The Washington Post - 05.03.2020

A12 eZ sU THE WASHINGTON POST.THURSDAy, MARCH 5 , 2020

the coronavirus outbreak

BY JEANNE WHALEN, ABHA BHATTARAI AND JAY GREENE

Glow Beauty knew it was hold-
ing solid g old, and it was not afraid
to charge for it. On Amazon this
week, it was asking $348 for four
plastic bottles of Purell hand s ani-
tizer.
That included free shipping,
mind you. And the bottles were
40.5 ounces each. Still, buyers
were not i mpressed.
“Outrageously expensive, but
needed for a patient waiting
room,” one commented on the
seller’s Amazon page. “There’s a
fine line between gouging and
supply and demand.” After ques-
tions from The Washington Post,
the seller said it was removing the
listing.
Widespread fears about coro-
navirus have caused acute short-
ages of hand sanitizer, creating a
cottage industry online: Purell
speculation. Amazon has been
awash with sanitizer arbitrage, as
third-party sellers hawk their re-
maining supply at premium pric-
es. ( Amazon founder and C EO Jeff
Bezos owns T he Post.)
On Wednesday, a seller called
Pure Products Direct was asking
$79.99 for two eight-ounce b ottles
— a relative steal considering an-
other vendor wanted $54.99 for
one bottle. A day earlier, Village
Pharmacy and Boutique was ask-
ing $400 for a case of 24 two-
ounce bottles. “Collectible — Very
Good,” it said of the cargo’s condi-
tion.
Sellers were also a ctive on Face-
book Marketplace, where an
eight-ounce bottle of Purell was
priced at $ 40 o n Tuesday.
Amazon last week said it was
cracking down on third-party ven-
dors that are trying to profit from
the coronavirus frenzy. But some
sky-high listings continued
through Wednesday afternoon.
“There is no place for price
gouging o n Amazon,” s pokeswom-
an Cecilia Fan said by email last
week. “We are disappointed that
bad a ctors are attempting to artifi-
cially raise prices on basic need
products during a global health
crisis and, in line with our long-
standing policy, have recently
blocked or removed tens of thou-
sands of offers. We continue to
actively monitor our store and re-
move offers that violate our poli-
cies.”
On Wednesday, Fan said Ama-
zon was continuing to review and
delete exploitative listings. In an

emailed statement, Facebook said that “sellers are responsible for complying with local laws, which include those related to an emergency.” S ome states have laws banning price gouging during a crisis. California Gov. Gavin Newsom (D) was not impressed by the trade. “Seriously, @Amazon? These prices are absurd,” h e tweet- ed Tuesday, sharing an image of a few high-priced Purell offerings. A Baltimore-area seller on Face- book Marketplace defended his $40 asking price for an eight- ounce bottle. “I’m a poor guy with 4 children I’m just taking advan- tage of situation trying to make a little extra money for my family,” he wrote in an exchange with The Post. He s aid he had “more than o ne” bottle to sell and that he had bought them easily at a store, in- sisting the sanitizer was currently available at some pharmacies and grocery stores. “Just the online people g oing crazy,” h e wrote. Despite his l uck in f inding sanitizer he could resell, retail shelves in many parts of the country were stripped b are. CVS and Ta rget stores in the District h ave been sold out of Purell and other sanitizers in recent days. A Bed Bath & Beyond was cleaned out Saturday, after one woman bought $86 worth of purse-sized bottles, according to a cashier who would give only her first name, S hanee. A Ta rget employee who fulfills online orders at a store in Rich- mond said it was “dead out of hand sanitizer.” “One customer ordered 60 three-ounce bottles,” the employ-

ee said. “That was l iterally all they wanted.” Local media and Twitter users i n other parts of the country also reported empty shelves. Ta rget, Bed Bath & Beyond and CVS did not respond to requests for c omment. Ta rget’s chief executive told in- vestors Tuesday that coronavirus- related fears had led to “aggres- sive shopping” at its stores, al- though he did not address hand sanitizers specifically. Gojo Industries, the Akron, Ohio-based company that makes Purell, has “increased production significantly” and has employees working overtime to deal with booming demand, spokeswoman Samantha Williams said in an email. Gojo said i t became aware of the coronavirus in December and be- gan increasing production in Jan- uary, b efore there were any reported cases in the United States. The company’s factories — two in Ohio, one in France — have been running at f ull capacity since then. “We have experienced several demand surges in the past during other outbreaks, and some have gone on for many months,” Wil- liams said. “A t this point, the ag- gregate i ncrease in demand i s still below historic levels. That said, orders have i ncreased very significantly i n the past several days.” The sanitizer speculation is not limited to Purell. On Amazon on Tuesday, two third-party sellers were offering a two-pack of 16- ounce Equate-brand sanitizer for $50. [email protected] [email protected] [email protected]

As sanitizer speculation takes hold,

Purell prices are spiking on Amazon

brIAN sNyder/reUTers Hand sanitizer at a campaign office for Sen. Elizabeth Warren. Online retailers have listed the product for hundreds of dollars.

BY AMY GOLDSTEIN, CAROLYN Y. JOHNSON, LENA H. SUN AND LAURIE MCGINLEY

A day after Vice President
Pence touted a new policy allow-
ing “any American” to be tested
for the novel coronavirus with a
doctor’s order, some health offi-
cials and physicians expressed
concern that people with mild
symptoms might overwhelm t he
nation’s still-limited testing ca-
pability.
During a White House b riefing
on Tuesday, Pence announced
government testing guidelines
were being loosened to empha-
size that physician judgment —
not other criteria, such as recent
travel to China — would be the
main driver in deciding who gets
tested. The move drew praise
from experts who said the previ-
ous guidelines from the Centers
for Disease Control and Preven-
tion were far too restrictive in
the f ace o f a virus t hat has spread
to more than 75 countries and
sickened more than 95,000 peo-
ple.
But other health experts
warned the action might inad-
vertently send the wrong mes-
sage, prompting a surge in de-
mand for tests from people with
mild symptoms who should sim-
ply stay home until they recover.
They also noted that laboratory
capacity for virus testing, while
on the rise, is still lagging. Tests
that can be done in doctor’s
offices don’t exist.
“This means that right when
we need to be careful and me-
thodical about this new testing
capacity, we may be over-
whelmed,” said Lauren Sauer,
who runs emergency prepared-
ness for Johns Hopkins Medicine
and the university health system.
Sixty public health labs are
now running the just-fixed CDC
test. In the next several days and
weeks, testing capacity is expect-
ed to increase as more labs come
online and private companies
ship thousands of test kits.

Pence’s announcement took many officials at the Department of Health and Human Services and the CDC by surprise, according to an HHS official who spoke on the condition of anonymity to discuss the matter frankly. On Thursday afternoon, the CDC added the new information to its guidelines for evaluating people who may have the disease, known as covid-19. Steven Hinrichs, chair of the Department of Pathology and Microbiology at the University of Nebraska Medical Center, said if large numbers of people with colds were to seek testing, it could cause delays in emergency rooms for the seriously ill. Dur- ing the 2001 anthrax scare, he said, people tried to have their pizza boxes tested because they saw white flour on the bottom. But s tate epidemiologists, who are on the front lines of manag-

ing the outbreak, said they w ere largely satisfied with the new criteria. “They’re getting calls from their providers, hundreds a day, saying, ‘I have this person who may have mild illness b ut a vague possible exposure, can I get [them] tested?’ ” said Jeffrey En- gel, executive director of the Council of State and Te rritorial Epidemiologists. “They just w ant to know how to manage the numbers coming in.” James Lawler, an infectious- disease clinician at the Universi- ty of Nebraska Medical Center, also welcomed the new policy’s emphasis that testing decisions are up to doctors. “There was an eventual need to open up that diagnostic ability to allow clinical judgment to drive the decision,” he said. But by Wednesday, Pence’s pledge had become a rallying cry

in Kirkland, Wash., where seven residents of the Life Care Center nursing facility have died of the virus. Many families were de- manding that all residents and staff be tested. “Let’s not wait till they’re symptomatic,” said Kevin Con- nolly, whose 81-year-old father- in-law is a resident of the center. “These are all elderly. A positive test is a death sentence.” King County physicians thought that testing everyone who asked was not a medically sound rationale. Susan J. Baumgaertel, an in- ternist at a large Seattle clinic, described seeing a mother on Wednesday who was worried because she had attended a bas- ketball game before her child’s school closed early for spring break. “I just had to calm her down,” said Baumgaertel, who tried to reassure the patient she

probably had the common cold and didn’t need to be tested. “I don’t think it’s a good public message,” she said of Pence’s announcement. Once test kits become available in King County later this week, she said, “what we are going to see is suddenly the cases are going to go s kyrocketing h igh because we have testing. The minute you see that, Pence’s words will echo, ‘Oh, we should get tested.’ Which is insane, for most people. You are going to see people come out of the wood- work.” Some people are struggling to get tested even with the looser criteria. A 51-year-old Indiana woman, who spoke on the condition of anonymity, citing privacy concerns, said she developed a persistent cough about a month ago followed by shortness of breath. The woman, who works at an airport car rental agency where she frequently deals with people traveling from abroad, tested negative for flu. On Wednesday, she went to her family doctor, who wasn’t sure how to request a test for the coronavirus. She spent an hour in the office waiting for a reply from local and state health officials and in the end was told, incorrectly, that she didn’t quali- fy because she had not recently traveled out of the country and wasn’t hospitalized. “I’m not sitting here c onvinced I have it, nothing like that,” she said. “But none of this other stuff has worked — and because I work in an airport, I just feel it’s prudent at this point to test.” W hile d octors have always had authority to order tests, the government’s new guidelines em- phasize that. “Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with covid- and whether the patient should be tested,” the CDC said on its website. But Corinne Heinen, who works in a Seattle primary-care

clinic, said Wednesday that Pence’s suggestion that any person could ask their doctor to get tested runs counter to strict guidance still in effect at University of Washington Medicine. Under those criteria, patients should be tested only u nder extremely limited circumstances. “Patients should not self-present for testing,” the guidance says in bold letters. Under those criteria, it is not enough to have a fever higher than 101 degrees Fahrenheit, a new cough and new shortness of breath, if the person is not sick enough to be hospitalized and does not have any high-risk fac- tors. Only people who have traveled to select international hot spots, or have been close to someone who has, or who have spent time at the nursing facility where deaths have occurred are allowed to get a test. So can people with immune systems suppressed for specific reasons. That means that even “pregnant patients and HIV-positive don’t count,” Heinen said. She said that on Tuesday, a patient arrived at a primary- care clinic who made “deliveries to people’s doors in Kirkland,” the town in which the nursing facility is located. The patient had respiratory symptoms, Hei- nen said, but the clinic no longer allows chest X-rays under such circumstances because of the risk to others in the clinic. The patient did not meet the medical system’s test criteria, either. “This person came in quite ill and did door-to-door deliveries and could not get tested,” Heinen said. Despite what the White House said, she added, “there’s no testing available unless the people are in extremis.” [email protected] l [email protected] [email protected] [email protected]

Maria sacchetti in Kirkland, Wash., contributed to this report.

Some fear expanded testing may overwhelm U.S. labs

JAbIN boTsford/THe WAsHINgToN PosT Vice President Pence holds a news conference on the coronavirus Tuesday at the White House. Pence announced that physician judgment would be the main driver in deciding who is tested for the virus.

BY SIMON DENYER

tokyo — With the coronavirus, it may pay to be an isolated, paranoid loner. As the epidemic grips China to the north and spreads quickly in South Korea on the other side of the demilitarized zone, North Ko- rea’s separation from the global economy presents a rare advan- tage. But Kim Jong Un’s insular world also could face a major crisis if the virus that causes covid-19 finds its way in. An outbreak could overwhelm the feeble health system — ranked 193 out of 195 on the Global Health Security Index — in a country already stalked by mal- nutrition and diseases such as tuberculosis. “It is easy to see how an outbreak of covid-19 could easily overrun the limited capacity to treat those patients,” said Kee Park, a scholar at Harvard Medi- cal School who has studied North Korea. Pyongyang has insisted it has no cases of coronavirus, and the World Health Organization said it has seen no indications to contradict that. But three news outlets with extensive contacts inside the country, NK News, Daily NK and AsiaPress, have reported cases in the border cities of Sinuiju or Rason and said that some people may already have died. The reports could not be independently verified. North Korea has moved swiftly to close its limited contacts out- side its borders. It b egan by banning tourists on Jan. 22, then shut down all flights and trains in and out of the country. Visitors from abroad were quarantined, and foreign diplomats were placed under vir- tual house arrest in Pyongyang. Anyone showing possible symptoms faces a month-long quarantine, as do customs in- spectors and trade officers who deal with China. On Tuesday, South Korea’s spy agency told lawmakers in Seoul that the North has put at least 7,000 people under quarantine. Trade across the border with China — a critical economic life- line for Kim’s regime — has col- lapsed. A major crackdown on cross-border smuggling also has been imposed, news reports say. Kim warned last week of seri- ous consequences for the country

if the virus enters. His propagan- da machine has cranked into overdrive. Rodong Sinmun, the ruling- party n ewspaper, called the battle against coronavirus one of “national survival” and last week urged citizens not to gather in restaurants. “Talking while eating would become a major route of infec- tion,” it warned. The media coverage has been “highly unusual, in terms of vol- ume, level and duration,” said Rachel Minyoung Lee, an analyst at NK News. She described it as “a strong indicator of how seriously con- cerned North Korea is about the virus.”

“The virus situation, should it spiral out of control, could pose a major setback to the Kim regime’s domestic and perhaps even foreign policy goals,” she added. The restrictions are also con- siderably tougher than those imposed during the severe acute respiratory syndrome epidemic in 2002-2003. They are already having a noticeable effect on the economy. To urism from China was a major source of foreign currency, while consumer goods from Chi- na are disappearing from mar- kets, news reports say. This espe- cially stings because so many North Koreans depend on income from private trading to supple- ment meager official incomes. The self-imposed shutdown has ironically served to close loopholes in international sanctions, noted Bruce Klingner, a former CIA analyst and North- east Asia specialist at the Heri-

tage Foundation. Market information compiled by Daily NK shows prices of rice, corn, diesel and gas all rising, some to their highest levels in a year or two. The regime has re- sponded by trying to impose price controls and ordering sugar and soybean distributors to release stocks. Kim’s attempt to develop his country’s economy was already foundering under sanctions. And his attempt to come in from the cold diplomatically suffered a major setback with the break- down of a summit with President Trump in Hanoi a year ago. Kim has already adjusted course, warning North Koreans in late December that they would have to further tighten their belts as the regime tries to be more self-reliant. Andrei Lankov, a professor at Kookmin University in Seoul, said t he virus is not good news for Kim but that “the news was bad anyway. This doesn’t change much.” And however bad it gets, it is not about to bring down the regime in a country where the control of the security services remains pervasive, he said. “Kim Jong Un may worry about regime stability, but there were no protests or uprisings in the 1990s when 1 million North Koreans died from starvation and related diseases,” Klingner said. Harvard’s Park said the international community is looking for ways to help. Doctors Without Borders was granted an exemption from U.N. sanctions to send in protective equipment and diagnostic tests. But foreign medical experts and humanitarian groups remain ex- cluded from the country by Kim. While the world frets about the coronavirus, North Korea’s nuclear weapons program has moved way down the global agenda. That could work in Kim’s favor, said Jean Lee at the Wilson Cen- ter. “The isolation buys him time to focus on his nuclear strategy as he watches political develop- ments in the United States,” she said, before voicing a more hope- ful thought. “I’d like to see Kim accept goodwill offers of humanitarian assistance for the sake of his people,” she said. “That might also open up a window of diplo- matic opportunity.” [email protected]

If virus arrives, N. Korea’s isolation

is a possible bu≠er but also a worry

“The virus situation,

should it spiral out of

control, could pose a

major setback to the

Kim regime’s domestic

and perhaps even

foreign policy goals.” Rachel Minyoung Lee, analyst at NK News

The Washington Post - 05.03.2020

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