Outbreak Stretches U.S. Health System With Supply, Test Shortage

Strains on the U.S. health-care system appeared to increase Thursday under the weight of the spreading coronavirus outbreak. Medical workers warned of supply shortages, and hospitals were uncertain when they’ll be able to test suspected cases without relying on government labs.

Even as the number of confirmed infections in the New York area doubled, lawmakers said the federal government would fall far short of being able to test a million people by week’s end as promised.

America struggled to catch up with an outbreak that began months ago far from the nation’s shores and is increasingly affecting daily life. The number of U.S. cases exceeded 130, with 11 deaths. Authorities warned the public to brace for more.

“This will spread, and because the more people you test, the more positives you’ll find,” New York Governor Andrew Cuomo said. “The number has to go up.”

Markets declined, with the S&P 500 Index dropping 3.4%. Limits on the number of tests available added to uncertainty over how many other cases might be going undetected.

Private lab companies including Quest Diagnostics Inc. and Laboratory Corp of America Holdings said they’re racing to bring tests to market after federal officials loosened rules to speed the process. California Governor Gavin Newsom ordered health plans in the state to eliminate cost-sharing for doctor-ordered tests. Health insurer Cigna Corp. said it would do the same for members.

Test Shortfall

Even as industry took steps to respond, by Thursday morning it became clear that the government would fall short of Vice President Mike Pence’s assertion that a million tests would be available soon. Federal health officials have said more tests should be done in front-line hospitals.

“There won’t be a million people to get a test by the end of the week,” Republican Senator Rick Scott of Florida said in Washington. “It’s way smaller than that. And still, at this point, it’s still through public-health departments.”

The Centers for Disease Control didn’t respond to questions about when more lab testing capacity might be available.

With few ways to gauge the outbreak, New York City authorities asked residents returning from China, Italy, Iran, Japan and South Korea to isolate themselves for two weeks. As of Thursday morning, 2,773 New Yorkers were under home isolation, the health department said.

New infections in New York state doubled to 22, but only 122 people had been tested by Thursday afternoon. Health Commissioner Howard Zucker estimated that the state lab could test about 200 a day.

Testing for Covid-19 currently begins with a swab stuck deep in the nose and bottled. From that sample, lab technicians kill the virus, breaking it open and extracting its genome to determine whether the individual has coronavirus.

At Northwell Health, New York’s largest hospital system, scientists this week were trying to equip their lab in Lake Success to perform tests for patients at the system’s 23 hospitals.

Tests must be proven accurate, and chemicals known as reagents acquired. Northwell is “cautiously optimistic” that it can begin early next week, said Dwayne Breining, executive director of Northwell Health Labs.

“We will, of course, be working through the weekend,” he said.

Emory University Hospital in Atlanta is working to make the CDC’s version of test work. “That test is not for the faint of heart,” said Eileen Burd, director of Emory’s clinical microbiology lab.

She said the hospital hopes to get a commercial product that’s faster and easier to administer in the weeks ahead.

Stanford Medicine in California said Thursday it began using a diagnostic the system developed itself that should return results in 12 to 24 hours.

Hospital Shortages

Inside hospitals, the strain of uncertainty was growing. Hospitals are getting fewer than half the N95 respirator masks they’re ordering, said Chaun Powell, a vice president at Premier Inc., which helps 4,000 hospitals purchase supplies.

“They’ll get down to you know, a mask box or two,” Powell said. Running out could force hospitals to cancel operations. “We’re having to juggle and ship a lot of very small shipments just to make sure the procedures can be executed,” he said.

The nation’s largest union of nurses said members were concerned that inadequate training, access to protective equipment, and communications might endanger people. Only 63% of nurses had access to N95 masks on their unit, according to a survey the union published Thursday.

Across the U.S., most coronavirus tests must still go to state labs.

New Jersey officials received their second batch of tests from the CDC, allowing the state lab to perform an additional 216 tests, Christopher Neuwirth, assistant Health Department commissioner, said at a news conference. It’s the only lab in the state testing for Covid-19.

Reagents Needed

New Hampshire’s biggest hospital is in the market for reagents as it seeks to develop its own diagnostic. Dartmouth-Hitchcock Medical Center has already acquired an analyzer and has federal approval for tests, said Edward Merrens, chief clinical officer. He said testing could begin in a week — once they can find reagents.

The state launched a mobile testing facility, where people can drive up and be swabbed without leaving their vehicles, Merrens said. The hospital depends on the state to test any possible cases, he said, adding that the state got 60 test kits from the CDC and is waiting for more. “We would certainly like that to happen,” Merrens said.

The state so far has two cases, both connected to a hospital employee who visited Italy, a man faulted for not self-isolating after showing symptoms last week.

Trump Assurances

Trump administration officials sought to reassure the public that more tests are coming.

Health and Human Services Secretary Alex Azar II said that by the end of this week the CDC will have shipped enough kits to public health labs to test 75,000 people. A manufacturer that works with the agency, Integrated DNA Technologies Inc., believes it will independently have sent out enough to test an additional 400,000, Azar said.

Those are being sent to hospitals, labs and other health facilities, Azar said. There should be enough tests for as many as 1.7 million people by the end of next week, an amount “far far ahead of similarly impacted major countries around the world,” Azar said.

Hospital officials on the front lines hope that will happen.

Nuvance Health, with seven hospitals in Connecticut and New York, doesn’t plan on developing its own test, according to Majid Sadigh, an infectious disease specialist and director of global health.

“I just wish we could do the test quick, and I wish the test was available in all of the hospitals,” he said. “At this point in time, everything is in the hands of the CDC.”

— With assistance by Henry Goldman, Emma Court, Daniel Flatley, Jeannie Baumann, Michael McDonald, Shira Stein, Keshia Clukey, and Stacie Sherman

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