There are three related needs to deal with amid the crisis: the crash production of scarce medical supplies, the construction of overflow hospital facilities and the training of additional medical workers. We should have begun this process two months ago, as soon as the scale of China’s epidemic was evident. But better late than never.
The best model for the buildup is something we already have on hand: The government-led mobilization in World War II.
After Japan’s attack on Pearl Harbor, the Roosevelt administration commenced a buildup like none the world had seen. The War Production Board worked with automakers to convert car production lines to ones for airplanes and tanks. Substitutes like synthetic rubber were invented to replace products that were no longer imported. Millions of people were trained, in short order, to weld, nurse and fight. When the United States joined the shooting war, the military built field hospitals and taught medics to care for the wounded.
This crisis is like a war. But compared with a true war, the response ought to be a lot easier — if we just do it. President Trump, at least, is beyond his denial phase and is starting to listen to the public heath professionals. He declared a state of emergency last Friday, although questions remain about what’s this means. If he’s serious about it, here’s what the emergency actually requires.
Medical supplies. The easiest part, and the most inexcusable delay, is dealing with the shortage of surgical masks, ventilators, other protective equipment for health professionals and, of course test, kits. The Department of Health and Human Services has a national strategic stockpile of vital medical supplies, but it has been hoarding it.
In February testimony to the Senate Appropriations Committee, HHS Secretary Alex Azar said the United States possesses 12 million N95 masks; the nation will need about 300 million to respond to the emergency. As of Tuesday, 30 governors had made requests for masks, ventilators and other urgently needed supplies but were told that these supplies would be distributed at a pro rata share of only about 25 percent of the requests.
The administration has issued a request for proposals for domestic manufacturers to increase production, but it has no coherent system for promoting that production. Honeywell and 3M manufacture N95 face masks — in China. They could make them at home. A Honeywell spokesman says the company is in talks with HHS procurement officials to begin making N95 masks for the national stockpile at its plant in Smithfield, R.I.
Chris Kiple, CEO of Ventec Life Systems, a Washington-state-based firm that makes ventilators (lifesaving machines that pump oxygen into the lungs of patients with serious pulmonary conditions, such as covid-19, the disease caused by the novel coronavirus), told Forbes that his company could increase production fivefold within 90 to 120 days if requested to do so.
Rather than using his authority to ramp up immediate domestic production of these supplies, Trump said on a conference call Monday with state leaders that they were on their own. “Respirators, ventilators, all of the equipment — try getting it yourselves,” he said in a call that was recorded. The president has all the authority he needs under a 1910 law, as updated by the Bayh-Dole Act of 1980, to enter into emergency contracts with suppliers, overriding patents if necessary, to procure vital medical supplies. He just needs to do it.
Overflow hospitals. The United States has roughly 924,000 hospital beds. Only a small fraction of these are intended for infectious disease patients, and the number of isolation units is even smaller. The total number of medical-surgical intensive care beds is only about 47,000, according to the American Hospital Association. The number of people expected to contract the virus is projected well into the millions.
An analysis by the Harvard Global Health Institute projects that as many as 40 percent of Americans will be infected and that hospital capacity will be inadequate in much of the country. As The Washington Post recently reported, hospitals have been setting up tents, commandeering gyms and cafeterias, and postponing elective surgeries. But this will not be sufficient. If anything like the projected number of virus cases materializes, hospitals will be overwhelmed, as those in Italy have been. There, doctors have been practicing triage and letting elderly people die.
During World War II, the military built 400-bed field hospitals and evacuation hospitals that could treat as many as 750 wounded troops. These were set up on a few days’ notice and were kept at least 30 miles behind the front lines. Planners used tents, schools, barracks, hotels, villas, even stadiums. They did not offer fancy amenities, but they did provide a safe and centralized place for patients to recover under medical supervision, in a fluid and violent situation.
Trump has reprogrammed several billion dollars to build a wall along the border with Mexico. He could easily direct the Army Corps of Engineers to work with governors to build emergency field hospitals and isolation units. These could be in empty college dorms, depopulated hotels or Federal Emergency Management Agency trailers. Mobile military hospitals already exist in the national emergency stockpile and function as a blueprint for building more.
Medical personnel. Nursing staff in places like Washington state are already at or beyond their capacity. The urgent need is not just for more physical hospital facilities but for trained people to staff them. There have been calls for retired nurses to come back to work and pitch in. But they tend to be in a high-risk age group; and if my interviews are any indication, a large number retired because of burnout. Even without the added pressure of covid-19, nursing is a high-stress occupation.
One place to look for supplementary skilled medical care is in the force of certified nursing assistants, or CNAs. These professionals, some 1.5 million of them, who make up most of the staffs of nursing homes, are underappreciated and underpaid. They typically earn about $25,000 per year, according to the Bureau of Labor Statistics. Experienced CNAs do some of what nurses do. If we began a crash program to train CNAs in the specialized care of covid-19 patients, they could help relieve exhausted and depleted nurses. The Service Employees International Union (SEIU) has long promoted career progressions for CNAs.
Home-care workers could also help keep people with mild infections out of hospitals. Ai-jen Poo, director of the National Domestic Workers Alliance, told me, “We should be protecting, employing and training as many home-care workers as possible while ensuring their own health and safety.”
This pandemic will be a catastrophe no matter what we do. But the nature of our response will make the difference between it being a disaster whose effects can be minimized and a true national tragedy.
The United States has become dangerously dependent on China for vital medical supplies. We have allowed our national flow of medications, masks, ventilators, surgical gowns and other lifesaving equipment to reflect purely corporate decisions to produce offshore. We need to bring this production home, with government playing a hands-on role.
Congress will soon enact the third in its series of escalating responses to the epidemic. If Trump can’t manage to take these steps, Congress should play a much more enhanced role in mandating national action.