As an illness, COVID-19 is daunting, but it is manageable. We have the tools, technology, and experience to deal with the symptoms. We understand how to treat and manage sick patients, and we are rapidly learning and adapting to the new medical challenges associated with COVID-19. Our current situation is not a capability challenge; it is a capacity challenge.
What is not working out so well is our ‘system’ to support that need for capacity. Modern businesses—and healthcare is absolutely a business first in today’s world—have evolved to be as lean as possible to control costs. That means using just-in-time strategies to minimize the number of resources that are not actively in use. A friend who is a corporate officer for a regional hospital system told me that:
“…capacity costs money. If there aren’t patients in the beds or using the equipment (read as ventilators), then that costs us more money to make and keep them ready for use. We gambled that if we needed surge, the Government would step in and provide it – why should we pay for it?”
That just-in-time approach works to manage day-to-day operations where things are relatively predictable. We can plan for seasonal influenza. We can prepare for the annual summer increase in traumatic injuries, and we can even plan for a surge in the number of medical mistakes every July when newly made residents start their rotations.
Just-in-time does not, however, work for a pandemic.
We are now in an environment where predictability goes out the window. Demand for critical care resources has gone from 4 cases a day to 400 in less than a week, and we are collectively operating in a react/respond mode. In some places, we are desperately trying to prevent the total collapse of the local healthcare system, and if we fail, we face the potential for a cascading progression of other failures as our systems struggle to cope with the stress.
Acknowledging that point, public health and preparedness experts have predicted this crisis for years. This means we could have been significantly more prepared. Decades of neglect and ambivalence have resulted in dry-rotted masks, broken ventilators, and localities that are so dependent on Federal support that they cannot get out of their own way.
So, where am I going with this? I recently read a story titled The US doesn’t just need to flatten the curve. It needs to “raise the line.” BLUF: while controlling infection rates and flattening the curve, effectively managing demand for healthcare services, are essential parts of mitigating the consequences of COVID-19 crisis, we need to increase our healthcare capacity and address the crisis from both sides of the equation. While I don’t agree with all of the points raised in the article, they do a pretty good job of scoping the problem and laying out some initial ideas on how to address it.
The majority of ongoing COVID-19 response operations are focused on immediate efforts to raise the line. For example:
- Medical Reserve Corps have been activated, bringing retired and re-professioned healthcare providers back into an active role.
- The Strategic National Stockpile has been deployed (and depleted) in an attempt to provide supplies and equipment to the areas hardest hit by the virus.
- The Defense Production Act of 1950 has been brought into play to re-direct our manufacturing infrastructure and increase the production of the equipment and supplies that are needed.
- Military units and resources have been activated and deployed to support response operations across the nation.
- There are groups of healthcare providers traveling across the country to back up their peers in the areas that are the hardest hit.
- Volunteers are manufacturing personal protective equipment (PPE) and coming up with creative ways to extend the value of ventilators and other pieces of critical care equipment.
All of these things contribute toward raising the line. We’re having to work much harder to accomplish that because we collectively decided that there were better things to spend our resources on besides being ready for a disaster.
Quantifying crisis readiness—and a lack-there-of
I prefer to think of readiness in terms of lives saved, and disruptions mitigated. I have learned that most people don’t look at the challenge that way, but everybody seems to understand dollars and cents. A United Nations study published in 2017 looked at quantifying the return on investment from emergency preparedness programs. They found that across the UN Disaster Relief portfolio, for every US$ 1.00 invested in preparedness, the average savings-to-investment ratio was US$1.40. The researchers excluded several high-value outliers in their analysis. Inclusion of the outliers brings the ratio to US$2.60 saved for every US$ 1.00 invested. There was also a mean gain in response time of 14 days. A 260% savings in the cost of a disaster, and a two-week reduction in how long it took for effective response operations to be in place.
We are just beginning to realize the scope and scale of the consequences associated with COVID-19. I have no idea what the impact of decreasing our national response time to this crisis by 14 days could have been, but I’m willing to guess it would have been a significant decrease in the number of people who have died.
The economic impact of the COVID-19 crisis is going to be measured in the trillions, if not hundreds of trillions of dollars. What would the savings from actually being prepared have looked like?
Was the decision not to invest in pandemic readiness worth it? And now that we’re here, are experiencing the consequences and are aware, what will your choices look like moving forward?