Current data on coronavirus spread suggests that social distancing protocols will not be enough to stop the pandemic in the United States. Officials in key hotspot areas appear to have already conceded that “the battle to contain the virus is lost.” President Trump and conservative pundits seem to be preparing the nation for failure and accept the loss of life as necessary to keep the economy from collapsing. “We cannot let the cure be worse than the problem itself,” Trump stated on Monday, March 23, reportedly adding as justification, “You look at automobile accidents, which are far greater than any numbers we’re talking about.”
The callous disregard for human life amidst this global disaster illustrates how our society is allowing panic to drive our nation’s response. As Congress pursues an economic stimulus package aiming to put money in American pockets, current pandemic hotspots on the US coasts are harbingers of how little that economic bailout matters as the local healthcare infrastructure faces unprecedented strain. In New York, Governor Cuomo is already preparing his state for the inevitable collapse of its ability to care for patients. “The rate of increase in the number of cases portends a total overwhelming of our hospital system,” he said recently. In a letter to the President, California Governor Newsom reportedly predicted that more than half of the state’s nearly 40 million people will be infected within weeks.
While governors across the country are focused on the ground truths of coronavirus exposure, prioritizing their efforts against the problems that they can control, Congress and the President are panicking at signs that the economy is going into recession. They are on track for misappropriating federal power to merely treat surface symptoms. The economy will not work if the American people are unconvinced that conducting business will be safe, and we will not be safe until we have a health care infrastructure that can support population sustainment during a long-term pandemic.
The federal government should instead leverage its massive economic power to accelerate foundational improvements in the operational healthcare industry supply chains, substantially incentivize a workforce expansion of healthcare professionals, and concentrate our world-leading biomedical research complex into a multifaceted “Manhattan Project” aimed at advancing pandemic treatment regimes and technology-support infrastructure.
Rather than prioritize more money in our pockets that we will likely hoard versus spend, our political leaders should recognize that our long-term economic resilience depends on putting American lives first. Taking rapid and definitive action to support healthcare critical infrastructure needs by mobilizing the power of our nation’s industry and people will save lives while also providing new opportunities that will promote greater inherent economic strength.
Activate the Defense Production Act to Improve Critical Supply Chain Needs
Our front-line defenders of public health are reportedly facing widespread shortages of even the basic supplies they need to test for coronavirus infection, treat patients, and protect themselves from getting sick. If our country’s attempts at social distancing protocols continue to be inconsistent, the US could be facing hundreds of millions of coronavirus cases by May based on current projections of known infections doubling every three days. We can certainly hope to “flatten the curve,” but resilience teaches us that we need to prioritize our efforts against what we can control because time will be wasted if efforts pinned to hope prove unrealized.
It is heartening that private industry is ramping up production of critical medical supplies. However, depending on a standard market environment has created chaos as states and hospitals compete for those supplies. Many governors recently noted that, with demand far exceeding supply, they are competing against each other while also paying inflated prices. Worse yet, Massachusetts Governor Baker informed the President on a March 19 conference call that his state lost three bids for medical supplies to the federal government, saying, “I’ve got a feeling that if someone has the chance to sell to you and to sell to me, I am going to lose on every one of those.” Trump responded, “Prices are always a component of that also. And maybe that’s why you lost to the feds, OK, that’s probably why.” He’s right. The power of federal procurement will always outweigh that of any individual state.
Supply and demand market dynamics should not restrict a state’s ability to serve the urgent needs of its citizens during a crisis of this magnitude. Healthcare providers across the country need more materials now. By activating and employing the Defense Production Act, the President would be able to immediately curtail competition for resources by making the federal government the sole arbiter in price negotiations and supply chain distribution. The government would also be able to influence production at other manufacturers to help shore up short-term supply chain gaps. Incentivizing manufacturers with contract guarantees to retune production for meeting critical healthcare needs, likely reactivating factories and plants shut down due to decreasing demand in their associated markets, would put more people to work, improving individual short-term financial well being far beyond the capacity of a stimulus check while also avoiding prolonged unemployment that would be a drag on the overall economy.
Using the Defense Production Act to put more people back to work so that they can improve healthcare delivery during a pandemic makes economic sense. In the short term, more people will be able to work while the nation’s frontline healthcare workers would have more of the supplies they urgently need to get ahead of the crisis. Then, increasing capacity would streamline supply distribution as the nation encounters anticipated new waves of coronavirus infections.
Facilitate a Rapid Expansion of the Healthcare Workforce
Many areas of the country, especially those likely to be worst hit by the coronavirus, were already facing a shortage of healthcare workers before the pandemic. According to research discussed at a 2009 medical workshop, researchers determined that there will be “a shortage of 500,000 full-time nurses” by 2025. A 2019 update by the Association of Medical Colleges (AAMC) further predicted a “shortage of up to nearly 122,000 physicians by 2032.”
Already struggling with the challenges associated with an overall shortage of frontline medical workers, recent statistics illustrate the additional dangers that healthcare workers expect to operate under when facing coronavirus-infected patients. China’s National Health Commission reportedly suggested that healthcare workers accounted for approximately 5% of all infections. A recent study published in the Journal of the American Medical Association (JAMA) further found that 29% of coronavirus patients at one hospital were healthcare workers. Just when we need them the most, our nation’s physicians and nurses are facing unprecedented risks to their health and that of their families.
The federal government is in a unique position to rapidly enhance the resilience of our frontline defenses by promoting healthcare workforce expansion initiatives that bolster medical personnel ranks and provide needed support services. One proposal that the government should strongly support was made by Dr. Donald Landry, Physician-in-Chief, Chair of the Department of Medicine and Director of the Division of Experimental Therapeutics at New York-Presbyterian Hospital/Columbia University Medical Center. In it, Dr. Landry explains how conferring medical degrees immediately to fourth-year medical students who have already been assigned to upcoming residencies could immediately add around 20,000 physicians fully prepared to serve patients. The President should immediately call on medical schools to grant degrees and governors should call on institutions in their states to accelerate onboarding of new residents.
Nursing shortages should also motivate the government to encourage out-of-work people to join a new rapid response medical support corps to serve in pop-up facilities meant to surge patient care in hotspot areas and provide non-medical services at healthcare facilities. For example, using a boot camp approach, retired physicians and nurses could be called upon to rapidly train people to serve in basic patient support roles and allow registered nurses to focus their experienced attention on patient care. The government can incentivize participation by offering stipends and no-interest loans to pursue nursing degrees in the future while also providing family health benefits.
Increasing the capacity for patient care depends on infrastructure and support services that will also need to surge. For example, while the nation’s governors are scrambling to add more beds, ventilators, and personal protective equipment (PPE), they will also need tradespeople to bring temporary facilities up to healthcare standards, general contractors to retrofit more hospital rooms for intensive care, and more janitors to enhance cleaning protocols. That surge of support staff will also rely on the availability of child care services and transportation. Governors can leverage the National Guard to manage the logistics of providing these support services to ensure that need is prioritized against supply, centralizing coordination to make the most efficient use of available resources.
Leadership during crisis means quickly adapting to changing circumstances rather than trying to predict external factors. Rather than apply Darwinian principles of survival in hopes of restarting the economy, our political leaders should focus on using the power of government to meet the unprecedented urgent need for people able to support our medical first responders. That will significantly improve the short-term state of the economy while establishing a stronger basis for its growth from short-term damage caused by social distancing efforts.
Harness Research Capabilities in a Medical “Manhattan Project”
Prioritizing initial response actions to the coronavirus pandemic is necessary to establish a new productive baseline for the country. By the middle of 2020, the healthcare surge executed in the early stages of community spread will then need to evolve into a long-term strategic disaster response and recovery effort. Acting with coordinated purpose to establish and maintain a new national resilience against the pandemic will be critical for rebuilding the country’s social and economic foundations.
Political leaders must first be cautious about making long-term decisions based on unrealized expectations from external variables. For example, one of the most prominently discussed outcomes is that government officials expect a coronavirus vaccine to be available in a “year to 18 months.” That timeline is reportedly very ambitious, perhaps better described as extraordinary, given that vaccines are complex to make and experts have said that the traditional timeline can be as long as 20 years.
Even assuming that the accelerated timeline for developing a safe vaccine is feasible given the extreme urgency of the crisis, political leaders must be very wary of over-promising due to high probability that supply-chain uncertainties and market factors will prevent timely distribution of any approved vaccine. One leading pharmaceutical company executive describes the challenge bluntly, “We have never made a vaccine for the world.”
While we might hope for a vaccine in the near future, the outcome is too far beyond our control for leaders to depend on positive results. Instead, the government should proactively work to improve our nation’s capacity to treat patients and discover new processes and technologies for accelerating the supply chain once a suitable vaccine has been verified safe and effective. Meeting those objectives will require a herculean coordinated research and development effort akin to the Manhattan Project.
Rather than attempt to steer vaccine development efforts already being pursued by as many as 20 different research groups, we should prioritize researching advancements in effective treatments, developing new technologies to improve manufacturing timelines, and enhancing the medicinal supply chain. Those efforts align well with the federal government’s power to build novel industrial collaborations. To smooth the associated bureaucratic processes, the President should charge the Defense Advanced Research Projects Agency (DARPA) to immediately convene a new multidisciplinary group of researchers to lead the effort. In parallel, Congress should appropriate the necessary funds through already established contract vehicles so that DARPA can speed through the procurement processes needed to engage industry.
The coronavirus has exposed the systemic healthcare weakness of not just our country, but the world. All signs point to a long-term pandemic that will redefine our nation’s economic strength. To be resilient, the US must resolve to correct critical deficiencies and seek to improve the foundations for patient care. Funding new extraordinary research and development efforts will not only strengthen our ability to respond to the pandemic, it will channel financial resources into those industrial capabilities that we will rely on the most to discover the next generation in healthcare delivery. That incentive will represent the catalyst for our markets to adapt and provide the support needed to move our country forward.
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