The COVID-19 Response Ecosystem
Craig Montuori, the cofounder of the Global EIR startup visa program, joined the C19 Coalition team as domestic partnerships lead. This note offers his overview of the current COVID-19 response ecosystem. Comments welcome.
The world has been called to action by the COVID-19 crisis, and we’re in the midst of our generation’s Dunkirk moment, where organizations are stepping up to do their part in overcoming the crisis. We’re slowly beginning to surmount the first crisis — that faced by urban hospitals’ desperate need for PPE and the rapid collapse of their supply chain — but face newly emergent hotspots as COVID begins spiking in rural areas, while preparing to both contain future COVID outbreaks and building infrastructure to respond more effectively to a broader class of crises.
The ecosystem that has emerged is complex, and it’s easy to get lost. An early key resource that served as the ecosystem encyclopedia is the PPE Index from @Pistachio, who has since joined the team and advised the launch of the index to the C19 directory.
This post intends to expand the mapping of the response ecosystem and to define the functional roles covered by C19 Coalition partners and organizations committed to facing this crisis.
Early Response
The PPE Coalition initially spun up as part of the ‘get PPE to hospitals’ crash effort. We quickly realized that ‘get PPE to hospitals’ unpacked into ‘import PPE to urban hospitals via international and last mile logistics systems,’ and as we ran experiments and gained understanding about the needs of the ecosystem, we also recently rebranded as the C19 Coalition.
There are three main components to the initial effort:
- Supply vetting and supply-demand matching, e.g. Project N95
- Distribution e.g, Operation Masks
- Logistics e.g. Flexport
The basic problem the COVID response ecosystem assembled to solve was finding PPE on the international open market, vetting it and ensuring regulatory compliance, importing it, matching available supply with prioritized demand by hospitals, and delivering it for use. Numerous groups emerged to contribute to parts or all of this problem. The scale of the need is immense, with hundreds of millions of pieces of PPE needed to meet the surge in demand and billions of dollars being spent over the course of responding to immediate public health needs.
Increasingly, the needs of individual hospitals and healthcare systems are being aggregated by mayors and governors, with coalitions of these political leaders emerging to further assemble coordinated ordering. Groups like the National League of Cities, the National Governors Association, and others are stepping up to provide both the necessary coordination infrastructure and protection of contracted orders against seizures and rerouting by federal agencies.
Financing
As the initial supply chain was rebuilt to meet the needs of the COVID crisis, the C19 Coalition realized that high-velocity financing was a missing piece of the puzzle. The problem is that slow-moving/frozen hospital and state procurement efforts are missing opportunities to secure stockpiles and production lines. Other countries have implemented centralized purchasing efforts during the crisis and in a much faster loop than the US currently can achieve. We and our partners at the C19 Coalition are aggregating $30M+ in funding — both philanthropic and private — that are in the process of coming online. These funds will serve as middlemen without markup in buying PPE stockpiles and production lines. They will help the US get on an equal playing field with other countries’ purchasing efforts.
Rural and Decentralized COVID Needs
Let’s return to the initial problem the ecosystem organized to solve and unpack issues beyond the initially served community of urban hospitals. As of mid-April, we’re seeing an emerging distinction between the first part of the first covid wave focusing on cities and a growing second part of the first wave hitting rural areas of the US.
The primary difference between the two are logistics-based, as a low-density region is significantly more costly to reach with fewer logistics resources to draw on. Groups like Angel Flight East and Operation Masks are an effort to move PPE supplies from primary import hubs to regional airports, while Tulip is an example of a distributed logistics platform that can identify last mile transport to get PPE from a regional airport to a rural hospital or tribal nation.
Essential Workers’ PPE Needs
Beyond hospitals, there are a whole set of new issues to serve the needs of essential workers and their employers. These workers are primarily trying to prevent incidental COVID spread rather than managing the hospital environment situation in hospitals. As a result a wider range of PPE can be deployed to essential workers beyond the medical-grade PPE delivered to frontline workers.
Second, most acquisition efforts to date have specifically focused on hospitals, meaning that the supply chain infrastructure serving essential workers hasn’t surged in the same way. There are significant distinctions between industry verticals, too, between grocery stores, agriculture supply chain and farming, between transport logistics and ridesharing networks.
Testing
Testing is a major bottleneck that has simultaneously been both less urgent than solving PPE shortages but critical for both managing the hospital load surge and reopening the country. There are two verticals of tests, swab-based — tests if you have COVID now — and antibody — tests if you had COVID and have likely developed immunity. The main bottleneck for scaling swab tests is twofold: swabs and reagents. The swab bottleneck is beginning to be met, with groups like Formlabs stepping into the breach alongside traditional industry leaders like Puritan, though problems with logistics proved to be more difficult at the needed level of scale than increasing production. We’re still learning about antibody tests, but false negatives and an FDA bottleneck seem likely as issues that will need to be surmounted.
Domestic Manufacturing and Building Future Surge Production Capacity
Scaling domestic PPE and related COVID mitigation manufacturing capacity is critical to build anti-fragility into our production and supply chains for future pandemic crises. This topic is divided into two verticals: maker- and manufacturer-scale.
Makers are individual 3d printers, machine shops, sewing machines, etc., and include groups like Open Source Medical Supplies. From there, a transition passes through massively parallel (sometimes distributed) collections of 3d printers and communities of makers, such as Slant 3D, Fictiv, and AON3D alongside maker spaces within major corporations like Northrop Grumman.
At the largest scale of production, there are both new factories and factories pivoting into PPE production. The latter divides into two categories that we’ve identified so far: textile/fabric and plastic/metal, with groups like Eagle Fabrics representing the former and Honeywell and GM representing the latter.
One especially interesting issue is understanding the financing necessary for these two categories to shift into PPE production from whatever they were producing before. Other complexities arise: for example, medical-grade PPE (e.g. N95 masks) is bottlenecked by polypropylene, which is meltblown into the strands that effectively filter air. Machines that can handle this process are specialized and not typically found in other production processes. There are also shortages in Tyvek 1443R fabric that make isolation suits, while PET/PETG/APET plastic sheets are beginning to disappear as more are converted into facial shields.
Transcending the Crisis
The C19 Coalition is actively seeking partnership and commitments to action from organizations that are working to address medical supply shortage, including:
- States and localities interested in sharing information about demand needs, including specific facilities that need access to working capital to de-risk PPE purchases.
- Domestic manufacturers that are producing, or want to repurpose and retool to produce, net new PPE at scale.
- Philanthropists and institutional investors who are interested in providing philanthropic zero interest loans or low interest working capital loans to purchase PPE.
