How fast can the U.S. go back to work? Our disaster preparedness capabilities, and the supporting supply chains, will help to determine the answer to that question.
When it comes to these issues, there are few better sources than Dr. Pinar Keskinocak and Neelima Ramaraju.
Dr Keskinocak is a professor at Georgia Tech and Director of the Center for Health and Humanitarian Systems. She is also the President of INFORMS, the leading professional society for analytics and operations research. It is Dr. Keskinocak’s picture associated with this story.
Ms. Ramaraju works with LLamasoft, a provider of supply chain analytics software and consulting services. She is Senior Director of the Global Impact Team at LLamasoft. LLamasoft has been working in the Global Health space for over a decade. The company has workeding in over 25 countries. Projects have included working with countries that are trying to get vaccines to children; achieve better distribution of medicines for deadly diseases like HIV, malaria and tuberculosis; and setting up effective testing networks.
Going Back to Work is Impacted by Supply Chain Issues
The difficulties we are facing in responding to the pandemic are in part due to the design of medical supply chains. “During normal times, most companies prioritize efficiency and a low-cost supply chain over resiliency,” Dr. Keskinocak of Georgia Tech points out. “Creating a resilient supply chain does require more effort, but it is not always that much more costly.”
Before America goes back to work, ideally a cost benefit analysis would be done. But Professor Keskinocak says that is difficult in the current situation. “We are quite uncertain in terms of the number of people impacted. We are incredibly behind in testing, and this makes it hard to assess our current situation, estimate the demand for healthcare services in the coming weeks, and evaluate the impact of intervention strategies.”
The challenges with COVID-19 testing in the US are not because of limitations in technology or knowledge, but mostly due to supply chain issues. Pandemics present some very difficult disaster supply chain issues because the outbreak is global in scale. With localized outbreaks, like a hurricane, the affected area can expect critical supplies to flow into the area as other regions with excess supplies are willing to contribute.
In this pandemic, there is a critical shortage of medical supplies – masks, ventilators, COVID-19 tests and other supplies. Chris Murphy, a U.S. Senator from Connecticut (Democrat), points out that “in all 50 states and thousands of hospitals are being forced to fight against each other in a bidding war for these scarce supplies. And in some cases, as governors and hospitals are desperately trying to find suppliers, they are spending precious time trying to figure out which ones are legitimate and which ones are scam artists…this encourages hoarding and price gouging.”
Dr. Jon LaPook of CBS Morning News has also reported on the value of antibody tests for past coronavirus infections. “It’s very likely that a lot of us have already been infected with the coronavirus without even realizing it. We had few symptoms, or we had no symptoms… if we’ve already been infected, then the likelihood is, we have immunity.” These are the people that can go back to work. “We’re talking right now about this friction between “saving” the economy and treating COVID-19. Well, we should be able to get our arms around both.” Technically, this is not hard to do. But the U.S. has not prioritized this kind of test.
Professor Keskinocak pointed to the importance of resource allocation and prioritization in all disasters, but particularly in a global pandemic. “Medical supply distributors might be getting calls for personal protective equipment from all over. Who gets them, how much, and when?” Companies and local governments might be making these decisions with limited information and visibility into where the needs are the greatest. There needs to be a “system wide response” that coordinates these decisions across the nation.
Going Back to Work: What is the Role of the Government?
One way this response could be organized would be based on the federal government working with the private sector for achieving visibility and supporting a coordinated response. Professor Keskinocak points out that the government – e.g., Federal Emergency Management Agency – could serve as an enabler or convener for critical visibility, collaboration, and sharing of best practices.
Dr. Keskinocak’s more collaborative approach is not the only approach being suggested. Senator Murphy is a cosponsor of the Medical Supply Chain Emergency Act. This bill would authorize the government to take over the responsibility for the allocation and distribution of these critical items.
But global visibility and system wide thinking is critical. When Puerto Rico was trying to recover from Hurricane Maria, items arrived at the port and needed to be prioritized. Water might be prioritized over components needed to rebuild the power infrastructure. That might seem logical, but at a certain point rebuilding the power infrastructure was much more important. This was not always obvious to local decision makers who had a limited point of view and limited visibility to the island’s needs. “These kinds of decisions can hamper the response and delay the recovery,” Dr. Keskinocak stated.
While Dr. Keskinocak pointed out that if the life sciences private sector had built more resiliency into their supply chains, things would be better in this crisis, Ms. Ramaraju, of LLamasoft, believes health service supply chains often need to be more coordinated.
Ms. Ramaraju said, “Parallel systems were not efficient. In order to cost-effectively scale, there is often a need to integrate networks. For example, as new testing capabilities/tools were coming online, there was a need to make decisions about how many and where those would need to go.”
“If the U.S.’s Federal Emergency Management Agency (FEMA) and the individual states shared data and had visibility into needs, it would allow for a coordinated response. AI (artificial intelligence) algorithms could help predict where the hotspots would be and where critical supplies would be needed. This would allow for our resources to be used most effectively. The last thing we want is for us to spend all this money expediting shipment of products, and then having too much in one place and not enough in another. This is a standard problem commercial supply chains are constantly dealing with – but in this case, it’s life and death!”
That is not to say that resiliency in public health supply chains is unimportant. “We designed a network for Haiti after all the natural disasters to account for another one in the future,” Ms. Ramaraju said. “This involved using multiple ports of entry and warehouses to ensure redundancy in supply lines.”
Videos and reporting coming out of South Korea suggest they have gone back to work. There are workers in protective gear taking the temperature of masked workers entering a factory. Anyone with a fever is tested and quarantined if necessary. There is careful tracking of who the infected person interacted with. And there is an application used to make sure the quarantine is respected.
But South Korea began ramping up their ability to respond in January. “Their testing capacity,” Dr. Keskinocak said, “is orders of magnitude larger than ours. The testing really helped them to understand how the disease was spreading and take action. We don’t have near the testing capacity that they have. Hopefully this will change in the coming weeks. It is important for us (Americans) to have patience and continue physical distancing and gain precious time. We need to flatten the curve.”