Wednesday, August 20, 2014

Ebola and Operations Research

It is impossible not to be moved by the impact of the Ebola virus on communities in western Africa with the World Health Organization (WHO) reporting a death toll of over 1,200 people.  Two Americans, Dr. Kent Brantly and Nancy Writebol, who had contracted Ebola while doing healthcare and missionary work in Liberia are now recovering at  special isolation wards at the Emory University Hospital in Atlanta, Georgia. Both were treated with the experimental drug ZMapp  and 3 doctors in Liberia, who were also given this drug, seem to be recovering.

There is no cure for Ebola and the fatality rate ranges from 50%-90%.

You may have seen the transport provided for both Brantly and Writebol from Africa to the US, with each traveling in white suits that enveloped their bodies on a specially equipped plane and being then transferred to the isolation facility by specially dressed workers in white "hazmat suits."

One of my colleagues was in Sierra Leone in June and this country had had the greatest number of cases. I saw him in mid-July and, thankfully, and with great relief,  he seemed fine. The incubation period is 2 to 21 days.

Last spring I taught a course on Humanitarian Logistics and Healthcare at the Isenberg School of Management and will be teaching it again in the Spring of 2015.  This healthcare crisis I will certainly be covering since, as I read the news, I keep on thinking of the complexity of the situation and when the problems and challenges are extra difficult, then my discipline of Operations Research may be able to contribute.

One of the issues which is so startling is the low level of many of the hospitals and healthcare facilities in western Africa with some hospitals not even having water and the healthcare workers not having access even to plastic gloves. Some are being offered extra pay for the hazardous duty associated with treating and taking care of Ebola victims. Having the proper medical supplies is essential for stemming the spread of this contagious disease, which supposedly does not spread through the air but, rather, through the exchange of fluids. I was reminded of a paper that we wrote: Supply Chain Network Design for Critical Needs with Outsourcing, Anna Nagurney, Min Yu, and Qiang Qiang, Papers in Regional Science 90: (2011) pp 123-142. By “critical needs” we mean products that are essential to the survival of the population, which can include, for example, vaccines, medicine, food, etc., depending upon the particular application. “Critical” implies that the demand for the product should be met as nearly as possible since otherwise there may be additional loss of life. We also studied the multiproduct aspects in the paper: Multiproduct Humanitarian Healthcare Supply Chains: A Network Modeling and Computational Framework,  Anna Nagurney, Min Yu, and Qiang Qiang, in the Proceedings of the 23rd Annual POMS Conference, Chicago, Illinois, April 20-23, 2012.

There are also ongoing disruptions to the supply chains of the affected countries, since some suppliers and freight service providers are reluctant to take the risk of possibly contracting the disease, which is truly horrific. The economies of these countries may also be affected. Our paper,  A Bi-Criteria Indicator to Assess Supply Chain Network Performance for Critical Needs Under Capacity and Demand Disruptions, Qiang Qiang and Anna Nagurney, Transportation Research A 46(5): (2012) pp 801-812, provides metrics to enhance decision-making in disaster situations and can even be applied to assess the delivery of food and medicines.

Moreover, there are policies such as the cordon sanitaire being implemented in parts to isolate the communities where Ebola is rampant to minimize its spread to other communities.  I thought about the research on "cliques" that our Operations Research community is a leader in.

Finally, this healthcare humanitarian crisis also has aspects of hazmat transportation, but with new challenges, since we are no longer transporting hazardous materials (we have done work on medical nuclear supply chains, for example) but people, who, in effect, are hazardous since they have Ebola.

As the new academic year begins, I know that certain colleges in the US are taking precautions since they have students coming from the affected countries. Also, many of us travel alot via air and I am sure that we will be a bit anxious in flying.

Given that there is no cure, but that ZMapp appears to have had very positive effects in those who have been lucky to acquire it, it is imperative to assist the company in its production, especially that the supply has now been exhausted.  And, here again, through analytics and Operations Research, I believe that our models and algorithms can be helpful: Pharmaceutical Supply Chain Networks with Outsourcing Under Price and Quality Competition, Anna Nagurney, Dong Li, and Ladimer S. Nagurney, International Transactions in Operational Research 20(6): (2013) pp 859-888.

In conclusion, I would like to thank the selfless, truly courageous healthcare workers battling Ebola, under such difficult circumstances.  Our hearts go out to the families who are suffering so much.  Organizations need to team up to battle this scourge.