Innovative Practice and Supply Chain Resilience during COVID-19 Pandemic: A case study in Thailand
Since its outbreak in Wuhan, China in December 2019, the novel coronavirus disease shortly known as COVID-19 has been spreading to almost every part of the world. WHO declared that COVID-19 is a global pandemic and has caused so many issues and challenges. Without an exact cure, the situation depends more on medical supplies, especially for those health professionals who stand in the front line. Thailand is one of the countries that face the pandemic and the issues of the non-drug supply chain, and there was no system available to handle the issues. Therefore, after going through many works and with cooperation across both private and public sectors, the SmartMedSupply platform was introduced. This chapter aims to provide the details of how this SmartMedSupply platform was designed, developed, and implemented. The major contribution is the integration of the information across 6 systems plus Business Intelligence (BI), where the data was centralized and shared among the stakeholders to support decision making. Consequently, the SmartMedSupply platform helps to balance the demand and supply of medical supplies to achieve maximum benefits and is an innovative practice using COVID-19 as a case study that can be a lesson learned for future trends of integrated supply chain and emergent situation. Finally, collaborations among stakeholders are a must. In this kind of situation, both government and private sectors along with the research team need to build good cooperation and support, and the roles of each stakeholder need to be identified.
COVID-19, logistics management system, supply chain management, medical supplies, SmartMedSupply platform
The outbreak of the novel coronavirus disease 2019 (COVID-19) is a global issue. This public health emergency has affected many countries around the world in terms of global economics, international relations, etc. Besides, under this pandemic situation, the world also encounters many problems and challenges in supply chain management, where the demand and supply of both drug and non-drug pharmaceuticals are imbalanced. Without any immediate medical treatment, during the early pandemic situation, non-drug supplies were highly needed. Those non-drug or medical supplies include alcohol sanitizer, surgical mask, face shield, personal protective environment (PPE suit), equipment for healthcare professionals, and other medical equipment.
Thailand is one of the countries that suffer the effects of COVID-19, and one of the concerning emergencies was the shortage of those medical supplies. Although supply chain management is a key factor to cope with the issue, a logistics management system does not exist. During the early pandemic stage, Thailand and so many countries confronted many of these logistics and supply chain management matters including medical supplies shortage, demand-supply imbalance, and inventory control challenges among hospitals and health facilities throughout the country. The arose of these problems initially happened when logistics management of those medical supplies was under the control of the government procurement and donation acceptance, where supplies must be accepted by the Ministry of Public Health (MoPH) before distributing to hospitals and other health facilities. This procedure, however, was considerably slow and ineffective to cope with the emergent situation. Besides, proper logistics management system is not available to check and update the information of the distribution processes. Track and trace could not be updated in a fast manner since the procedure are done manually. Moreover, information was not properly centralized and shared which affects work performances, time, and money.
Base on observation of all encountered problems and challenges related to supply chain management, an empirical study regarding integrated supply chain management under the pandemic crisis was conducted leading to a development and implementation of a new supply chain platform using information technology to support the logistics management system and having COVID-19 as a case study in Thailand. Consequently, the SmartMedSupply platform was developed as a new system that supports the logistics of medical supplies throughout Thailand. In this chapter, the SmartMedSupply platform will be introduced in detail.
2. Overview of the Literature
2.1. Challenges and Immediate Actions
Coronavirus disease 2019 (COVID-19) has caused server disruptions across the world supply chain, particularly in the healthcare supply chain. Since there is no exact medical treatment, medical supplies are urgently in need in different parts of the world. This problem created big supply chain management challenges such as demand shocks, supply shortage, demand-supply imbalances, inventory control, etc. These challenges put a lot of concerns not just to reduce the outbreak but also to protect the health professionals who are the front-line people with a high risk of infections. “Without secure supply chains, the risk to healthcare workers around the world is real. Industry and governments must act quickly to boost supply, ease export restrictions and put measures in place to stop speculation and hoarding. We can’t stop COVID-19 without protecting health workers first,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. Therefore, WHO urged the industry and the government to escalate medical supplies manufacturing by 40 percent to cope with urgent global demand. Early April 2020, the United Nations (UN) initiated a project named COVID-19 Supply Task Force in collaboration with the World Health Organization (WHO) and World Food Program (WFP) to manage the supply and delivery of personal protective equipment (PPE), test and diagnostic equipment, respirators, and oxygen concentrators to various countries (Bauchner et al., 2020). Besides, a project of COVID-19 Supply Chain System to service data management of the needs for medical supplies, procurement, allocation, and distribution to various organizations having Centre of Disease Control acts as a coordinator to check and verify order requisition, allocate the currently available stock, seek out suppliers who can manufacture, and distribute to destinations with cooperation from different organizations.
In the past, challenges addressing the 2009 H1N1 flu pandemic were derived with difficulty in forecasting supply and demand for respirators and N95 masks due to the uncertainty of the outbreak and the complexity of the supply chain stated by the Association of State of Territorial Health Officials, 2010. Lesson learned from dealing with the pandemic of H1N1 flu in 2009 and responses to the outbreak of Ebola in 2014 indicated the need to improve the coordination and cooperation throughout both public and private sectors to design strategies and action plans to supply and usage of medical supplies (Fiore et al., 2010). This can lead toward a balancing of supply and demand during the pandemic situation and help improve the mobility of medical supplies allocation, resulting in effective responses to the outbreak to be better by proposing strategies for managing medical supplies (Patel et al., 2017). Those strategies include:
– To follow up the usages and distributions of medical supplies by developing the system to trace procurements, usages, and distributions to achieve the highest efficiency to respond to the outbreaks.
– To prepare Centralized Visibility used for tracing procurement that helps manufacturers to distributors to see the changes of needs for real usage, leading to better planning in producing and distributing more efficiently.
– To share medical supplies between health facilities located closer to each other.
– To update the Just-In-Time Supply system to create flexibility to respond to demand volatility for medical supplies during the outbreaks.
– To level up manufacturing capability to be flexible to the changes in demand.
– To exchange information and communicate regularly between related departments.
Allocation of medical supplies that is suitable to the pandemic crisis is necessary and is one of the ways that is proposed to cope with the outbreak of COVID-19. Four ethical values must be considered including the use of existing limited resources for maximum benefit, equal treatment of patients, focus on value to the people who use the device and make the most out of it, and focus on those minorities (server patients and patients at the lowest age).
2.2. Available technologies responding to medical supplies issues during COVID-19
To cope with problems related to medical supplies during the early pandemic stage of COVID-19, there are some technologies made available. Table 1 listed four counties with their technologies in responding to COVID-19.
Medical supplies channels in different countries during the COVID-19 pandemic
Mask Map Thailand
Mask Map Thailand provides information related to the quantity and price of the facial mask in real-time. This application indicated some concerns: increasing price of the mask, limited mask in the market, hoarding mask, etc. It acts as a map showing the amount of mask, location of selling shop, and price in real-time that can be accessed via https://maskmapthai.web.app/. The information is shown in the map referenced from Internal Security Operations Command, and everyone can register to help update the information. This platform eases the people who need to buy the masks.
It is a website collecting all the information of the needs and aids of medical supplies. It was developed by Nok Hook Group to service the information of the needs of medical supplies necessary for doctors to the public so that they can provide support or donation. InfoAid can be accessed at https://www.infoaid.org/, with a database collected from 20 foundations throughout Thailand.
This is a platform using the Line application to follow up COVID-19 situation. It was developed by MAPEDIA with 5 main functions: 1) notification when entering closer to the risky locations with the number of affected people, 2) routing to COVID-19 site, 3) Current statistics of the number of affected people, 4) Donate/Accept medical supplies as the connection between people who wish to donate mask and alcohol gel to hospital in needs, and 5) shops with available medical supplies. It can be accessed and registered to add Line friend at https://lin.ee/aiQ8lsq.
This is a website developed by Thai technicians to provide updated information from the hospital that has a shortage of medical supplies located throughout Thailand. It only provides the information of the needs, so that people who wish to donate can provide the support directly and accordingly.
It is an application used for checking mask availability in real-time. It is helpful and responsive to those who are looking to buy masks in Taiwan. It presents the shops on the map where masks are available for sale, and buyers can communicate directly with the sellers via the application to avoid waste of time and risky areas.
It is a website opened for the donation of PPE for emergent needs in the United States. It can be accessed at https://getusppe.org/, allowing civil people and suppliers who wish to donate PPE to contact and provide straightforwardly to the site they preferred.
It is a website used for seeking the units where masks are needed. This is supportive to those who need the masks can request the order then the donor can contact conveniently to the right requisition.
It is a company that develops a small sensor used at the sleeping bed to oversee the sleep, pulse, and other movements to assist medical staff to monitor patient symptoms. It is being used in Israel.
It is a technology that was developed and used for sending foods and medicine utilizing flying drones.
Besides, some available information technologies support logistics management in addition to the channels of medical supplies listed above. The use of this information technology system can support decision-making, improve work efficiency, support warehouse management, gather data and information automatically, and improve the transportation system.
2.3. National Medicinal Product Catalogue Database (NMPCD)
Health expenditures in Thailand have been increasing yearly, and one of the fundamental reasons is the fragmented supply chain where the foundation for standard data and standard data exchange is missing. Seeing this pain point, the National Medicinal Product Catalogue Database (NMPCD) was developed as the database system, collecting information and different feature of medicines available in Thailand. This database system can connect medicinal information and standard codes with relevant data that have been used in different departments for different purposes. NMPCD is a part of a research work conducted to design and develop a logistics infrastructure system and initiate data integration to establish big data, moving toward a digital economy of Thailand. NMPCD was studied focusing on three major foundations: (1) gathering medicine information codes such as medicine 24 digits, TMT code, and GTIN-13 (barcode), (2) mapping different medicine codes – between 24 digits with TMT and between GTIN-13 with TMT, and (3) controlling dissemination of medicine codes and mapping, which is stored in the MMIS system of the hospitals that can also link to the track and trace system and Business Intelligence (BI).
Figure 1. Structure of NMPCD
In the NMPCD database system, more than 25,000 drug items were collected with various standard codes, and data relationship was made in two ways: manual mapping and semantic mapping as shown in Figure 2. While semantic mapping relies on a system to associate the information using semantic principles and confirms the correctness of relationships, manual mapping requires pharmacists who have knowledge and expertise in medicine to associate and confirm the correctness of relationships.
Figure 2. Model of database relationship
Data dissemination of the NMPCD system can be done in three ways: website, application program interface (API), and excel file upload. The major contribution of this system is the central codes that help communicate between various computer systems to correctly identify the products although different units have different drug codes and names. Consequently, this linkage allows different systems and data to work synchronously with each other.
After reviewing all the available platforms and technologies used as an immediate action to cope with COVID-19 outbreaks as well as the experience in designing and developing the National Medicinal Product Catalogue Database (NMPCD), the SmartMedSupply platform was developed. While the conceptual framework of the studies is available but excluded, this chapter will introduce the details of the platform and how the platform works.
3. Design principles and technical details of smartMedSupply platform
As stated above, COVID-19 outbreaks caused so many problems and challenges, and those encountered issues are mainly related to drugs and medical supplies such as demand shocks, supply shortage, demand-supply imbalances, inventory control, etc. In Thailand, these supply chain and logistics issues caused so much pain. Even though there are supplies through the government procurement budget and donations, the issue of demand-supply imbalances still exists because of the lack of a track and trace system as well as centralized information.
SmartMedSupply Platform was introduced having a combination of a total of 6 systems together with Business Intelligence (BI) processing system as illustrated in Figure 3.
Figure 3. Logistics system of SmartMedSupply platform
From Figure 3, design principles and technical details of the platform can be explained starting from receiving information of product/item (Supply) from procurement of the government budget and/or donations through the web page. Information of medical supplies and the quantity are fed to the webpage with item catalog available from Product Catalogue Database to ease the users. After that, the system will collect all needed information and send it to Virtual Stock for the allocation process. Then the information is sent to Matching System to match demand and stock availability, and allocation through this matching is based on emergent needs and other criteria of the outbreak as well as the hospital itself. These considerations are to make sure to balance the supplies with the real demand needed. In the process, the system will analyze and allocate the stock associated with the demands from the hospitals that were collected from Order Management System, where the hospitals input the demand information. After that, the system works according to the logarithm to match the demand and stock with considerations of the number of patients, numbers of health professionals, available in stock, level of use, and level of severity, etc. As a result, a worksheet with details of allocations regarding, items, destination, quantity, where then the virtual stock will be cut off and updated, and the information is then sent to the Tracking System to announce to the Thailand Post Distribution (THPD). As the distribution company begins the process, the tracking number is available for the hospitals through Order Management along with the confirmation of delivery (ASN). The hospital can use the tracking number to check the updated status of delivery, and when the delivery is received by the hospitals, the information will be updated to the Tracking System so that the stock will be cut off and updated in the Virtual Stock system.
3.1 Product catalog database and hospital master database
The principles of non-drug pharmaceutical code structure are taken by the ATC drug code and TMT drug code. The advantage and strength of the ATC drug code are that every element of the code can be interpreted. For example, A10Ba02 is an ATC code for Metformin, where A refers to the Alimentary tract and metabolism, A10 represents drugs used in diabetes, A10B refers to Blood glucose lowering drugs, excl. insulins, A10Ba is the Biguanides, and A10Ba02 together is Metformin. The design of the non-drug code structure in the product catalogs system is taken from the running number principle to make it easier to retrieve and for the convenience of adding more information to the system. Thus, each medical supply code is made to be able to group the medical supplies to ease the usage. Thus, the structure of the non-drug supply code was designed using the concept of this relational database system. A detailed study of the lists of medical supplies is obtained from the Ministry of Public Health (MoPH). It is found that the list of non-drug supplies was distributed according to brand. Therefore, two concepts were proposed having the combination of each brand of non-drug supplies in the same category (type) to provide ease at use and the combination of different types of those medical supplies into category (group).
Besides, the hospital master database system was developed as a database that compiles general information between the hospitals and health facilities with the cooperation of the principles from the database of the MoPH. Besides, information from the MoPH can be used to design a system that enables the addition of different units/facilities at different levels of the hospital in response to allocation and support from the government in the distribution of the non-drug supplies. To respond and support the operation of the system, the details available include the use of hospital code having 5-digit numbers that are used as central information to connect, run, and retrieve information within the system of the SmartMedSupply platform. With this master database, hospital name, health area, type of infirmary, specific unit/department, number of staff, and current address are available.
3.2 Web page
Web page is an order entry system to receive information of the number of medical supplies needed to be allocated from two sources of supplies: donations and government procurement budget to systematically manage logistics of those medical supplies. This order entry system allows donors to be able to give donations via web application then facilitate the administrative team who oversees donation information and the central staff who manages the allocation from the government procurement budget. The architectural design can be seen in Figure 4.
Figure 4. The architectural design of the SmartMedSupply platform
Besides, there is a web server for users to access at https://Smartmedsupply.Moph.Go.Th. These three interconnected parts are stored in the cloud, hosted by the MoPH. The web page will extract information from the product catalog database and hospital master database. The SmartMedSupply is a web application that shows the list of items that donation is needed for allocation. The catalog is presented referencing an E-commerce system showing the item name with a picture and button for detailed descriptions. Users can access and update the information as can be seen in Figure 5 and Figure 6.
Figure 5. Website interface presenting the list of items that donation is needed
Figure 6. Website interface for users to add or change items of donations
3.3 Virtual stock
The virtual stock provides three pieces of information including supply-in, supplies allocation, and order tracking. First, the supply-in feeds the information of donations and/or procurement from the SmartMedSupply system. Donation/procurement information with details of brand, quantity, packages, location, and lead time. After receiving information of allocation, data information will be sent to the Dxplace system belonged to Thailand Post Distribution (THPD). Second, medical supplies allocation indicates the information of the remaining stock for allocation and transfer data by integrating all collected information of donation and procurement received. Third, the order tracking system is responsible for transferring the data to THPD via Dxplace. The system updates the status of delivery or receipts of the medical supplies to the donors.
Figure 7. Data exchange chart between SmartMedSupply system and virtual stock
3.4 Matching system
A matching system is a designed system for planning and allocating the medical supplies obtained from the government procurement and public donors and distribute to the hospitals. The process of matching system requires data from (1) order management system consists of patient information, the number of patients, hospital code, and workforce of the hospital, and (2) current information of product quantity from virtual stock such as stock on hand and stock in transit. The design of the matching system is overly complex, using source code and cloud computing.
3.5 Order management
Order management is an information system of the needs of the medical supplies at the hospital. The hospital must fill out some information such as daily usage, inventory or stock on-hand, and level of use into the system. The system updates the information and transfers the information to a matching system that can provide information for planning and deciding on allocation. At the same time, the hospital can also track the information and update status through the tracking system called Co-Ward that was developed by the Information and Communication Technology Center of MoPH.
3.6. Tracking system
It is a system that monitors the status of medical supplies distributions. This system begins its process after the matching system matched the stock from the sources of supplies with various hospitals. The operation of this tracking system is to transfer the data of medical supplies that were received to donors and central staff to follow and update delivery status whether the allocated items are delivered to the assigned destination. The data information can be extracted from the Dxplace of the THPD, and APIs available are used by the THPD to calculate the routing and scheduling the transportation to receive the products either from the manufacturers or other distributors and then deliver the products according to the specified destinations. The entire process can be tracked easily using the tracking number, and when the products are delivered successfully to the destinations, the tracking system will send the information to cut off and update the stock in the virtual stock system. There rea four statuses shown in the tracking system interface: available, allocated, picked up, and delivered.
Figure 8. The status of stock based on the virtual stock system
3.7. Business Intelligence (BI)
This is a system designed from the Power BI program that incorporated data from various systems. The design details of the medical supplies logistics management system are to develop a supportive decision system that will be used for monitoring, evaluating, analyzing the status of demand as well as giving supports based on the shortage and necessity of use with limited supply for maximum benefits. This BI system can pinpoint the situation of the demand needed and provide a detailed view of the medical supplies list as well as the location of the hospitals and health facilities in each province throughout Thailand. Healthcare management is a mechanism that Thailand has already supported and able to operate effectively. The system has been designed in 2 parts. Part I includes a dashboard display overview related to monitoring and evaluating (M&E), and the situation needed to use COVID-19 medical supplies according to the level of scarcity.
Figure 9. Overall elements of dashboard Part I
Part II involves a dashboard overview related to the surgical mask distribution tracking system.
Figure 10. Overall elements of dashboard Part II
4. Implementation and results
In this section, the implementation of the SmartMedSupply platform and results are explained.
4.1. Implementation of the SmartMedSupply Platform
Design and development of the SmartMedSupply platform have been a complicated and difficult project to combine all 6 systems with the business intelligence (BI) processing system for most of the system was began from scratch. Design and development were completed lately April 2020, and the system has been operated since then. Two logistics management teams were formed to supervise the front-back system with close cooperation of the research team, the private sector, and the government team from the Information and Communication Technology Center of MoPH, and the Food and Drug Administration (FDA). The work process is divided into two parts.
– Mask allocations from the government procurement budget
This process begins after receiving the information of products from manufacturers with officially agreed by the FDA. The information is transferred to the Web Page (order entry system), and at the same time, the page also monitors the status of demands of hospitals and health facilities then extracts the data of demand from the Order Management system. The data after that will be sent to the Matching system where demand and stock are being matched using the calculation of the developed algorithm. As a result, a worksheet of the product allocation for each hospital is created, and the data of the worksheet is sent to the Virtual Stock to release the status, update in-transit delivery, and transfer to the Tracking System that connects with the Dxplace system of the THPD. Finally, delivery information can be tracked through the tracking system using monitoring status and tracking numbers.
– Donations allocations
This work process starts right after receiving the information of medical supplies from the Health Administration Division (HAD) that has been undergone for quality and standard check by FDA. There are varieties of donations from many different sources. Some donations do not contain production information; therefore, the product code is needed to be created first, where all the available detailed pharmaceutical information is included. This is done by users who are responsible to monitor the database system. After the product information is created and found in the system, the information is sent to the Web Page. After that, all the information will be processed through all the processing steps similar to the mask allocations mentioned above.
The final process is to transfer the data from different systems to be processed in the BI system using data of products in the stock, the number of products used from the Order Management system, and the information of hospital allocation from the Tracking system. All the above-mentioned data information will be transferred to check for correctness and then send to the correct form of the developed system with the algorithm to calculate the level of shortage, needs, number of days for usage, and more. The results are illustrated by the Power BI program and the SmartMedSupply platform.
After going through all of the design and development steps, the SmartMedSupply platform was initially implemented on 15 April 2020. Since then, donations were collected and allocated through the SmartMedSupply platform for more than 20 types of medical supplies of which a total of 3,500,000 pieces were delivered to 1,587 hospitals and health facilities. Those medical supplies are the mask of 1,936,010 pieces, Nitrite gloves of 351,600 pairs, alcohol sanitizer pad of 193,500 sheets, protective clothes of 85,295 sets, and alcohol gel of 69,367 tubes. Moreover, from the government procurement budget via the GPO (Group Purchasing Order) 134, 965,000 pieces of surgical masks were distributed to 3,490 destinations, which 32,060,000 pieces in May, 51,492,000 pieces in June, and 51,413,000 pieces in July. The allocations were made mainly to the provincial hospitals that also act as a cross-dock to distribute to other hospitals and health facilities in the province.
The contributions of implementing the SmartMedSupply platform include the advantages of integrating information across the 6 systems plus dashboard presentations of the BI system, making it possible to allocate and distribute medical supplies to be balanced and can track and trace the information in real-time. The platform also centralizes and shares the data that is greatly beneficial to the government and other involved stakeholders in making decisions.
SmartMedSupply platform was developed and implemented following the integration and bringing the knowledge of computer engineering as well as the experiences in researching the public health system in Thailand. The platform was made to handle the matters of the supply chain of non-drug pharmaceutical logistics management system just in time of need. The design of data and information flow systems and operating systems from upstream to downstream make the SmartMedSupply platform to be one of the innovative practices for supply chain resilience during COVID-19 outbreaks. There has not been any research done to design and develop such a system to support not only information and communication technology but also covering the supply chain and logistics management.
While healthcare providers and citizens continue to face the COVID-19 pandemic, concerns for the quality of life and safety are imposing global challenges. The pandemic has caused so many problems and so many challenges in all aspects of life for every country around the world. Those challenges also include logistics and supply chain management, especially in the field of pharmaceuticals. Having not yet found the exact cure, primary actions include mainly the availability of medical supplies. Similarly, to almost every country around the world, Thailand faced so many regarding medical supplies logistics, and supply chain. Seeing the pains and based on experiences and great cooperation, the SmartMedSupply platform was developed and implemented. More than 20 items of the medical supplies were managed and allocated using the SmartMedSupply platform trying to balance the demand and supply to the right place and the right people at the right time with overall benefit maximization. The major allocation was surgical mask distribution. This platform can provide a best practice of contribution to the future trend of integrated supply chain management that can be adaptive to normal and pandemic situations. Results of the balance of supply and demand, inventory optimization, sharing of information, and more have been a good lesson learned. The proposed conceptual framework, which is not presented here, and together with the platform design and implementation can suggest and recommend for future study to connect the platform and necessary data information with the artificial intelligence and internet of things (IoT). This will provide the possibility to promote an innovatively integrated supply chain management for the future. Most importantly, data analytic for predicting the situation was a powerful tool for this kind of pandemic logistics and supply chain.
Finally, this chapter can conclude that collaborations among stakeholders are a must. In this kind of situation, both government and private sectors along with the research team need to build good cooperation and support, and the roles of each stakeholder need to be identified. Key stakeholders in this project including the research team from the Centre of Healthcare Logistics and Supply Chain Management (LogHealth), Mahidol University, the government sector of Information and Communication Technology Center from the Officer of the Permanent Secretary, Ministry of Public Health, Health Admission Division, Food and Drug Administration, and the private distributor of Thai Post Distribution Company limited.
This project is fully funded by the National Research Council of Thailand with full cooperation and support from the Ministry of Public Health and Mahidol University.
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