THE WALL STREET JOURNAL. **** Saturday/Sunday, February 29 - March 1, 2020 |A
WASHINGTON—President
Trump and top administration
officials said the U.S. is consid-
ering new steps to address the
coronavirus outbreak but
called the current risk to
Americans low, as federal
health officials urged lawmak-
ers on Capitol Hill to approve
emergency funding in anticipa-
tion of more cases.
Mr. Trump said that he was
considering restricting travel
from additional countries that
are experiencing major coro-
navirus outbreaks, without
specifying which countries he
had in mind.
“We’re looking at that right
now and we’re looking at a
couple of countries—a few
countries—that have a little bit
disproportionately high num-
ber,” he told reporters, adding
that he would make a decision
“very soon.”
Mr. Trump had previously
signaled he was considering re-
strictions on travelers from It-
aly and South Korea, on top of
existing restrictions rolled out
in January regarding China, the
epicenter of the outbreak.
In a Friday afternoon brief-
ing, Health and Human Ser-
vices Secretary Alex Azar
urged Congress to quickly pass
an emergency funding package,
which is on track for nextBYANDREWRESTUCCIA
ANDANDREWDUEHRENficials have already begun dis-
tributing critical medical sup-
plies from public stockpiles.
Gov. Andrew Cuomo said
Wednesday the state will be
seeking approval from the New
York state Legislature for $
million in emergency funds to
combat coronavirus in the state
and pay for needed equipment,
including protective gear for
health-care workers.
Hospital and public-health
emergency plans include con-
tingencies for a surge in pa-
tients, which include possible
makeshift wards outside hospi-
tals, if necessary, said Jenna
Mandel-Ricci, who is heading
emergency preparedness for
the Greater New York Hospital
Association, a trade group.
Hospitals are also seeking to
create temporary isolation
rooms with specialized equip-
ment, she said.
Montefiore Health System in
New York readied a two-room
isolation unit, outfitted with its
own laboratory, in recent weeks
to prepare for possible patients,
said Montefiore’s health-care ep-
idemiologist, Theresa Madaline.
Local governments are also
pushing ahead with emergency
declarations in efforts to pre-
pare for coronavirus cases, with
San Francisco joining the list
this past week. “Although there
are still zero confirmed cases in
San Francisco residents, the
global picture is changing rap-
idly, and we need to step up
preparedness,” said Mayor Lon-
don Breed.
The second California case,announced Friday, came in
Santa Clara County, just south
of San Francisco, where an
older adult woman was con-
firmed as infected with corona-
virus. The finding came after
the woman was hospitalized for
a respiratory illness and her
physician requested testing for
the deadly new virus.
In Oregon, an individual
tested positive for coronavirus
and the state was awaiting con-
firmation on the results from
federal officials, state leaders
said. The individual, who had
contact with people in an ele-
mentary school, isn’t believed to
have traveled to areas affected
by the virus, suggesting possible
community spread, they said.
Government and other agen-
cies say they are working to
prepare businesses, schools and
other community gathering
places for potential closures.
Kris Ehresmann, the Minne-
sota Department of Health in-
fectious disease director, said
the state is working out plans if
schools need to close, asking
businesses to come up with
new sick-leave policies that al-
low people to work from home
or in shifts, and finding ways
for houses of worship to gather
virtually rather than in person.
“We can’t stop this from
happening, but we can take
measures to slow down the
spread,” Ms. Ehresmann said.
—Erin Ailworth, Jim Carlton,
Stephanie Armour
Melanie West
and Lee Hawkins
contributed to this article.tients. The CDC doesn’t track
the number of hospital isola-
tion rooms.
More widespread screening
could make it easier to track
the spread of the virus in the
U.S., Dr. Toner said. Health and
Human Services Secretary Alex
Azar told Congress Thursday
that testing capacity is expand-
ing, with 40 labs qualified to
screen for coronavirus.
Hospitals and local public
health agency officials say they
are working to coordinate ac-cess to hard-to-get medical
supplies, such as protective
masks, and track where hospi-
tals have space to safely isolate
a coronavirus patient across a
region.
The Health and Human Ser-
vices Department keeps a stra-
tegic stockpile of critical medi-
cal supplies, including
protective equipment, which is
available to hospitals when
they can’t replenish inventory
from the market or state and
local reserves. HHS hasn’t re-
ceived requests or deployed
protective equipment in re-
sponse to the epidemic, a
spokeswoman said Friday.
In New York, state health of-Hospital emergency
plans include
contingencies for a
surge in patients.reports of coronavirus in China
emerged, an effort to hold back
supply in case of a U.S. corona-
virus outbreak.
A domestic outbreak would
also land more critically ill pa-
tients in hospitals, which are
already seeing a seasonal surge
from flu patients, the infec-
tious-disease specialists said.
Widespread coronavirus cases
could lead to hospital-services
demand that would likely be
worse than the 2009 pandemic
of influenza, said Eric Toner, an
infectious-disease specialist at
the Johns Hopkins Center for
Health Security.
Emergency-room patient
volume soared 18% during the
fall of 2009, versus the same
period from 2005 to 2008, re-
searchers reported in the pub-
lic-health journal Medical Care.
Not all hospitals saw a surge of
hospitalizations, but those
hardest hit saw admissions in-
crease 20%.
A repeat of that could strain
overall hospital capacity, Dr.
Toner said. Hospitals have plans
to respond to surges but need
time to get them in place, he said.
Less is known about how cor-
onavirus is transmitted, and
there are no existing antiviral
drugs for the new virus, unlike
influenza, requiring new plans
for what might be needed in the
event of a surge in patients, said
CDC spokeswoman Martha Sha-
ran. Coronavirus patients also
require isolation to prevent oth-
ers from being infected.
The CDC is working to adapt
its influenza plans to respond
to a potential surge in demand
for hospital services from coro-
navirus cases, Ms. Sharan said,
adding that guidance for hospi-
tals is expected to be released
next week.
When dealing with conta-
gious diseases, such as measles
and tuberculosis, hospitals typi-
cally place patients in rooms
with special ventilation to pre-
vent air carrying disease from
circulating around their build-
ings. But most hospitals have
few such rooms. Some hospitals
also have units where ventila-
tion can be switched to safely
isolate a group of infectious pa-
ContinuedfromPageOne
ation and noted the company’s
diversified supply lines, but
warned that shortages could
occur in the future. The com-
pany’s president, Rajiv Malik,
said, “Our whole industry is in
one way or other way con-
nected with China, but you
would expect us to be much
better placed.”
Experts believe China is
also the only maker of key in-
gredients in a class of de-
cades-old antibiotics known as
cephalosporins, which treat a
range of bacterial infections,
including pneumonia.
“The antibiotic supply chain
is becoming increasingly frag-
ile, even without a global epi-
demic centered in the major
manufacturing location,” said
Dan Diekema, director of in-
fectious diseases at the Uni-
versity of Iowa Healthcare, ahospital. “If we were to have
major disruptions that caused
shortages of several antibiot-
ics at once, it would challenge
our ability to adapt.”
Several generic manufactur-
ers have seen prices on phar-
maceutical raw materials grow
by as much as 50%, including
those for common products
such as cholesterol-lowering
statins, according to research
by Sanford C. Bernstein & Co.
Drugmakers are adjusting,
including by looking for alter-
native suppliers and raising
prices, said industry experts
and officials. Some Chinese
firms stopped shipping to
manufacturers in India, said
David Light, chief executive of
Valisure, an online pharmacy
that works with advisers in In-
dia. The Indian generic-drug
industry, which the FDA sayssupplies 40% of U.S. generic
drugs, relies on China for
much of its active ingredients.
With hundreds of manufac-
turing plants and other work-
places in China suspending op-
erations in an effort to contain
the spread of the coronavirus,
more pressure on the pharma-
ceutical supply chain looms
large. Yet details on the medi-
cines supply lines into the U.S.
are limited, hampering authori-
ties’ ability to anticipate which
drugs are most vulnerable.
China is recognized as the
world’s biggest supplier of the
raw materials—known as ac-
tive pharmaceutical ingredi-
ents—that form the basis of
medicines. That dependence
on China makes shortages
more likely should Chinese
manufacturing be shaken, ac-
cording to a 2019 U.S. govern-ment report. China’s domi-
nance is growing: The U.S.
imported $3.9 billion worth of
pharmaceutical raw material
from China in 2017, an increase
of nearly one-quarter from the
prior year, says IHS Markit.
Even before the outbreak of
the Covid-19 disease, experts
for years have warned that
overreliance on a single region
posed risks to the U.S. health-
care system. An explosion in
2016 at a plant in China led to
a world-wide shortage of the
antibiotic piperacillin.
“The pharma industry is
pretty much bound hand and
foot with manufacturers in
China,” said Robert Walsh,
whose company Samara Bio-
pharma Consulting audits Chi-
nese factories on behalf of
Western drugmakers.
The industry has someWORLD NEWS
cushion. Drugmakers tend to
stock up in advance of China’s
Lunar New Year holiday, over
which factories typically close
for two weeks. They also order
raw materials in bulk and
maintain about six months of
supply, industry officials say.
“The question is, how far in
time do these stockpiles go,
and can we continue to rely as
heavily as we do on manufac-
turing of these critical supplies
offshore,” said Rita Numeroff, a
health-care business strategist.
The intricacies of the sup-
ply chains for individual medi-
cines—which companies keep
under wraps for competitive
reasons—remain hidden from
the public. While the FDA re-
quires manufacturers to report
when there is a shortage of a
specific product, companies
that make the raw materials
aren’t subject to such de-
mands. Nor must they disclose
the size, or timing, of ship-
ments being made to the U.S.,
limiting the ability of hospitals
and other providers to plan for
potential supply disruptions.
The FDA says it has no way
to track API volume out of
China. “We technically have no
idea what is actually manufac-
tured in China,” said Soumi
Saha, senior director of advo-
cacy at Premier, one of the larg-
est group-purchasing organiza-
tions in the U.S. contracting for
drugs and other supplies for
hospitals. “We’re missing that
upstream visibility.”
Trying to shed light on the
medicines-supply chain is
Mike Osterholm, director of
the Center for Infectious Dis-
ease Research and Policy at
the University of Minnesota.
He is leading an effort to map
out the supply chains for
around 150 of the most impor-
tant medicines and medical
devices in the U.S., by piecing
together information from
shipping records, company
disclosures and FDA data. Al-
though the project started
around 18 months ago, he said
the coronavirus outbreak has
put it “on steroids.”Factory shutdowns across
China because of the coronavi-
rus have exposed an uncomfort-
able health-care reality: Many
medicines rely on raw materials
that are made in that country.
The U.S. Food and Drug Ad-
ministration Thursday said one
drug already has gone into
shortage because of difficulties
obtaining a raw ingredient
from a site affected by the cor-
onavirus. It didn’t disclose
which drug or its manufacturer.
For several weeks, the FDA
has been contacting more than
180 drug manufacturers, re-
minding them to provide noti-
fication of any expected supply
shortages. That includes the
makers of roughly 20 products
the agency has identified as
containing key pharmaceutical
ingredients from China.
Most vulnerable are generic
drugs, which make up some
90% of the medicines taken by
Americans. Nongeneric, or
branded, prescription medicines
tend to have supply lines linked
to other parts of the world.
Certain classes of drugs,
too, are at special risk. China
is a key supplier of the chemi-
cal and raw materials for pop-
ular blood pressure medicines
and several older antibiotics
that are no longer manufac-
tured in the U.S., such as doxy-
cycline and penicillin.
Big drugmakers such as
Teva Pharmaceutical Indus-
tries Ltd., one of the world’s
largest generic manufacturers,
have said in statements before
the shortage was announced
that they were monitoring
their supply chains and hadn’t
experienced any disruptions.
On Thursday’s quarterly
earnings call, Mylan NV said it
continues to monitor the situ-
BYDENISEROLAND
ANDJAREDS.HOPKINS
In U.S., a Risk to Drug Supply Emerges
China is a key provider
of raw materials,
chemicals for medicines
popular abroad
Trump Considering
New Steps to Take
With Coronavirus
CHINA DAILY/REUTERS
Chinese employees work on the production line of an antimalarial drug that officials say has a curative effect on the coronavirus.A person wearing a protective mask sits in a Bay Area Rapid Transit train in San Francisco Thursday.DAVID PAUL MORRIS/BLOOMBERG NEWSHospitals
In U.S.
Prepare
week, and said the administra-
tion is considering using the
Defense Production Act. That
act, first passed during the Ko-
rean War, gives the president
powers to require businesses
to produce goods tied to na-
tional defense.
Mr. Azar said that the risk
to the American public from
the coronavirus is low and that
it was too early to say what
measures, such as closing
schools, could be needed to
slow the virus’s spread.
The U.S. has 60 people with
confirmed cases, including 45
individuals repatriated to the
U.S. More than 85,000 people
globally have contracted the
disease, causing nearly 3,
deaths, according to the World
Health Organization.
Earlier this week. Mr.
Trump put Vice President Mike
Pence in charge of federal re-
sponse efforts.
Dr. Anthony Fauci, director
of the National Institute of Al-
lergy and Infectious Diseases,
told House lawmakers that
they should expect many more
cases of the disease in the U.S.,
according to a person who was
in the room.
The White House is taking
steps to better coordinate mes-
saging on the outbreak, in-
structing senior officials to
seek approval from Mr. Pence’s
office before speaking publicly
about the epidemic.Vice President Pence, center, at a news conference with Florida
Gov. Ron DeSantis and Jerome Adams, the U.S. surgeon general.SAUL MARTINEZ/BLOOMBERG NEWS