The crest of the wave: strategic situation on April 1st

Why haven’t you seen this poster?

The number of Covid-19 cases, hospitalizations, and deaths is growing, and the best estimates from epidemiologists and health policy experts say the overall peak for the country is two weeks away. With D-day fast approaching away, there will not be time to meaningfully increase the crucial medical supplies available to the health system: ventilators, masks and other PPE, virus testing materials. We must go to war with the army we have.

Although we are desperately short on resources, there are two aspects of the overall strategic situation which in principle greatly increase our chance of having the medical resources available to care for the coming crush of Covid-19 patients. First, not every state or locality will hit the peak at the same time. For example, California’s epidemic peak is expected to be April 28, while New York’s peak is April 9th. Second, not every area is expected to be equally affected. There are some areas which will be more affected, and areas which will be less affected.

Both these factors mean that it will be possible to concentrate resources first to the areas that need them the most. This includes (i) doctors and other health care workers (ii) ventilators and associated equipment (iii) masks and other PPE.

There is no shortage of aircraft to transport to transport the resources (passengers are not flying, so air craft are idle). In fact in order to secure their share of the stimulus, many airlines are flying empty planes around the country. There is no shortage of accommodation for the health care workers, hotel rooms across the country largely empty.

A trickier question is whether there are currently enough doctors available. But given the fact there are mass layoffs of doctors and healthcare workers around the country, it seems to be the case there is a large current reserve of current doctors that could be enlisted to help see patients. Different specialists can chip in. Recently retired doctors are another potential pool, however since the elderly are most affected it may be too risky to put them in the line of action. We could potentially import more foreign doctors, but this is potentially months down the line.

Doctors must be able to easily move between different hot zones: between different hospitals in a county, areas of a state, and even between different states. Ventilators and associated equipment must be able to move between different states.

It turns out there are actually existing organizations and systems to shift health care resources, but they are unknown, unorganized, ineffective, and poorly resourced. It is criminal that a national medical resources board has not been set up to organize the distribution of materials during the crisis, and a national medical labor board has not been set up to organize the medical workforce.

The US did have a strategic reserve of equipment, but unfortunately it was disbursed on the basis of political favor, and is now empty. There is a strategic reserve of 10,000 ventilators which is being held back, and which will undoubtedly be given to the right wing state which sucks up the most to the administration.

State governments are slowly trying to put into place systems to transfer health care resources, but from what I’ve read it doesn’t seem particularly organized. Andrew Cuomo has created a statewide command center, and apparently has convinced public and private hospitals to share resources.

Doctor reallocation

There is a federal system for signing up volunteers that is already in place which was set up after 9/11. But its website, which is designed to link volunteers to state-level registries, is little-promoted and recently had a major glitch. The separate website for the national medical reserve system has no mention of Covid-19 or our current crisis, and has not be updated for a year. There has been widespread advertising campaign for the reserve system and no general call to service for medical volunteers.

But even more crucially, there does not seem to be any plan in place to get volunteers to the places that need them the most.

Individual states are pursuing the following policies:

  1. New York has started a Medical Reserve Corps, with Governor Cuomo calling on volunteers from across the country to chip in. They have 11,000 volunteers so far, and so far 358 have signed up for shifts at health care facilities.
  2. Virginia’s Medical Reserve Corps has 11,000 members.
  3. Maryland’s corps has been activated, with its 5,000 volunteers.
  4. DC has approximately 1,600 members of its reserve corps.
  5. California is starting a Medical Corps.

Other Countries

Italy has recently formed a task force of 8000 doctors.

Jacob Robbins

Author: Jacob Robbins

Jacob Robbins is an assistant professor of economics at the University of Illinois at Chicago.

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