How Could This Happen? Stuff that I have Noticed #29

Excerpts from a piece by my brilliant new acquaintance Bruce Silverman:

Why is the protective gear needed by healthcare workers is in such short supply? Why should that be? Why can’t the vendors simply step up production and deliver more to their customers?

I’ve learned that the answer to that question is simple (but in many ways, stupid): healthcare supply vendors and their customers over-relied on “Just In Time” production/delivery schedules. And now that’s biting them in the ass.

Most of us remember a time when just about every business – including hospitals – maintained extensive inventories of everything they needed or sold. If you didn’t see something on the shelf at the supermarket, or at a department store, you’d ask a sales clerk if “they had it in the back.” And, more often than not, they did!

Not anymore. … Computerization, which tracks the velocity at which goods are sold (or in the case of hospitals, used), enabled the advent of “Just in Time” production/delivery scheduling. So instead of maintaining big inventories, shipments are scheduled to arrive based on when they are (typically) needed. Most hospitals adopted “just in time” deliveries years ago for just about everything they typically need in a given period of time, such as gloves, gowns, and yes, even masks. And while the better hospitals maintained a fairly substantial inventory of these sorts of supplies so as to be ready for surges, hardly any were ready for a pandemic. Making it all worse, manufacturers weren’t equipped for a surge either. Production capacity was limited… and why not? Why be able to crank out twice or three times as many masks than their customers would ever need?

But what if there was a pandemic? These things DO happen.

And the federal government, as well as some states, had – at least in theory – plans on how to deal with that.

During the SARS epidemic, the Schwarzenegger administration in California actually purchased and warehoused a large supply of personal protective gear, ventilators and even about a hundred military-style, 100-bed, field hospitals. Thankfully, SARS never reached the U.S., but the idea was a good one. Be ready “just in case.” Unfortunately, over time, a lot of that equipment “aged out,” and most of the hardware was sold off.

The Federal Government has long maintained a strategic stockpile of emergency gear, but it was mostly intended for use by the military or the VA. But in 2015, somebody in the Obama administration had a brilliant idea that would have helped everyone, everywhere in the U.S., right now. The NSA formed a Pandemic Response Unit that consisted of scientists and physicians who were charged with creating a plan and being responsible for implementing it if an epidemic such as SARS or Ebola broke out in the U.S. That unit created a “playbook,” which included strategies and tactics for a Federal response. One of the most important responsibilities of the unit was to “blow the whistle” as early as possible if an epidemic might be on the horizon. The most effective way to combat an epidemic is to cut it off as early as possible. Another was a tactic that would have put the DOD or Federal Office of Procurement in the position of being “the purchaser” of emergency supplies in the event of an epidemic, rather than individual hospitals or states or cities. The Feds would then have been responsible for disbursing that stuff on an as-needed basis. That would avoid what’s happening now, where states are bidding against states, hospitals against hospitals, etc. for supplies. High bidder wins… which means a lot of people being cared for at low-bidder facilities will unnecessarily die.

The Trump administration disbanded the pandemic unit two years ago. When asked about that decision a few weeks ago, Trump denied knowing anything about it. (The unit’s office was in the White House!) It is VERY evident that nobody in the current administration read the playbook.

That is why the Federal government’s response to the Coronavirus epidemic was so late, so disorganized, and – frankly – so ineptly managed. Just about the worst thing anyone can do during a health crisis is to say “we have nothing to worry about.” But that’s exactly what the Trump administration initially did… and the country has been trying to catch up ever since.

I’ve long wondered why millions of middle and lower-income people vote against their economic self-interest by voting for Republicans in general, and Trump in particular. …Now, I’m even more mystified. Trump’s approval ratings have shot up since the epidemic hit our shores. Most assuredly, the increase in that rating is coming more from places where the epidemic is less pronounced (at least for now); you can take it to the bank that his ratings are way down in New York (not that they were ever high there), Detroit, Chicago and New Orleans… all of which are disaster zones. But why anyone would think the administration – and especially Trump – is doing a good job right now totally escapes me.

[BB Insert: Most of the aforementioned folks get their info through the distorted lens of right-wing media.]

Trump praised “the pretty good job we’ve done” when he predicted in late February that the number of Americans infected by the coronavirus would dwindle to “close to zero” in a couple of days. Over the last weekend, [28/29 March] one of his most chaotic since the pandemic struck, Trump drastically redefined success, claiming that if the pandemic kills between 100,000 and 200,000 Americans, “we all together have done a very good job.” Trump has stood in front of TV cameras nearly every day the past few weeks, holding forth with meandering, frequently testy, news briefings that often go 90 minutes or longer while tens of millions of Americans are marooned at home, desperate for real information.  The constant exposure has provided a real-time look at Trump’s decision-making process – the vacillating, the wishful thinking, the lies, the degree to which he’s influenced by whoever talked to him last or whatever he last saw on Fox – that has long been reflected in the daily chaos of his presidency but never tested as when so many American lives were at stake.

In this case, Trump’s mixed messages have left state and local leaders, as well as corporate CEO’s and others, unsure what medical supplies and other support the federal government will provide as they attempt to survive the double-barreled public health crisis and economic shutdown. … Six days after he said he hoped the locked-down country would be “raring to go” by Easter, he abruptly reversed course and extended the national shutdown guidelines for another month.  He also said that he expects the epidemic to peak in about two weeks. Public health experts say that’s “wishful thinking.” The public deserves straight talk from its President*, not bullshit.
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It is beyond outrageous that Americans have to witness the spectacle of public health officials tailoring their responses to questions so as to not offend the president*. It’s the pandemic version of Kremlinology, parsing the statements of responsible officials for hints of the truth beneath the boilerplate praise and line-toeing.

It’s even worse that we all have to put up with a president* who answers questions off the cuff without regard for facts or concern for how what he is saying might be misinterpreted. Add in his incessant dedication to petty grievances, partisan puffery and chest-beating braggadocio along with all the obligatory obsequiousness he requires of officials who know far more than he does.
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Meanwhile, the Republican leaders of the Senate tried to push through a half-trillion dollar giveaway to big companies without any oversight; it would have allowed for corporations to use bailout money to buy back stock… or even to provide bonuses to C-level executives. Thankfully, when it became clear that Nancy Pelosi and her colleagues in the House wouldn’t stand for that, oversight was added to the bill (despite continued resistance from McConnell)… and use of bailout funds was to be focused more on employees than employers. (Speaking of Pelosi, in the past year the House has passed hundreds of bills that would have substantially benefited the American people, none of which have even been taken up for debate in the Republican Senate. She is a wonder.) Incidentally, Trump didn’t see anything wrong with the original bill (though he probably never read it). In some ways even worse, when the bill was unanimously passed in both houses, Trump didn’t invite a single Democrat to the signing ceremony, which would have demonstrated that in times of crisis, partisanship has no place. But no… not Trump.

And yet his approval ratings are up. If anyone has an idea of why that makes sense, please share it with me.

Bruce Silverman
www.brucesilvermanconsulting.com