“I would say that the design of the new U.S. med-
ical supply chain is exceedingly fragile,” Bernardes
says. “In these early stages, we can already experience
a shortage of personal protective equipment across
the country, such as N95 respirators. As the cases
spread, so will the scarcity. This shift in operation
tempo will result in further disruptions in the chain
of medical supplies. Now, most of these items are
currently produced abroad, and those manufacturers
are experiencing both a surge of demand globally
and local disruptions as their sites become affected
by the pandemic.”
He continues, “Another crucial aspect is that
the medical supply chain has become leaner over
the years, so there is less of a buffer to cushion
the ramp-up of other emergency measures. For
instance, many large pharmacy retail chains and
hospital chains have not stocked medical products
in their warehouses because the costs are just too
high. Instead, they have agreements with their
distributors to hold an agreed-upon number of
hours replenishment of inventory. As the stock of
these retailers and hospitals now depend entirely on
that of their distributors, shortages at the distributor
can impact retailers immediately. The government’s
strategic reserve of healthcare supplies can function
as a transition buffer while manufactures ramp up
production. However, the level of those stocks is not
high, and those states that have requested it have
already experienced rationing. The new pandemic
has highlighted crucial vulnerabilities in the medical
supply chain, which current design is based on global
sourcing from a limited set of regions to cope with
thin margins.”
The PPE Shortage
At the time of writing in late March, the PPE
shortage was becoming more critical, as healthcare
providers and first-responders were resorting to
crafting their own masks to buy time until supplies
form the Strategic National Stockpile and other
sources reached them. In recent weeks, public- and
private-sector efforts saw the production of millions
more articles of PPE and critical medical devices such
as ventilators, and the ramp-up of manufacturing of
hand sanitizer by distilleries.
On March 27, President Donald Trump signed a
$2.2 trillion stimulus and coronavirus relief package
that includes billions in aid for hospitals and medical
facilities, but healthcare workers won’t feel its impact
for weeks, according to a University of Notre Dame
business professor.
“While stimulus dollars may be able to help speed
how quickly companies can increase their production
capacity for personal protective equipment and other
medical supplies, it could take some time for hospitals
and doctors’ offices to have a stable amount of
supplies to comprehensively treat patients who are
infected with the coronavirus,” says Kaitlin Wowak,
assistant professor of IT, analytics and operations at
the University of Notre Dame’s Mendoza College
30
Q
& A
The Best and Worst-
Case Scenarios for the
Healthcare Supply Chain
Healthcare Hygiene magazine spoke with Li Ern
Chen, MD, a physician advisor on the board of the
Association for Healthcare Resource & Materials
Management (AHRMM), as well as Mike Schiller,
senior director of supply chain for AHRMM, about
what’s ahead.
Li Ern Chen, MD
Mike Schiller
HHM What is the best- and worst-case scenario when PPE runs
short in healthcare facilities?
Li Ern Chen (LEC): Healthcare personnel are creative! There are
already groups coming together to create novel PPE and figuring out
ways to extend the life of the PPE that they do have. They are also
looking to other industries for ideas. I am optimistic that engineers
and health care providers can solve this problem creatively and quickly.
Mike Schiller (MS): We strongly recommend healthcare orga-
nizations visit the CDC COVID-19 website, there 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.
HHM Is it a manufacturing shortfall or a distribution shortfall
at this point in the COVID-19 outbreak scenario?
LEC: Currently, manufacturing cannot keep up with consumption;
there are hospitals using up stockpiled six-month supplies in a single
week. With the COVID-19 pandemic shutting down manufacturing
around the world, the supply is just not meeting the demand.
When factories do come back online, they will likely be ramping up
production above prior levels. At that point, we will likely then run
into the problem where distribution channels become rate limiting.
HHM What do you anticipate will happen to the healthcare
supply chain if the curve does not flatten, versus if it does?
LEC: The exponential rise in the number of cases is already causing
an enormous strain. We will recover from the current crisis mode in
which we are functioning. Flattening the curve will allow us to get
our feet back under us more quickly. Regardless, the stress that the
healthcare system is under is forcing the supply chain to be more
creative, more resourceful and more efficient, which I hope will carry
into the future.
MS: There are number of active initiatives that span the federal,
private industry, and community levels. Last week President Trump
invoked the Defense Production Act. There is discussion of retooling
non-healthcare manufacturing facilities to produce PPE supplies and
encouraging examples of community engagement as highlighted
with the Million Mask Project, and distillers making hand sanitizer.
HHM How would you describe the current state of readiness in
healthcare facilities relating to their inventory of PPE and other
resources needed by frontline healthcare workers?
LEC: Based on history and experience, many health care facilities
and health systems had stockpiles of PPE ready for emergency scenarios
Continued on page 31
april 2020 • www.healthcarehygienemagazine.com