Week Two Of Taking It Seriously

     And, of course, since I set ground rules for comments, commenters are testing the limits.

     They're pretty strict.  If you have ideas, feelings, thoughts that you simply must get off your chest, and they are not supportive of your fellow humans trying to get through this thing, please get your own blog (they're often free!).  I'm not going to publish them.  I will try to answer them.

*  *  *      For the RN, irked at the government's response and the limited supplies, I don't have much comfort.  I'm slightly less qualified to explain supply-chain logistics than a non-surgical nurse is to explain the subtler details of brain surgery: I sometimes see it happening and occasionally I help it along, but....

     Still, I'll give it a try.  In normal times, the usage of PPE is essentially constant. The factories know their market and produce about what they need; this probably doesn't get warehoused in any great quantity (the miracle of just-in-time manufacturing processes!).  Instead, it goes on train cars to a wholesaler, and on trucks from from the wholesaler to retailers and bulk purchasers.  Figure the whole process takes somewhere between one and six weeks.

     Ramping that up -- first, you need raw materials.  Assume them, and if the factory was running one shift, it can run three, if it can find the workers.  Congratulations, you have tripled the supply; a week to train them, and a week, minimum to get to get the PPE to the end users, if they have ordered them; better add another week to sort that out.  Meanwhile, hospitals and testing in the hardest-hit areas is burning through these supplies five or six times as quickly as normal.  And changing from a supply-and-demand model to a command model won;t make it any faster or ensure the supplies get to where they are most needed.

     Federalism plays into this as well.  Public health in this country is a good example of federalism; it's bottom-up, as FEMA and CDC keep trying to explain: locally run, state managed, Federally supported.  FEMA does not have any super-deep infinite stockpiles; they have some supplies, suitable to support a state's response to an ordinary disaster, to get them through the first few weeks while the supply chain reacts.  The scale of this problem is ten to a hundred times as great.  FEMA's stockpiles, your state's stockpiles -- they're like spitting on a bonfire. 

     I'm sorry the Feds and state-level agencies lack the power of precognition, but that's the case.  Complaining about it now won't help.  Chewing them out just wastes time better spent on doing what we can, while we can.  Take notes and write a searing analysis after we're through this.   Do what FEMA appears to have done after Katrina: take a good hard took at the mission and how to manage it, and try to figure out how we can avoid this kind of problem in our next response.

     Testing is a PPE problem.  I will keep explaining this: the only way to keep the testers from risking passing the virus from the infected to the merely worried is for them to discard their PPE -- gloves, at the very least -- every time they take a sample.  If you're low on PPE, you restrict testing.  You need that PPE for the caregivers treating the people who are already ill.

*  *  *      Another commenter asked if I really believed that flattening the curve won't reduce the death rate.

     The answer is that it's probably not going to make a huge difference in the direct death rate.  Probably the overall deaths will be lower, though by how much is impossible to say.  People are saved by having equipment available to save them,m and the flatter we make the curve, the better that looks.  The virus puts the same proportion of the people it makes ill in mortal danger. 

     It is very likely someone you know is going to die of this, especially if you live in a large city.  And I'm damned sorry about that.