Lack of personal protective equipment and medical supplies could last for years without strategic intervention from the government, health and manufacturing officials said.
Officials said logistical challenges continue seven months after the coronavirus reached the United States as the flu season arrives and as some state emergency agencies prepare for a fallout in Covid-19 cases.
Although addiction is not as widespread as this spring, hospitals said rolling shortages of supplies range from special beds to disposable insulating jackets to thermometers.
“A few weeks ago we had a very hard time getting the sanitary napkins. You just could not get them, ‘said Dr. Bernard Klein, principal director of Providence Holy Cross Medical Center in Mission Hills, Los Angeles. “We actually had to produce our own.”
This same dynamic has played a number of critical deliveries in a hospital. First masks, then insulating jackets, and now a specialized bed that allows nurses to turn Covid-19 patients on their bodies – equipment that helps workers with what might otherwise be a six-person task.
“We have seen whole families with Covid come to our hospital, and several members have been admitted to hospital at the same time,” Klein said. “It’s very, very sad.”
Test articles ran short because the predominantly Latino community served by Providence Holy Cross was hit hard by Covid, and even when nearby hospitals could process 15-minute tests.
“If we had a more coordinated response with a collaborative relationship between the medical field, the government, and the private sector, it would help deliver the chain to the areas that need it most,” Klein said.
Klein said he expects to see equipment and supply shortages by 2021, especially as flu season arrives.
“Most people focus on those N95 respirators,” said Carmela Coyle, CEO of the California Hospital Association, a sector group representing more than 400 hospitals in one of America’s hardest-hit states.
She said she believed Covid-19-related supply challenges will continue through 2022.
“We are challenged by the lack of insulating jackets, face shields, which you are now starting to see in public places. Every single piece that is in short supply or unavailable poses a risk to patients and healthcare professionals, ”said Coyle.
At the same time, trade associations representing manufacturers saying convincing customers to move to U.S. suppliers had been difficult.
“I also have sector that only works at 10-20% capacity, which can make PPE in our own backyard but have no orders.” said Kim Glas, CEO of the National Council of Textile Organizations, whose members make reusable cloth jackets.
Manufacturers in their organization have made “hundreds of millions of products,” but without long-term government contracts, many are reluctant to invest in equipment to support economies of scale, and ultimately need to lower prices.
“If there remains an upward trajectory of Covid-19 cases, not just in the U.S. but worldwide, you can see these supply chains breaking again,” Glas said. “It’s a safety issue of health care.”
For the past two decades, personal protective equipment has been supplied to health care facilities in lean supply chains in the same way that toilet paper was delivered to groceries. Chains between large manufacturers and end-users were so efficient that there was no need to stockpile goods.
But in March, the supply chain broke when large Asian PPE exporters embargo materials or shut down just as demand increased exponentially. Thus, health care institutions were in much the same position as regular shoppers, who tried to buy large quantities of a product they had never needed to deposit.
“I am very worried about PPE in the long run [personal protective equipment] deficit for the foreseeable future, ”said Dr. Susan R. Bailey, president of the American Medical Association.
“There is no doubt that the situation is better than a few months ago,” Bailey said. However, many health care organizations, including their own, have difficulty obtaining PPE. Bailey practiced in an allergy clinic of 10 doctors, and was met with a minimum of 10,000 masks when she tried to order N95 respirators.
“We have not seen any evidence of a long-term strategic plan for the manufacture, purchase and distribution of PPE,” the government said in a statement. “The supply chain needs to be dramatically strengthened, and we need less dependence on foreign goods to produce our own PPE in the US.”
Some products have now returned to be made in the US – although factories are not expected to be able to meet demand until mid-2021.
“A lot has been done in the last six months,” Rousse said. “We are largely out of the hole, and we have planted the seeds to make the United States independent,” said Dave Rousse, president of the Nonwoven Fabrics Industry Association.
In 2019, 850 tons of the material was used in disposable masks in the US. In 2021, 10,000 tons are expected to be produced, which is perhaps 80% of the demand satisfied. But PPE is a suite of items – including gloves, jackets and face shields – that have not all seen the same success.
“Thermometers are becoming a real issue,” said Cindy Juhas, chief strategy officer at CME, a U.S. distributor of health care products. “They even expect a problem with needles and syringes for the amount of vaccines they have to make,” she said.
The federal government’s efforts to tackle the supply chain have largely been thwarted. The Federal Emergency Management Agency, responsible for responding to Covid-19, told congressional interviewers in June it had “no involvement” in spreading PPE to hotspots.
An initiative led by son-in-law Donald Trump Jared Kushner, called Air Air, flew PPE from international suppliers to the US at the expense of taxpayers, but was phased out. Furthermore, the government has not responded to the AMA’s call for more distribution data.
Probably Klein is one of the best placed to ward off such distractions. It is part of a 51-hospital chain with purchasing power, and among the institutions, distributors prioritize when selling supplies. But hardships persist even in hospitals, as shortage of buyers has driven them to look directly to manufacturers, often through a swamp of companies that have jumped overnight.
Now distributors are being called not only by their traditional customers – hospitals and long-term care homes – but by almost every segment of society. First responders, schools, clinics and even food companies are all buying medical equipment now.
“There will be many other shortcomings that we have not even thought of,” Juhas said.
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