Thread by @T_Inglesby

We need to increase the operational capacity of the US fed govt COVID response by orders of magnitude now. We need a new model - what we have isn't powerful enough. And this is with the COVID epidemic only at its earliest phases here. 1/x

There are dire shortages of masks around the country – N95 and surgical masks. This
NYT report says doctors and nurses are at war with this virus with no ammo:
nytimes.com/2020/03/19/hea… 2/x

There are shortages that are impairing diagnostic testing – critical reagents, swabs and pipettes. There are anticipated major shortages of ventilators as the numbers of critical ill pts rise around the country. 3/x

And there is a shortage of hand sanitizers, procedural masks, and will be shortages of any medicines that may prove to be effective. 4/x

Responsibility for dealing w/ these shortages is distributed around small offices, tiger teams in White House, in HHS agencies. They are doing what they can, but they aren't logisticians or logistics agencies, and the scale of the effort isn't close to what country needs.5/x

We need a massive logistics effort to deal with all of these shortages, and the shortages and material needs that will come. Responsibility shifted to FEMA today. FEMA does have large logistics capability, but their focus is normally on disaster
recovery. 6/x

The agency best suited for the massive logistics and supply chain operation now needed across the country may be the Defense Logistics Agency. dla.mil/TroopSupport/M… 7/x

DLA provides more than $37 billion in goods and services annually. Employs about 26,000 civilians and military. Manages nine supply chains and about 5 million items. Operates in most states. 8/x

We need an experienced logistics leader and agency, that has run huge prolonged operation(s), responses to disasters, and/or preparation for
military engagements. DLA has done that: en.wikipedia.org/wiki/Defense_L… 9/x

This is not to say that the other leaders now involved in COVID response at top of government aren’t key. We need all of them that are there now because there are so many serious challenges and many more to come. 10/x

Public health, scientific, research and clinical leaders in the fed govt should be focusing on those issues which they know so well. For the massive logistics work that is needed now, we need a huge logistics operation run by professionals who do logistics for a living. 11/x

We need top possible logistics agency and leadership to maximize supply chain output across the full range of medical assets needed to cope with COVID – starting with N95s and surgical masks which are in desperate shortage around the country. 12/x

We need to urgently protect HCWs around the country. Doctors and nurses from front lines are sending emails saying they have no more masks. @CDCgov yesterday sent an email out telling nurses they should use bandanas when they run out of masks. 13/x

We have thousands of hospitals around the country, all of which will have different needs and different moments. The idea of each one trying to do its own deals with manufacturers in competition with everyone else is awful. They need massive centralized help from fed gov. 14/x

At minimum, this fed gov logistics effort should: identify all med items in shortage or soon to be; what does each hosp around country need – there are thousands of hosps of different sizes; and, create data management system to organize needs and track response to them. 15/x

This fed logistics operation needs to maximize all possible w/ existing supply
chain for items in shortage – how much more can a given Plant X produce if the
fed govt is the guaranteed buyer? 16/x

And this fed logistics operation needs to work with private sector to convert factories making other products into ones that make the critical med items the country will need to cope with this epidemic in the months ahead. 17/x

And this fed logistics operation needs to take the products coming off the line and
distribute them around the country to where they are needed, with the help of the private sector distributors. 17/x

In WWII, the US created the en.wikipedia.org/wiki/Office_of…
as one of many major efforts to make what the country needed for the war effort. We now need the full logistics power of the USG to deal with terrible med supply shortages around the country. 18/x

The US Defense Logistics Agency seems to have the size, professionalism, experience and capacity for this mission. 19/x