Supplies for COVID-19 testing, diagnostics and treatment are at risk of shortage
In 2021, there is a different set of challenges for the healthcare supply chain than previous stages of the COVID-19 pandemic, including shortages that are shifting from the personal protective equipment (PPE) scarcities that characterized 2020 to exponential demand for the supplies that play a vital role in COVID-19 testing, diagnostics and treatment, according to a Premier, Inc blog post by Andy Brailo, Chief Customer Officer; Wayne Russell, RPh, PharmD, FASHP, Vice President, Pharmacy; and Matt Bossemeyer, Director, Supply Chain IT Services Analytics.
They continued:
Since May 2020, for example, health systems’ average daily usage of sterile water has increased 350 percent and pipette tips that are critical to performing COVID-19 tests has increased more than 50 percent. For vital PPE, including isolation gowns, surgical masks, N95 respirators and exam gloves, average daily usage is at an all-time high.
Premier analyzed both historic and predictive data from our supply chain forecasting technology to identify the latest supply categories at risk ─ and assess how sourcing has fundamentally altered the economic landscape for gloves, gowns and N95s, including:
Sterile Water
When Hurricane Maria crippled manufacturing on the island of Puerto Rico in 2017, hospitals across the country faced dire storages of IV saline bags and other medications, including sterile water. Fast forward to 2021, and sterile water is once again a top supply at risk as a result of the COVID-19 pandemic. According to Premier data across a representative sample of health systems, since May 2020, average daily usage of sterile water has increased 350 percent and inventories have fallen 50 percent ─ drifting down to a median of just three days of supply on hand.
Sterile water is currently on the American Society of Health-System Pharmacists shortage list and has historically rolled on and off the Food and Drug Administration’s (FDA) shortage list due to production delays and heightened demand ─ with some suppliers currently reporting a 200 percent increase in demand for both 1,000ml and 2,000ml bags.
This demand spike is due, in part, to the variety of ways in which sterile water is used in patient treatment settings and across the care continuum. For example, COVID-19 has stressed the supply of sterile water for inhalation as humidification is recommended for patients receiving invasive mechanical ventilation.
Sterile water is also used to reconstitute many medications for injections, including remdesivir, which has been shown to speed COVID-19 recovery times. When sterile water supplies are low, clinicians must either administer a different medication or use a different sterile liquid to mix with the drug, despite a lack of definitive information about the effects on drug stability and compatibility.
Premier’s PremierProRx and ProvideGx programs provide members access to more than 150 drugs that are or have been recently designated as shortage drugs, including sterile water, and have proven their ability more effectively deliver product to its members in and out of a pandemic.
Pipette Tips
As of January 4, the FDA had updated its device shortages list to include pipette tips and micro pipettes in the testing supplies and equipment category. A vital lab/diagnostic item, pipette tips are needed to quickly and precisely move liquid between vials during the COVID-19 testing process.
Since May 2020, hospitals’ average daily usage of pipette tips has increased more than 50 percent, and the volume of outstanding (open) purchase orders has tripled – from six to 18 days of supply on order, according to Premier data.
This is a particular concern because average product lead time – the timeline between placing an order and receiving it – has increased from just a few days in the fall of 2020 to more than 25 days as of January 2021.
COVID-19 case surge correlates directly with the need for more testing. In fact, some labs had built the capacity to process 20,000 COVID-19 test samples in a single day by November 2020 – up from about 2,500 a day last spring. This heightened activity and demand for COVID-19 testing capabilities create a ripple effect and a strain on pipette tips supply for providers and labs across the country, impeding efforts to track and curb the spread of the disease.
Gloves, Gowns and Masks
While not nearly as dire as the demand spikes and shortages seen in the spring, supply concerns for fundamental PPE remain prevalent.
Isolation gowns, surgical masks, N95 respirators and exam gloves are all seeing all-time highs in terms of average daily usage among health systems. Per Premier data:
· Isolation gown usage has doubled from September 2020 to January 2021
· Surgical mask usage has increased 250 percent since June 2020
· Exam glove usage has doubled since June 2020 and now exceeds existing production capacity by 37 percent
· N95 respirator usage has increased 500 percent since July
These ongoing demand spikes – coupled with global manufacturer, logistics and labor issues – could lead to shortage situations for a subset of providers over the near term.
Take nitrile exam gloves, for instance – cited in a recent Premier member survey as the no. 2 greatest challenge to care for COVID-19 patients (after clinical staffing).
In late December 2020, one of the world’s largest global glove manufacturers was forced to shut down 28 plants and run the rest of its fleet at partial capacity for 10 days due to COVID-19 outbreaks at the factories. Add to this the fact that NBR (acrylonitrile butadiene rubber), the raw material used to make nitrile gloves, is also in short supply with capacity issues expected to persist into 2022.
As a result, many providers are now implementing glove conservation practices and other precautionary measures to increase product days on hand and help ensure a reliable supply of gloves.
The Economic Cost of Shortages
The ongoing product/PPE demand spikes and continued supply chain instabilities are coming at a significant economic cost and exacerbating healthcare providers’ margin pressures.
Health system PPE spend in 2020 has also skyrocketed. March 2020, for example, saw the largest spike ─ a more than 14,000 percent increase in N95 and KN95 mask spend as compared to March 2019. And overall, 2020 spend on several key PPE supplies increased 500 percent over 2019.
Estimates from spring 2020 showed hospitals are losing about $1,200 per COVID-19 case, and according to a November 2020 Premier analysis, the cost for providers to treat a mechanically ventilated COVID-19 patient is more than five times higher than for patients not receiving this treatment.
Even amid heightened PPE demand and some supply challenges, Premier data suggests that our nation, and the healthcare supply chain, are better prepared for the third pandemic wave than for the spring and summer surges.
Premier data shows that average days on hand and product lead time have improved in January 2021 for gloves, gowns and masks.
Even for N95 masks, where pre-COVID-19 consumption saw approximately 25 million per year compared to roughly 300 million in 2020, data shows that most health systems now have a median of about 150 days’ supply on hand. In contrast, an April 2020 Premier member survey found that most health systems had approximately 23 days of N95 supply on hand – and those with active COVID-19 patients had an average of just three days’ worth.
In addition to conservation measures, nearly 90 percent of providers have been actively contributing to their stockpiles since the summer, and hospitals are equipped with more sophisticated product burn data and a greater visibility into their inventory status and prospects.
Manufacturing capabilities have also increased over recent months, including new Premier and member investments in domestic manufacturing for isolation gowns and face masks. And Premier’s direct sourcing arm worked directly with manufacturers to increase production globally as well as execute innovative forward buys to secure 130 million masks and 50 million gowns in 2020 alone.
Although widespread PPE shortages are less severe than they were in the spring or summer of 2020, almost any product or drug could slip into shortage.
As COVID-19 cases rise, testing capabilities ramp up and the global landscape faces ongoing economic and political uncertainty, health systems need technology and expertise that helps plan for COVID-19 case spread as well as the critical supplies they will need at any given point in the disease’s progression.
In applying lessons learned from the pandemic, chief among them is the power of data to build resiliency and power the healthcare supply chain of the future.
