A Deep Dive Into The US Healthcare Supply Chain and Testing for COVID-19

Resources from AHRMM, Suppliers, and GPOs

By Abbas Mooraj, Managing Director, Health and Life Sciences

As part of a series of articles I am writing during the COVID-19 pandemic, and to follow-up on my previous post, I plan to focus this piece on the healthcare supply chain. Though seemingly disjointed, healthcare and non-healthcare organizations are collaborating and creatively working together, and in fact, many non-healthcare companies have become extended healthcare players literally overnight.

In this article, I’m going to highlight efforts to boost the production and delivery of much-needed testing and medical supplies and equipment, and what a leading organization, the Association of Healthcare Resource Materials Management (AHRMM) of the American Hospital Association (AHA), is doing to help healthcare organizations source and deliver critical items to caregivers, as well as challenges they face. I will also provide information on contact testing and tracing, including antibody tests to determine who has had COVID-19, is now immune and for how long, and diagnostic polymerase chain reaction (PCR) tests.

Supply Chain Challenges

Long before the coronavirus pandemic, hospital supplies have been scrutinized because they account for an average of 15% of all expenses in a healthcare system, and can go as high as 40%, which is why many organizations function under a just-in-time supply delivery methodology. But during the pandemic, urgently needed personal protective equipment (PPE) from the national strategic stockpile has been depleted, according to Health and Human Services, with 90% of PPE distributed to states, and the remaining 10% reserved for federal employees. Now hospitals are scrambling to find enough PPE for their frontline caregivers.

The Federal Emergency Management Agency and HHS have created a supply chain task force to address concerns that focus on:

• Preservation of PPE by limiting unnecessary use and developing techniques to clean and recycle products
• Acceleration of manufacturing to meet demand
• Expansion of manufacturing capacity with more machinery and retooling assembly lines to produce new products
• Allocation of critical resources based on data that shows where supplies are needed most

Even with this coordination, states are not getting the number of requested supplies, and some supplies they receive have expired. To respond to critical needs, hospitals have started shipping items from around the world on their own, with 80,000 testing swabs flown in from Italy, and 12 hospitals in New York working with a medical supplier to fly shipments from China.

The main supply concerns continue to be:

• Inadequate number of test kits and materials needed to conduct and process tests.
• Lack of PPE, including gloves, masks, and face shields.
• Insufficient ventilators to manage surges in ICU admissions.
• Lack of clear guidance between the CDC, FEMA, federal, state and local governments on the proper use of off label supplies.

Some organizations are working together to creatively solve these challenges, such as Premier, Resilinc and Stanford Health Care developing an online supply exchange to help hospitals locate and exchange critical medical supplies among themselves. For example, a hospital can search for N95 face masks and offer hospital gowns in exchange. The plan is to ship supplies directly to hospitals and have the exchange available online soon, and enroll 2,000 hospitals by the end of April.

AHRMM Guidance to Healthcare Organizations

While states, hospitals and healthcare systems work on sourcing needed supplies and equipment, AHRMM has worked with a variety of organizations to support supply chain efforts within hospitals to prepare and respond. Here are some of the resources they offer:

• AABB’s Tips for Hospitals — Extending the Blood Supply.
• CDC guidance for extended use and limited reuse of N95 filtering facepiece respirators.
• Contact email for the Strategic National Stockpile on pharmaceuticals and medical supplies: sns.ops@cdc.gov.
• Emergency Use Authorization for disposable filtering facepiece respirators approved by the National Institute for Occupational Safety and Health.
• Association for the Health Care Environment COVID-19 Resources for oversight of environmental services.

AHRMM also offers information for more than 100 non-traditional suppliers of PPE and other critical supplies that are vetted for best practices and fraud abuse. In addition, healthcare organizations can use AHRMM to find a list of organizations that are offering COVID-19-related items at no cost, including scrubs, hotel rooms, and medical equipment used in ICUs, for example. Lastly, AHRMM offers alternate valid supply channels for PPE and other critical supplies.

While this doesn’t resolve all the concerns of hospital supply chain professionals, it does offer information and alternatives for PPE and other supplies needed to fight the pandemic and protect caregivers.

What Healthcare Group Purchasing Organizations Are Doing

The Healthcare Supply Chain Association (HSCA) reports that Group Purchasing Organizations (GPOs) deliver critical cost savings to providers during events like COVID-19, and individual GPOs are certainly stepping up to the plate to deliver critically needed supplies. Here’s what a couple of top GPOs are doing:

• Vizient makes a variety of resources available to their provider community, including an FAQ on most frequently asked questions that covers emerging clinical practice and evidence, food service, laboratory, managing critical supplies, conserving PPE, staff impact, surge capacity, testing, and visitation.
• Premier Inc. offers information related to creating resilient supply chains, aiding infection preventionists, guiding complex decision making, and has formed a disaster preparedness response group with its members, and the Premier Safety Institute.

What Suppliers are Doing to Increase Production and Delivery of PPE and Crucial Medications

There are a variety of medical supply and pharmaceutical distributors that are working toward making PPE and crucial medications available to providers. Here’s what suppliers are doing.

• McKesson is working with the current administration, FEMA, and the Department of Health and Human Services to deliver supplies where they are needed most. Some challenges include delays in getting supplies from China, which is slowly starting to recover from the worst of their pandemic. Also, McKesson is working with current customers to make sure they are not over-ordering supplies.
• AmerisourceBergen has shifted operations and developed fair share allocation programs to safeguard high-demand products and ensure customers do not overstock due to fear of shortages. This is meant to safeguard drugs and supplies related to treatment and prevention and increase the inventory of other needed supplies.

Ventilator Manufacturers Continue to Step Up

The following organizations are planning to increase the production of critically needed ventilators for patients in ICUs.

• Philips has struck a deal with the US government to deliver 43,000 ventilators by the end of the year.
• Hamilton Medical, which normally produces 15,000 ventilators a year, has ramped up production by 40%.
• Medtronic will produce lightweight, portable ventilators with production of 400 a week by the end of April, 700 a week by end of May, and 1,000 a week by end of June, as well as remote monitoring for ventilators outside ICUs, to prevent potential cross-contamination.

Testing Status

There are multiple challenges facing the supply of tests needed to determine whether a patient has COVID-19 (polymerase chain reaction or PCR) that help determine how widespread the virus is among communities and antibody tests that can not only detect active infections but can tell whether a person has been infected in the past. Antibody tests offer labs an alternative to waiting for or buying commercial tests and can help determine if people have developed immunity to COVID-19. This testing would pinpoint quarantining only those with the virus, and allow non-infected individuals to return to work and get the economy back on track more quickly. COVID-19 testing challenges include:

• Delays in test kit development
• Limited availability of chemicals to process tests
• Bottlenecks from commercial labs if they are not equipped or have the capacity to test their own samples
• Delays in delivering lab results

While all of these challenges remain uppermost in everyone’s mind, there are some bright possibilities with organizations developing antibody testing capabilities, including:

• Michigan-based Beaumont Health is launching possibly the nation’s largest test for coronavirus antibodies and plans to use the test on 38,000 of its own healthcare workers.
• Mount Sinai Health System began working on a serology test before the first coronavirus was confirmed in the US, which has been licensed to a biomedical research company to test large numbers of people.
• Mayo Clinic Laboratories is making a serology test available to healthcare organizations and is working with state and federal officials to prioritize access to testing capacity to protect frontline staff. Initial testing capacity is 8,000 tests a day, with plans to ramp up and return results within 24 hours.
• Abbott Labs will begin shipping nearly 1 million antibody tests this week to US customers while increasing manufacturing to ship 4 million total during April. By June, Abbott will ship 20 million tests each month.

A new saliva test was recently approved by the FDA that was developed by Rutgers University, Spectrum Solutions, and Accurate Diagnostic Labs. The benefit of this new test is that it can broaden the community while decreasing healthcare workers’ exposure to the coronavirus and uses fewer supplies.

Concluding Comments

While the healthcare supply chain has had numerous challenges in responding to COVID-19, many organizations are working to come up with solutions that will ensure adequate care for patients, and protection for healthcare workers. Each day brings new developments and players. Coordination and a fluid and open exchange of information is key, and I encourage you to reach out to me with comments, questions, concerns or insights into how your organization is fighting this unseen enemy.