Lead Time and Dedicated Resources

The lack of adequate personal protective equipment for medical personnel dealing with the covid-19 pandemic, the lack of adequate numbers of respirators, and the lack of advance planning in the United States is an unfortunate and yet inevitable outgrowth of the “instant internet” and “just-in-time” mindset that has become prevalent in the United States, particularly in the last twenty years. Unhappily, major crises aren’t susceptible to “instant” solutions. Solutions require time and advance allocation of resources, and extreme capitalist societies like the U.S. don’t like setting aside resources that could be “better” used for making more money now.

Unfortunately, that mindset isn’t totally new. It’s just worse, aided by a society addicted to instant satisfaction. The United States has always had a habit of trying to avoid looking at and dealing with unpleasant truths… and not wanting to spend thought and resources on preparation and understanding. I won’t go into all of the examples, but World War II and the Vietnam War were two more recent examples, as was the financial melt-down of 2008. For six years before Germany actually invaded Poland, Hitler broke treaties, annexed other countries, demonized, persecuted and killed Jews and others the Nazis found “undesirable.” By the mid-thirties the Japanese were taking over large sections of China. The U.S. reaction? Zilch. The U.S. Army was at one of the lowest levels ever, and the isolationist America First movement was the predominant political view.

The Vietnam War was largely fought by the U.S., until the very end, on the WW II assumption that massive numbers of men, bombs, high tech and costly weapons, and defoliants could defeat a popular movement using asymmetrical warfare tactics, even though the Vietnamese had driven out the French. Over more than a thousand years, China had attempted to conquer the Vietnam area, but the Vietnamese never gave up and always pushed the Chinese out, and the Chinese always had more men and better weapons. Until the very end, the military and the Washington establishment never looked at that history, or, when they did, they disregarded it.

The 2008 financial meltdown came about the same way. Even though more than a few experts and analysts questioned the over-mortgaging of American and the securitization of subprime mortgages, few policymakers wanted to look at the underlying weaknesses of the system, and no one planned for the future, because everything was about making more money “now.”

Every reputable epidemiologist knows that pandemics happen. They’ve happened throughout history, always with high body counts, economic havoc, and political instability. So what did the Trump administration do? They eliminated the very office created to deal with pandemics, and the result was the loss of at least a month of time for preparation. There also weren’t enough back-up supplies, and it turns out – not to my surprise – that it takes time to retool factories to produce surgical masks and respirators… time, it turns out, that cities like New York don’t have. The just-in-time economy and instant internet aren’t very good at dealing with crises like covid-19. We will muddle through, but more people will die who didn’t have to, and many of them will be medical professionals in the front line… and, also, in the process, a great many workers and their families will suffer unnecessary financial hardship.

There are reasons to know history and to have enough equipment of the right kind ready on standby, even though it’s not “instantly” profitable… but somehow it seems every generation has to learn that truth the hard way… and some politicians and people never do.

2 thoughts on “Lead Time and Dedicated Resources”

  1. Wine Guy says:

    “Surge capacity” in US hospitals is another issue: when mass casualty incidents occur, very few hospitals are set up to take a sudden rush of 50+ (or even 20, or 10… or my little hospital, 5) seriously injured or ill patients. I hold up various bus and passenger rail catastrophies, the Las Vegas shooting, and the Boston Marathon bombing incidents as recent examples.

    Keeping staff, space, and equipment for such situations is extremely expensive and most hospitals (even ‘for profit’ ones) run on razor thin margins. 2% is considered a good year. And the government does help reimburse for related expenses… but erimbursement is not forward planning and it certainly does not help with contracts for goods and services that might be in place for months to years beforehand.

    And when it comes down to brass tacks, US citizens don’t like the concept of triage. We have a hard time accepting that some people will have to do without because someone else needs it more.

    1. Wine Guy says:

      There are accounts from my ED and intensive care colleagues in NYC and other places who are having to make tough decisions about who gets the ventilator and who does not – and the ‘does not’ person will likely die. Some are claiming that the doctors will be ‘morally injured’ because of this. It’s a fancy way of saying ‘PTSD-in-the-making’ because very few civilian physicians, nurses, and medical administrators train for mass casualty situations.

      When the USNS Comfort pulled into NYC and the Captain said he was ‘excited’ to get started, I took the statement at face value. As a former military physician, getting a chance to put into practice what many, many days and months of training have honed (and what many of us actually got to practice in austere battlefield environments) IS exciting. Not fun. Not easy. Exciting – because we finally get to do what we are good at for people who need it… and we aren’t being shot at or have to wear 40# of body armor to do it.

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