All Hands-On Deck and All Decks on Hand: Surmounting Supply Chain Limitations During the COVID-19 Pandemic

Abstract

Testing during the COVID-19 pandemic has been crucial to public health surveillance and clinical care. Supply chain constraints-spanning limitations in testing kits, reagents, pipet tips, and swabs availability-have challenged the ability to scale COVID-19 testing. During the early months, sample collection kits shortages constrained planned testing expansions. In response, the University of Vermont Medical Center, University of Vermont College of Medicine, Vermont Department of Health Laboratory, Aspenti Health, and providers across Vermont including 16 area hospitals partnered to surmount these barriers. The primary objectives were to increase supply availability and manage utilization. Within the first month of Vermont's stay-at-home order, the University of Vermont Medical Center laboratory partnered with College of Medicine to create in-house collection kits, producing 5000 per week. University of Vermont Medical Center reassigned 4 phlebotomists, laboratory educators, and other laboratory staff, who had reduced workloads, to participate (requiring a total of 5.3-7.6 full-time equivalent (FTE) during the period of study). By August, automation at a local commercial laboratory produced 22,000 vials of media in one week (reducing the required personnel by 1.2 FTE). A multisite, cross-institutional approach was used to manage specimen collection kit utilization across Vermont. Hospital laboratory directors, managers, and providers agreed to order only as needed to avoid supply stockpiles and supported operational constraints through ongoing validations and kit assembly. Throughout this pandemic, Vermont has ranked highly in number of tests per million people, demonstrating the value of local collaboration to surmount obstacles during disease outbreaks and the importance of creative allocation of resources to address statewide needs.

Keywords: COVID-19; inventory management; pandemic; specimen collection kits; supply chain.

Figure 1.

(A) Timeline of specimen collection kit production in response to COVID-19 pandemic: events leading to and resulting in the preparation of COVID-19 specimen collection kits at University of Vermont Medical Center (UVMMC) in conjunction with significant Vermont COVID-19-related events. (B) A focus on events occurring in late March that allowed for the production of COVID-19 specimen collection kits.

Figure 2.

Process maps for specimen collection kit production to include the steps to produce and distribute specimen collection kits during use of viral transport media.

Figure 3.

COVID-19 specimen collection kit assembly within the pathology conference room. (A) A photograph of specimen collection supplies and assembled kits within the first few months of COVID-19 pandemic response. (B) A photograph of COVID-19 specimen collection kit assembly instructions. This poster, which was housed at the site of assembly, was used in lieu of protocol development.

Figure 4.

Process maps for specimen collection kit production to include the steps to produce and distribute specimen collection kits during use of saline.

Figure 5.

Process maps for specimen collection kit production to include the steps to produce and distribute specimen collection kits during use of externally sourced automated liquid handling system.

Figure 6.

On-hand distribution specimen collection kit normalized by the last study date. The distribution delineates between New York and Vermont hospital distribution. A minor portion of specimen collection kits were housed at affiliated New York hospitals.

Figure 7.

Distributed collection kits by type: external media kits (those with and without swabs; blue); in-house, College of Medicine (COM)-made viral transport media (VTM; green); in house, UVM-made phosphate-buffered saline (PBS; orange); and commercial PBS (red).