March 25, 2020

A horse, a horse!  My kingdom for a horse!   That familiar phrase, first uttered in Act V of Shakespeare’s Richard III, reminds us that sometimes seemingly unimportant or everyday items can become downright invaluable given the right situation.  Trading an entire kingdom for a single steed is quite the bargain if your very life or life’s calling is contingent upon that particular animal at that particular moment.  That is the situation we now face in the healthcare environment. Because of the transmission capabilities of the coronavirus (COVID-19), our medical personnel need special masks and other personal protection equipment (PPE) to keep from contracting the virus themselves.  Because COVID-19 patients often experience pneumonia-like symptoms, devices such as ventilators are in desperate demand.  More patient beds may be needed, as well.

Shortages in the States

The problem is there is a worldwide shortage of masks, gowns and gloves for healthcare providers, according to information released on March 18 by the State of Washington’s Department of Health (DOH).  “We are also facing a crisis in which we may not have enough space in our hospitals, nor life-saving equipment like ventilators available for people who need them.”  The DOH requested 64,690 N-95 respirators, 154,103 surgical masks, 29,344 face shields and 23,925 gowns from the federal government on Friday, March 13, according to an official state press release. As of Thursday, the request was still awaiting approval.

The supply shortage and dire conditions are not limited to Washington.  California health officials are observing how the hospitals in their state are grappling with a shortage of protective gear during the coronavirus pandemic.  According to Kaiser Health News, Gov. Gavin Newsom on Thursday issued a statewide order for California residents to stay at home. He “projected that 56 percent of the state’s population could be infected by COVID-19 over an eight-week period if mitigation efforts were ignored. Meanwhile, health workers in some Bay Area hospitals are wiping down and reusing masks and other equipment that used to be discarded after each use.”

As far as bed availability, Reuters reported on March 23 that “California’s governor said that the state needs 50,000 additional hospital beds to accommodate a surge in coronavirus patients predicted by computer modeling.”  This is disquieting news to be sure, but also raises a point about what other states and facilities can do to more accurately tailor their preparations.

Strategies to Pursue

There was one positive bit of information that was released by the Washington DOH.  The populace had been urged by health officials to remain at home unless they were truly in need of advanced care.  It was made clear to the people that this request was being made in order to save vital hospital space for the critically ill.  That guidance appears to have been quite effective as ED volume has actually dropped.  According to the DOH, “people who would normally come to our ED are looking for alternative care.”  Perhaps this is one takeaway that other state health officials need to replicate.  Communication is the key.

Another example of leading by communicating is what we’re seeing In Louisiana.  Recently, the state’s premier professional and university head football coaches have used their positions of prominence and popularity to urge the state’s citizens to follow the governor’s guidelines for staying healthy.  This is particularly important now that Louisiana has just been declared as having the highest growth rate of the virus than any other state, or any other country in the world. Other states are now looking to leverage their sports heroes or other celebrities to be the mouthpiece of government guidelines during this crisis.

Communication alone, however, will not add PPE to the hospital shelves or beds to the hospital floors.  Decisive action will need to be taken to obtain these vital supplies.  The first step is to determine with some reasonable certainty what the need will be.  As we’ve seen, California determined its number of beds needed based on computer modeling.  Similarly, Louisiana’s governor determined his state’s rate of viral increase based on a study done at the University of Louisiana at Lafayette.  Information is power, and in this current crisis the information is always changing.  Hospital executives and those in charge of supply procurement are encouraged to proactively look for any studies that have most recently been done and that are applicable to their local areas that might give them an estimate of the number of PPE units and beds that will be needed in the weeks ahead.

Once you have determined the number of extra supplies and/or beds that will be required to address the influx of COVID-19 cases, you will then need to figure out the best way of obtaining those items.  In a recent afternoon press conference, California’s governor revealed that the state had gone to the open market looking to purchase some 200 million pieces of protective gear for doctors and nurses treating patients with the virus.  So, for some hospitals, your state government is already helping you meet these approaching requirements.  In such cases, coordination of information between the hospital and health department will be crucial.  You’ll need to go over the numbers together with your state officials as to the need and projected time of need, and then discuss the logistics of receiving whatever help your state may be in a position to give you.

The federal government is also engaged in obtaining extra supplies.  Hospitals may want to reach out to their congressional representatives to determine exactly what supplies might be forthcoming from these federal efforts, to include specific timetables of delivery, costs, etc.  In the meantime, the Centers for Disease Control (CDC) in Atlanta has published a list of Strategies for Optimizing the Supply of PPE which you can find here.

So much concerning this pandemic is changing—the numbers, the closures, the solutions.  Many are on information overload.  During this time of confusion and concern, we remain a steadfast resource on which you can rely.  Please feel free to share with us what’s happening at your facility that might be of help to others, to include projections, interim protocols, supply chain, case levels, employee issues.  Otherwise, let us know if there is any way we can be of service to you.  MiraMed has global resources to provide customized tailored solutions for hospitals.  Please contact us at info@MiraMedGS.com.