Collectively, we are about to get schooled in the art of scaling up, and the need to make do.
As New York hospitals are overwhelmed by COVID-19 cases, some nurses have posted photos of themselves wearing black trash bags as personal protective equipment. Hospitals in Ontario are rationing paper surgical masks and are asking the public for donations of gear. Malaysia – which makes three out of five rubber gloves the world produces – is hard-hit by the virus and is on lockdown. Manufacturers there are warning of global rubber-glove shortages.
Policy makers in both the U.S. and Canada appear to have shelved pandemic-equipment preparedness since SARS in 2003, or H1N1 in 2009. Health-care workers are being forced to use medical equipment past their expiration dates. In a mad scramble, factories are being retooled to make masks and ventilators. More temporary hospital, and morgue, structures will go up around hospitals.
Health-care workers around the world are calling their work on hospital front lines a battle. If they are the like soldiers in risking their lives, they need to be properly equipped. And a war-like footing means that there needs to be a new emphasis on using every scrap of what we already have, and ramping up production to build what we need.
For privileged North Americans who haven’t lived through the Great Depression or a world war, scarcity has never felt as close as it has this month. We are going to be changed for it.
What does this mean in concrete terms? Reuters reported this month that pallets of N95 masks and face shields, needles and more stockpiled by the Ontario government more than a decade ago had expired because there was no funding to manage the inventory.
Although the emphasis of early stories was that no one had replenished the stockpile with new equipment, it’s increasingly clear that hospitals now need any and all equipment – including the pieces that have expired. The fact that provincial authorities threw away any masks or other equipment is what, on reflection, will be the real point of remorse.
The U.S. Centers for Disease Control and Prevention have advised, in examining their own stockpiles, that the majority of N95 masks manufactured between 2003 and 2013 – all of which have definitely exceeded their supposed shelf life – still meet performance standards. “The [masks] exceeding their manufacturer-designated shelf life are only being released due to the potential urgent demand caused by the COVID-19 public-health emergency,” the CDC said last month.
The U.S. is going to need every single respirator it can get its hands on. In recent weeks, we have collectively awoken to the realization that throwing stuff out because it’s past a best-before date – whether it be a can of beans or a respirator mask – is actually not a good idea. Old stockpiles, though imperfect, are absolutely essential in a crisis.
As countries close borders and medical equipment becomes more scarce, it’s also going to prompt a fundamental rethinking of our supply chains and “just-in-time” inventory systems. Policy makers are asking whether North America can manufacture more gloves and other gear instead of relying on shipments from overseas. Canadian manufacturers are going to become skilled at making stuff that they’ve never made previously.
These are the heartening examples. A Coquitlam, B.C., textile company that normally manufactures pillows and dog beds says it will be able to soon produce 100,000 surgical masks a day, according to the Tri-City News. Calgary component construction company Falkbuilt is working to team up with Sprung Structures – which manufactures tent-like "fabric buildings” – to create “superfast” hospital wards that can be assembled in days. Work is under way to boost Canada’s countrywide supply of about 5,000 ventilators.
We obviously forgot about necessary equipment, and some lessons learned from SARS, less than two decades ago.
But maybe we need to look even further back to understand what is possible, to deal with what is even a bigger event than SARS. The history of the Second World War tells us that the Allies won in large part because the U.S. was able to ramp up its manufacturing capacity so quickly, and out-build the Germans.
Auto manufacturers retooled old production lines to make tanks and aircraft. Small American towns with ample labour pools were mobilized to produce cannon, shells and ammunition. The mass building of ships was streamlined by 1945.
Even Canada’s smaller manufacturing contribution to the war effort saw the country build more than 300 merchant ships by 1944, when it never had produced any before.
Simultaneously, governments and people need to act quickly to deal with the now, and prepare for a longer battle with the virus than we expected. That might involve much more in the way of emergency measures.
The slogans of flattening or planking the curve are not only about saving health-care systems from being overwhelmed right at this moment. It’s also about the careful use of available supplies, creating time to source or manufacture more medical equipment – all the while not creating legions of burned out, broken health-care workers in the months or years ahead.
Decisions and actions that come now will be a major determinant in how long the virus rules our health-care systems, and therefore our lives.
Kelly Cryderman