key: cord-0828950-wd55fmaw authors: He, Shuhan; Bala, Ram; Anupindi, Ravi; Ranney, Megan L title: Effective supply chain surveillance for PPE date: 2021-05-06 journal: Lancet DOI: 10.1016/s0140-6736(21)00783-2 sha: 56c2ba6ff7d55a3cac3c2d655ac196acf2827e20 doc_id: 828950 cord_uid: wd55fmaw nan longterm effects of COVID19. The expert advisory panel for developing the NICE-SIGN-RCGP guideline had 23 members who contributed substantial clinician and patient experience to discussions. 2 Two stake holder consultations were held and the guideline was adapted in response to feedback from patientled, health, and care organisations. This adaptation included the addition of a table of commonly reported symptoms. The panel heard evidence from clinicians and patients who felt that symptoms were not taken seriously. A need for detailed assessment of all symptoms and their overall effect on a patient was emphasised. We stressed the need for timely referral and investigation and for the development of individualised treatment plans. We reject Gorna and colleagues' 1 suggestion that we overly focus on selfmanagement. The panel's rationale for the term post COVID19 syndrome is to reflect that the acute phase of the illness has ended, and that the ongoing illness includes a wide range of symptoms that might not have been evident during the initial infection. Patient feedback raised the concern that the term long COVID implied ongoing infectivity, for which there is no evidence. The panel did not consider that there was adequate existing evidence to propose under lying mechanisms for postCOVID19 syndrome at this time. Research recommendations were made relating to the urgent need for mechanistic studies and clinical research into best investigative and treatment approaches. The guideline will be continually updated as such evidence becomes available. WS A key impediment to increasing the supply to meet this demand is reliable data on nationwide needs. 2 Reliable forecasting models could help provide information to more accurately scale PPE production, set expectations for healthcare facilities on bidding and pricing, and enable appropriate deployment of resources, such as funds from the Coronavirus Aid, Relief, and Economic Security Act (2021). 3 However, predictive modelling of needs for key necessities during public health disasters are largely non existent. To the best of our knowledge, the most comprehensive publicly available data has been the Get Us PPE shortage index, but it is an incomplete and nonrepresentative picture of national PPE needs within the USA. 4 We recommend the following framework to better inform crisis response for inevitable future public health disasters. First, there is a need to aggregate demand data. Similar to a strategy to estimate incidence of injuries in emergency departments, data should be collected from a representative sample of healthcare institutions (eg, acute and nonacute care facilities and clinics) where PPE is necessary. 5 Key data elements and a comprehensive humanitarian data dictionary should For Get Us PPE see https://getusppe.org/ issues as CICP does not have the ease of access to, and levels of compensation provided by the US National Vaccine Injury Compensation Program available at normal times, exacerbating long standing inequities based on income, race, and ethnicity. 3 Japan has a longestablished no fault compensation scheme for people who have adverse drug reactions from vaccines or drugs. The vaccine health damage relief system (a nofault compensation scheme authorised by the Immunisation Act of 1976 is managed by the Japanese Ministry of Health, Labour and Welfare (MHLW) and prefectural governments. 4 Between February, 1977, and December, 2019, 3419 people were certified by the MHLW. 5 In fiscal year 2019, the MHLW received 134 health damage relief claims of which 88 were certified; the annual MHLW budget for these claims in 2019 was US$10·8 million. 5 Japan is unique in that it has a no fault compensation scheme for drugs financed mainly by contribution from pharmaceutical companies. France, Germany, New Zealand, Taiwan, Denmark, Norway, Sweden, and Finland have similar systems. 6 In Japan, the scheme for drugs was introduced in 1979 and is authorised by the Pharmaceuticals and Medical Devices Agency (PMDA). 7 In fiscal year 2019, the PMDA received 1590 relief claims, 1285 of which were certified, and US$22·6 million was paid within the same fiscal year. 8 The COVID19 pandemic presents an opportunity not only for vaccines, but also for covering drugs under nofault compensation schemes. YF be developed and redeployed in future scenarios (appendix). Second, there is a need to aggregate supply data through periodic reporting by manufacturers and incentivised by a federal procurement commitment when a crisis occurs. The Drug Supply Chain Security Act (2013) provides a template for a track and trace programme using a unique serial number that can then be used to develop aggregated estimates. Third, we recommend using the collected data to project supply and demand trends over time. Integration of COVID19 incidence rates, use of PPE by institution type, and supply available at representative institutions will help us forecast gaps. Integration of susceptibility indices that include socioeconomic and racial equity indicators ensures that the groups who are at high risk of being exposed to COVID19 are prioritised for PPE distribution. Finally, we need to drive action. Forecasts should have a clear call to action with predetermined bench marks for supply chain preparedness and response, including activating the Defense Production Act (1950), offering large contractual commitments for PPE, and activating a designated national digital clearing house for PPE similar to how Get US PPE currently functions. To our knowledge, no model cur rently fulfills this framework. Our framework enables the collection of appropriate data and the development of relevant live models that can inform PPE allocation during any future public health crises. SH Nofault compensation schemes for severe adverse events can help build confidence in vaccine safety after marketing. 1 25 of the 194 WHO member states have implemented such nofault vaccine injury compen sation programmes. 2 Although the USA is covering COVID19 vaccineassociated adverse events with the US Counter measures Injury Compensation Program (CICP) for the duration of the public health emer gency declaration, the country is having challenging Wrong but usefulwhat COVID19 epidemiologic models can and cannot tell us An impactoriented approach to epidemiological modeling As COVID19 cases surge, health care workers say PPE is still a struggle US Consumer Product Safety Commission. National electronic injury surveillance system (NEISS)