The consequences of poor federal planning for the COVID-19 public health emergency and mismanaged allocation of resources has posed immense risks for frontline care providers. Personal protective equipment is needed for all essential workers, but in particular for those in hospitals and other care settings.
Hospitals have had to force workers to reuse single-use PPE for days or even weeks due to critical shortages. The Centers for Disease Control and Prevention suggested on March 17 that healthcare providers "might use homemade masks (e.g., bandana, scarf) for the care of patients with COVID-19 as a last resort." That nurses have had to wear bandanas instead of surgical masks and garbage bags and ponchos instead of gowns is inexcusable.
"Without secure supply chains, the risk to healthcare workers around the world is real," World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus has said. "Industry and governments must act quickly to boost supply, ease export restrictions and put measures in place to stop speculation and hoarding. We cannot stop COVID-19 without protecting health workers first."
Sadly, some healthcare workers have died of COVID-19. In some cases that may be due to a lack of PPE and safe working environments.
In normal times, hospitals try to maintain margins and increase profit. Stockpiling PPE is seen as a wasteful practice, since much of it will eventually be disposed of due to expiration dates. But as the pandemic has shown, running out of such critical equipment during a crisis such as this one can have dangerous risks. A better way to manage and allocate stocks of these resources is needed going forward.
I propose to develop a Federal Reserve-type structure for PPE supply chain management. It would be a federally funded program that cannot be influenced by politics and would perform "stress tests" for healthcare organizations.
These tests, similar to the ones the Fed requires of banks after the 2008 financial crisis, would be designed to ensure hospitals have the resources to adequately handle any emergency. They would look at allocation practices, assess hospitals' ability to adapt to changing situations with bed management or reallocation of physicians, nurses and other healthcare workers.
Importantly, this program will use blockchain technology to monitor and control the allocation of resources. The use of blockchain can be extremely beneficial in monitoring these stockpiles and allowing for the allocation of resources quickly and efficiently.
As an open, distributed ledger that can record transactions between two parties efficiently and in a verifiable and permanent way, blockchain can allow government agencies to track the amount of PPE available in real time. It can also offer visibility into critical shortages in hospitals and allow for the reallocation of resources for those hospitals.
It also enables proof of ownership, and the transfer of ownership from one hospital to another, as has been shown in many use cases across the pharmaceutical supply chain.
Reallocation of stockpiles from hospital to hospital (with critical need) via blockchain can decrease a need for a federal or state reserve stockpile. This can ultimately help eliminate waste by not requiring the government to keep supplies for these hospitals that are critically low.
Quantitative data is needed to help with the distribution of resources and will prevent any conflicts of delivery, such as political interference. This program will use artificial intelligence technology with blockchain to swiftly deliver resources to hospitals and reorder supplies from manufacturers, regardless of which state they're in.
During pandemics, states and municipalities should not be in bidding wars with each other for critical safety equipment. Capitalism is an essential aspect of American society, but in times of national emergency, we need to be focused on the allocation of resources – swiftly and wherever needed.
This program would allocate resources quickly via usage of the U.S. Postal Service and would not contract any for-profit delivery company unless delays begin to impact the safety and welfare of areas in need. Blockchain technology will track the PPE from production, to transport, to collection by healthcare organization.
Ultimately, the program could serve as a transparent method to prevent unsafe working conditions during an emergency. Every hospital would be mandated to carry a certain amount of PPE, with recommendations of the minimum required equipment to be determined by the size of the hospital, its total staff and the population of the area it serves.
Failure of compliance should result in fines or decreased reimbursement rates by the Centers for Medicare and Medicaid Services. Hospitals that cannot afford to start a stockpile could receive government assistance, but a freeze on executive pay and bonuses would occur for two years after receiving that support.
Measurement of the success of this program will be assessed through the improvement of working conditions, financially responsible reallocation and the ability to respond, with sufficient protective equipment, to public health emergencies like COVID-19.
Alex Klotsche is an RN at NewYork-Presbyterian Weill Cornell Medical Center. He is set to earn his master's degree in health leadership from University of Pennsylvania in 2020.
