By late March, COVID-19 cases were rising, masks were getting scarce and the usual sources of protective personal equipment were drying up. Although the situation wasn’t desperate yet, basic equipment was running low. Dr. Andrew Artenstein, chief physician executive of Baystate Health system in Massachusetts, realized that making a few phone calls wouldn’t cut it.
“We all felt that it required me to step in,” says Artenstein, whose training in infectious disease is combined with a background in bioterrorism and pandemic response. He entered negotiations and agreed to an unusual meeting at a nondescript warehouse to connect with “nontraditional” PPE suppliers, that he learned about thirdhand through a supply-chain team member. Other health systems couldn’t offer much information about PPE sources as they were also scouring for PPE themselves.
Just when it seemed like the unorthodox transaction was complete, FBI and Homeland Security agents showed up at the warehouse proceedings, insisting that Artenstein identify himself and peppering him with questions. Fortunately, they realized that transaction was legitimate.
“It was surreal,” Artenstein says. “I’ve been in the business for 30 years and I had never experienced something quite like that in health care. I’ve read about it in non-health care — if you watch Marty Scorsese movies you see some of it. But that was just strange.”
Still, Artenstein reached his objective — obtaining a massive supply of KN95 respirators and face masks — to protect the roughly 12,500 employees, along with patients and family members, at Baystate Health.
The importance of PPE for shielding front-line health care workers from the coronavirus cannot be overstated. N95 respirator masks in particular keep the infection from spreading among nurses, doctors, respiratory therapists, nursing home caregivers and other employees exposed to patients with known, suspected or asymptomatic COVID-19. Gowns, gloves, surgical masks, goggles and face shields are also essential PPE.
The worldwide PPE shortage has put health care workers in dire straits. Many have gotten extremely sick and some have died from COVID-19. Health care workers are terrified of getting infected themselves or unknowingly transmitting the disease to patients and their own family members.
“Under normal conditions,” Artenstein says, “the supply chain works. It’s kind of a just-in-time-system: There’s enough to go around.” Routine bulk purchases keep health systems stocked with PPE for their employees, he explains.
But these are not normal conditions.
“With any stress in the system, though, it becomes difficult,” says Artenstein, who is also the regional executive dean of the University of Massachusetts Medical School-Baystate. “And when that stress in the system is global and it’s occurring at all places at the same time — like a pandemic — and the needs are astronomical, like what was happening in the Northeast back in March, the supply chain completely broke.”
Deal Goes Down
Artenstein recently described his in-person purchase in the New England Journal of Medicine. Not quite the publication’s standard research-focused fare, the April 30 article, “In Pursuit of PPE,” reads like a suspense thriller.
In early April, supply-chain team members and a mask fit tester from his health system were flown to a small airport near an industrial warehouse in the mid-Atlantic area. Artenstein arrived by car to make the final call on the deal. Disguised as food vehicles, two semi-trailers arranged by the health system met the hospital team at the warehouse. (With PPE in such high demand, there was concern that the contents could be detained or redirected en route back to its ultimate Massachusetts destination, thus the disguised vehicles.)
The almost unavoidable comparisons to an illicit drug deal in a movie continued. “Even our supply-chain professionals aren’t used to dealing with this kind of thing,” Artenstein notes. “We were not only physically at the warehouse, but we were testing supplies on the loading dock to be sure they were the real thing.”
That’s when the FBI agents showed up, flashing their badges. “They were respectful,” Artenstein says. “They were doing their jobs, as well. They were out there, they told me, for the right reasons — to make sure (the PPE) got into the right hands.”
The Dept. of Homeland Security was the next hurdle. The agency was was considering redirecting the PPE elsewhere, according to the officials who were also present. However, intervention by a Congressional representative after a quickly placed call prevented the supplies from being seized.
The Homeland Security agents were also “totally fine,” Artenstein adds. “It just was obviously quite startling for a chief physician executive to be dealing in that domain. Typically, that doesn’t happen.”
No, Artenstein didn’t bring a cash-filled briefcase to the mysterious meeting. But he and his group did have to make payment for PPE supplies right on the spot.
“We physically had to go through the act of wiring money while we there,” Artenstein says. “And we were talking about a lot of money — let’s just say millions of dollars. Which is a much greater sum than we would normally pay for this stuff, and much greater volume than we would normally need, frankly.” Even so, he notes the staggering cost was only in the midrange of price quotes his group was receiving and not the top-dollar prices some systems in need have been forced to pay.
For the exit plan, the disguised trucks took separate routes back to Massachusetts. In the NEJM article, Artenstein described being worried and nervous on his long drive back, feelings only relieved by the midnight call that the PPE had reached its destination. Previously unheard-of measures were then taken to protect the hard-won supplies.
“Back in April, for the first-time ever, we rented separate warehouse space in a location in our region and put in 24-hour security, physical security with security guards, as well as lock-and-key and security cameras,” Artenstein says. “That’s just to guard the PPE. And we maintain that to this day and we will continue to maintain it, because as this pandemic resurges — as it probably will this winter in some form — we expect things to get pretty chaotic again.”
Earlier in his career, Artenstein served as an active duty physician with the U.S. Army Medical Corps, based at what is now called Walter Reed National Military Medical Center in Bethesda, Maryland. During that decade, he conducted research at home and in Thailand, and was eventually named head of protective immunity in the division of retrovirology — studying retroviruses like HIV — at the Walter Reed Army Institute of Research.
In 2001, Artenstein moved on to eventually become the founding director of the Center for Biodefense and Emerging Pathogens, based at Memorial Hospital of Rhode Island/Alpert Medical School of Brown University. There, Artenstein coordinated epidemic and pandemic preparedness efforts, helped lead multisite vaccine trials and worked on developing anthrax antitoxin and other therapeutic agents to counteract bioterrorism threats. “We dealt with pandemic influenza, we dealt with anthrax, we dealt with Ebola,” he says.
Now, Artenstein faces another formidable foe: the novel coronavirus. “This one is different,” he says. “Because this one is actually the worldwide, large-scale pandemic that we’ve been fearing for generations.”
COVID-19 is in some ways unique from other viruses Artenstein has encountered. “Anytime you have a new virus in the human race, it’s going to provide a whole bunch of new manifestations,” he says. “First-time viruses tend to be the most severe because collective immunity has no experience with it.”
Artenstein says that he was “shocked” by the national lack of strategic planning while the pandemic was brewing. “What surprised me most about the response is that a country like the U.S. with all our advantages — technologically, scientifically, intellectually, resources — that we couldn’t pull testing or PPE together and get it organized, coordinated and somehow applied fairly in a way that made sense seven months ago,” he says.
However, Artenstein praises the efforts of front-line doctors and nurses, supply-chain people, researchers and many others all working in a focused way toward their common goals for withstanding the COVID-19 threat.
Challenges persist. “In some way we’re doing better,” Artenstein says. “But for some of the basic things — testing and PPE — it’s still a jungle out there.”
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Doctor Makes ‘Surreal’ Warehouse Rendezvous to Get PPE for COVID-19 originally appeared on usnews.com