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COVID-19 has caught Pinar Keskinocak well prepared. For years, she has studied how societies manage pandemics, and how outbreaks overtax the health care system and wrack supply chains to worsen pandemics. Here she shares her insights.

Empty classrooms and supermarket shelves marked the beginning of the COVID-19 pandemic. But Keskinocak expects more signs of the times to come – such as pop-up pandemic clinics and the shortage and rationing of medical supplies beyond masks and ventilators.

Keskinocak is the director of the Center for Health and Humanitarian Systems at the Georgia Institute of Technology, which studies how government and private sectors can cooperate to handle health and humanitarian crises. And she is William W. George Chair and Professor in Georgia Tech’s H. Milton Stewart School of Industrial and Systems Engineering.

In previous research, Keskinocak’s team created a model that accurately ran the course of the 1918 Spanish flu pandemic, and when COVID-19 struck, her team was already in the middle of modeling how special clinics could significantly slow a pandemic. In the meantime, temporary clinics in Wuhan, China, appear to have validated her model.

Healthcare expansion now

The surge of COVID-19 patients pushed Italy’s health care system into a very ugly crisis, and the U.S. needs to take measures now to handle similar patient surges. Pandemics often strike in two waves or more, and the second is usually the worst, so measures need to be lasting, Keskinocak said.

Even without COVID-19, the U.S. healthcare system has been under strain. Emergency rooms are often overcrowded; it takes a long time to schedule an appointment, and there is a chronic shortage of nursing staff.

[Read Keskinocak's guest op-ed in the New York Daily News: COVID clinics now]

“We need to expand capacity and unleash creative flexibility in our healthcare systems. We should use more telemedicine and create self-service stations for testing. I would particularly like to see specialized COVID-19 clinics established now,” Keskinocak said.

“Special clinics could be separate spaces in existing facilities or standalone facilities. As COVID-19 spreads, we expect a lot more people with cold- and flu-like symptoms to seek testing and care. The healthcare capacities are just not there for a business as usual approach, and taking it could harm patients by delaying care and increasing risk of infection.”

Gathering COVID-19 patients in tight spaces like waiting rooms with other patients would increase the coronavirus’ spread, and patients with preexisting conditions could face mortal threat. Contagion could also spread into hospitals.

“Dedicated pandemic clinics could implement targeted hygiene, air filtration, and specialized protective equipment beyond masks and gloves for healthcare workers. They can tailor workflows to test and care for patients quickly and effectively and keep them away from other patients and staff,” Keskinocak said.

Payment needs to be easy, too, including financing the uninsured. In the middle of a public health emergency, it is vital to not get bogged down by restrictions meant for normal times.

Potentially dangerous shortages

Toilet paper will make a comeback in supermarkets, but in its place, life-saving medications could become perilously scarce. Countries need to act now to prevent this from compounding the COVID-19 crisis.

“Dwindling availability of hospital beds, ventilators, and personal protective equipment like masks and gloves during a patient surge – those are the obvious things. But we could also see shortages of items like asthma medication or antidepressants. Worst case, even food supplies could run low,” Keskinocak said.

[Read Keskinocak's guest op-ed in The Hill: medical supply chain dangers]

Here’s how shortages work and can lead to price gouging and also rationing. The latter can have good effects.

“Shortages are the result of supply-demand imbalance caused by either an unexpected increase in demand or unexpected decrease in supply or both. Shortages are common in crises such as natural disasters or health emergencies. But given the worldwide slowdown of economic activity in pandemics, disruptions could get much worse this time,” Keskinocak said.

“Supply chains are actually intricate webs of multiple parts that span the globe. Pandemics damage many of those parts, and it can take time to recover. This creates a more serious and worrisome imbalance between supply and demand.”

Toilet paper will return because people fear-hoard it in a panic but consume it at normal rates. When the panic runs its course, demand slows back down to the actual rate of consumption and its normal supply chain, which is relatively simple, catches up.

“With medicine and healthcare services and supplies, the increase in demand is typically already in line with consumption, so a shortage in supply or increase in demand can create a supply-demand gap that continues for a long time,” Keskinocak said. “Medical supply chains are also very complex and fragile.”

Future vaccine distribution

In normal times, most supply chains work at a plodding pace, and when crisis strikes, it is tough to ramp them up due to expensive equipment, complex logistics, and strict regulations, particularly in health care. Even temporary shortages of medicines and medical devices can have consequences for patients who need them.

“If shortages become serious, rationing – with a priority allocation to those most in need – can help balance demand and supply for critical items like medications.”

Once created and approved, the production of vaccines or antivirals for COVID-19 will ramp up slowly and could be in short supply at first. Decision-makers need plan investments now in the supply chains necessary for their effective distribution.

This will include painful, necessary decisions like prioritizing first doses for healthcare workers, people with pre-existing conditions, and the elderly. The current system of restocking vaccines in the U.S. after initial distribution also has serious gaps that need fixing to save many more lives.

In the meantime, social distancing is one of the best ways to protect everyone and reduce the patient surge into clinics. Do it if you or anyone in your household has any cold-like symptoms.

[Read Keskinocak's commentary on social distancing on AJC.com]

Also read: Vaccine Supply Gaps Can Make Pandemics Deadlier

Media contacts: Ben Brumfield (ben.brumfield@comm.gatech.edu) and John Toon (john.toon@comm.gatech.edu)