Hospitals ‘Nervous’ Over Knock-on Effects From COVID Medical Supply Breakdown

A secondary, knock-on effect of coronavirus is that patients who come down with other illnesses may be unable to get treatment due to medical shortages caused by the outbreak.
SEATTLE, WA - FEBRUARY 29: Healthcare workers transport a patient on a stretcher into an ambulance at Life Care Center of Kirkland on February 29, 2020 in Kirkland, Washington. Dozens of staff and residents at Life C... SEATTLE, WA - FEBRUARY 29: Healthcare workers transport a patient on a stretcher into an ambulance at Life Care Center of Kirkland on February 29, 2020 in Kirkland, Washington. Dozens of staff and residents at Life Care Center of Kirkland are reportedly exhibiting coronavirus-like symptoms, with two confirmed cases of (COVID-19) associated with the nursing facility reported so far. (Photo by David Ryder/Getty Images) MORE LESS
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March 5, 2020 11:12 a.m.
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The expanding outbreak of COVID-19 poses a series of threats to the healthcare system’s ability to treat patients, as hospitals and state governments brace for the disease to impact their communities.

Among those threats are shortages of protective masks and sanitary gowns, along with reams of other categories of medical supplies.

The shortages stem from a combination of factors. Slowdowns in manufacturing in China have thrown a wrench in medical supply chains, while individuals and institutions have responded to the threat by hoarding. In other cases, medical providers have simply been forced to expend far more resources than expected to handle the outbreak.

Professionals in the field told TPM that the shortage creates the risk of a secondary, knock-on effect of coronavirus — that patients who come down with other illnesses may either be limited or unable to get treatment due to shortages caused by the COVID-19 outbreak.

The secondary problems could end up being more serious than the direct effects from the lack of medical supplies to treat coronavirus itself, medical officials told TPM.

A run on ventilators needed to treat serious COVID cases, for example, could divert hospital staff from people with other, serious respiratory diseases. Deficits in sanitary gowns, manufactured in China, are already being felt around the country, making it more difficult to maintain hygiene in medical operations. Hospital systems are starting to check state-level stockpiles.

Other items like sanitary waste bags, one official told TPM, also threaten to run short — posing problems for the disposal of biohazards like blood, used samples, and other potential contaminants.

Liam Yore, a Seattle-area emergency room doctor and former head of the Washington chapter of the American College of Emergency Physicians, told TPM that his hospital had run out of test kits for the flu and other common, viral diseases. (Yore emphasized he was speaking in his personal capacity, not on behalf of any hospital that employs him.)

“We ran out of test kits for the viral panel because we’ve had so many people coming in,” Yore said.

Yore said his hospital, without COVID 19 test kits, had been using the other test kits to isolate potential COVID cases through process of elimination.

“Because of what’s going on, we’re assuming that everyone has it. It’s an effective workaround, but it’s not an effective long term strategy,” he added.

China

Beijing dealt with the COVID crisis through mass closures and by shutting off the city of Wuhan, where the outbreak is thought to have originated.

That effort has included closing down factories around the country, which form an integral part of the medical supply chain for everything from electronics that are used for complex medical devices to face masks and sanitary gowns.

FDA Commissioner Stephen Hahn told reporters last week that his agency was “keenly aware that the outbreak will likely affect the medical product supply chain, including potential disruptions to suppliers [and] shortages of critical medical products in the U.S.”

But the consequences of the breakdown can have unexpected effects that ripple throughout the country.

Following Hurricane Maria in Puerto Rico, for example, the U.S. faced a shortage of saline solution and IV bags, after the storm knocked out a crucial factory of the material that was located on the island.

Richard Bartlett, emergency preparedness coordinator for the Kentucky Hospital Association, told TPM that “some raw materials used to make these items are primarily made in China or other countries.”

“Domestic manufacturers may also need to find new sources,” he added, saying that hospitals are having trouble “finding replacement stock” while other suppliers are shipping fewer items than asked for.

“They are nervous about the future,” Barlett told TPM.

Hoarding

But the shortages come down as much to perception as it does to the reality of supply chain disruptions, medical officials told TPM.

As fears over breaks in the chain have mounted, both individuals and institutions with the means to do so have started to hoard resources, exacerbating the potential for shortages.

According to Duane Morris partner Delphine O’Rourke, who advises hospitals on responding to COVID, the crisis has led to a “gold rush” in medical supplies, with some bigger facilities buying up large amounts of items in anticipation of shortages.

“What are hospitals concerned by now? Anticipation of a shortage of critical medical supples that are necessary to treat patients,” O’Rourke told TPM.

She added that while the country has yet to reach “a breakdown phase, we are starting to see hoarding,” which occurs with every emergency.

The key difference with COVID is that the crisis threatens to go on for a full year — much longer than a brief, but intense shock to the system like a natural disaster or attack, potentially further depleting supplies.

Logistics built on fragility

The knock-on effects from supply chain issues go in part to the fragility of how American hospitals operate.

Many run thin profit margins, meaning that they need detailed data to predict what inventory will be needed at different times.

Danny Chun, an official at the Illinois Health and Hospital Association, told TPM that “everyone is acutely aware of the situation,” and added that hospitals around the state were “inventory-ing what their current supply is” in conjunction with the state Department of Health.

Bartlett, the Kentucky hospital official, told TPM that hospitals use “just in time” supply. “So projecting their needs forward given the new paradigm is prudent.”

Some plan on relying on state-level caches of medical supplies. Tim Blasl, President of the North Dakota Hospital Association, told TPM that hospitals were consulting with the state’s reserve cache with that eventuality in mind.

For Yore, the Seattle-area doctor, and others, however, the lack of reliable data from the Department of Health and Human Services was making it difficult to plan.

Hospitals running on tight margins find themselves in a tight spot without hard data. Artificial ventilators, for example, take multiple people with expertise to operate and are necessary in severe COVID cases.

But without the ability to predict what is going to come and where, it’s impossible to budget resources effectively.

“Unless they’re very secure financially, they probably aren’t in a position to stock supplies in a significant way,” O’Rourke said.

Key Coronavirus Crisis Links

TPM’s COVID-19 hub.
Josh Marshall’s Twitter List of Trusted Experts (Epidemiologists, Researchers, Clinicians, Journalists, Government Agencies) providing reliable real-time information on the COVID-19 Crisis.
COVID-19 Tracking Project (updated data on testing and infections in the U.S.).
Johns Hopkins Global COVID-19 Survey (most up to date numbers globally and for countries around the world).
Worldometers.info (extensive source of information and data visualizations on COVID-19 Crisis — discussion of data here).
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