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The Latest Obstacle to Getting Tested? A Shortage of Swabs and Face Masks The Latest Obstacle to Getting Tested? A Shortage of Swabs and Face Masks
(3 days later)
Just as the nation’s ability to test for coronavirus is expanding, hospitals and clinics say another obstacle is looming: shortages of testing swabs and protective gear for health care workers.Just as the nation’s ability to test for coronavirus is expanding, hospitals and clinics say another obstacle is looming: shortages of testing swabs and protective gear for health care workers.
At the UCSF Health — a San Francisco hospital system at the heart of one of the nation’s coronavirus outbreaks — officials said they would have to stop testing patients in about five days because they will run out of nasopharyngeal swabs, which are inserted into patients’ nasal passages to get samples for testing. Other hospitals elsewhere in the country were ending their practice of using a second swab to test for the flu in an effort to preserve their supply.At the UCSF Health — a San Francisco hospital system at the heart of one of the nation’s coronavirus outbreaks — officials said they would have to stop testing patients in about five days because they will run out of nasopharyngeal swabs, which are inserted into patients’ nasal passages to get samples for testing. Other hospitals elsewhere in the country were ending their practice of using a second swab to test for the flu in an effort to preserve their supply.
The main manufacturer of the swabs, Copan, is an Italian company whose manufacturing plant is in Northern Italy, a region that has itself been hard hit by the coronavirus outbreak. It says it has ramped up manufacturing to deal with the extraordinary demand for an otherwise unassuming product to which many doctors gave little thought, until now.The main manufacturer of the swabs, Copan, is an Italian company whose manufacturing plant is in Northern Italy, a region that has itself been hard hit by the coronavirus outbreak. It says it has ramped up manufacturing to deal with the extraordinary demand for an otherwise unassuming product to which many doctors gave little thought, until now.
“We weren’t really thinking about, ‘Wow, what’s our swab supply?’ because we haven’t really faced anything that depleted our swabs before,” said Dr. Josh Adler, the chief clinical officer of U.C.S.F. Health. Making matters more difficult, the swabs must have just the right ingredients — the shafts cannot be wood, for example — or the virus might not be properly detected. “You can’t go to your local store and get Q-tips,” he said.“We weren’t really thinking about, ‘Wow, what’s our swab supply?’ because we haven’t really faced anything that depleted our swabs before,” said Dr. Josh Adler, the chief clinical officer of U.C.S.F. Health. Making matters more difficult, the swabs must have just the right ingredients — the shafts cannot be wood, for example — or the virus might not be properly detected. “You can’t go to your local store and get Q-tips,” he said.
On Wednesday, UCSF Health said it had secured another two-day supply of swabs.On Wednesday, UCSF Health said it had secured another two-day supply of swabs.
Dr. Ulrike Sujansky, a physician in solo private practice in San Mateo, Calif., one of the areas with the most cases, said she has only been able to test a few patients because of problems with supplies.Dr. Ulrike Sujansky, a physician in solo private practice in San Mateo, Calif., one of the areas with the most cases, said she has only been able to test a few patients because of problems with supplies.
“We cannot test. We cannot test,” she said. The swab kits she ordered from the two biggest lab companies, LabCorp and Quest Diagnostics, either arrived late or were not the right type, she said. She also does not have adequate masks or protective supplies, despite weeks of efforts to purchase them and recent appeals to state and local health authorities and hospitals. “I’m not given any tools to deal with this complete crisis.”“We cannot test. We cannot test,” she said. The swab kits she ordered from the two biggest lab companies, LabCorp and Quest Diagnostics, either arrived late or were not the right type, she said. She also does not have adequate masks or protective supplies, despite weeks of efforts to purchase them and recent appeals to state and local health authorities and hospitals. “I’m not given any tools to deal with this complete crisis.”
After a botched rollout of coronavirus tests in February, the Trump administration has tried to quickly expand the number of tests available to Americans by lowering regulatory hurdles and approving commercial tests made by companies — like Roche and Hologic — whose machines can run thousands of samples a day. Major lab companies like LabCorp and Quest Diagnostics have been ramping up their capacity, as have hospital labs around the country.After a botched rollout of coronavirus tests in February, the Trump administration has tried to quickly expand the number of tests available to Americans by lowering regulatory hurdles and approving commercial tests made by companies — like Roche and Hologic — whose machines can run thousands of samples a day. Major lab companies like LabCorp and Quest Diagnostics have been ramping up their capacity, as have hospital labs around the country.
But shortages like those with the supply of swabs now threaten that broader testing effort. Premier, which buys medical supplies on behalf of many U.S. hospitals, said its members were also encountering problems.But shortages like those with the supply of swabs now threaten that broader testing effort. Premier, which buys medical supplies on behalf of many U.S. hospitals, said its members were also encountering problems.
“Our hospitals are eager to do their part to help expand access to testing, but are struggling to do so absent necessary testing supplies,” said Soumi Saha, the senior director of advocacy at Premier. She said that the company requested additional information from the F.D.A. about how to address the swab shortage days ago, but has not heard back.“Our hospitals are eager to do their part to help expand access to testing, but are struggling to do so absent necessary testing supplies,” said Soumi Saha, the senior director of advocacy at Premier. She said that the company requested additional information from the F.D.A. about how to address the swab shortage days ago, but has not heard back.
On Wednesday, the Food and Drug Administration said in a statement, “We have heard concerns from labs who have questions about the availability of certain supplies. We are updating frequently asked questions for labs and test developers, providing information on alternative sources of reagents, extraction kits, swabs and more.” The agency said it also set up a toll-free line, 1-888-INFO-FDA, to help labs with questions about approvals or supplies.On Wednesday, the Food and Drug Administration said in a statement, “We have heard concerns from labs who have questions about the availability of certain supplies. We are updating frequently asked questions for labs and test developers, providing information on alternative sources of reagents, extraction kits, swabs and more.” The agency said it also set up a toll-free line, 1-888-INFO-FDA, to help labs with questions about approvals or supplies.
Gabriela Franco, a spokeswoman for Copan, which makes the testing swabs, said the company has increased production at its plant in Brescia, Italy, to 24 hours a day, seven days a week. “We are asking our customers and distributors to rationalize their ordering so we can maximize throughout,” she said, adding that in the United States, a busy flu season had already depleted supply. The company has about half of the market for testing swabs in the United States.Gabriela Franco, a spokeswoman for Copan, which makes the testing swabs, said the company has increased production at its plant in Brescia, Italy, to 24 hours a day, seven days a week. “We are asking our customers and distributors to rationalize their ordering so we can maximize throughout,” she said, adding that in the United States, a busy flu season had already depleted supply. The company has about half of the market for testing swabs in the United States.
She said the lockdown in Italy — which has been hit particularly hard with more than 2,500 deaths — — had not affected the business or the export of goods.She said the lockdown in Italy — which has been hit particularly hard with more than 2,500 deaths — — had not affected the business or the export of goods.
She said the company was taking precautions to protect its workers and to keep production running. “We are working with the Italian regional and national authorities to preserve the current manufacturing conditions in order to serve the world with our products, even in case heavier restrictions are applied,” she said.She said the company was taking precautions to protect its workers and to keep production running. “We are working with the Italian regional and national authorities to preserve the current manufacturing conditions in order to serve the world with our products, even in case heavier restrictions are applied,” she said.
The swab shortfall is just one example of the strain on the supply chain amid global demand for testing for coronavirus. Testing has also been hampered by dwindling supplies of RNA extraction kits, which are needed to extract the RNA from samples in order to run the tests in many cases. In response, the F.D.A. has widened the number of extraction products that can be used in the tests.The swab shortfall is just one example of the strain on the supply chain amid global demand for testing for coronavirus. Testing has also been hampered by dwindling supplies of RNA extraction kits, which are needed to extract the RNA from samples in order to run the tests in many cases. In response, the F.D.A. has widened the number of extraction products that can be used in the tests.
A shortage of masks, gowns and other protective gear — which has put a strain on many other areas of care — is also getting in the way of testing. Patients often sneeze or cough when the swab is inserted deep into their noses, which can expose the workers who are doing the tests to the virus.A shortage of masks, gowns and other protective gear — which has put a strain on many other areas of care — is also getting in the way of testing. Patients often sneeze or cough when the swab is inserted deep into their noses, which can expose the workers who are doing the tests to the virus.
“That’s been the bottleneck for what I call the crisis within the crisis,” said Dr. Christopher Crow, the president of Catalyst Health Network, who is setting up drive-through testing in locations around North Texas. His network of more than 800 physician offices serves one million people.“That’s been the bottleneck for what I call the crisis within the crisis,” said Dr. Christopher Crow, the president of Catalyst Health Network, who is setting up drive-through testing in locations around North Texas. His network of more than 800 physician offices serves one million people.
Until Tuesday, Dr. Crow was experiencing such a shortage of masks and other gear that he was facing the possibility of closing the sites Wednesday, just as he was preparing to vastly expand his capacity from about 30 people a day.Until Tuesday, Dr. Crow was experiencing such a shortage of masks and other gear that he was facing the possibility of closing the sites Wednesday, just as he was preparing to vastly expand his capacity from about 30 people a day.
"You can’t go scuba diving without oxygen, a regulator and a mask,” he said. “If you don’t have that equipment to test, then you can’t test.”"You can’t go scuba diving without oxygen, a regulator and a mask,” he said. “If you don’t have that equipment to test, then you can’t test.”
Updated June 12, 2020Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
On Tuesday afternoon, he learned that he had been granted permission by a regional authority to use a shipment of gear from the national stockpile, solving his problem, for now.On Tuesday afternoon, he learned that he had been granted permission by a regional authority to use a shipment of gear from the national stockpile, solving his problem, for now.
Some patients say the shortages have prevented them from getting tested, even when they are showing symptoms of the coronavirus. Aliesha O’Raw, a graduate student in Durham, N.C., said her primary care doctor sent her to an urgent care clinic after she had a fever and a dry cough for two weeks.Some patients say the shortages have prevented them from getting tested, even when they are showing symptoms of the coronavirus. Aliesha O’Raw, a graduate student in Durham, N.C., said her primary care doctor sent her to an urgent care clinic after she had a fever and a dry cough for two weeks.
Ms. O’Raw, who is 26, has asthma and Ehlers-Danlos syndrome, an inherited condition that affects the body’s connective tissues, like skin and joints. Both are underlying conditions that could make the disease more severe. She tested negative for the flu, and antibiotics did not work.Ms. O’Raw, who is 26, has asthma and Ehlers-Danlos syndrome, an inherited condition that affects the body’s connective tissues, like skin and joints. Both are underlying conditions that could make the disease more severe. She tested negative for the flu, and antibiotics did not work.
When she visited the urgent care clinic on Monday, the doctor declined to test her because there was a shortage of swabs and they were rationing, she said. Because she did not have known contact with an exposed person, she was denied a test.When she visited the urgent care clinic on Monday, the doctor declined to test her because there was a shortage of swabs and they were rationing, she said. Because she did not have known contact with an exposed person, she was denied a test.
She would like to be tested “not for my own knowledge,” she said. “It’s that I know I have people around me who are starting to get sick.” Her boyfriend, who ran errands for her while she was ill, is now sick, she said, as are some classmates who were around her before she developed symptoms.She would like to be tested “not for my own knowledge,” she said. “It’s that I know I have people around me who are starting to get sick.” Her boyfriend, who ran errands for her while she was ill, is now sick, she said, as are some classmates who were around her before she developed symptoms.
Her doctor ordered another test, and she was able to use a drive-through testing site that just opened. She was tested on Wednesday and is awaiting her results. “It’s happening,” she said. “It’s just taking longer than either of us expected.”Her doctor ordered another test, and she was able to use a drive-through testing site that just opened. She was tested on Wednesday and is awaiting her results. “It’s happening,” she said. “It’s just taking longer than either of us expected.”
Sheri Fink contributed reporting.Sheri Fink contributed reporting.
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