I'm going to repeat something here, because it can't be repeated too often and it's fundamentally important to our attitude toward the pandemic threat. I'm prompted to revisit the topic because I wanted to share a very useful illustration from a notable figure in U.S. public health.
First, two points for context:
Point #1: Many of the larger entities in the medical community - especially the for-profit enterprises like equipment and pharmaceutical manufacturers and many hospitals - have adopted just-in-time delivery and inventory management business practices, just like other industries.
Point #2: We often hear the opinion - usually from a health professional - that a deadly repeat of the 1918 flu pandemic isn't feasible because, regardless of the virulence of any future pandemic influenza, we have many medical treatments and tools (and knowledge) which didn't exist in 1918.
The problem with Point #2 is Point #1. The efficiencies and savings of streamlined business operations in medical settings become an Achilles' heel in a widespread medical crisis like a flu pandemic.
With that in mind, Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, told USA Today that U.S. government efforts to stockpile antiviral drugs and prospective vaccines aren't enough. Not nearly enough...
"Today we have a just-in-time delivery system for masks, syringes, for IV bags," he says. "Most people don't realize that 80% of the drugs we use in this country come from offshore. Right now, the two manufacturers of N95 masks in this country are operating on 100% capacity. They have no surge capacity. We will run out quickly of all these things. And at that time, we'll be dealing with the equivalent of a 1918 health care system."
If a pandemic comes, it doesn't matter what medical treatments we have today which we didn't have in 1918, if we don't have enough of them at the point and time of need.
The Wall Street Journal also discussed this:
The very rules of capitalism that make the U.S. an ultra-efficient marketplace also make it exceptionally vulnerable in a pandemic. Near-empty warehouses are a sign of strong inventory management. Production of drugs takes place offshore because that's cheaper. The federal government doesn't intervene as a guaranteed buyer of flu drugs, as it does with weapons. Investors and tax rules conspire to eliminate redundancy and reserves. Antitrust rules prevent private companies from collaborating to speed development of new drugs.
Most fundamentally, the widely embraced "just-in-time" business practice - which attempts to cut costs and improve quality by reducing inventory stockpiles and delivering products as needed - is at odds with the logic of "just in case" that promotes stockpiling drugs, government intervention and overall preparedness.
For another aspect of the "surge capacity" problem, see my post from yesterday, "No Vacancy in the hospital: Seasonal flu can be all it takes."