Reducing Viral Exposure of Healthcare Officials During the COVID-19 Outbreak- A Draft

Introduction

In pandemics, like the current COVID-19 outbreak, the first concern is to stop the spread of the virus. The administrative decision by President Trump to limit the travel from Europe to the United States is not exactly effective in decreasing the rate of the virus spreading because it is already in our country. The CDC just recently issued a statement urging residents from New York, New Jersey, and Connecticut to refrain from non-essential domestic travel for 14 days, along with other travel restrictions in other areas in the United States.[1] Although the spread from citizen to citizen is important to control, the main focus should be on preventing the spread of the virus to healthcare professionals, which none of these current mandates have worked to achieve.

Without healthy doctors, nurses, and other healthcare workers, the death rates would increase significantly, and hospitals would not be able to function or treat the high-risk people that are in desperate need of care in these times. Personal protective equipment, or PPE, is especially important when working with contagious viruses, like COVID-19. Since this virus spreads by direct contact with fluids from an infected patient, health care workers must reduce this contact as much as possible.[2] Already, hospitals around the country are reporting a major lack of PPE including respirators, gloves, face shields, gowns, and hand sanitizer. This situation is so drastic that a new hashtag, #GetMePPE has been trending around the country, urging a change to the lack of PPE in hospitals.[3] In Italy, health care workers experienced high rates of infection and death due to a lack of PPE, so if the United States wants to protect its workers and prevent a similar occurrence, there needs to be immediate action in supplying PPE to hospitals.[4]

There are a few ways that would increase the availability of necessary PPE to protect the health care workers. The Defense Production Act (DPA) allows the President to direct private companies to produce equipment needed for a national emergency. By utilizing this act, companies could halt the production of other products and focus all attention on the production of PPE. Their suppliers should also be encouraged to maximize the raw material available to these companies to increase production, which would, in turn, increase the output of PPE.

Since only a few companies would have the expertise to produce these devices, the federal government needs to rope in other industries in the production effort. The automobile industry and the fashion industry could have the adequate materials to make PPE and contribute to these efforts, ensuring that United States healthcare workers have the adequate means to provide care to infected individuals while also protecting themselves against infection.[5] After these companies begin manufacturing PPE, their suppliers will need to increase the raw materials necessary for these products to ensure a massive output of material to be distributed across the country.

The simultaneous activation of the DPA and a push for increased PPE production would monumentally change how the United States is trying to combat the pandemic of COVID-19. As the country is facing new challenges economically and socially, the United States government and major manufacturing corporations need to utilize their power and implement the necessary means to flatten the pandemic curve and protect its citizens.

A Global Increase in Lack of Personal Protective Equipment

Personal protective equipment is one of the most widely used method of disease prevention in hospitals and daily life. But, with surging rates of infections in more than 200 countries, the demand for PPE has risen.[6] Since the start of the COVID-19 outbreak, prices of surgical masks have seen a six-fold increase, N95 respirators have tripled, and gowns have doubled.[7]

The available limited stocks then are frequently sold to the highest bidding country, leaving countries without the necessary PPE. The World Health Organization (WHO) has tried to help these countries by shipping almost half a million sets of personal protective equipment to 47 countries, but supplies are rapidly depleting. Based on predictions by WHO, an estimated 89 million medical masks are required for the COVID-19 response each month. For examination gloves, 76 million are required, while international demand for goggles stands at 1.6 million per month. To meet rising global demand, industries must increase manufacturing by 40 percent. This means that no additional aid will be provided to the United States, and the country as a whole needs to take responsibility for its PPE deficit by altering its manufacturing practices.

Taking the Issue into Its Own Hands: How the United States Should Respond

Without the ability to rely on outside sources for PPE supply, the United States needs to step up and take up the challenge of increasing PPE manufacturing. This can be achieved through several steps. The first step needs to include the implication of the Defense Production Act (DPA). The ability to designate the production of necessary PPE to private companies that can contribute to help in a national emergency is a powerful tool that the United States government has not taken full advantage of. With all private and public medical supply companies working together on PPE production, the gap between the current deficit of supplies and the amount needed to keep the United States healthcare workers safe could be closed. Although President Trump just recently activated the DPA in response to COVID-19 on March 18, 2020, encouraging General Motors to make ventilators, it concerned many public officials how postponed the reaction was to such a widespread issue.

Conflicts with the Defense Production Act

It has come to the attention of many that the DPA has finally been pushed in the United States to order private companies to produce ventilators, but there are several issues tied to this decision. It is being argued that this lackluster and delayed response is signification that the United States government is leaving citizens to fend for themselves and taking a more hands-off approach. There is evidence that the Trump administration has used the DPA over the past three years to prioritize issues for national security, from rare earth metals to building lasers to constructing body armor for Border Patrol agents. It is estimated that the Defense Department alone uses the power of DPA around 300,000 times every year, while the Department of Homeland Security prioritized 1,000 orders in 2018 for disaster response efforts.[8] The prioritization of defense over responsiveness to the pressing pandemic on hand is somewhat concerning and needs to be addressed.

The U.S. Chamber of Commerce and the heads of major corporations have convinced the administration against using the DPA. They say that it could be counterproductive, imposing limitations on companies when they need the flexibility to deal with closed borders and shuttered factories. Although this may help companies deal with their economic troubles associated with the decline in the stock market, it does not help the safety of United States doctors and medical workers. By not encouraging more companies to produce PPE, the lack of protective equipment will continue to be a problem, healthcare workers will continue to get sick, in turn altering the productivity of hospitals and likely causing the death rates of patients to skyrocket due to unavailable care. It is a terrible snowball effect that needs to be taken on immediately by more heavily employing the DPA.

More Supplies, More PPE—How Other Industries Can Contribute

Reports show that it was predicted that the United States would dislodge China as the most competitive manufacturing industry in the world.[9] This should be an indication of the United States’ incredible power as a manufacturing powerhouse. This incredible capacity for producing goods needs to be harnessed. If the DPA is activated, it will likely only focus on designated medical supplies manufacturers, not on companies who have the materials to produce PPE but are not specifically part of the medical manufacturing umbrella. In this case, major wealthy companies must realize their stake in the issue and also step up to solve the PPE crisis. Although many argue that these companies are already feeling the effects of the downward spiral of the stock market, companies have proven successful in their endeavors towards aiding medical manufacturers by producing more masks and other PPE.

The fashion industry has already made a considerable commitment and effort to trying to solve this issue. Eddie Bauer, an outdoor apparel company, said it had shifted production to making protective medical equipment at capable vendors that typically make its technical outerwear. Nordstrom, which calls itself the largest employer of tailors in North America, is working with Kaas Tailored, a clothing manufacturer in Washington state, to sew masks made by cutting up and restitching surgical wrap provided by Providence, a healthcare organization asking for help making masks.[10] These few examples alone demonstrate how protective medical equipment production is not just the responsibility of the healthcare field, and if companies and organizations work together, more PPE could be manufactured and sent out to hospitals around the country.

As with any product, more raw material supplied to the manufacturer, the more supplies can be produced. To make this chain of action completely successful, the materials necessary for manufacturing masks, other PPE, and medical supplies need to be readily accessible to the companies who are taking on this challenge along with the medical suppliers that are desperately trying to meet the demands. The initial problem stems from the dependence on China, for most of the medical supply manufacturing responsibilities along with material export were placed on a single country. For future crisis similar to the PPE deficit, the United States should use this as an example to realize that the capability to be a similar manufacturing giant as China is there, it is just not being acknowledged.

The Time for Change Has Passed—Action is Needed NOW

As the epidemic curve is continuing to rise in the United States and other regions across the globe, the push for medical PPE is more desperate than ever. The United States government, along with CEOs of major manufacturing companies, have the power to make a change, but many are not taking full advantage of their resources and incredible power.

To provide the protective equipment that the healthcare workers need to keep healthy and safe to properly care for the infected, PPE productions need to skyrocket. This can feasibly be achieved by a three-step process of first, the United States government activating the DPA heavily, second, major corporations with medical equipment manufacturing capabilities switch production focus from their usual goods to medical supplies, and third, the raw material suppliers of these corporations increase access to the materials necessary for making the PPE. If the United States works as one united force, the PPE crisis can be solved. But there is no more time for waiting. It is only a matter of time before hospitals begin to lack adequate staff due to sickness. The time is now.

Bibliography

“Coronavirus and Travel in the United States.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, March 30, 2020. https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html. [1]

“How Coronavirus Spreads.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, March 4, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html?CDC_AA_refVal=https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html. [2]

Padilla, Mariel. “’It Feels Like a War Zone’: Doctors and Nurses Plead for Masks on Social Media.” The New York Times. The New York Times, March 19, 2020. https://www.nytimes.com/2020/03/19/us/hospitals-coronavirus-ppe-shortage.html. [3]

Ranney, Megan L., Valerie Griffeth, and Ashish K. Jha. “Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic.” New England Journal of Medicine, March 25, 2020. https://doi.org/10.1056/nejmp2006141. [4]

Orvitz, Kevan. “PPE the Automotive Industry Needs to Invest In.” Occupational Health & Safety, April 1, 2019. https://ohsonline.com/Articles/2019/04/01/PPE-the-Automotive-Industry-Needs-to-Invest-In.aspx?m=1. [5]

“What Are Digital Therapeutics?” Digital Therapeutics Alliance, May 9, 2019. https://dtxalliance.org/dtx-solutions/. [6]

“Coronavirus Cases:” Worldometer. Accessed April 2, 2020. https://www.worldometers.info/coronavirus/. [7]

“Shortage of Personal Protective Equipment Endangering Health Workers Worldwide.” World Health Organization. World Health Organization. Accessed April 2, 2020. https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide. [8]

Stieb, Matt. “Trump Invoked Defense Protection Act All the Time, But Stalled for Coronavirus.” Intelligencer. March 31, 2020. https://nymag.com/intelligencer/2020/03/trump-used-defense-production-act-stalled-for-coronavirus.html. [9]

Selko, Adrienne. “Top 10 Manufacturing Countries in 2020.” Industry Weekly, December 9, 2015. https://www.industryweek.com/the-economy/competitiveness/media-gallery/22011658/top-10-manufacturing-countries-in-2020. [10]

Bain, Marc. “US Fashion Brands Having to Make Medical Masks Expose a Failure of the Health System.” Quartz, March 30, 2020. https://qz.com/1826057/us-fashion-brands-making-masks-expose-a-failure-of-the-health-system/. [11]