On March 22 of last year, I got a call from the Gov. Greg Abbott’s office asking me to participate in the state’s COVID-19 response. The next day, Sunday the 23rd, I was in the governor’s office talking with him and others about his concept of a series of “strike forces” to respond to the pandemic.
I was charged with advising the Supply Chain Strike Force, and in particular, helping to prepare our hospital system to handle a surge of COVID-19 cases. That was the focus of the first few months of the pandemic. We were fortunate to have the time to prepare, so when the first wave hit, we had enough beds and providers to care for everyone. As we’ve moved into the fall and winter, we’ve remained vigilant about hospital capacity, and have been able to handle subsequent surges. Some of the emphasis of our work has shifted, however, to preparing the supply chain for the dissemination of vaccines and promising therapeutic treatments. By the time you read this, the focus may have shifted again.
Every pandemic is different, but I think there are some hard lessons we’ve learned during this process that we would be wise to take to heart. Below are what I consider three of the most important ones.
The supply chain should come home
In the early weeks and months of the pandemic, there was an enormous rush to obtain enough personal protective equipment (PPE) to equip our frontline health care workers with things like gloves and face masks and face shields. And we were racing to get this equipment along with the rest of the country and the world. What we found out was that much of it was manufactured overseas, and it wasn’t obvious how to plug into that global supply chain when there was so much competing demand. We went down so many rabbit holes. When we did find suppliers, we usually found ourselves bidding against other states, driving up the price.
It got better when the federal government stepped in to coordinate the distribution of supplies. At that point we were able to more efficiently and equitably distribute to those who needed it the most. Since Texas was hit later than the coasts, we were able to stay ahead of the virus even though we weren’t at the head of the line. But the lesson learned is that we are incredibly dependent on foreign resources for these things, and that has to change. As a country, and as a state, we need to become more reliant on ourselves for the production and stockpiling of PPE so that we can respond quickly in times of crisis.
We can absolutely do this. One of the most positive things I observed in the early months of the pandemic involved a medical supplies manufacturer in the Dallas/Fort Worth area that already was producing face shields and face masks but not at anywhere near the level of the demand. With assistance from the Texas National Guard and other business partners, we worked with the manufacturer to significantly increase capacity. They were able to distribute face masks and face shields right from the factory to our health care facilities.
We can partner with industry to produce and stockpile PPE domestically if we make it a priority.
People can be “stockpiled” too
One thing we’ve learned is that the biggest limitation when it comes to handling a surge in cases is not beds. It is manpower. When you eliminate elective procedures, and expand into other spaces in the hospital, we have a lot of space for beds. To be as cautious as possible, we developed plans for alternative care sites and set up a few in the Rio Grande Valley, but for the most part they haven’t been necessary. Even New York, when it was at its peak of cases, was able to manage almost all of the care within the hospital system itself. There was very little utilization of the alternative care sites.
The challenge is finding people who can work in an extreme situation. Part of how Italy got overwhelmed, for instance, was that early on they lost health care manpower to COVID-19. Providers got sick and couldn’t take care of patients. Even when that’s not the case, hospitals don’t typically operate with a lot of excess manpower sitting in the wings ready to come in. Hospitals and health care systems make and break their budget on the ability to flex their staff.
So, what you need, and what we’ve been fortunate to have, is a system for expanding the available pool of health care workers very quickly and flexibly. And it’s possible to do. Even when there’s nationwide demand, as there is right now, there are a lot of people who can be brought in to help, including retired physicians and nurses and technicians, military staff, disaster relief workers, and others. But the relationships, contracts, and networks have to be in place ahead of time. In that sense we can “stockpile” people.
The state has worked very closely with BCFS System, a San Antonio-based non-profit that provides emergency health and human services in Texas and around the world. They are very effective at managing relief efforts, disaster situations, and other emergencies and have become a very trusted source for manpower. With COVID-19 they have been able to respond quickly and effectively even in the midst of global demand for health services. It’s expensive, but it’s a price worth paying.
Going forward, the lesson is to maintain and strengthen relationships with organizations like BCFS, and others, to make sure that we can ramp up very quickly if needed and then ramp back down when the need goes down.
Be transparent and honest
New or newly infectious viruses present challenges that are unavoidably novel. It takes time to understand how they’re transmitted, how they’re best treated, and which public health practices will best limit their spread. At the same time, we have a lot of accumulated epidemiological and biological knowledge. Good public health requires public trust. Public trust is undermined when you’re not honest, when you overpromise, and also when you wait too long to act. It can be lost quickly and can take a long time to rebuild. So the challenge is to make the best possible decisions with limited information, to recognize that mistakes will be made, and to level with the public about what we do and don’t know, and why we are making the decisions we are making.
John M. Zerwas, MD,is executive vice chancellor for health affairs at The University of Texas System.
Tex Med. 2020;117(2):14-15
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