When it comes to responding to Covid-19, there seems to be one indispensable approach: Think fast.
“We’re at that junction now where lots of areas are being affected, so [Direct Relief’s] strategy is flexible and adapting,” said Leighton Jones, Direct Relief’s director of emergency response, who is heading the organization’s response in the United States.
After Covid-19 was first reported in Wuhan, China, late last year, Direct Relief focused on providing personal protective equipment and other supplies to Hubei province (where Wuhan is located) and the surrounding areas.
But by the time the Chinese government quarantined the city of Wuhan, an estimated 5 million people had left the city. “We had an idea of what might be coming our way,” said Alycia Clark, a Direct Relief pharmacist.
For that reason, the organization began increasing supplies to United States health care providers as well, bolstering medication and supplies for its vast network of health centers and free clinics.
In the meantime, the world’s supply of masks, gowns, gloves, and other personal protective equipment (commonly called PPE) was dwindling.
Protecting health workers
“Before Covid broke out, we had a fairly sizable inventory of PPE in our warehouse,” Jones said. Now, “as with anybody, our inventory is challenged because of the supply challenges.”
And Covid-19 was starting to appear in the United States by February, as far afield as Seattle, southern California, and New York City.
At first, Direct Relief focused on areas that were seeing significant numbers of confirmed cases, providing PPE and other supplies to Washington, New York, California, and Massachusetts.
But as the coronavirus has gained ground in all 50 states, more widespread help was needed.
On March 18, Direct Relief announced that it had begun sending 250,000 masks and other protective gear to about 1,000 facilities – a shipment designed to help them keep on screening patients and providing much-needed primary care, which is frequently disrupted during a crisis.
Since then, the organization has continued to provide protective gear and other supplies to both hospitals and safety net providers.
Direct Relief is also providing tents to help health care organizations triage patients more safely in the open air.
Even during this outbreak, health centers, clinics, and other care providers are keeping their doors open, providing on-the-phone advice to patients, assessing potential cases, and monitoring the chronic conditions and mental health concerns that, left unchecked, can cause health crises of their own.
While Direct Relief has added hospitals to its list of recipients, “we’re still continuing to assist [health centers] and free clinics, because they are still at the front lines of seeing their communities. They also know their communities better than everyone else,” Jones explained.
But even as the organization works to meet existing scarcities, it’s trying to get ahead of the curve.
The world is currently focused on the crisis caused by a lack of personal protective equipment – which is reportedly placing some health care providers in unsafe positions and even jeopardizing the ability of some safety net providers to keep their doors open.
But Clark thinks that, as severe cases begin to build up in hospitals, lifesaving emergency-room medicines will become harder and harder to keep in stock.
Health care organizations haven’t yet run into shortages of IV fluids, broad-spectrum antibiotics, or vasopressors, which help to increase the blood pressure of severely ill patients, she explained.
“Everybody’s still scrambling for PPE…and they haven’t thought too much about the medications,” Clark said. “I think that that’s the next risk, that those things are going to be highly coveted and they’re going to run out.”
Right now, no vaccine and no specialized treatment are available for Covid-19. Clark explained that hospitals can only provide supportive care and treat some of the potential complications of the disease, which include bacterial infections and even sepsis.
So Direct Relief is working with its partner network acquire some of the medications that the organization’s team thinks are most likely to be in short supply, using a specially-created calculator to anticipate how much of individual medications will be required.
“We’re trying to think ahead to what we can do that could possibly be helpful,” Clark said.
The Covid-19 outbreak is also predicted to create a widespread shortage of hospital beds. To help keep some patients out of hospitals – and make it possible for recovering patients to return home more quickly – Direct Relief has acquired more than 2,000 oxygen concentrators to distribute.
These compact units increase the amount of oxygen a patient can take in, helping them breathe more easily without the need for hospital equipment. “Patients that are doing better but just need a little bit of oxygen…it gets them out of the hospital faster,” said Clark.
Preventing chronic-care crises
But Covid-19 won’t just affect the people infected with it. The infection also threatens to disrupt primary care and other programs, which could have catastrophic consequences for people dealing with health conditions as different as diabetes and substance abuse.
An unmanaged health condition can quickly spiral into a crisis, threatening individual patients’ lives – and putting further strain on overburdened emergency rooms.
While recommendations that people stockpile several weeks’ worth of medications led to shortages at some pharmacies, “we were concerned that the most vulnerable may not have that ability,” said Damon Taugher, Direct Relief’s vice president of global programs.
To keep up with increased needs, “we began to look more expansively, and to accept more than we may otherwise have done, hedging against potential stockouts,” Taugher said.
Direct Relief operates a long-term replenishment program that makes it possible for vulnerable patients to more easily obtain vital medications from their health center or pharmacy.
With the crisis in mind, Direct Relief worked with the manufacturers involved in the program to revise the guidelines and allow patients to receive 60- or 90-day supplies of chronic-care medications.
Traditionally, patients who receive care through a health center or clinic have gone to their local facility to receive medications and consultations. During the Covid-19 pandemic, health care providers “are trying to shift the model,” Taugher explained, offering curbside delivery or even at-home visits to patients sheltering in place.
Making sense of social distancing
But the world needs more than medication, supplies, and even a vaccine to beat Covid-19, said Andrew Schroeder, Direct Relief’s vice president of research and analysis.
“The most salient issue outside of that is social distancing, and it is the one that is having the largest impact on the country and the world,” Schroeder said. “If [people] don’t do this, all the medical supplies in the world aren’t going to make a difference.
But social distancing has never been practiced on such a large scale, Schroeder explained. It’s hard to know whether people will follow the rules, what the effects will be, and whether it will be enough. And little is known about human behavior during large-scale social distancing, which makes it difficult to make other predictions.
That’s where Direct Relief’s research and analysis team – which frequently uses anonymized data to track population movements – can help. “This is a problem that’s the same kind of thing as what we’ve been doing [to track] evacuations and such. It’s just sort of in reverse: It’s not about movement, it’s about stasis,” said Schroeder.
Direct Relief’s research and analysis team is offering consultation and guidance on accessing anonymized data to help guide official actions and policy.
“This is not a one-angle problem,” Schroeder said, explaining that medical goods, a future vaccine, and social distancing all have vital roles to play in stopping the disease’s spread.