The Wall Street Journal - 04.04.2020 - 05.04.2020

A10| Saturday/Sunday, April 4 - 5, 2020 *** THE WALL STREET JOURNAL.

THE CORONAVIRUS PANDEMIC

Test results can take days or weeks. Above, a decontamination zone at a Covid-19 testing facility at Landmark College in Putney, Vt.

KRISTOPHER RADDER/ASSOCIATED PRESS

Change in average travel distance from Feb. 28 to March 28, by county

Change in average travel distance in counties that have confirmed cases of Covid-

Number of

Covid-

cases

5,

1,

100

No change/increase -30% -20% -10%

1 2 10 20 100 200 1k 2k 10k 20k 100k

Confirmed cases (log scale)

00000000000

-100%

-80%

-60%

-40%

-20%

20%

0

40%

In stateswithstay-at-home measures

KEY: In stateswithoutstay-at-home measures

A circle’s size is proportionate to the number

of Covid-19 cases per 100,000 population

Where America Is Staying In

Data collected from mobile phones reveals

how much Americans are complying with

social-distancing instructions and how much

their daily habits have changed. Unacast Inc.,

a company that collects GPS location

information from some 25 million U.S. mobile

devices, provided data on the distance people

travel each day showing how behaviors have

changed over time in every U.S. county.

States that have enacted stay-at-home

orders have generally seen the greatest

reduction in residents’ average daily travel

while the decline in travel distance has been

much more acute in areas that have reported

a high number of cases of Covid-19. Counties

with the largest declines are typically more

urban, with higher incomes, more white-

collar workers and younger populations.

Westchester Co., N.Y.

813 cases per 100,

Orleans Parish, La.

333 cases per 100,

New York City

353 cases per

100,

Sources: Unacast (distance); Johns Hopkins University (cases) Yan Wu, Patience Haggin and Max Rust/THE WALL STREET JOURNAL

Cook Co., Ill.

50 cases per

100,

TRAVELING LESS

Morgan Katz, an assistant pro-

fessor at Johns Hopkins Uni-

versity. Also, nursing homes

often aren’t able to get timely

access to testing for residents

who don’t have symptoms of

Covid-19, the disease caused

by the new coronavirus, mak-

ing it difficult to strictly sepa-

rate them, she said. “That’s

great in theory, but they can’t

do that if they don’t have a

sense of who has it.”

CMS Administrator Seema

Verma said the agency is urg-

ing that nursing homes be pri-

oritized for receiving protec-

tive equipment and is allowing

labs to go to nursing homes to

do testing. Many decisions

about testing are made at a lo-

cal level, she said.

As of March 27, there were

Covid-19 cases in more than

400 long-term care facilities,

according to the Centers for

Disease Control and Preven-

tion. The number has almost

certainly grown since then,

and CMS late Thursday said

hundreds of facilities have

seen increased numbers of

cases among residents. People

over 60 are at higher risk of

dying from the disease.

In one nursing home in Car-

roll County, Md., testing has

confirmed 77 residents with

Covid-19, while 18 employees

were also infected, according

to the county. Five residents

have died. An employee of

Pleasant View Nursing Home

said there was no one immedi-

ately available to comment.

At the Life Care Center of

Kirkland, an inspection in mid-

March revealed several prob-

lems, according to CMS, in-

cluding failure to have a plan

for when the medical director

was unavailable during a cri-

sis; failure to report the out-

break to authorities fast

enough and failure to provide

quality care to residents dur-

ing an outbreak. Through

Thursday, the Life Care Center

of Kirkland was linked to 40

Covid-19 deaths, according to

local health authorities.

The report describes one

nurse who had concerns about

a cluster of respiratory infec-

tions around Feb. 12, two

weeks before the nursing

home told authorities about

atypical respiratory illnesses

there. The nurse said she

didn’t consider calling because

it was flu season, and resi-

dents there commonly have

pneumonia, the reports said.

The facility was conducting

rapid flu tests at the time that

were coming back negative,

the CMS report said.

CMS has levied a $611,

fine for the problems found at

the Kirkland nursing home,

which it said could go up or

down depending on how Life

Care responds.

Life Care Centers of Amer-

ica, which owns the nursing

home, didn’t respond to a re-

quest for comment Friday.

Earlier, Life Care spokes-

man Tim Killian had said the

facility “had adequate disaster

plans in place relative to nor-

mal procedures,” but the coro-

navirus was unprecedented.

Life Care thought it was man-

aging a normal flu outbreak

and reported issues to author-

ities when appropriate, but

the facility wasn’t able to test

its residents for coronavirus

until March 5, he said. He said

the facility has already cor-

rected the issues cited by the

regulator.

Facing an exploding number

of coronavirus cases in nurs-

ing homes, the Trump admin-

istration unveiled new guide-

lines aimed at stemming the

spread, including aggressive

steps to segregate the infected

and constant mask-wearing for

staff members.

The Centers for Medicare

and Medicaid Services’ call for

universal masking of staff and

some other aspects of the new

guidelines go beyond previous

recommendations from the

agency, according to industry

officials and researchers.

Earlier guidance from the

agency didn’t go far enough,

said Kathryn Hyer, a professor

at the University of South

Florida. “They didn’t recog-

nize how susceptible the nurs-

ing-home residents will be.”

The latest guidance comes

as CMS released a detailed ac-

count of what happened dur-

ing a fatal outbreak at the Life

Care Center of Kirkland, near

Seattle. It was the first U.S.

nursing home to become over-

whelmed by coronavirus and

has served as a warning of

just how devastating the virus

can be in a place where some

of the most vulnerable people

are living in close quarters.

Industry officials and out-

side researchers said many

nursing homes lack the equip-

ment and access to testing

needed to implement the

agency’s guidelines. The new

guidance also says nursing-

home staffers should wear full

personal protective equip-

ment, such as gowns, gloves

and medical-grade masks,

when caring for all residents

once coronavirus spread oc-

curs in a facility.

“There’s no way they’ll be

able to support that with the

PPE they have available,” said

BYANNAWILDEMATHEWS

ANDJONKAMP

Nursing-Home Guidelines

Beefed Up to Curb Virus

There are Covid-

cases in hundreds of

long-term care

facilities.

cities bidding against cities
and states bidding against
states, and masks flowing to
those who can pay fastest
rather than those most in
need, such as New York City,
which accounts for 22% of the
country’s confirmed coronavi-
rus cases and 24% of coronavi-
rus-related deaths, according
to the Johns Hopkins Corona-
virus Resource Center.
The president similarly crit-
icizedGeneral MotorsCo. last
month for not working fast
enough to make ventilators.
GM executives were surprised

ContinuedfromPageOne

state’s Department of Public

Health, with turnaround times

from two hours to two weeks.

Gov. Gavin Newsom attri-

buted California’s delays to an

increased demand for testing,

echoing experts across the

country.

“It’s basic math,” said Dr.

Geoffrey Baird, interim chair

of laboratory medicine at the

University of Washington

School of Medicine. The longer

turnaround, he said, is a result

of having more samples than

capacity to process them.

More private labs have pro-

vided and processed tests af-

ter getting FDA approval, but

the increased volume hasn’t

always meant quicker results.

Quest Diagnostics, which sells

tests to health-care facilities

and then processes the results,

began processing its tests at a

single lab starting March 9th.

But by March 25, the company

had been inundated with so

many test results that it devel-

oped a backlog of 160,

tests, it said. Quest has since

expanded testing labs around

the country, but said its back-

log nationwide remains in the

six figures, at 115,000.

The time to get results var-

ies based on whether patients

are deemed as high need by

their health-care systems.

LabCorp, one of the nation’s

other major private test provid-

ers, said it has about 80,

pending results in its labs and

the typical wait is 4 to 5 days.

Patients asked to self-moni-

tor at home typically have

mild symptoms and can more

safely wait longer for results,

Dr. Baird said. But if someone

with symptoms is admitted to

an emergency room, finding

out if the person is positive or

negative for coronavirus

quickly is vital, as it deter-

mines how much space and

personal protective equipment

must be used for treatment.

Many states, including New

York and New Jersey, which

have the most cases in the na-

tion, still restrict testing to

those who are symptomatic or

gravely ill, and health-care

workers and first responders.

tests as of Wednesday, accord-

ing to data collected by the

Covid Tracking Project, and is

now running an average of

100,000 tests a day. Two

weeks ago, a total of only

100,000 tests had been com-

pleted across the country.

The real number may be

significantly higher, as com-

mercial and hospital-affiliated

labs are only required to re-

port positive tests, except in a

handful of states including

California and Massachusetts.

But the more that tests are

conducted, the more the

mostly private labs that pro-

cess results can become even

more backed up, and the lon-

ger some people have to wait

for results. Many faster sys-

tems can process only one, or

a few, samples at once, in-

creasing overall turnaround

times for results exponentially.

Though there is tremen-

dous variation in processing

times, with some as short as

several hours, extreme cases

like that of Ms. Estrella are in-

creasingly common.

In California, where more

than 90,000 tests have been

conducted, 59,500 of those

hadyettobeprocessedasof

Wednesday, according to the

Maria Estrella has been
waiting for her Covid-19 test
results since March 17. The
South Florida resident began
feeling ill, with a sore throat,
fever and headache, after re-

turning from a trip to north-
ern Italy. When she was tested
at the Mercy Miami Hospital
emergency room, staff said the
results were sent to a private
lab in Georgia and would take
three to six days.
Ms. Estrella’s symptoms
have subsided, and she has re-
turned home, but the uncer-
tainty continues to disrupt her
life. Her husband, who has dis-
played no signs of illness, has
temporarily moved out of
their apartment.
“It’s a very grave situation,”
said the 44-year-old. “There
are thousands of people like
me, without results.”
As tests for Covid-19 be-
come more widely available,
fears of a national shortage of
tests have begun to ease,
though access is still limited in
many areas. The U.S. has com-
pleted more than one million

ByDeanna Paul,

Ian Lovett

AndDan Frosch

Why a Covid-

Test Result Takes

TwoWeeksorMore

by the criticism and felt the

company was being unfairly

targeted, people familiar with

their thinking told The Wall

Street Journal. GM emphasized

the extent of its efforts to ad-

ministration officials, a person

familiar with the matter said,

and the president changed his

tone a couple of days later,

saying the auto maker is doing

a “fantastic job.” Mr. Trump in-

voked the DPA against GM last

week.

3M is the primary U.S. pro-

ducer of N95 masks, and health

workers consider its products

the best on the market. Since

cases of the coronavirus began

to proliferate in China in Janu-

ary, 3M has doubled mask pro-

duction to some 100 million

masks a month globally. Mr.

Roman said 3M would be mak-

ing masks in the U.S. at a rate

of 40 million a month within

weeks, up from 35 million a

month currently.

That is the bulk of the U.S.

capacity to make about 50 mil-

lion N95 masks each month,

according to industry execu-

tives. Other companies includ-

ingHoneywell International

Inc. are also working to raise

output. The Department of

Health and Human Services es-

timated in March that the U.S.

would need about 300 million

N95 masks a month to con-

front a pandemic.

Mr. Roman said invoking the

DPA could compel 3M to bring

masks produced internation-

ally to the U.S. Such action

could face legal challenges in

those countries because they

have export bans. 3M said it

was importing 10 million

masks from its factory in China

to the U.S. at the administra-

tion’s request. But the com-

pany said it would continue to

send less than 10% of the

masks it makes in the U.S. to

Canada and Latin America on

humanitarian grounds, unless

compelled to stop by govern-

ment action.

Peter Navarro, a Trump ad-

ministration adviser who is

overseeing DPA implementa-

tion, said the government

didn’t ask 3M to stop exports

to Mexico or Canada.

“3M’s strategy has been to

ignore data requests about

what they produce and where

they produce it and deflect re-

quests for more masks,” he

said.

While 3M has maintained

substantial mask production in

the U.S., other companies

moved output abroad years

ago. U.S. hospitals and suppli-

ers said importing during the

pandemic has been slow and

expensive. Airports are short-

staffed, and some countries

have restricted exports of med-

ical supplies and raw materials

to fight the virus locally.

City officials said regular

suppliers, including W.W.

GraingerInc. andFastenalCo.,

don’t have enough masks to

meet the massive need for

workers in hospitals, emergency

services and other city jobs.

City officials estimate they

will need 30 million masks ev-

ery four weeks. They have

pleaded with 3M to sell di-

rectly to the city, offering to

send tractor-trailers to 3M

plants to pick up pallets of

masks, said a senior city offi-

cial. 3M declined, the official

said.

3M said it is working with

six large health-care distribu-

tors and FEMA to send prod-

ucts where the need is highest.

“Those are the most efficient,

effective ways to get products

to the health-care workers,”

Mr. Roman said.

In desperation, procurers

for the city and its public hos-

pitals are striking deals with

unfamiliar suppliers. Procurers

have been inundated by calls

and emails from brokers and

companies promising masks,

some marked up as much as

1,000%, the senior city official

said.

Prices that U.S. government

agencies and public hospitals

are paying for masks have

spiked in recent weeks, accord-

ing to contracting-data pro-

vider GovSpend. N95s are sell-

ing for $3.59 to $6.89 each,

compared with between 86

cents and $1.20 before the cri-

sis.

Mr. Roman said 3M’s autho-

rized distributors weren’t price

gouging. He said resellers were

raising prices on masks they

found sitting on store shelves

or in warehouses. “That inven-

tory has moved and found its

way into resellers.” Mr. Roman

said. “They are doing unethical

things, criminal things.”

—Allison Prang

contributed to this article.

3M Pushes

Back on

Mask Work