented.”

A dearth of testing
“The availability of testing has been restricted severely and that’s because of supply chains and all sorts of issues about how to get the components that go into a test and into a laboratory and then even how to get a sample out of a person and get that to a laboratory,” explained Mina. “These things that seem like they should normally be simple, become extraordinary difficult when the basic supply chains start to break down and demand outstrips supply. Even with all of these new tests becoming available, we’re still woefully undertesting our population.”

One of the main challenges facing hospitals right now is obtaining the necessary swabs to conduct the tests. One of the world’s leading manufacturers of the swabs, Copan, is based in Italy, one of the earliest and hardest-hit countries, which Mina said has put a strain on production. On top of that, major laboratories are flooded and overwhelmed with processing the samples they do receive.

While the U.S. does have a national stockpile of PPE and other medical equipment and supplies, including ventilators, Mina says it’s not nearly enough to supply the nation on a continuous basis. “What this is really demonstrating from a preparedness position, is that we don’t have these types of manufacturing operations sitting idly by.”

In the meantime, experts are fast at work trying to figure out if and how masks can be sanitized for safe, repeated use. “There are things like ozone and different gas sanitization processes,” Mina said. “Research groups are working on it right now.” In situations where shortages are extremely severe, recycling masks, letting them sit for two or three weeks before reuse, might be a solution because scientists believe the virus dies completely after 10 to 15 days.

Schiller added, “Supply chain is uniquely positioned, in that our role engages with both our internal constituents and external business relationships. We are able to identify opportunities and match resources with need as a result of these relationships. Collaborating with partners, including suppliers, distributors, GPOs, and Health IT — understanding current or expected product shortages and allocations, identifying and implementing conservation measures, and working with their state and local emergency management agencies.

“Look to nontraditional healthcare suppliers including veterinary clinics, dental clinics, and the construction/trade industry,” continued Schiller. “We strongly recommend healthcare organizations visit the CDC COVID-19 website, FDA website, and Joint Commission website where you’ll find strategies on how to optimize the supply of PPE. AHRMM has developed and offers a comprehensive COVID-19 resource page that is available to members and non-members alike.”