Messy Business

Here's the thing... we've known about and have been planning for this (or something very similar) for years. We've known about supply line vulnerability, the incredible shortages of medical consumables and the very real possibility that we would have to adapt to austere medical standards of care (read: tough decisions because there's not enough ventilators, beds, etc). This IS NOT new or a surprise. OK...maybe toilet paper hoarding caught everybody off guard.

As the media and arm chair epidemiologists launch criticism just think about how far worse this could be. In the last 20 years we've poured millions into hospital preparedness, planning for and equipping communities for a bio/infectious disease scenario, organizing federal and state resources to support locals. So, set aside the notion that this wasn't expected. By the same token if I tell you I'm suddenly going to jump out of a bush a scare the crap out of you, but not when, you'll still need to change skivvies when it actually happens. You can only be so prepared for something.

From my perspective I think we're doing pretty well. Is the response perfect? Hell no. I've yet to see any incident, much less a disaster, go perfectly as planned. The world doesn't work that way. The military says no plan survives first contact with the enemy. In EMS we just say that the patients don't read the protocols. Point is, no matter how much you plan, practice and stockpile things are GOING to go sideways. It's expected.

So let's look at what's gone right: strong action on the part of leaders at all levels, communities enacting plans at all levels and adapting to their circumstances, the private sector and government pulling together and mobilizing to meet the immediate and projected needs. It wasn't that long ago that agencies would have been feuding over who's in charge, we lacked the protocols and capability to share much information at all, and civilian/military integration was cumbersome at best. The private sector wasn't looked at as a full partner (crazy right? but unfortunately true) and specific to this scenario: the regulators and payers actively set aside common sense in favor of bureaucracy. At a national level exercise a while back one of my epidemiological colleagues went head to head with the FDA rep over using something off label. The doc just told them she was using it, and when the FDA said she couldn't she just said, "stop me." That was in an exercise. That's a good time to wrestle these issues to the ground. Now isn't such a good time, and I have to credit to the FDA. Based on previous experience I never thought they could be as nimble and adaptive as they are. Issues like that have to be thought and fought about ahead of time. We've done a lot of that and frankly it shows.

Nothing about this is easy, and even knowing we faced huge gaps doesn't change the reality of bridging them. We can't stockpile enough stuff for something this big. What we can do, and have done, is work out how we work together, talk to each other and ultimately how we solve the big problems facing us today. A few warehouses full of degrading paper supplies and outdated ventilators wouldn't have changed anything. The planning, practicing, and problem solving that's taken place over the past 20 years for everything from fires to hurricanes will.

We got this. It'll be messy but we'll come out the other side.