China typically does not solicit foreign aid, and Direct Relief typically does not donate to hospitals. So when the head of the largest hospital in Wuhan, China, got on the phone to ask for supplies from the Goleta-based humanitarian aid organization, Direct Relief President and CEO Thomas Tighe instantly understood the urgency of the coronavirus outbreak.
A medical provider of last resort, Direct Relief has responded to crises caused by disease and disaster from Ebola in West Africa to wildfires right here in California, all the while cementing a reputation for dependable competence. They also warehouse supplies and provide service to Santa Barbara County (as an act of courtesy without a contract).
Since February 1, Direct Relief has delivered 69 shipments of requested medicine and medical supplies — including masks, gowns, gloves, and thermometers — from its own inventory to 27 health-care recipients in Santa Barbara County. In the past two days, it has delivered over 111,000 N95 masks and 1,000 face shields to Cottage Health, as well as 13,000 procedure masks to both Cottage and Marian Regional Health Center.
Direct Relief donated personal protective equipment (PPE) like masks and gowns to Wuhan, the origin of a now-global pandemic, but after a couple of weeks, Tighe said, “We told them we need to preserve our inventory to fulfill our obligations here in the [United] States.” At this point, the federal government still had not set aside funds to battle the outbreak.
As Tighe explained in an interview with the Santa Barbara Independent about Direct Relief’s response to the COVID-19 pandemic, one way of understanding the organization he leads is that it fills the gaps — as best it can — for those who are not protected by institutions like the market economy or the government. Unfortunately, the novel coronavirus has revealed that gaps may be chasms.
In our interview, Tighe touched on the unique challenges posed by the COVID-19 pandemic. The following answers have been edited lightly for length and clarity.
On Direct Relief’s approach to the pandemic:
One of the things we learned during the Ebola outbreak is that all the attention was focused on Ebola in West Africa, and as a result there was very little attention on anything else. A consequence was a near-collapse of primary-care services at the hospital for things you can’t defer, like women giving birth, a broken leg, or cancer treatment. Hospitals became infectious-disease wards. Unmanaged chronic diseases — hypertension or diabetes or asthma — can become crises themselves, so that will push people into hospitals.
What we’ve been doing and what we normally do is make sure the frontline community health centers that serve low-income people have the wherewithal to continue operating … at a time when we don’t want people going to the hospital.
For us it’s been [about] maintaining, bolstering, [and] supporting the primary-care nonprofits. We’ve distributed PPE to all 50 states. [We’ve sent] PPE to hospitals that were seeing clusters initially, which were Seattle, New York, L.A. [And we’ve been] backing up the state of California and working with the County of Santa Barbara.
On navigating the global supply chain:
We’ve drained out our preexisting inventory, but we’ve been trying to acquire additional resources along with everyone else in the world. We had our own purchasing arrangement before COVID-19 ever appeared where we could buy our own NIOSH-approved N95 [masks], we had an order in for a million and a half that was deferred, so we’ve been trying to keep that channel of PPE that we’ve been accustomed to.
We’ve received contributions from 3M and other companies like Home Depot that had 35,000 masks they made available to us as a donation. So we’ve been able to keep the flow of materials going at a modest level hoping that some of our preexisting contracts and other large-scale efforts will address this crisis of PPE throughout the states. We’re set up well to support community health centers in all 50 states; we’re trying to adjust to gear up to address increasing requests from hospitals to help to the extent that we can.
FedEx has been a great corporate partner for years. The past three weeks, they have made over 4,200 deliveries at no charge to all 50 states. That includes both PPE and medications that are typically for low-income, uninsured patients at community health centers. That’s what we’ve always done. We thought that was important. As everything was contracting, we would accelerate what we were doing for as long as we could. FedEx has allowed us to overextend what would be our normal allocation of a grant.
We’ve been able to do more in the past three weeks than at any time in our history in terms of the volume of our activity. The challenge that we and others are facing is supply availability, especially for PPE. Global demand has spiked at the same time there’s been a contraction in supply because China stopped its exports for several weeks which has now resumed. So you have a huge backlog and bidding wars among people who are desperate for the same items, most of them made in China.
On the importance of human behavior:
The main lever that public agencies have pulled is stay at home, shelter in place. The question is if it’s working. [Direct Relief] scientist Dr. Andrew Schroeder has been really involved with a COVID-19 mobility consortium of researchers and experts that have been looking at anonymized location data that comes from Facebook and other sources to see on a county-by-county or city-by-city level if people are staying put or not. They’ve been working with the state, tech firms, Harvard, Berkeley and other places … to get a proxy of whether people are staying put or traveling.
The good news is that social-distancing policies do seem to be having a significant effect on people’s mobility. They are measuring how far or how frequently people go. They can see how many people on a county-by-county basis are staying put relative to the baseline of the last couple weeks of February. It doesn’t say who is not staying put. One of the research questions is: Are there certain subsets of people who are not, and why is that so? Should there be some tweaking or some additional instruction, different language so the policy is penetrating to people to keep them safe?
On the social safety net:
The old axiom is that emergencies — whether it’s Hurricane Maria or Hurricane Harvey or Hurricane Katrina — expose vulnerabilities that were already there. The issue of public health, who is responsible for public health, and what resources are devoted to public health has exposed some real shortcomings. Who is responsible for it at the state, local, and federal levels? What is involved in those roles in particular? How do we mobilize resources rapidly and coherently in a very wealthy country that does things like distribution as well as they have ever been done in history?
I don’t know what the fix is; you need diagnosis before treatment. Had we had a better stockpiling process, had we had better notifications, had we moved more aggressively and coherently at a national level, not just state and local, would it have made a difference? A lot of good things will come from [diagnosis], I hope.
It’s almost always true that the people who are most vulnerable have the least money, have the least voice, and don’t have the options that others do. Making sure that the safety net for our communities is stronger is always a takeaway.
The people vulnerable in an emergency were vulnerable before the emergency. Look at the homelessness crisis in California. It was on everyone’s consciousness, but now it’s become really clear that people that are living on the street are particularly vulnerable to viral transmission because of their living conditions and their health conditions.
On the influence of Santa Barbara:
We have all these great ingredients here in Santa Barbara that don’t always exist everywhere else. It’s not just a government-focused effort; it’s a community effort like the Bucket Brigade epitomized after the mudslides. They were a startup group that did very good work driven by committed leadership and very good people. That is the type of thing that makes a difference that doesn’t show up in anyone’s forecasted plans for who is going to be active and play a role in emergencies. Sometimes these startups end up being the most noble, the most insightful, and the most capable.
We all live here, and that’s the closest physically and closest to our hearts. Everything we’ve learned about how things might be done or how we approach community health centers in other areas is based largely and initially upon how it works here in Santa Barbara. We have a very fine hospital system with Cottage, but in a wealthy community where not everybody is wealthy, it is important to have an equally fine primary-care nonprofit organization like Santa Barbara Neighborhood Clinics. The fact that we have started what’s now a 50-state program working with thousands of community health centers started because we were working with the Santa Barbara Neighborhood Clinics.
Every community is different, but they have a lot in common. There is wealth and poverty in many, and there are strong institutions that everyone knows about and quieter institutions that everyone doesn’t know about. I always thought that you should never try to do anything in another state or another country unless you can do it in your own town. If you are not good at medical distribution in your own country, don’t try to do it in Africa.
Any time you do anything, it’s local to somebody. We are there to support the local, not to intrude or impose anything.
On the relationship between government and NGOs:
There’s a lot of public service, and a lot of people who want to work in public service find their way into the nonprofit sector. Direct Relief is an example of public service that is done privately. It’s government-like in its purpose, but it’s business-like in its function, and I think that it’s a trend that is not new, but the trend seems to have been going on for a long time.
The government as a direct provider of services still exists in a very strong way in things like the operational public agencies like firefighting, law enforcement, and armed forces. They are very good in emergencies. They do very well in chaotic times that require operational adjustment because they are operational organizations.
Many of the other agencies are advisory, regulatory — they are financing organizations, but they are not providing services directly. Forty or 50 years ago, health services would be provided by state-run facilities or county-run hospitals and clinics. The government still funds those activities and regulates them, but it doesn’t do them. That trend is fairly well in place and likely to continue. This may cause a rethinking of whether or not there needs to be a revisiting of what government should do directly and what they should oversee and arrange, but that remains to be seen. It would be the reversal of a fairly strong trend over the past few decades.
Certainly, at the national level, whatever your belief is about the role of government and how expansive or lean it should be, everyone is for government working well. What they do, they should do really well, including public health, including emergency response preparedness.
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