Covid-19 Pandemic: Six Months into the Response

Medicines essential for ICU care of Covid-19 patients are prepped for shipment in Direct Relief's warehouse. The modules contain medicines needed to care for complications of Covid-19. (Lara Cooper/Direct Relief)
By Tony Morain

This report summarizes Direct Relief’s response and ongoing activities over the six-month period since the organization first responded to Covid-19. Because the scale and profound effects of the pandemic continue to accelerate, as do Direct Relief’s activities, the information will be dated rapidly.

However, the deep involvement, generosity, and participation of hundreds of thousands of individuals, and thousands of businesses of all types and nonprofit organizations that have been part of Direct Relief’s activities elevate the importance of public reporting – particularly to those who have so generously provided financial or other support — so they know how, how much, where, and for what purposes those contributions have been used.

Direct Relief’s Response

Direct Relief is funded entirely with private charitable contributions of goods, services, and money and focuses its humanitarian health activities on serving people who are most vulnerable – typically those with the fewest financial resources and least access to essential health care.

The organization’s ongoing efforts involve mobilizing private charitable resources, including essential medications and basic health commodities, and providing them upon request — and free of charge — to an extensive network of locally run partner health organizations that provide services to those most in need.

In emergencies, the approach is the same. Those who are most vulnerable in emergencies are generally the same people who were most vulnerable the day before the emergency occurred.

This has been the case during the unfolding Covid-19 pandemic and why Direct Relief has prioritized the provision of assistance to areas and people where the new threat of Coronavirus made even more severe the existing chronic challenges to obtain needed health services.

With that basic focus, Direct Relief’s Covid-19 response efforts have focused on the following areas:

The First Six Months

PPE and other Essential Material Support

Six months ago, on January 27, Direct Relief dispatched its first shipment of PPE in response to the outbreak to China. A day later, on January 28, a month before the CDC confirmed the first case of community spread in the U.S., Direct Relief deployed thousands of N95 masks, protective gowns and exam gloves to health facilities throughout California and Washington State.

Responding early to the outbreaks afforded Direct Relief unique insights into what medical items would become essential for treatment purposes.

Well before medical supply shortages hit the U.S. and the rest of the world, Direct Relief learned from Chinese physicians and hospital administrators of the precipitous need for PPE, intensive care medication and equipment.

Recognizing that if Covid-19 were to spread globally, it would lead to a tremendous demand for these lifesaving products, Direct Relief worked to get ahead of the pandemic by boosting its inventory of protective gear, including masks and face shields, identifying and sourcing the medicine and medical supplies hospitals would need to treat an influx of patients, and procuring diagnostic and respiratory equipment, such as pulse oximeters, oxygen concentrators, and ventilators.

N95 masks staged in Direct Relief’s California warehouse. (Tony Morain/Direct Relief)

Six months later, Direct Relief is among the world’s top distributors of protective gear and critical care medication.

By the Numbers

In the past six months, Direct Relief has scaled up its operational activity far beyond any it has engaged in during the past 72 years.

The organization has delivered 17,553 medical aid shipments to 2,591 health facilities in 54 U.S. states and territories and 86 countries.

These shipments have contained 2,800,000 lbs. (1,400 tons) of medical essentials, including 76,858,730 Defined Daily Doses of medications, with a value of $636,815,730 (wholesale acquisition cost).

Emergency Financial Assistance to Safety-Net Health Facilities

Complementing the extensive quantities of PPE and other essential health products deployed to the front lines of the Covid-19 pandemic, Direct Relief has issued $30 million+ in grants to 523 community health centers, free & charitable clinics, and other non-profit health providers serving people and places across the U.S. at disproportionate risk from the effects of the virus.

For the past 16 years, Direct Relief has worked in close partnership with and in a supporting role for the vast network of nonprofit community health centers and free and charitable clinics in the U.S.

More than 30 million of the country’s most vulnerable residents — 65 percent of whom are members of ethnic and racial minority groups — rely on these local nonprofit providers for health care. On a daily basis, Direct Relief provides charitable donations of prescription medications and medical essentials to these facilities in all 50 states and U.S. territories for patients who need but cannot afford the items and lack other options.

Direct Relief developed the emergency grant program that has now provided over $30 million following the early signals that Covid-19 was having disproportionate effects among persons with low incomes and in communities of color – the same people for whom these safety-net facilities devote their efforts.

The spontaneous, extraordinary outpouring of public support that Direct Relief received that made it possible for Direct Relief, in turn, to direct emergency funds to these frontline facilities  struggling to keep their staffs safe while maintaining ongoing essential services and also step up public health measures, such as taking on community-based Covid testing.

These frontline community-based providers are using the funding to sustain and expand their activities and services, which include the protection and safety of health workers; telehealth services; Covid-19 screening and testing; and ensuring healthcare access for homeless and elderly populations and patients with chronic health conditions.

According to the National Association of Community Health Centers, this is the largest-ever philanthropic infusion of financial support to U.S. community health centers.

By the Numbers

Analytical Support

In February, when the rapid spread of Covid infections led to immediate crisis-level shortages of PPE and crisis planning to address the severe concerns about the availability of ventilators, Direct Relief began developing an estimating tool for the volumes of medications likely to be needed for the supportive care of Covid-19 patients while in intensive care units.

This tool, which incorporated broad input from clinicians and pharmaceutical companies, was then used to develop, in close consultation with the Society of Critical Care Medicine, a pre-pack kit of ICU medications that could be (and has been) deployed rapidly to areas immediately hit with a surge in ICU patients.

Each kit contains medications to treat 100 patients during an ICU stay.

Extensive product contributions from the manufacturers of the items needed for the kit allowed for more than 500 to be produced and distributed – enough to cover supportive care for 50,000 severely ill patients hospitalized and in intensive care.

In addition, extensive analyses have been conducted to inform policymakers and public health agencies with implementing and modifying social distancing measures, as well as guide its own activities, Direct Relief helped assemble the Covid-19 Mobility Data Network, a global collaboration of infectious disease epidemiologists and technology companies to share insights derived from population movement dynamics — the results of which are documented in numerous pre-print and peer-reviewed studies on mobility data and infectious disease modeling.

Articles and Resources:

Financial Support and Use of Funds

Direct Relief recognizes that the generous supporters who made financial contributions to Direct Relief in response to the Covid-19 pandemic did so for the clear purpose of assisting health workers responding to and people affected by the pandemic.

In accepting funds for Covid-19 relief efforts, Direct Relief understands that both those who contributed, and people affected by the virus for whose benefit the contributions were made, deserve to know, in detail, how Direct Relief is using these funds.

As of June 30, Direct Relief had received over 125,000 financial contributions totaling $104 million for its Coronavirus response.

Direct Relief does not rely on any funding from government grants, and 100 percent of contributions received for Covid-19 are restricted for the exclusive use of responding to the pandemic.

Of the $104 million Covid-19 contributions received, more than half included an additional geographic or thematic designation indicating where the contributors intended their support to be used.

Of the funds received with a geographic restriction, 84% were intended for use in the U.S. only.

Expenditures

Over the past six months, Direct Relief has spent $72.9 million on response efforts — nearly 70 percent of the $104 million in contributions it received — across the following regions:

The $72.9 million in funds were used to support relief activities across the following functional areas:

Procurement

Direct Relief’s assistance model typically involves receiving requested product donations of Rx medications, vaccines, and medical supplies directly from manufacturers, which are in turn provided without charge to partner nonprofit health organizations that serve vulnerable people. When finances permit, Direct Relief also purchases specific such items that are needed by partner organizations but not available from manufacturers.

Direct Relief also maintains emergency stocks of PPE and essential prescription medications and supplies to be able to respond rapidly to emergencies. These stocks include products that are donated by manufacturers but also include purchased items. Among the items Direct Relief has routinely purchased in recent years are NIOSH-approved N95 respirators, which Direct Relief has manufactured in China and bear their own NIOSH approval and registrations (as well as distinctive in color and marked “Not for Resale.”) This step was prompted by the series of historic wildfires that California has experienced in recent years and the recurring situation of N95 shortages and rapid escalation in prices when the fires occurred. When Covid-19 broke out, Direct Relief fortunately had significant stocks of Direct Relief N095 respirators and other PPE, much of it donated by manufacturers such as 3M, that enabled an immediate response.

The expenditure of $30 million to purchase Covid-related materials over the past six months is the most expansive Direct Relief has ever done. The specific items purchased were based on the urgent requests received from partner health organizations, and extreme care was taken to obtain only products that had appropriate certifications and approvals for use in the U.S. (such as from NIOSH and/or FDA) and at a reasonable price – which was a challenge given the global shortages and wild price fluctuations.

In total, the expenditure of $30 million in procuring essentials met those standards. The specific items purchased include over 77 million units of PPE and several thousand other durable medical commodities, including oxygen concentrators, oximeters, ventilators, and “no touch” infrared thermometers. Distribution of these essential items continues on a daily basis, and the quantities of each item purchased are listed below:

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