On Friday March 20, the Anchorage Office of Emergency Management (Alaska) appealed for donations – not of money but of swabs to test for COVID-19:
Due to global demand, there is no definite shipping date for more swabs. Based on the current demand of 250-280 tests a day, Anchorage will run out of swabs by Sunday March 22.
Another appeal followed on Saturday March 21 – this time for Personal Protective Equipment (PPE). There was an immediate need for examination gloves (but not made of latex), respirators, surgical masks, medical gowns, and face shields that protect the eyes.
The shortage of PPE exposes medical personnel to infection. ‘I figure I probably won’t make it through all this,’ says Emergency Room nurse Kellen Squire, RN.
We don’t have enough ventilators. We don’t have enough drugs to sedate the number of patients we’re anticipating. Imagine having a tube jammed down your throat and being conscious the whole time — and these COVID patients are intubated for days, even weeks.
It would probably be easier to list items that are not in short supply than items that are.
There are many reasons. Most, however, are directly or indirectly connected with the system of production for profit not use.
Especially important are new products that might radically change the situation for the better. Like a vaccine. Like material for tests that yield results in a matter of hours rather than days. But they can make a big difference only if made widely available – and as soon as may be technically possible.
Unfortunately, this is not in the interest of the producing company. The way for it to maximize its profit is to take out a patent on any new product and exploit to the full the monopoly position that the patent temporarily gives it. That means delaying the start of large-scale production and charging an exorbitant price. For examples of the harm done by patents in the healthcare field see my article here.
But to return to the problem of short supply of things that have long been in wide use.
Shortage at times of heightened need is largely attributable to the practice known as ‘just-in-time’ or ‘lean’ manufacturing or the Toyota Production System. This practice, first developed in the 1970s in Japan at the manufacturing plants of the Toyota company, has since spread throughout the world. The basic idea is to avoid space, labor, and other costs associated with storage by producing only to satisfy demand definitely known to exist – ideally, only to meet orders that are already in hand. Maintaining production capacity or inventory to cope with possible demand above this level is considered wasteful. A similar approach is taken to minimize storage costs at retail outlets.
When demand suddenly leaps upward, as it does for medical supplies during a pandemic, the just-in-time system ensures that there will be very little if any spare production capacity or inventory to help satisfy the increased demand. With sufficient investment it should still be possible greatly to expand output, but this inevitably takes time – and in an emergency time is short.
Consider, for example, the German diagnostic firm Qiagen, which makes a genetic analysis kit used for coronavirus testing. The ‘normal’ level of its output enables the testing of 1.5 million patients per month. In mid-March Qiagen announced that it aims to quadruple its output of COVID-19 test reagents within six weeks. This is quite impressive – but the number of people requiring to be tested is also rising very rapidly.
A rational system of production for use would enable society to maintain reserve production capacity and inventory of essential goods adequate for foreseeable contingencies. True, not everything that can happen is foreseeable and mistakes of judgement will always be possible.Stephen Shenfield