Should the President Exercise his Authority under the Defense Production Act?

In a week, it will be three months, let me say that again, three months- a quarter of a year – since all of us learned about the outbreak of the novel coronavirus infections in China.

No one could have predicted this?

Is it true that no one could have predicted this? No. As a hospital and health system CEO, I have been worrying about the threat of a new infection for at least two decades. Was I some kind of prescient genius? No. These concerns have been widely held. In fact, it was a good thing that the briefing room was not filled with physicians, health care executives, insurance executives, scientists, and even the government’s own U.S. Government Accountability Office (GAO) when the President asked, as he so often does, “who could have imagined this?” because every hand would have been raised.

How did we know?

• This is not our first (and, unfortunately, will not be our last) pandemic. I am not even listing epidemics, here is just a list of pandemics:
  • 1918-1919 (yes, more than 100 years ago) H1N1 virus – this was an influenza pandemic – some call it the “Spanish Flu.”
  • 1957-1958 H2N2 virus – another influenza pandemic – the so-called “Asian Flu.”
  • 1968 H3N2 virus – another influenza virus- the so-called “Avian Flu.”
  • 2009 H1N1 virus – another influenza virus, which was completely new to animals and humans.
• So, you say, well all of these were influenza pandemics. Perhaps we could have imagined another influenza pandemic, but could anyone have imagined this new coronavirus pandemic? Yes. We already dodged this bullet twice with new coronavirus outbreaks (in fact, one of these previous outbreaks was also from China) that could have, but thank God did not become pandemics. Remember SARS in 2003 and MERS in 2012? Like the current novel coronavirus – 2019, the SARS and MERS coronaviruses were also novel coronaviruses that made the leap from animals to humans.
• Okay, so yes, we could have imagined another pandemic, and yes, we could have imagined a novel coronavirus emerging and potentially becoming a pandemic, but could we have imagined a novel coronavirus emerging from China and causing a pandemic. It turns out the answer is yes, and we did in…wait for it…2007. Scientists published an article entitled, “Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection” in Clinical Microbiology Reviews in 2007. Even just from the title, we get “Severe Acute Respiratory Syndrome” – that is SARS, ”Coronavirus”, “Agent” – cause, “Reemerging Infection.” Do you now what the scientific name for this novel coronavirus that we are currently battling is? SARS-CoV-2 – SARS Coronavirus – 2. In fact, in 2007, we knew that the 2003 SARS virus came from bats and civet cats. Guess where we think our current coronavirus came from – a bat.
• Well, then in the President’s defense, you suggest people can hardly be blamed for overlooking one single article in 2007. Well, it turns out that the fear and high mortality that the 2003 SARS virus epidemic caused and the economic disruption that this virus caused resulted in more than 4,000 articles on this subject.
• In fact, this article in Clinical Microbiology Reviews even identified the Chinese wet markets, where large numbers and varieties of exotic wild game animals are sold for food consumption in overcrowded cages with a lack of biosecurity measures, as a likely breeding ground for this virus and a risk for transmission from animals to humans. Guess where we believe the current coronavirus came from? You guessed it – a Chinese wet market in Wuhan.

Were we prepared?

If we have foreseen this for at least 13 years, were we prepared? No.

I have to say I was far more gullible than I should have been. All this time, as the hospitals and health system I oversaw prepared and then updated our pandemic plans over the past many years, I always thought that if things became bad, we would rely on the federal government and the Strategic National Stockpile. It turns out that in a time of crisis, states are largely left to their own and there isn’t nearly as much stockpiled in the Strategic National Stockpile as I thought there was. And, even what is there is pretty darn hard to access.

Unfortunately, because of inadequate stockpiles and inadequate federal response, our brave healthcare providers are on the front lines of fighting this “war,” as President Trump called it, without adequate supplies. To listen to the White House and White House Coronavirus Work Group press conferences, you would get the impression that we are having a few hiccups, but overall, our government’s response has been nearly perfect. Can you imagine if we were fighting a traditional war, and our troops were complaining that they don’t have adequate equipment and supplies and were going into battle vulnerable and exposed? Can you imagine what cries of outrage would emerge from our citizens? Well, that is what is happening in our war against the coronavirus. We are experiencing such severe shortages in protective equipment and supplies that we are sending in our healthcare providers in some parts of the country vulnerable and exposed.

So, don’t take it from me. Here are what some officials and health care providers from across the country are saying.

UCSF Medical Center

@UCSFHospitals

PLEASE SHARE: Help front-line UCSF providers caring for all who need it during the #covid19 pandemic by donating critical supplies such as masks, disposable gloves & more at three sites in #SanFrancisco and #Oakland starting tomorrow.

https://ucsfh.org/2WA28DG #coronavirus #sf

City of New York

@nycgov

“Our health care leadership here in the city has made it clear that supplies and medical equipment are a deep concern…but the most important factor is personnel.” –

@NYCMayor

on NYC’s need for supplies to fight COVID-19 Learn more at http://nyc.gov/coronavirus

In case you might be thinking, well that is California and New York that have been especially hit hard, but the rest of the country, my town or city should be fine, this is from the chairman of the department of emergency medicine at OSF LCMMC in Evergreen Park, Illinois, not necessarily a place most of us would think of as a hotbed of coronavirus activity:

Sunil A.

Chair of Emergency Medicine at OSF LCMMC

“Am I scared? I sent my wife and two kids to another state, as have other front line physicians. Exposure to them was a major factor but knowing full well that WE will need to cover for our sick colleagues made this a time when home and duty cannot co-exist…. Scared is the only logical emotion that can go along with that scenario. A nation that is ok with sending their troops in without protection needs to take a long deep look in the mirror and decide if this is what they wanted.”

It really is shocking that South Korea was performing more coronavirus testing in a day than we did in our entire country for the first more than two and a half months.

It is shocking that the world’s most advanced, richest country has not been able to provide enough testing kits, reagents, testing supplies (like swabs and viral transport media), gowns, masks, goggles, and face shields, even as of today. Our government’s solution, despite the fact that it is not consistent with the manufacturer’s advice is to wear masks for extended periods of time and sanitize the masks periodically with hand sanitizer (which is also in short supply). Worse, imagining the time when we are completely out of masks, the CDC has advised providers to wear scarves or bandanas over their mouths and nose as if we were some developing country.

So, should the President have exercised authority under the Defense Production Act?

Yes, about two months ago. At that time, the President had not yet implemented his “travel ban” from China, yet the disease was not isolated to China. It had already spread to more than 20 other countries. We also knew that this was a novel virus for which no one in the world had immunity. Given the globalization of economies and travel, I don’t think any epidemiologist would have told the President that the virus could not come into the U.S. and spread swiftly through the population.

Further, while many of us believed that there were ample supplies in the Strategic National Stockpile and the President could rapidly deploy those, we were mistaken. Here we are two months later and hospitals, physicians, nurses, mayors and governors are begging for these supplies. Surely the President’s advisors informed him that there was no way the federal government could meet the needs of hospitals all across this country were the virus to spread.

We first relied on a flawed CDC test. Finally, this month, the government allowed large commercial labs to offer the testing. At least two of those labs have been overwhelmed and stopped accepting specimens, at least temporarily. The others have been ramping up testing, but the turnaround for these tests can be 4 – 5 days, compared to the public health labs’ capability to turn these tests around in less than 24 hours. Further, providers still face shortages of testing supplies to be able to submit specimens to these labs. And, current testing puts the person testing at risk, so they have to have personal protective equipment, and this remains in short supply.

So, private businesses have not saved us so far and neither has the federal government. We are told that is about to change, however, we have been told that for more than a week. Now, in the world’s most medically advanced country, we are telling providers to reuse their supplies, to use scarves and bandanas to cover our faces, to consider using ventilators for multiple patients, and volunteers in our communities are sewing home-made face masks for us.

We are told that the private sector will come through for us. Let’s pray that happens, because the federal government has failed us.