FILE - In this March 17, 2020, file photo, a traveler uses hand sanitizer from a dispenser at Sky Harbor Airport in Phoenix. The Associated Press has found that the critical shortage of testing swabs, protective masks, surgical gowns and hand sanitizer can be tied to a sudden drop in imports of medical supplies. (AP Photo/Sue Ogrocki)
The critical shortage of medical supplies across the U.S., including testing swabs, protective masks, surgical gowns and hand sanitizer, can be tied to a sudden drop in imports, mostly from China, The Associated Press has found.
Trade data shows the decline in shipments started in mid-February after the spiraling coronavirus outbreak in China led the country to shutter factories and disrupted ports. Some emergency rooms, hospitals and clinics in the U.S. have now run out of key medical supplies, while others are rationing personal protective equipment like gloves and masks.
The United States counts on receiving the vast majority of its medical supplies from China, where the coronavirus has infected more than 80,000 people and killed more than 3,200. When Chinese medical supply factories began coming back on line last month, their first priority was their own hospitals.
The government required makers of N95 masks to sell all or part of their production internally instead of shipping masks to the U.S.
The most recent delivery of medical-grade N95 masks arrived from China about a month ago, on Feb. 19. And as few as 13 shipments of non-medical N95 masks have arrived in the past month — half as many as arrived the same month last year. N95 masks are used in industrial settings, as well as hospitals, and filter out 95% of all airborne particles, including ones too tiny to be blocked by regular masks.
Governors across the country are becoming panicked as states run out of equipment. President Donald Trump has urged them to buy masks on the open market, but few if any are available.
“Without adequate protection, more of our hospital staff could become ill, which would mean there wouldn’t be people to care for patients,” said Nancy Foster, the American Hospital Association’s vice president of quality and patient safety policy.
Some hospitals are down to just a day or two of personal protective equipment, she said.
The AP found that in the past month, hand sanitizer and swab imports both dropped by 40%, N95 mask imports were down 55%, and surgical gowns, typically sourced from China, were at near normal levels because the sourcing was shifted to Honduras.
Typically, medical supplies are delivered along both coasts. But almost all the supplies that did arrive in the past month came into Newark, New Jersey, across the country from the earliest and most severe coronavirus outbreaks.
The AP identified the falling imports by looking at shipment data maintained by ImportGenius and Panjiva Inc., services that independently track global trade.
In mid-February, the World Health Organization warned that global demand for safety gear for medical providers was 100 times higher than normal. Prices were 20 times higher, stockpiles were depleted and there was a four- to six-month backlog. Despite this, federal contracting data shows there was no big effort at that point to submit orders.
Trade policies haven’t helped. Tariffs on medical supplies made them more expensive, and they were only lifted March 5, even though health care associations asked the administration last year to exempt items like masks, gloves and gowns. And now countries including South Korea, India and Taiwan are blocking exports of medical supplies to save them for their own citizens, leaving the U.S. with fewer options.
“The lag time could be weeks. It could be upward of months,” said Khatereh Calleja, CEO of the Healthcare Supply Chain Association.
Doctors, nurses and first responders in the U.S. are resorting to spraying their masks with bleach at the end of each day and hanging them up at home to dry to use for another day, according to the American College of Emergency Physicians.
“There is a little bit of anxiety, as you can imagine, going to work and not knowing if you will have enough personal protective equipment,” said Dr. David Tan, president of the National Association of EMS Physicians.
The decline in swabs included multiple varieties, not just ones needed to test for COVID-19. The Centers for Disease Control and Prevention has for weeks warned state and local health departments about shortages of swabs, which are needed for the testing that is critical to containing the pandemic.
Even over-the-counter medical shipments are decreasing. Ten shipping containers filled with medical thermometers arrived at U.S. ports a year ago this month. But in the last 30 days, there were just five.
Hand sanitizer, also commonly sourced from China, has disappeared from U.S. stores, and it may stay scarce. Last year by this time, 223 shipments had arrived. This year, since January, just 157 shipments have come.
The shortages affect patients because they can’t get tested and their providers may be carrying the virus from one person to the next. But the far greater risk is to medical personnel: Already, there are reports of dozens of doctors, nurses and medical staff who have contracted the virus.
Nurses across the country report that they are not receiving the proper personal protective equipment and their hospitals don’t have the isolation rooms they need to safely care for COVID-19 patients, according to National Nurses United, the largest union of registered nurses in the U.S.
“It’s not safe at all. Nobody is safe,” said Consuelo Vargas, an emergency room nurse at Cook County Hospital in Chicago. On Friday morning, after a possible exposure at work, she went to a local hardware store and bought all the painter booties and jumpsuits they had to wear while caring for people.
“It’s so frustrating because we feel like health care workers are being asked for a lot — and that’s fine, we can do our job. We’re just asking for the equipment we need,” she said.
The shortage doesn’t affect only health care. The humanitarian medical firm Direct Relief thought it was heading into 2020 well-stocked, with several million N95 masks. The organization had increased its orders in 2019 after massive wildfires in the West filled cities with smoke, squeezing its supplies in recent years.
But then bushfires overwhelmed Australia with smoky skies and so Direct Relief began sending the masks there, vice president Tony Morain said.
When the coronavirus hit China, the organization began shipping the masks to Wuhan — the outbreak’s epicenter — in an effort to contain the disease.
Morain said they’ve ordered 2 million more masks and are awaiting the shipments. Those typically take at least five weeks to arrive: two weeks to make the masks, two weeks of shipping and a week to get through the port. Meanwhile, he said, Direct Relief has received well over 100 requests from hospitals and health centers down to their last boxes.
In an effort to fill the gap, Minnesota-based 3M is running its Aberdeen, South Dakota, plant around the clock, producing millions of N95 masks per month. The company is also ramping up production of surgical masks and commercial cleaning solutions, CEO Mike Roman said.
Nonetheless, one federal contract with 3M for $4.8 million of N95 masks dated March 12 says the masks will be delivered April 30 — seven weeks later, according to public contract data.
A number of Chinese companies told the AP this week that they will be resuming exports — which bring higher prices — but that they are overwhelmed and can’t meet demand.
“Chinese mask manufacturers have received too many orders from abroad, but have no time to produce all of them and make a delivery,” said David Peng, manager of Ningbo Buy Best International Trading Co. Ltd.
Trade data shows importers have managed to maintain some supplies by shifting to factories outside China. Shipments of surgical gowns, for example, have dropped less than 5% since December, since they are now coming from Honduras. The same is true for medical gloves, which are now primarily coming from South Korea.
The federal government said a national stockpile was being made available at the state level, but governors said they weren’t getting what they need.
“I think every governor in the United States has been banging on the door of the federal government with respect to the stockpile. We certainly have, and we’re going to continue to,” Massachusetts Gov. Charlie Baker said at a news conference this week.
Dr. Peter Chin-Hong, an infectious-disease specialist at the University of California-San Francisco, said he was alarmed by new CDC advice for hospitals that run out of masks.
“For the CDC to say people can wear bandanas is actually quite frightening,” he said. “I never thought the CDC would say something like that. We’re in the United States of America in 2020, and we have a recommendation to use bandanas?”
US virus testing faces new headwind: Lab supply shortages
FILE - In this Wednesday, March 11, 2020 file photo, a technician prepares COVID-19 coronavirus patient samples for testing at a laboratory in New York's Long Island. Wide scale testing is a critical part of tracking and containing infectious diseases. But the U.S. effort has been plagued by a series of missteps, including accuracy problems with the test kits the CDC sent to other labs and bureaucratic hurdles that slowed the entrance of large, private sector labs. (AP Photo/John Minchillo)
WASHINGTON (AP) — First, some of the coronavirus tests didn’t work. Then there weren’t enough to go around. Now, just as the federal government tries to ramp up nationwide screening, laboratory workers are warning of a new roadblock: dire shortages of testing supplies.
The shortages are the latest stumble in a botched effort to track the spread of coronavirus that has left the U.S. weeks behind many other developed countries. Dwindling supplies include both chemical components and basic swabs needed to collect patient samples.
There are “acute, serious shortages across the board” for supplies needed to do the tests, said Eric Blank, of the Association of Public Health Laboratories, which represents state and local health labs.
\Late Friday, Blank’s group and two other public health organizations recommended that testing be scaled back due to “real, immediate, wide-scale shortages.” The groups said only patients with COVID-19 symptoms who are elderly, have high-risk medical conditions or are medical staff should be tested.
“Testing for individuals who are not in these three groups is not recommended until sufficient testing supplies and capacity become more widely available,” said the joint statement, issued with the Association of State and Territorial Health Officials and the Council of State and Territorial Epidemiologists.
Testing is a critical part of tracking and containing infectious diseases like COVID-19. But the U.S. effort has been plagued by a series of missteps, including accuracy problems with tests the CDC sent to other labs and bureaucratic hurdles that slowed the entrance of large, private sector labs.
With the virus spreading, officials in the U.S. have shifted focus from tracking the virus to extraordinary measures to blunt its damage. On Thursday California’s governor told its 40 million residents to stay home indefinitely and venture outside only for essential jobs.
But public health experts stress that policymakers are “flying blind” in deciding how to manage the pandemic.
“The only way to get through it without testing is to keep the entire country quarantined for the next 18 months” said Dr. Ashish Jha, a Harvard University global health professor. “That obviously is untenable.”
Jha and his colleagues say the U.S. should be screening 100,000 to 150,000 people per day. The current rate is roughly 20,000 per day, he estimates, though it is accelerating as larger commercial companies ramp up testing.
The director of Missouri’s state lab said Friday that his facility is facing shortages of swabs, liquids to store patient samples and kits to develop the results. Many labs are having similar problems, said Bill Whitmar.
“Quite frankly, 95% to 98% of the talk between lab directors has been about the shortage of supplies,” Whitmar said.
At this point only 500 swabs are available. And the lab only has supplies to last through Tuesday, he reported.
The Jefferson City lab does only a fraction of the coronavirus testing performed in Missouri, with commercial labs now doing the largest share. But Whitmar’s lab is where tests are run on the people most likely to be infected in that state.
The shortages have become a central concern in increasingly urgent communications among governors and federal officials.
“Most of my phone calls today have been about swabs,” Gov. Gina Raimondo of Rhode Island said during a Tuesday news conference. “That’s our big issue at the moment.”
The Trump administration’s top health official suggested Friday that the “anecdotal” reports of shortages are caused by confusion about how to find alternative supplies.
“Usually it’s that the lab people do not understand that there are alternative supplies in the marketplace that they are perfectly free to use,” Secretary of Health and Human Services Alex Azar told reporters in a briefing at the White House. He said the federal government is purchasing and shipping swabs to states.
Whitmar, the Missouri lab director, said many suppliers just don’t have the products in stock.
“An order is not a swab in hand,” he said.
On Friday, New York City health officials directed medical providers to limit COVID-19 testing to people sick enough to require hospitalization, saying wider testing is exhausting supplies of protective equipment. The city’s health department said unnecessary testing was contributing to a shortage of masks, gowns, collection swabs and other supplies.
The coronavirus test uses a chemical chain reaction to detect tiny traces of the virus’ genetic material and reproduce it many times. State and local health labs follow the technique first developed by the CDC, which calls for a specific genetic kit made by German diagnostic firm Qiagen. Labs around the globe are reporting shortage of those kits.
Qiagen said this week it is trying to boost production from normal levels, which are capable of testing 1.5 million patients per month, to amounts that would allow for testing more than 10 million patients by the end of June.
The World Health Organization has instructed countries to “test, test, test” to track and isolate those carrying the virus. But the evolving message from U.S. decision-makers acknowledges that many suspected cases will likely go untested.
The White House has increasingly emphasized that testing should prioritize the elderly and health care workers who have symptoms of the virus. While most cases of COVID-19 are mild and tens of thousands of people have recovered, older people and those with underlying health problems are at higher risk for more serious problems, such as pneumonia.
“We don’t want everyone to go out and get a test because there’s no reason for it,” President Donald Trump told reporters in a briefing Friday. (Two weeks ago, Trump declared “anybody who wants a test can get a test.” But his deputies later walked back that statement.)
The CDC tells people to seek testing if they have certain symptoms of the flu-like illness caused by the coronavirus – fever, cough and trouble breathing – and if they have traveled recently to an outbreak area or have been in close contact with someone who is infected. They should first be tested for the flu and other routine infections.
While doctors are supposed to decide who ultimately gets tested, many state labs have adjusted their guidelines depending on testing availability.
The Trump administration is expected to soon announce the rollout of nearly 50 community-based testing centers around the country, including drive-thru sites.
Full Coverage: Virus Outbreak
Some experts worry the introduction of convenient, mass screening will divert supplies from people with severe symptoms to those who face lower risks.
“It’s taking supplies that are already in very short supply away from the testing laboratories that are doing necessary testing,” said Blank, of the public health labs association.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
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