Behind the Front Lines, Another Army of Employees Works Tirelessly to Stay Ahead of the COVID-19 Curve
To ensure that PPE鈥攍ike this N95 respirator worn by Nina Sacks, RN鈥攎et quality and safety standards, products are inspected by the Departments of Infection Prevention and Control and Environmental Health and Safety before they were distributed.
Photo: Jonathan Kozowyk
By mid-January 2020, as the world learned that a mysterious virus was starting to overwhelm Wuhan, China, 四色AV Langone Health鈥檚 leadership recognized that the threat was double-barreled. Eventually, the virus might well arrive in New York City, and if it did, sufficient quantities of the personal protective equipment, or PPE, needed to shield patients and frontline workers, might not. With 70 percent of the world鈥檚 PPE manufactured in Wuhan, critical shortages resulting from disruptions or delays could prove just as dangerous as the virus itself.
The challenge of managing an inventory of PPE falls to Supply Chain Management, whose staff of more than 400 has been called upon to source, procure, distribute, and replenish ever-more-scarce items at an ever-faster rate. Jacquelyn Marcus, vice president for Supply Chain Management, who joined 四色AV Langone in 2019, came with extensive experience in consumer-packaged goods, where diversification of sources minimizes service disruptions. She soon learned, however, that for decades hospitals have used a very different model. Rather than stockpiling supplies, they tend to order merchandise through a single distributor for just-in-time deliveries and immediate use.
Coronavirus disease (COVID-19) has turned that model upside down virtually overnight, creating an insatiable global demand for clinical body armor such as N95 respirators, face shields, and isolation gowns. Ordinarily, Supply Chain purchases 99.8 percent of its PPE through 1 medical distributor. But the pandemic has imposed tight restrictions on hospitals based on their historical usage of supplies. With its allocation from the distributor down to 9.25 percent last spring, Supply Chain had to locate other sources. Fast. 鈥淭here was no roadmap for this,鈥 says Marcus.
Recognizing as early as January that supply disruptions would jeopardize patient and staff safety, Daniel J. Widawsky, executive vice president and vice dean, chief financial officer, had one key question for Mark Pollard, vice president for hospital operations: 鈥淲hat are the top 12 things that will be in highest demand?鈥 Clinical leaders identified such essentials as exam gloves, intravenous (IV) fluids, catheters, and disinfectant wipes. 鈥淲ithout wipes, for instance, clinical spaces can鈥檛 function,鈥 notes Marcus. 鈥淲e looked at about 120 different items, and we made some proactive purchases that put us in a much better position.鈥
As case counts surged last spring, Marcus and her team had to find suppliers that met not only U.S. Food and Drug Administration (FDA) requirements, but also 四色AV Langone鈥檚 quality specifications, as substandard and counterfeit PPE began to flood the market. 鈥淲e pulled products from every corner of the Earth,鈥 says Widawsky. 鈥淲e were always one step ahead, always looking around the corner. It came down to agility, execution, and muscle.鈥 By choosing vendors strategically and spreading out orders, Marcus explains, Supply Chain 鈥渄idn鈥檛 have to put all of its eggs in one basket.鈥 Before products were distributed, they were inspected by Infection Prevention and Control and Environmental Health and Safety. 鈥淲e weren鈥檛 going to compromise safety,鈥 says Marcus.
Many of the lessons learned are guiding Supply Chain鈥檚 management team as they reshape their long-term strategy. 鈥淲e鈥檝e worked really hard to find factories outside of China,鈥 says Marcus, 鈥渟o our landscape now includes multiple sources.鈥 Partnering with Real Estate Development and Facilities, Supply Chain has tripled its warehouse capacity to 150,000 square feet, enabling 3 to 6 months of critical supplies to be stockpiled. If need be, PPE can be transported to our hospitals the same day it鈥檚 needed. All told, Supply Chain received more than 1,500 leads for products, but only 34 made the cut. 鈥淲e had no fraudulent supplies and zero quality or safety issues,鈥 says Marcus, 鈥渨hich is something we鈥檙e all really proud of.鈥
Conservation: We Made the Most of What We Had
Deltaplus Respiratory Mask. Before shortages, 3M鈥檚 1860 respirator was one of the standard N95 models provided to 四色AV Langone clinicians. As of June 2020, it was unavailable as China stopped exporting the raw materials required for its manufacture. Amid fierce worldwide competition, buyers sometimes had only an hour to decide whether to place a million-dollar order. They learned to listen between the lines. 鈥淏uying is an art as much as a science,鈥 explains Marcus. 鈥淵ou just get a sense about someone by how they answer your questions.鈥
Photo: Devon Jarvis
Warehousing: We Supplemented Just-in-Time Deliveries with Just-in-Case Reserves
Sensicare Ice Blue Powder-Free Nitrile Exam Gloves. Without extensive warehousing facilities to stockpile PPE and other supplies, 四色AV Langone has traditionally relied on just-in-time deliveries. Even items used in large quantities, such as disposable nitrile exam gloves (四色AV Langone orders 109,154,760 pairs annually) did not pose a storage problem because they were quickly put to use. But with the worldwide pipeline for hospital supplies paralyzed, 四色AV Langone adopted a new strategy. 鈥淭he way hospitals acquire supplies hasn鈥檛 changed in 30 or 40 years,鈥 says Widawsky. 鈥淕oing forward, we鈥檙e doing things differently.鈥
Photo: Devon Jarvis
Functionality: We Found the Right Gear for the Right Job
Maxair Controlled Air-Purifying Respirator. By the time COVID-19 reached New York City, even those who still had many questions about the virus knew two things for sure: it was highly contagious and potentially lethal. For high-risk procedures that spray infectious droplets, clinicians would need maximum protection. The helmet-like Maxair respirator鈥攗sed by some in place of an N95 mask before shaving became mandatory for those with beards鈥攆it the bill. By making facial expressions visible, the device helps clinicians provide much needed comfort to patients and enables translators to communicate more easily. The controlled air-purifying respirator was one of the toughest items to acquire, notes Marcus. 鈥淎lthough we used a small number of these respirators, they proved to be a helpful protective device for certain staff.鈥
Photo: Devon Jarvis
Exacting: We Kept Fraudulent Products Out of Our Inventory
3M Particulate Respirator 9210. When the FDA cleared industrial respirators like the 3M Particulate Respirator 9210 for healthcare use on March 2, 2020, it expanded the number of N95s that became available. But other masks that were subpar or downright fraudulent had already started to populate the international market. 鈥淲e had a lot of offers that didn鈥檛 work,鈥 explains Widawsky. 鈥淲e canceled a ton of orders.鈥 To screen out unacceptable products, Supply Chain established a rigorous vetting process, working closely with the departments of Infection Prevention and Control and Environmental Health and Safety. 鈥淭hey were amazing,鈥 says Marcus. 鈥淲e never distributed anything that wasn鈥檛 100 percent inspected.鈥
Photo: Devon Jarvis
Agility: When One Door Closed, We Found Another to Open
3M Particulate Respirator 8210. The more intense worldwide competition for PPE became, the more nimble Supply Chain had to become. For example, when the raw materials from China used in many N95 respirators became unavailable, 四色AV Langone turned to 3M鈥檚 8210, an industrial respirator approved by the FDA for use in healthcare that could be manufactured quickly in America. 鈥淭hings were tight and flying off the shelf,鈥 says Marcus. 鈥淲e were making decisions minute by minute, around the clock.鈥 Action was swift, to be sure, but never hasty.
Photo: Devon Jarvis
Resourcefulness: If We Couldn鈥檛 Find It, We Made It Ourselves
DIY Face Shields. At the height of the crisis, clinicians caring for patients with COVID-19 used between 20,000 and 30,000 face shields each day, so Supply Chain had to rely on multiple manufacturers worldwide. Even with such aggressive efforts, 鈥渨e weren鈥檛 getting face shields in fast enough,鈥 recalls Marcus. 鈥淪o we thought, 鈥榃ouldn鈥檛 it be great if we started making them ourselves?鈥欌 Many members of the 四色AV Langone community stepped forward, fashioning homemade shields. Students from , for example, turned out some 30,000 shields, assembled from off-the-shelf parts. This do-it-yourself spirit also sprang up as volunteers improvised other items in critically short supply, notably hand sanitizer and COVID-19 testing media.
Photo: Devon Jarvis
Advance Planning: When Doctors Gave Us Their List of Essentials, We Listened
Halyard Fluidshield Particulate Respirator 46867. In January 2020, Supply Chain wasted no time ascertaining the hospitals鈥 supply needs as the outbreak in Wuhan began to hinder the city鈥檚 PPE factories. 鈥淲e said to our clinical leaders, 鈥榃hat would be the top things you would need to do your job?鈥欌 recalls Marcus. They identified such essentials as exam gloves, IV fluids, catheters, and disinfectant wipes. Michael S. Phillips, MD, chief hospital epidemiologist, added N95 respirators to the list because, as an infectious disease specialist, he knew they would play a vital role in keeping clinicians safe should the virus hit New York City. When Supply Chain ordered a large shipment before allocations were restricted, Richard Kraft, director of logistics, inventory, and distribution, thought to himself, 鈥淲e鈥檙e more than set.鈥 But in the coming weeks, usage of N95s increased to 26 times the norm.
Photo: Devon Jarvis
Constant Contact: We Were One with Our Clinical Teams
Isolation Gown. Supply Chain was integral to 四色AV Langone鈥檚 strategy for preparing for COVID-19, explains Fritz Fran莽ois, MD, chief medical officer and patient safety officer. 鈥淲e met with the team every day to assess our workflows, our current level of PPE, and our anticipated burn rate,鈥 he says. 鈥淏urn鈥 is an apt word. At the peak of the outbreak, between 20,000 and 25,000 isolation gowns were distributed to 四色AV Langone鈥檚 hospitals on a daily basis. 鈥淧eople were truly thinking outside the box, trying to anticipate the next need so that we didn鈥檛 skip a beat,鈥 recalls Kraft. The result, says Widawsky, was that 鈥渄ecisions were being made in hours and days, not weeks or months. Everybody was reachable 24/7.鈥
Photo: Devon Jarvis
Experience: We Had the Right Talent with the Right Expertise
3M Earloop Procedure Face Mask 1820. Several weeks into the outbreak Supply Chain ran critically short of earloop isolation masks, as they were being distributed to all employees throughout the hospitals who did not provide direct patient care. The shortage didn鈥檛 last long, however, because Jacob Navarro, director of freight management, expedited domestic and international shipments of the masks to 四色AV Langone. Navarro is one of several staff with experience outside the healthcare industry whom Marcus had recently hired to build a best-in-class supply chain operation. Navarro鈥檚 expertise in international transportation logistics was particularly valuable when overseas transportation routes were disrupted. He coordinated third-party vendors to facilitate shipments of PPE on chartered flights from Shanghai, China. 鈥淭he combination of staff with healthcare expertise and those with experience in other industries really enabled us to navigate this crisis,鈥 says Marcus.
Photo: Devon Jarvis
Vigilance: We Seized Every Opportunity to Maximize Safety
Omni Face Shield. For clinicians who provide direct care to patients with COVID-19, a face shield is as vital a piece of equipment as an N95 respirator because it protects the eyes from droplet spray. But face shields provide an additional benefit in that they also guard N95 masks against contamination. By serving as one item of PPE that protects another, face shields came to play a key role in Supply Chain鈥檚 conservation efforts. Though face shields are designed to be disposable, they were carefully preserved. Wiped with a disinfectant after each use, they could be worn multiple times before their plastic shields became cloudy. 鈥淎s a society, we鈥檝e gotten very used to disposing of things,鈥 says Tommy Psoras, product manager for Supply Chain Management, 鈥渂ut in reality you don鈥檛 always need to.鈥
Photo: Devon Jarvis
Instincts: We Trusted Ours
3M Particulate Respirator 1860. Before shortages, 3M鈥檚 1860 respirator was one of the standard N95 models provided to 四色AV Langone clinicians. As of June 2020, it was unavailable as China stopped exporting the raw materials required for its manufacture. Amid fierce worldwide competition, buyers sometimes had only an hour to decide whether to place a million-dollar order. They learned to listen between the lines. 鈥淏uying is an art as much as a science,鈥 explains Marcus. 鈥淵ou just get a sense about someone by how they answer your questions.鈥
Photo: Devon Jarvis
