Friday 20 March 2020 ★ FINANCIAL TIMES 3
spot when Covid-19 entered a commu-
nity. Instead, many countries focused
on whether people had travelled to an
affected area or been in contact with an
infected person.
Singapore decided early to test any-
one with flu-like symptoms. Dr Frieden
said this was a “model”. “They picked
up some people who they wouldn’t have
found otherwise,” he said.
In Spain, those with mild symptoms
were initially tested but in Madrid only
the worst cases are now getting tested.
Fernando Simón, the doctor spearhead-
ing the coronavirus response, said Spain
hoped to resume more general testing in
the coming days.
“We are preparing to do it, probably in
the next two or three days; there are
teams working very hard on this,” he
said on Tuesday. “In Spain, we are very
aware that the best ways of protection is
diagnosis and isolation.”
France and the UK tightened their
testing policies so that only patients
with significant breathing difficulties,
serious symptoms or requiring hospital-
isation were tested. Donald Trump, who
himself delayed before being tested, —
said anyone could get the test, but has
since said it should only be used on peo-
ple who have symptoms.
The changes in tack might be wise to
protect patients with mild symptoms
and help reduce the burden on health-
care systems. “It’s important to under-
stand that things can change quite rap-
idly,” Dr Frieden said. “And what is the
needed strategy one day, might change
in days.”
Additional reporting by Leila Abboud in
Paris, Daniel Dombey in Madrid, Miles
Johnson in Rome, Camilla Hodgson in Lon-
don, Wang Xueqiao in Shanghai, Yuan
Yang in Beijing and Andrew Edgecliffe-
Johnson in New York.There are also concerns about swab
supplies.Copan, one of the largest pro-
ducers, is based in Lombardy, at the cen-
tre of the Italian outbreak. The com-
pany has increased production from
five days a week to seven. It is asking
customers and distributors to “rational-
ise” orders.
Susan Butler-Wu, an associate profes-
sor at the University of Southern Cali-
fornia school of medicine and director
of a lab in Los Angeles county, said she
had heard of emergency departments
limiting swabs. “We are sort of borrow-
ing and not quite stealing but trying to
get what we can, or where we can, and
it’s a constant source of stress.” she said.Speed of testing
The high throughput machines
developed by companies such as
RocheandThermoFishercan
do between 1,000 and 4,
tests in 24 hours. The time
from swab to result varies
according to how far the
sample has to travel. In
Italy, tests are being
turned round in
four to six hours.
In China, most
h o s p i t a l s h av e
results back within a day.
In the UK, it takes at least
24 hours to get a result back. US
hospitals rely on commercial labs
that must wait days for transportation
— sometimes by air.
Dr Frieden said emergency depart-
ment doctors are worried that patients
will deteriorate during the delay.Who to test?
Dr Goodman said there would ideally
have been widespread testing before
people developed symptoms, simply toKorea created pop-up, drive-through
clinics. In Italy, some are being per-
formed in people’s homes.
The US is partnering with retailers to
create tents for testing in store car
parks, and France is expanding tests
from hospitals to high street diagnostics
clinics. In the UK, tests are still being
conducted in hospitals.
At-home, handheld kits are still in
development. Covid-19 sits low in the
oesophagus and lungs so patients need a
long swab to reach far up the nose and
then twirled for 10-15 seconds to collect
a sample.
Dr Frieden said one study had shown
only a third of swabs found the disease
in confirmed coronavirus patients.
“So, even if the laboratory is doing
everything right, the sample
might not have the virus
on it,” he said.Shortage of
supplies
The supply chain of
ingredients for testing
is stretched, particularly
for materials used to take
the virus’s genetic material,
known as an RNA extraction kit.
Manufacturers including Ger-
many’sQiagen are increasing pro-
duction and the US regulator is allow-
ing labs to look to suppliers beyond
those on the original approved list.
Jeremy Levin, chair of BIO, the US bio-
tech industry trade association, said it
was an “absolute acute crisis”. “It’s an
unpreparedness challenge. Why is it
that you have tens of thousands tested
in South Korea and China?” he said.
“They learned from the last crisis. They
stockpiled key items they might need
and they trained to deal with this... ”H A N N A H KU C H L E R— N E W YO R K
Global systems for rushing out tests are
buckling under the strain of the corona-
virus pandemic, leaving patients strug-
gling to get diagnosed.
South Korea has tested more than
250,000 people out of a population of
almost 52m after it invested in building
capacity following the Sars epidemic.
Italy has tested almost 150,000 of its
6 0m citizens. But testing in other coun-
tries remains stuck in the tens of thou-
sand. The UK has screened about
5 0,000 out of its 67m people and the US
just 32,000, with more at private facili-
ties, out of more than 330m.
Jesse Goodman, former chief scientist
at the US Food and Drug Administration
and now a professor at Georgetown Uni-
versity, said problems with access had
“crippled” visibility into the spread of the
disease. “It probably reduced opportu-
nities to contain the virus and... slowed
the whole response down,” he said.
Developing the test
The World Health Organization says
tests have been developed by govern-
ments and academic institutions in
China, the US, Germany, France, Hong
Kong, Japan and Thailand.
In the US, the Centers for Disease Con-
trol and Prevention’s first test failed and
it had to go back to the drawing board to
create a new one. Tom Frieden, a former
CDC director, said the body had been
slow to open up testing to private labs.
In China, there were problems with
accuracy but the supply of kits has
soared, and the country can produce
1.6m units a day, according to the WHO.
Where to test
Health systems fear a Covid-19 patient
walking in the door for testing. South
C O R O N AV I R U S
Testing frustrated by lack of
kits and struggling systems
Unprepared governments lack coherent approach to identifying the infected
Road test: samples are taken at drive-through sites such as this one in Arlington, Virginia, and using kits posted to patients in Wales, inset— Drew Angerer/Getty
FT R E P O RT E R S
California’s Long Beach port handled
$38bn in Chinese goods last year, but
activity at the normally bustling
harbour has more than halved from
normal levels as the coronavirus out-
break spreads around the globe, accord-
ing to harbour officials.
The pandemic forced factory closures
across China starting in January, with
ripple effects throughout the global
economy. Los Angeles’ ports have seen
50 “blank sailings” — ships scheduled
to arrive that never finished their jour-
neys — since the outbreak began,
according to Ray Familathe, a union
official at the port.
“This is not normal, this is very
extreme, things I have never seen,” Mr
Familathe said, adding that China’s
shutdown compounded shipping
declines caused by the ongoing US-
China trade war.
The port is a harbinger for how the
slowdown due to coronavirus in China,
the world’s second-largest economy and
biggest goods exporter, could threaten
already weak global trade. Even as
Beijing relaxes its containment meas-
ures, demand is falling elsewhere as
the virus spreads and many ports are
seeing sharp falls in activity.
World trade contracted 0.5 per cent
last year, the first annual decline since
2009 according to ING, the Dutch Bank,
as the Trump administration’s trade
war with China and threats to place tar-
iffs on EU exports created uncertainty.
The slowdown has pushed China-US
West Coast freight prices down 10 per
cent year on year, according to shipping
consultancy Freightos, a sign of weak
demand. Almost 80 per cent of US
importers surveyed by the consultancy
reported lower inventories.
Many ships heading to Long Beach
leave from China’s Shenzhen port, the
fourth-largest in the world by container
volume. Dock workers there told the
Financial Times that business had fallen
off by an estimated 50 to 75 per cent
since the coronavirus outbreak began.
China’s exports contracted by 17 per
cent in dollar terms in January and Feb-
ruary, with the declines caused by
“fewer working days, production sus-
pension and strict traffic restrictions
imposed after Covid-19 outbreak”,
according to UBS economists. By earlyMarch, Beijing was encouraging a return
to normal for businesses. However,
“only about 20 per cent of drivers have
returned to work [as] most people
haven’t been able to return from their
hometowns”, said one truck driver at
Chiwan port in Shenzhen.
Yangshan port in Shanghai has expe-
rienced similar declines. “The numberof trucks coming in and out has dropped
off by between 40-50 per cent,” said one
staff member. Rotterdam, Europe’s
largest port, saw traffic from China fall
20 per cent last week from a year earlier,
according to Leon Willems, a port
spokesman. About 470m tonnes of
goods pass through the port each year.
“If we take the starting point for the
virus as Chinese new year, and say hypo-
thetically that it will continue for 10
months, then we lose 20 million in
throughput,” said Mr Willems.
Ships take about 40 days to travel
from China to the US east coast — about
twice as long as to Los Angeles — so portsthere are only now starting to feel the
repercussions. “We are beginning to see
impacts on March volumes from when
many (Chinese) workers were quaran-
tined,” said Jim Newsome, chief execu-
tive of the South Carolina Ports Author-
ity which includes Charleston, the sec-
ond-biggest port on the east coast.
South Carolina’s ports are critical for
supplying components — some from
China — to European companies,
including BMW and Volvo, who have big
operations in the state. “We anticipate
that our container volumes will be down
about 15-20 per cent in March and April
versus our business plan,” he added.
As the number of new virus cases in
China began to decline in late February
and workers return to factories, exports
have begun to tick up again. Data from
maritime analytics Windward indicate
that activity levels at Chinese ports have
begun to recover from early March.
But as the pandemic spreads to
Europe and the US, the shipping indus-
try will have to contend with falling
demand there. “We’re really concerned
about the virus, but also about the
economic impact,” said Mr Familathe at
Long Beach port.
Reporting by Robert Armstrong, Demetri
Sevastopulo, Mehreen Khan, Tom
Hancock, Qian’er Liu, Wang XueqiaoShipping.Imports & exports
Ports bear brunt of sharp dip in freight trade
C H R I ST I A N S H E P H E R D— B E I J I N GChina has reported no new cases of
coronavirus from local transmission
forthefirsttimesinceJanuarybutwor-
ries persist about a potential second
waveofinfectionsfromabroad.The National Health Commission said
yesterday that the province of Hubei
and its capital Wuhan, where the virus
was first discovered, reported no new
cases the previous day.
Despite the encouraging signs, Presi-
dent Xi Jinping on Wednesday struck a
cautious note when he warned the Com-
munist party leadership to guard
against a “reversal”. He added that
China faced new challenges from
imported cases and from intense pres-
sure on the global economy.
“At the same time as approving fully
the successes of the epidemic preven-
tion, we must see clearly how compli-
cated and severe the outbreak situation
remains both in China and overseas,”
Mr Xi told a meeting of the politburo
standing committee.
The National Health Commission said
all the new cases reported in China were
found in travellers from abroad.
Although the reports of no new cases
is an important milestone, China
remains at least two weeks away from
being able to declare that all community
transmission of the virus had stopped,according to Xi Chen, a professor at Yale
University’s school of public health.
Prof Chen added that China’s strategy
of trying to suppress the spread of the
virus left the population vulnerable if it
were to mutate and return before an
effective vaccine was developed and dis-
tributed.
“If the outbreak reoccurs next spring
then China will be at major risk because
while other countries’ strategies
attempt to develop immunity in the
population, in China there is no such
immunity,” he said.
China’s leadership has in recent days
turned its attention towards preventing
a second wave of the outbreak, increas-
ing screening and quarantine proce-
dures for overseas travellers arriving in
the country.
China’s health commission reported
that although there were no instances of
local transmission, 34 imported cases
were confirmed on Wednesday. Of
those, 21 were in Beijing, which has
intensified efforts to identify all those
infected. Almost all arrivals in the city
must be quarantined for 14 days, at
their own expense, in hotels chosen by
the government.
In another sign of the authorities’ con-
fidence the outbreak was under control
in Hubei, the Wuhan city government
announced it would relax restrictions
for some residential compounds.Reversal warning
China reports no new cases of
local transmission for first time
J I M B R U N S D E N— B R U S S E L SMichel Barnier, the EU’s chief Brexit
negotiator, has tested positive for coro-
navirus, becoming the first senior
Brussels policymaker to confirm hav-
ingCovid-19.Mr Barnier said he was “doing well and
in good spirits” after testing positive for
the virus yesterday. “I am following all
the necessary instructions, as is my
team,” he said, adding that he was
“strictly confined at home”.
Ursula von der Leyen, the European
Commission president, is to be tested as
a precaution.
“President von der Leyen last met
Michel Barnier almost two weeks ago to
the day. She has no symptoms, and
therefore is continuing to work,” the
commission said. “She will be tested
obviously in view of this announce-
ment.”
Mr Barnier’s announcement raises
further questions about how Britain and
the EU will continue to negotiate on
their future relationship during the pan-
demic. The overwhelming nature of the
crisis has transformed governments’
priorities while rendering face-to-face
negotiations impossible.
So far one detailed negotiating round
has taken place. The second, which was
set to be in London this week, had been
cancelled before Mr Barnier’s
announcement.In Brussels, expectations are that Brit-
ain will ask for an extension of its post-
Brexit transition period, which expires
at the end of the year..
Whereas an EU-UK summit in June
had been seen as a main staging post for
the talks, the upheaval means no one
knows how much ground will have been
covered by then, or even if the summit
will take place.
Britain this week sent draft legal texts
to Brussels setting out the UK’s vision ofthe future relationship, in a move that it
hopes will help guide contacts over the
coming weeks. The commission has also
published a draft treaty.
EU officials said Mr Barnier’s situa-
tion did not change plans for Brexit talks
to continue remotely. The commission
said negotiators were looking at options
such as videoconferences and that “sub-
stantive work” would “continue over
the coming weeks”.
Mr Barnier’s announcement means
that there are 13 confirmed cases of
coronavirus among the commission’s
32,000 staff.
Notebookpage 8Brexit negotiator
Barnier becomes first senior
EU official to admit infection
H A N N A H KU C H L E R— N E W YO R KD O N ATO
PAO LO M A N C I N I— LO N D O NPresident Donald Trump yesterday
announced that the US Food and Drug
Administration had approved the use
of an antimalarial drug to help patients
who have contracted the coronavirus
torecoverfromthevirulentillness.Mr Trump said the FDA had accelerated
approval of chloroquine, one of many
drugs in trials for treating patients with
the coronavirus. The US president also
said that remdesivir, an antiviral drug
developed by Gilead would be available
to patients soon. Unlike the antimalarial
drug, however, it has not yet been
approved for other purposes.
Mr Trump said that chloroquine had
shown “very, very encouraging early
results” in treating the coronavirus. “We
are going to make that drug available
almost immediately, and that is where
the FDA has been so great.”
“There is tremendous promise based
on results and other tests,” Mr Trump
said at a White House press conference.
A small study in France reported on
Wednesday that chloroquine had accel-
erated recoveries and reduced how long
patients were contagious. But the medi-
cine can have serious side effects,
including acute poisoning and even
death if a patient overdoses.
Another formulation of the drug,hydroxychloroquine, has fewer side
effects.
Remdesivir was developed for Ebola,
but never went through regulatory
approval. The first results from the
many trials using remdesivir to tackle
the coronavirus are not due to be pub-
lished for at least a couple of weeks.
Rocheis launching a clinical trial of a
potential new Covid-19 drug, adding to
rapidly growing investments in combat-
ing coronavirus after the World Health
Organization unveiled plans for its own
trial to study potential treatments.
The Swiss drugmaker said yesterday
it was working with the US FDA and the
US government to initiate a phase 3 trial
to evaluate the safety of actemra, a drug
used to treat cytokine release syndrome
and rheumatoid arthritis, two inflam-
matory diseases. The drug is known as
RoActemra outside the US.
Some preliminary reports suggest
that patients with severe Covid-19 dis-
ease develop cytokine release syn-
drome, also known as a “cytokine
storm,” an overshooting of the immune
system, doctors have said. The study
will enrol about 330 patients globally
starting next month.
The announcement came the day
after the WHO launched its own trial —
named Solidarity — saying it will be sim-
ple enough to permit the participation
of hospitals struggling to cope.Treatments
US drug administration backs
use of antimalarial medicine
Michel Barnier:
said to be ‘doing
well and in good
spirits’ after
testing positive
for coronavirusChina shows signs of recovery
but Europe and US hit by
slowdown due to pandemic
‘Thisis not normal, this is
very extreme, things
I have never seen...We’re really concerned’
MARCH 20 2020 Section:World Time: 19/3/2020 - 18: 52 User: john.conlon Page Name: WORLD2 USA, Part,Page,Edition: USA, 3, 1