What role should federal agencies play during the COVID-19 pandemic? Should the government provide supplies to health providers across the country? To learn more about federal responses to emergencies, Michael Weissman of GLG’s healthcare team spoke with Greg Burel, former Director of the Division of Strategic National Stockpile (DSNS) at the Centers for Disease Control and Prevention (CDC). His comments, edited for length and clarity, are below.

Can you give a brief overview of the Strategic National Stockpile?

The Strategic National Stockpile is the nation’s repository of medicines, medical devices, and other types of medical material that might be needed to respond to chemical, biological, radiological, or nuclear threats, whether those are intentional or due to industrial accidents. We also respond to natural events, like hurricanes, floods, tornadoes, and fires.

How can the DSNS be used during the current situation?

In these types of events, the DSNS can provide additional material that acts as a bridge between the private sector and the commercial supply chain, allowing that supply chain to catch up with surge activity. For example, the DSNS is sending out a certain quantity of surgical masks or N95 respiratory protective devices. That stock is never meant to be the final answer – it’s only to help create a gap stopper between what the market can provide now and what it can fill later.

How has the federal government’s response so far compared with past epidemic responses?

With SARS and MERS, we were just trying to prepare in case it came here. The biggest response was to the 2009 H1N1 pandemic influenza, when we released about a quarter of our supplies. Fortunately, the disease spread was not as wide as we had thought it might be. With COVID-19, we didn’t come out as early in this process; there was a lot of uncertainty. Had our posture been different, had we known more about what was going on in China earlier, we could have gotten more ahead.

Despite that, the government is doing a good job, although it’s being criticized in many areas. Keeping in mind that, for example, the DSNS is never intended to be the sole source for masks, it’s doing a good job of allocating resources so states can place them where governors feel it’s most important to have them. Of all the responses I’ve been involved in at both FEMA and the CDC, none have started out as you would like. But as the scope and scale of what we’re dealing with emerges, it gets better and better.

How useful is FEMA in a pandemic response?

Through the national response framework, FEMA can coalesce many agencies to help provide a better government response. This is the first time we’ve seen FEMA called into play in responding to anything like this. FEMA’s role here is something of a question mark, and that’s probably yet another thing to assess as we come out the other side of this event and ask, “How did that work, and what do we need to change to make it work better?”

Can FEMA help build additional hospital beds and makeshift intensive care units?

FEMA doesn’t directly have the capability to do that, but it can use funds from the Disaster Relief Fund that becomes available when a disaster is declared under the Stafford Act. FEMA can call on, for example, the U.S. Army Corps of Engineers, who could work on building or modifying a facility rapidly. FEMA can also work across all federal agencies to contract facilities, such as hotels, and turn them into care facilities for decompressing non-COVID-19 or less acute patients who still need hospitalization.

We’re seeing responses differ by city, state, federally – it’s a piecemeal approach. Would you expect any effort to standardize responses to the virus?

One of the basic things to remember in any kind of emergency or disaster response is that the federal government looks to states to say, “This is what we need, and this is how we need help.” The demographics and geography vary by state, as well as the relationship of the population to the government. I don’t see a sustained identical response in every state happening, and I don’t even think that would be necessarily desirable.

What signals are public health officials looking for to ease some of the social distancing measures established across the country?

This is unprecedented in the experience of anybody involved in this response. We haven’t done a stay-at-home-and-isolate-yourself thing in the United States in 70 years. It’s hard to say exactly what’s going to be a trigger point. These community mitigation measures are intended to slow disease spread as much as possible. Experts want a more spread-out group of people going into healthcare for support for coronavirus symptoms rather than everybody showing up at once. Various disease surveillance systems are being monitored across the country; people will consult this data to see if new hotspots develop.

If I were involved in this response, I would expect we’d be looking at case counts. But I wouldn’t equate a decrease in apparent spread to an immediate indicator that we’re in the clear. It’ll be a matter of whether we see some sustained decrease in case count and a sustained fewer number of people presenting at emergency rooms and physicians’ offices who are presumptively positive for coronavirus. That must be balanced against getting the nation’s economy moving again and getting people back to work. That will be top of mind for many people: “Have we seen enough change in the spread of this disease that we can let people get out?”

What do you think are the learnings from this experience in the U.S.? What type of measures are here to stay?

The biggest learning is that the medical supply chain is fragile; it runs in a just-in-time fashion, and that’s not OK. Too much manufacturing does not occur in the United States to conduct basic healthcare services. In the case of many drugs, for example, there’s only a 30-day supply of most chronic disease medications all the way from your pharmacy back to the manufacturer. There must be more flexibility in that supply chain as well as a cushion safety stock. We need more onshore manufacturing. Second, we need to see manufacturers, distributors, and healthcare facilities invest in safety stock up to 120 days. We cannot let healthcare, particularly with these basic items, be a completely just-in-time delivery model. That’s what’s hurt us here.

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About Greg Burel

Greg Burel is the former Director of the DSNS and was a member of the Public Health Emergency Medical Countermeasures Enterprise Executive Committee. He is also a winner of the Service to America medal, Fellow of the National Academy of Public Administration, and a Franz Edelman Laureate.

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This article is adapted from the GLG’s March 23 teleconference “COVID-19: Federal, State, and City Response.” If you would like access to this teleconference or would like to speak with Greg Burel or any of our more than 700,000 experts, contact us.

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