ST. PAUL -- When she discovered that shipments of face shields from a Maryland-based manufacturer were on three-week back order through Amazon.com, Maggie Sartori — a supply chain director for Allina Health — threw up her hands and resorted to Plan B.
Sartori called up a manufacturer in Northeast Minneapolis, bought thousands of laser-cut sheets of thick plastic, and gathered dozens of Allina emploees.
They stapled and glued 10,000 shields together more or less from scratch. It’s a strategy she expects to repeat.
With many Chinese factories shut down in recent weeks, “it’s hard to get the supplies we need,” Sartori said.
Across Minnesota, health organizations are taking unprecedented action to get vital medical supplies.
In a dramatic departure from typical practice, corporate health care networks such as Allina and M Health Fairview have gone so far as to urge the public to donate expired items and craft surgical masks at home.
“We expect to use as many as 5,000 homemade masks a day at our clinics for patients who are experiencing COVID-19 symptoms,” reads a blog post from M Health Fairview.
The health system recently converted a 90-bed hospital near downtown St. Paul into a facility for those with the most severe cases of coronavirus.
Fairview set up a drop-off site on University Avenue in St. Paul and asked the public to contribute everything from vinyl gloves and thermometers to Clorox cleaning wipes. Homemade masks need to be crafted according to federally approved guidelines.
Why the shortages?
Minnesota nurses and other front-line workers blame inventory shortages on cost-cutting and efficiency strategies that have gained ground in recent years.
Others point to the decades-old American reliance on China for basic goods, a depleted national stockpile of emergency supplies as well as competition on the market between states and bureaucratic incompetence at the federal level.
“On the open market, California and New York are big states, and they and the federal government have been outbidding smaller states,” said Shaye Mandle, president and CEO of the Golden Valley-based trade association Medical Alley. “That’s been a problem for Minnesota. … And the initial burst of this was pulling a lot of the equipment off the market to countries in need.”
Even without those factors, experts say hospitals would be hard-pressed to meet the needs of so many patients impacted by the novel coronavirus at once.
“It’s a continuous event that creates continuous demand,” said Nezih Altay, an international supply chain expert with DePaul University in Chicago. “I’m 50 years old and I can’t remember something like this, and I do disaster research.”
Karthik Natarajan, a faculty member at the Carlson School of Management at the University of Minnesota, said the problem may well be all of the above.
“It is a combination actually, and the issues are slightly different for each kind of health commodity,” said Natarajan, who specializes in supply chain operations as they relate to nonprofits, health care and international federal aid.
If domestic companies keep up production and supply lines from China continue to open up, Natarajan foresees hospitals getting the personal protective equipment they need — masks, gowns and gloves — within about four weeks. April will be rough, but things should get better.
Ventilators are a different story.
“Medtronic is scaling up production, and they’ll go from manufacturing 250 to 500 ventilators per week,” said Natarajan, referring to the medical technology company based in Fridley.
“That’s the kind of scale that we’re talking about,” he said. “On a monthly basis, we’re talking about 2,000 ventilators. And if you’re looking at New York state, they’re asking for 30,000.”
Manufacturers can quickly produce gloves and masks, and supply chains disrupted by the outbreak in China. But it can take two or three weeks to ready a factory and workers to produce a relatively complicated product like a ventilator, and not just any manufacturer can do it.
The good news, he said, is that unlike a mask, a ventilator can be reused and even moved from state to state if demand peaks at different times.
Meanwhile, the University of Minnesota, the Mayo Clinic and others are in the process of designing simpler, smaller and easier-to-manufacture ventilators, and researchers at the Massachusetts Institute of Technology are sharing “open source” instructions for building a ventilator that costs hundreds instead of thousands of dollars.
‘Lean' management strategies
Critics say with an eye toward keeping beds, staffing and inventory lean, health networks now find themselves ill-equipped for what may be the largest national health crisis in 100 years.
The corporate “lean” management philosophy is big on eliminating needless work practices — including excess inventory.
“Hospitals have switched over to this ‘lean’ model of functioning,” said Rick Fuentes, a spokesman for the Minnesota Nurses Association. “In fact, they’re bragging about it. It’s strictly a cost-cutting measure, and honestly, it’s contributed to why we’re in this situation.”
Natarajan, however, said even after going “lean,” hospitals do keep excess inventory on hand for mass casualty events such as a tornado or terrorist attack. But not for once-in-a-hundred-year pandemics.
“When there was no COVID-19, people were complaining about hospital costs and hospital waste,” he said. “So hospitals were under a lot of pressure to bring the costs down, and that’s where they started to adopt lean principles to keep everything streamlined. And that works very well on a normal day.”
Altay said that natural disasters such as earthquakes are geographically isolated and create short-term demand for supplies in one city or region, which can be offset by production elsewhere. Pandemics, however, fuel demand surges everywhere at once, and likely for an extended period.
That’s especially difficult to offset if production falters as factories are shuttered or workers get sick.
Members of Congress seek answers
On March 22, Minnesota’s two U.S. senators and five members of the congressional delegation — all Democrats — penned a letter to the U.S. Department of Health and Human Services demanding clarity over when Minnesota would receive its shipment from the national stockpile and how the federal government is determining which states get what.
Federal allotments appear to be based in part on population and on the number of identified cases, among other factors.
Among the questions raised in the letter: “We have heard from health care professionals in Minnesota that there is an urgent need for information regarding what specific types of medical supplies and equipment will be allocated to the state, how much will be sent, and when it will be distributed.”
“How is HHS determining which states receive certain medical supplies? When will Minnesota receive the full order of medical supplies that state officials have requested?”
The letter was signed by U.S. Sens. Amy Klobuchar and Tina Smith, as well as U.S. Reps. Betty McCollum, Angie Craig, Dean Phillips, Ilhan Omar and Collin Peterson.
25% of request
The state ultimately received 25% of its allotment from the national stockpile.
The first shipment contained 55,000 N95 masks, 121,547 surgical masks, 23,145 face shields, 18,871 gowns, 97,000 coveralls and 67,191 pairs of gloves.
That may sound plentiful. But considering that M Health Fairview alone will go through upward of 5,000 homemade masks a day, it may not be enough.
Gov. Tim Walz also said peak demand could happen within the next four weeks, but identifying exactly how many supplies are needed will be a messy moving target.