The world finds itself In an unprecedented public health crisis. Corona virus is lethal to the young and old, the healthy and unhealthy, royalty and the average person. So far, Trump’s response to the corona virus pandemic, has been unorganized,ineffective and slow. Not only is his response impaired by narcissism, ignorance and incompetence, he is also a prisoner of a dysfunctional Republican ideology that values private over public, profits over people, states rights over federal action, and a free markets that somehow always provides the best solution to any problem. They see any federally imposed solution as an overreach and an anathema. Science is reflexively denied and experts who have spent lifetimes studying issues are ignored or dismissed as deep-state operatives.
What we now have are a patchwork of programs where governors and local officials decide when and where they will close businesses and public gathering spots, if and when they will institute social distancing, shelter in place orders, isolation policies and when and how they will reopen their states. The pandemic knows no borders,yet the Trump administration acts as if the it will respect lines arbitrarily drawn on a map or be intimidated by the president’s tweeting. With no comprehensive policies, states rights become national wrongs. Poor policy in one state can negate the best practices of its neighbors.
States are forced to bid against each other for ventilators, masks,personal protective equipment and other healthcare necessities. The bidding war unnecessarily raises prices and sends supplies not to where they are most needed but instead, to the richest states. Ironically, red states are among the poorest states. But, it’s the free market and who are we to interfere with the invisible hand of the free market’? Besides, that could cut into the the stable genius’s executive time.
Currently, there is no cure for the Corona virus. A vaccine is at a minimum 6 to 8 months away and more likely, 1 year to 18 months. While remdesivir shortens the course of the illness and probably decreases mortality, the drug won’t be widely available until October. The basics of pandemic medicine are are containment and supportive therapy for the ill. Containment relies on identification of people with Corona virus, and isolating them from the general public so they can’t spread disease. Slowing the spread of the disease, the so called “flattening the curve”, prevents hospital capacity from being overwhelmed by controlling the number of sick people at any given time. Currently, since we can’t test everyone you’re presumed to have Corona virus if your symptoms are consistent with it. Mild cases are sent home to recover while more severe cases require hospitalization for supportive therapy. Typical supportive therapy starts with supplemental oxygen and progresses to various forms of mechanical ventilation and intensive care unit treatment.
Hospital capacity is more than just the number of physical beds. Care of the critically ill, is very labor intensive. The real capacity is the number of beds that can be appropriately staffed. Currently,health care providers are sent into actions without adequate personal protective equipment, despite being months into the pandemic. Many will fall ill. and risk spreading the virus to their colleagues or patients. As more healthcare providers fall ill, a vicious cycle ensues where there are fewer and fewer healthcare providers and the hospital capacity steadily becomes degraded. Hospital systems in large cities can often recruit temporary help to make up for any shortfall. As the pandemic starts to move to more rural locations that often are already minimally staffed or under served, there aren’t people readily available to replace healthcare providers that become ill. We need adequate PPE for all front line healthcare workers as well as people in hospital support positions and prehospital staff such as paramedics and EMT’s. Not only can these people become infected in the hospital, they can bring their infections home and spread COVID into the community.
Just as dire as the inadequate supply of PPE is the supply of diagnostic and serology tests. While the supply of tests at the White House is marginally adequate, just down the street at the Capitol Building it is not, let alone the rest of the country. Testing lets you know who is infected and who needs to be isolated to prevent the spread of infection. Serology testing lets you know who has recovered and is presumably immune. Despite Trump’s claim that everyone that needs a test can get one, both types are in short supply.
The Defense Production Act should be used to address the critical shortages of PPE and testing. The Act can be used to compel manufacturers to produce items they normally don’t produce and establish supply chains in order to increase production of critical items. While Trump has invoked the act, his use of the act has been more aspirational than practical. He rage tweeted at GM to make ventilators and then invoked the DPA hours after they announced that they were going to make ventilators. In his mind, GM and Ford should be able to make lots of ventilators because they’re used to making lots of cars, even though they’ve not had any experience in this industry. Meanwhile, 4 of the top ten ventilator companies, Becton-Dickinson, Medtronic (although officially headquartered in Ireland for tax purposes), GE and ResMed are all US companies. All these companies have experience in mass production and already know how to make ventilators. Incidentally, GM and Ford partnered with Ventec and GE respectively, and leveraged their supply chains to provide the parts needed to make ventilators in increased quantity.
The more concerning issue regarding testing is that the FDA has given emergency clearance to many unvetted tests. We have tests that just don’t work. Some tests come from scammers. This free market free for all results in too many tests and tests of poor quality. Many of these tests have different procedures and reagents. If we decide on a limited number of tests, we would be able to scale up the production of reagents for testing instead of splitting these resources between multiple tests. Instead of leaving this to the invisible hand of the free market, we need leadership to decide on a limited number of effective tests and then produce the necessary reagents at scale. While the Trump administration might describe its approach as laissez faire, it’s really more like lazy faire.
As the push to open the economy intensifies, the need for testing and PPE will increase drastically. Testing will allow us to know who is infected and needs to stay home from work; who is recovered and assumed immune to re-infection. Both forms of testing are necessary for a healthy work place.
Besides increasing the level of testing, we need a drastic increase in the amount of personal protective equipment available for not only healthcare workers (healthcare is 15-20% of the economy) but also other essential workers. We need to develop workplace procedures that protect essential workers and allow them to work safely. We need both increased PPE supply and social distancing at work. This approach is entirely feasible. When I first heard that Intel and Google were donating PPE from their supply to the healthcare sector, I wondered why did they have PPE? Then I remembered what a semiconductor plant looked like. Modern day semiconductors are built to work on a nanometer scale. Dust and even virus particles are huge on this dimension. The manufacture of these devices occurs in rooms with ultra filtered air and personnel in full protective suits yet the electronics industry can produce these products in factories on a massive scale. If we had the desire, we could come up with similar procedures for other industries.
Instead, the Trump administration has used the Defense Production Act to classify meatpacking, as vital and forced plants to remain open despite rampant infection. The premise is, “You’re vital. You’ll just have to get sick.” In meatpacking, the workers need protections from each other. We could provide the protection if we wanted to provide it. However, this would increase the production costs in an industry notorious for relying on cheap and often, undocumented immigrant labor. If we had instant testing for all employees, a socially distanced production line, filtered air and personal protective equipment, the workplace could be much safer.
So, how can the Defense Production Act be used to increase the amount of testing and PPE? The best use of the DPA would be to establish supply chains that would allow increased production. For testing, you need testing machines, reagents, and supplies such as swabs and sample containers. Many hospitals and medical labs already have automated machines to perform tests. You need to start with an analysis of which automated machines are most available that can perform the required tests. This in turn, defines the reagent and testing supply requirements. Pharmaceutical companies and contract laboratories can then be contracted to make the required reagents through the DPA. Further contracts to electronic manufactures for additional machines, and to plastic manufacturers for swabs and sample containers could be made in parallel. A comprehensive and organized approach is required which seems to be beyond the capabilities of the Trump Administration.
To increase the supply of PPE, you need to increase the supply of the filtering material,electret charged, melt blown fabric. Melt blown fabric is made by extruding melted plastic through spinnerets and imparting an electric charge during the final phase of manufacture. The electric charge attracts the particles to the filter and removes them from the air. The material is used not only in PPE but also in air filters and HEPA filters. Manufacturers of these products could be an alternate source of materials for PPE. The largest use of melt blown fabrics is for the manufacture of diapers and sanitary napkins. These products are not electrically charged, however, the production process could be modified to charge them. This would be a perfect use for the DPA.
The United States military is also an untapped source of PPE. Gas masks provide superior protection to medical grade n95 masks. The accompanying chemical weapon suits supply better protection than any hospital gown. The only non-reusable part of the assembly is the gas mask cartridge. This equipment is available from National Guard and military stocks. They’re also made in the USA and production could be ramped up with the DPA.
To use the Defense Production Act effectively requires understating of manufacturing and its attendant supply chains. Creativity is needed to understand how one manufacturer can make a product that they don't normally make that can contribute to the supply chain of a vital product. To use the DPA effectively requires analysis, organization and consultation with industry experts. The stable genius seems to be having trouble with the analysis and organization aspects. O course he doesn’t need to consult because he’s the genius and already knows everything. Somehow, he does seem to need a little help. Perhaps, he can tap his son-in-law, Jared Kushner, a very stable smart guy if there ever was one. God help us all!
Liberal with a Machine Gun There's social injustice and he's pissed! Now somebody else's heart is going to bleed!
Disclaimer – Liberal with a Machine Gun doesn’t believe in violence except as a defensive necessity. No Republicans were harmed, except possibly rhetorically, in the writing of this document.