The United States prides itself in being a world leader in science, technology and innovation. Yet, the country has fallen sorely short of effectively mobilizing its resources and capabilities to fight COVID-19.
Three years ago, the U.S. Army had estimated that in a severe pandemic, the number of U.S. fatalities could be more than 1 million — double the total number of battlefield fatalities from all U.S. wars since the American Revolution. When America has gone to war, industry and labor have mobilized behind it.
To save lives during COVID-19, medical and public health professionals fighting on the front lines need the public and the private sectors to speedily generate the resources to support them. Instead, COVID-19 hotspots are fighting to get ventilators and even basic supplies like masks, pleading for anyone to help, while scientists harness their labs to manufacture what they can and reinvent what they cannot already make.
These contributions are noble and helpful, but real salvation lies in harnessing our mighty industrial systems and supply chains. They are as much a part of the response to the global pandemic as the health care system and running them is as challenging.
All hands must be on deck, with all players understanding what is needed from them and when and where it is needed, so that their actions synergize to make goods and services to flow to the right place at the right time.
It requires coordination on a national scale, which has been lacking while time has passed us by. In 2017, the U.S. Government Accountability Office published a report on such coordination challenges to explore opportunities to improve preparedness and response to a pandemic.
But COVID-19 spread in the United States for several weeks before FEMA was designated on March 19 to lead the federal response. FEMA then quickly activated its National Response Coordination Center, which coordinates federal support for major emergencies — but by then, through no fault of FEMA’s, more than two months had passed since the first confirmed COVID-19 case in the United States.
Contrast that with Hurricane Harvey in 2017, when the NRCC was fully activated prior to landfall.
The spread of COVID-19 in Asia and early cases confirmed in the United States were like advance warnings of a hurricane: a chance to prepare for the pandemic and promote social distancing early, a missed opportunity for the nation.
Some states and local communities made progress in coordinating volunteers, collecting supplies, expanding their material and human resource capacities to cope. But the United States got woefully behind in the necessary massive revving up of critical supplies such as test kits and ventilators that are necessary to handle the surging pandemic.
On a sweeping, national scale, there has been spotty guidance and coordination for producing resources and then distributing them to where they are actually needed when they are needed. This lack of coordination not only pits states against each other in bidding wars but potentially also sends the supplies to the wrong place at the wrong time.
Contrasted with the United States, South Korea has been a picture of efficiency. Its government took a concerted approach to mobilize multiple companies early in the pandemic to produce test kits. It fast-tracked regulatory approval processes and coordinated the sharing of hospital beds around the country.
Coordination in the European Union saw countries band together in a collaborative effort to address ventilator shortages while deflecting bidding wars and giving manufacturers more security to expand production capacity because they knew that someone would actually take delivery.
Along with the need for overarching coordination, there is also an urgent need to collect, update and share vital information. For example, real-time information about the location and availability of ICU beds, ventilators, respiratory therapists, and the current and upcoming needs for them, would enable us to monitor the gaps across different communities – and act.
There are large disparities in ICU bed availability across the nation as highlighted in a recent KHN report based on 2018-2019 data. And we don’t have exact enough data on ventilators. Most estimates about the number of ventilators in the United States are based on a 2010 survey.
Without nationwide visibility into the current shortages and estimated needs bearing down on us in the coming weeks, it will be very difficult for medical supply producers and distributors to decide whether or not to invest in expanding their capacities. They also won’t know how to allocate their preciously limited products – how much of what to send where amid a cacophony of pleas from health systems around the country.
Without coordination, participating companies can end up in production and distribution chaos, at odds with each other, shipping to the wrong places, charging forward with production and sitting on product or pulling back too far and costing patient lives. Companies need guarantees that delivery will be taken, so actual patient needs are met, and suppliers don’t face futility and ruin.
The recently established FEMA Supply Chain Task Force focuses on locating critical resources, accelerating their supply, and coordinating their allocation in collaboration with the private sector. This is a step in the right direction, but will its efforts turn into impact in time?
Federal agencies in the United States need to convene our disparate sources of strength into an orchestra and play the role of conductor, coordinating various subgroups with each other and propelling them in the right direction.
Pinar Keskinocak is the current president of the Institute for Operations Research and the Management Sciences (INFORMS) and a professor at Georgia Institute of Technology specializing in infectious disease modeling and evaluating intervention strategies.
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