by James C. Sherlock
We can’t click our heels like Dorothy in the Wizard of Oz to avoid the consequences of COVID-19. We have to do the hard work of reducing the spread and working intelligently with what we have.
Two military axioms apply directly:
- Surprise attacks are come-as-you-are events.
- Operational plans seldom survive the first contact with the enemy.
But strategic planning does survive first contact. Leadership at all levels does. Experience does. Training does. Forces held in reserve do. Logistics does. All of those win battles.
The pandemic virus plans are in place or are at least required to be. Inspections of readiness have been done regularly or at least were required to have been done. I have listed those plans and inspections in this space as a public service. We will discover whether leadership, training, staffing, and logistics are sufficiently robust.
Yet perfect preparation for a black swan event like a pandemic is never going to happen. Warren Buffet has famously said “when the tide goes out, you find out who has been swimming without a bathing suit”.
The military inspects everything it wants to work in combat. Sometimes those inspections reveal flaws, sometimes they don’t.
In the case of the CDC-sponsored inspection of civilian medical facilities, the system is flawed. The Medicare inspectors themselves are corporations hired and paid by the hospitals. The inspectors sell consulting services to their clients. The Centers for Medicare/Medicaid Services started recently before the COVID-19 to crack down on the selling of consulting services by inspection firms as clear conflicts of interest. Virginia could intervene in the vendor-client relationship between the hospitals and inspectors by requiring the hospitals to pay the state and the state to pay the corporate Medicare inspectors, assigning inspection teams on a random basis and including a state employee inspector on each team rather than allowing a long term relationship to develop. I have recommended that approach in the past and consider the failure to do so a systemic failure.
Does that mean that every facility fudged their records and none of the inspection teams did their jobs? Of course not. That’s crazy. It does mean that there was insufficient inspection quality control and some of the certified facilities may not be as prepared as they appear on paper. We don’t know if the inspection criteria themselves require enough personnel, supplies, equipment and training. We may find out.
The military has famous and unrepeatable sayings about assumptions.
Assumptions, either active or passive, were made by the healthcare community about the timing of the availability of test kits. The CDC failed in its first attempt to produce test kits. That was human error, not a systemic failure. Quest Diagnostics and LabCorp offer new COVID-19 coronavirus test services. Both were introduced after the FDA issued a new policy in late-February allowing certain laboratories to develop a diagnostic test for the disease. Now the universities are getting into the act.
The military has an all volunteer force which it pays far better than it used to. When we didn’t, a draft was used. It would be used again if there are not enough volunteers.
Most retired military personnel like me use the civilian physicians and facilities. DoD staffs its facilities only to meet the needs of active duty personnel and their families. The military will evaluate whether its medical personnel and facilities have any excess capacity beyond their own needs to help the civilian system. Certainly military facilities have already been used for quarantines. The VA hospitals, because they serve those with previous military service including a lot those who were injured in combat, may see a bigger relative surge in requirements than civilian hospitals.
Lots of our civilian medical facilities are short staffed even before their own folks need to self quarantine when sick. Some of the beds they physically possess, mostly in rural areas, are unstaffed. Hundreds of beds are unstaffed in Southwest Virginia. Some retired doctors and nurses will pitch in to help. American states will empty temporarily the medical and nursing schools if necessary to provide reserves for the line physicians and nurses. There is no reserve force for medical technicians except in the military reserves, and nearly all of them serve in civilian healthcare workforce already. The shortage of medical personnel is a long-term problem without a short term fix. I published a column before this started about the shortages in Virginia and recommended policy fixes. We’ll see if anything is done when the smoke clears from COVID-19.
The military’s logistics system sets it apart from the militaries of other nations. We supply the logistics requirements not only of our own forces, but those of our allies. The manufacturing and supply chains that support the American medical system including military medicine are too fragile.
The country has a stockpile of about 30 million N-95 masks. We’ll see if that is enough, but panic buying does not help and mask wearing is not indicated for everyone. Save them for the medical people on the front lines and their patients. Like ingredients for medicines, the supply chain for masks is largely foreign and vulnerable to disruption. China makes about half of the masks made worldwide. Many U.S. hospitals have sourced masks from China rather than from the U.S. because the Chinese products are cheaper. The vulnerability of that strategy is apparent.
Pharmaceutical companies have been hard at work on treatments and vaccines since the virus first surfaced in China. The FDA and internal protocols to make sure they are effective and are safe must be followed to ensure that we don’t make matters worse. We will get them as soon as they are ready for mass use.
Meanwhile, use coronavirus.gov for your information. Consult https://www.cdc.gov/coronavirus/2019-ncov/downloads/workplace-school-and-home-guidance.pdf about what to do as groups and individuals. Go to http://www.vdh.virginia.gov for Virginia-specific information. The rest of the internet should be treated like Tokyo Rose on this subject.
One thing we can do is take care of our elderly and infirm neighbors. Call them and make sure they have enough food and provisions. Pick up their meds for them. Use your computer to do things for them like order online that they may not have the skills to do for themselves. Those sorts of things. We can do all that and maintain social distancing (two yards) so that we don’t put them or ourselves at risk.
Don’t speculate, just use common sense and work with the professional recommendations of your physicians and the websites listed above.
