National redistribution of hospital supplies could save lives

It is here: The first massive, overwhelming swell in healthcare demand due to the COVID-19 pandemic is on the horizon and arriving in many areas of the United States. Despite our efforts and preparation, many areas still will not have enough ventilators, testing, and personal protective equipment (PPE) to meet predicted demand, inevitably leading to rationing of supplies and difficult, life-or-death decisions.

However, what if there was another way to stretch our current equipment supply, to make a difference that could save more lives?

Since we now know more about the predicted peaks in COVID-19 across the U.S., we can see that peak demand will likely occur at different times in different states and cities, starting in early April and extending through May. While some hospitals are already starting to drown, other hospitals that are further from their peak demand have stockpiles of unused equipment lying in wait.

What if there was a nation-wide system that allowed hospitals that have equipment but have lower present and predicted demand to lend some reusable (ventilator) and non-reusable equipment (PPE, testing kits) to hospitals that are currently being overwhelmed? Then, as demand in one area rises and the other falls, freed up ventilators could be re-distributed, and manufacturers will have had more time to generate non-reusable equipment for hospitals that lent their equipment. By taking from stockpiles of less stressed hospitals and sharing it with currently overwhelmed ones, we could maximize the use of our national inventory of equipment and save more lives.

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A nationally-organized healthcare supply redistribution system would have several important features.

We need guidance on a national level

First, the system should be organized on a national level, preferably with the federal government at the helm to maximize uniformity and centralization. Leaving states to coordinate with each other is bound to result in delays due to political disagreement and disjointed decision-making that could prevent the system from taking off as rapidly as is needed. Furthermore, federal directives would likely be necessary to generate the private partnerships and national coordination needed to support such a system. In the absence of federal leadership, a national, apolitical figure or foundation with the appropriate skill set (The Gates Foundation) could possibly fill the void.

Private company cooperation and coordination is needed

Second, private company partnerships would be vital. Partnerships with airlines could result in grounded fleets being put to use as equipment transport planes, providing rapid transport of supplies between hospitals and cities. There also would need to be organized allocation of newly minted PPE, test kits, and other supplies to ensure that hospitals who have shared their stockpiles have their supplies replenished. Such allocation would require coordination between the manufacturers and a central body keeping track of need and redistribution, so the distribution of supplies can match the dynamic demands as seen from a whole-nation perspective.

Supply and demand must be closely monitored

Lastly, there needs to be coordination and tracking of supply and demand between regions, hospitals, and manufacturers.

Of course, such a bold proposal will quickly have its opponents and rightful concerns.

If predictive models fall short, lending hospitals could be left with fewer resources during a time of need. Thus, any exchange of supplies should be insured with ready sources of backup supplies from another less affected hospital, state stockpile, or hospital whose COVID-19 census is declining. Additionally, supply exchanges should be executed with caution, taking smaller amounts from many hospitals rather than many supplies from a few sources.

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Next, hospitals with stockpiles may be unwilling to lend their equipment upfront. In addition to an appropriate guarantee that they will not be left without equipment when needed, we should consider ensuring that lending hospitals will be prioritized for new equipment disbursement and may consider financial incentives to encourage participation.

Finally, cost is always a concern. Receiving hospitals would likely foot the bill for the purchase of either new equipment at market value or a lower “rental” cost for equipment being borrowed. Transport imposes an additional cost. Distances should be minimized through logistical planning, but transport will still likely require some subsidization.

Clearly, this proposed solution is not without operational challenges. However, redistribution approaches in other settings have enabled vast functional expansions of limited supplies, including kidney transplants and donated food for food pantries across the U.S. Bottom line: Redistribution has the potential to improve the trajectory of COVID-19 mortality in the U.S. Our country is already on track to employ these measures at a state level or voluntarily, so delaying set up of cross-state exchange only means missing out on the maximal benefit of redistribution. In fact, as of this writing, New York’s Governor Andrew Cuomo has just signed an executive order enabling redistribution of medical supplies to struggling hospitals within New York state and Oregon has sent ventilators to New York.

In these coming trying times, our healthcare system is facing an unprecedented, deadly burden, and we need to make supplies available where they are needed most —independent of state lines. Now is the time to start making the changes, to call on the federal government, national leaders, and private partnerships to coordinate our efforts as a nation, so we can provide the best care possible with our limited supplies. Lives depend on it.

Diane R. M. Somlo is an MD/MBA candidate at the Yale School of Medicine and Yale School of Management. Dr. Howard P. Forman is professor of Public Health, Management, Economics and Radiology at Yale University. Follow him on Twitter: @thehowie. Dr. Deborah D. Proctor is a professor of Medicine at Yale University.

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This article originally appeared on USA TODAY: A nationally redistribution of medical supplies could save lives.