One year ago this month, we began to understand the reach of COVID-19. This is part of a periodic series at HopkinsAllChldrens.org/Stories on various ways the pandemic has made an impact.

In the glimmer of moonlight, the 53-foot semi-trailer glides through the gates of the loading dock area of Johns Hopkins All Children’s Hospital and backs up to the platform to unload.

It is 1 a.m.

While most are slumbering, for the hospital’s Supply Chain, this is how the day begins.

The Medline truck carries the hospital’s lifeblood — its main source of supplies to care for sick and injured children. But while the deliveries themselves have been consistent over the last year, what’s inside those trucks has been something less than predictable …

From Normal to Not

In “normal” times, supplies for Johns Hopkins All Children’s Hospital remain relatively constant. Like clockwork, items are ordered, delivered daily and unloaded into the efficiently sized basement warehouse, then shuttled into the labyrinth of meticulously organized supplies to be distributed throughout the campus.

“It’s everything you can imagine,” Supply Chain supervisor Susan Henry says.

“From diapers to catheters to surgical implants to IV dressings to needles to wash basins. We are the hub of everything.”

Keep in mind that a decade ago, when the new hospital was constructed, it was designed with best practices in mind with regards to “just in time” inventories — keeping only needed supplies on hand so that goods didn’t pile up and potentially expire on shelves.

Johns Hopkins All Children’s has always kept supplies for hurricanes and even a reserve of pandemic supplies deemed appropriate for the times.

Then, last March, as the fullness of the crisis of COVID-19 became real here and around the globe, everything changed.

“Nothing compares to this,” says Anna Stratigos, senior director of Facilities & Support Services Operations.

“Nothing ever, ever.”

As health systems worldwide began to assess needs regarding potential shortages of personal protective equipment (PPE) and other items, the Supply Chain team at Johns Hopkins All Children’s sprang into action.

There was tremendous uncertainty, but what quickly became clear is how the team would need to pull off the near-impossible. To locate and secure items that are precious to the mission. Supplies that everyone else in the country and the world happened to be competing for as well.

What was ahead? The need to work every angle to exhaustion, to tap every resource, to cultivate every new relationship possible with vendors and to leverage existing ones.

Kids were counting on them.

Hurdles

Early on, Support Services business manager Zac Burchfield, not one to shy away from a good spreadsheet, created a working visual of the critical items being used, as well as their burn rate, so supply levels could be assessed and shared with the Incident Command Center in real-time.

“We’ve continued to try to balance the demand for supplies with those we can actually get,” Burchfield says. “The measure of a good day is when we know our staff has what they need, and that they’re taken care of.”

But in a pandemic that charts its own course and seems to have a life force with no respect for the human toll it’s taking, the hurdles for the Supply Chain team would be enormous.

While Johns Hopkins All Children’s has been fortunate not to have received the flood of patients with COVID-19 that adult facilities have, the worldwide shortages have still resulted in a stunning impact on operations.

Among the first and most immediate challenges for Johns Hopkins All Children’s would be one of the most essential — hand sanitizer.

Where to get hand sanitizer in a world where there suddenly wasn’t enough?

The team had to get creative — and fast. Could the hospital make its own? That didn’t prove to be the best option.

The answer came when team members knocked on the door of a Tampa distillery.

Dark Door Spirits was not only focused on making vodka and gin. … They also happened to have an approved process for making hospital-grade hand sanitizer. Could Johns Hopkins All Children’s make this deal work?

It was worth a try.

The first samples came in super-sized 750 milliliter bottles — bottles which, in another life, might have been filled with a finely crafted whiskey.

The wheels were put into motion, the new solution was tested and approved, and a deal was struck.

“Within three weeks, we had a product,” Stratigos says. “We were jumping for joy!”

Related hurdles remained. The sanitizer still had to be bottled appropriately. Employees from various departments helped to gather bottles and wash and refill them. A new production line was created to meet a critical need, until the distillery was ultimately able to take over the bottling and labeling. New brackets went up for new bottles, and the issue was resolved.

Surface disinfectant wipes were also in short supply in the early months of the crisis. Environmental Services stepped up to provide a production line to make new wipes, and to bottle and store them.

Then there were the N-95 respirators …

In no time, the global shortage could be felt everywhere. Current vendors’ hands were tied. The Supply Chain team would have to forge new relationships with companies they had not dealt with before. And the respirators would all have to be approved and fit-tested to each individual.

The team worked from a list of vendors approved by the Florida Department of Health and made some headway. But seeking new vendors who could deliver often proved to be futile. Certain items would appear to be available, orders would be placed and the products would reveal themselves to be back-ordered, or the order would be cancelled altogether.

In the ensuing months, between donations, the cultivation of other channels for supplies and new alternatives, the N-95 respirator challenge slowly began to improve. As experts learned more about the virus, regulatory protocols adapted to new knowledge. Guidance that allowed for the re-use of N-95 masks in non-aerosolizing procedures, as an example, proved helpful to conserve the supply.

In late summer, another conundrum. The Supply Chain team learned the hospital would no longer be receiving the type of isolation gowns that they had always used. The isolation gown shortage mirrored what was happening everywhere. COVID-19 was impacting manufacturing — not just of pandemic-related items, but of all kinds of medical supplies and components that were made and shipped around the world.

The gowns available instead were made of a polyethylene material, with a plastic quality to them — less breathable and less popular. Fortunately, within a month, the team pulled out all the stops to help secure the original softer isolation gowns that are better suited to the tasks of a children’s hospital.

The year would unfold like a massive game of “whack-a-mole,” with challenge after challenge. As soon as one problem was resolved, another would pop up.

But in what some have labeled the “Hunger Games” of PPE playing out around the world, being a part of Johns Hopkins Health System (JHHS) has perhaps made the biggest and best difference.

JHHS has assisted with resources and options to help proactively manage and resolve tough supply challenges brought on by the pandemic. The support included sending trucks of N-95s, gloves and other PPE to Johns Hopkins All Children’s when they were unavailable through suppliers.

In late 2020, JHHS was listed in the Gartner Healthcare Supply Chain Top 25, which recognizes organizations that advance health care by improving outcomes while controlling costs.

“We’re really fortunate here, as part of a prestigious health system with the reputation and the contacts and the relationships with vendors,” Burchfield says. “While there are still challenges, we’re in one of the best situations.”

The pandemic continues to impact central distribution, as staff work tirelessly to keep up with the flow of new products and a maze of contingency plans.

“We’re three times as busy,” Henry says, “just keeping all the pieces in place.”

Beyond the heroic pace is the mental burden — the burden of not knowing what’s going to happen next. Not knowing whether COVID cases will wax or wane at any given time, not knowing whether regulatory advice will change and present new challenges, not having a crystal ball to determine what far away manufacturer will finally have to shutter its doors to the crisis — and what shortages may result.

“We’ve gotten into a groove,” Stratigos says, “knowing that we can never let up.”

The new groove is — there is no groove.

It may be early yet for “lessons learned,” but one thing team members can point to of lasting value is the new level of communication at the hospital. While departments can become somewhat siloed day to day when things are going smoothly — the pandemic has prompted the team to collaborate in a whole new way.

Supply Chain has always communicated with Occupational Health, with Infection Prevention, with Environmental Services, and many others to make the hospital the best it can be.

But now the quality of the conversation has changed.

“Will we look back and say, ‘Wow, that was a crazy time’?” Burchfield says. “Or will we say that was when everything changed for the better?”

Both may be true.

Unwritten

The COVID-19 pandemic is not over.

This story is still being written.

But spring is coming.

What is remarkable in the face of the scope of this crisis is how, throughout the last year, the mission held.

Supplies continued to get where they needed to go. Professionals kept their calm and the smile beneath their masks.

Children were treated and cared for. There was healing on every floor.

It’s what this hospital has always done.