The Washington Post - 18.03.2020

A10 eZ sU THE WASHINGTON POST.WEDNESDAy, MARCH 18 , 2020

The coronavirus outbreak

BY CAROLYN Y. JOHNSON, LAURIE MCGINLEY, JULIET EILPERIN AND EMMA BROWN

A small commercial laboratory
in Georgia has been selling do-it-
yourself coronavirus testing kits,
despite the fact that the Food and
Drug Administration has not ap-
proved at-home t esting for p eople
worried they may have been in-
fected in the global pandemic.
A physician at the health clinic
working with the Georgia lab said
there is no time to waste on feder-
al bureaucracy.
“We’re behind the eight ball. We
need to start testing m ore people,”
said David Williams, the chief
executive of Southside Medical
Center in Atlanta. “It doesn’t
bother me that they haven’t given
approval, because that doesn’t
mean it doesn’t work. That
doesn’t mean the test is not accu-
rate.”
The situation is an illustration
of the growing desperation
among Americans for confirma-
tion about whether they have
been sickened by a virus that has
spread to all 50 states, resulting in
more than 5,800 cases nation-
wide, according to researchers at
Johns Hopkins University, and
100 deaths, according to a Wash-
ington Post analysis.
The push to accelerate corona-
virus testing nationwide made
significant advances this week,
from the Pacific Northwest to the
Northeast. On Tuesday,
Adm. Brett Giroir said that nearly
59,000 tests had been done, with
commercial labs administering
8,200 o n Monday alone. A handful
of drive-through testing opera-
tions h ave been set up in large and
small cities: Giroir said 47 would
start up in a dozen states “over the
next few days.”
But the United States still lags
behind other countries, and the
apparent demand for at-home
te sting shows that government
and industry officials are still
struggling to launch widespread
testing needed to curb the pan-
demic’s s pread and c hange its out-
come.
With all 50 states tackling the
pandemic in varying ways, Ameri-
cans are experiencing uneven ac-
cess to care.
“If you get large-scale testing
such that everyone could do it, we
could have a much better sense of
the scale of the problem,” said
William Hanage, an epidemiolo-
gist at the Harvard T.H. Chan
School of Public Health.

LifeHope Labs, which began selling the at-home kits last week, had processed about 100 tests by Friday and more than 300 as of Tuesday afternoon, according to Tim Allen, the chief operating officer. Initially, the company charged $240 per test. Now, the price h as dropped to $150, including shipping and handling. Life- Hope is equipped to handle 846 samples a day and is ramping up to double that number this week. “For people who want to get tested, we just want to be able to give them a way to get tested,” s aid Allen, whose lab is federally certi- fied and has been running the coronavirus test developed by the Centers for Disease Control and Prevention. After Georgia officials warned that such direct-to-consumer testing was not allowed, Allen said, LifeHope partnered with physi- cians w ho can order the tests to be mailed after a telemedicine ap- pointment — still without FDA approval. LifeHope ships kits overnight to people who swab their o wn noses w ith a long cotton swab and then ship the sample back to LifeHope on ice. To m Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health, said such nasal swabs can be uncomfortable and difficult for an untrained person to perform effectively, raising the risk of false negative results. “It’s more complicated than s pitting in a cup,” he said. Another company — Zymo Re- search of Irvine, Calif. — has also developed an at-home kit that it hopes to get into the hands of first-responders and companies so that they can test employees. The kit contains a pair of latex gloves, a cotton swab for collect- ing a sample from the back of the throat and a liquid medium in a plastic tube to preserve the sample. Zymo acts as a middleman, passing the sample to Pangea Lab- oratory in Costa Mesa, Calif., said Marc Van Eden, vice president of business development at Zymo Research. The lab can process results in 24 hours, he said, but is waiting for FDA approval before going to market. With access to traditional testing still limited, the Trump administration has said priority will be given to health-care workers and people older t han 65, who are at higher risk for complications. On the ground floor of a park- ing garage at the University of

L abs step up as

Americans clamor

for more testing

BY ANNE GEARAN AND DAVID NAKAMURA

China’s expulsion of American
reporters from three major news
organizations on Tuesday
marked a major escalation of a
proxy war between the world’s
two largest economies over the
origin and global spread of the
novel coronavirus that President
Trump has called the “Chinese
virus.”
Chinese authorities an-
nounced Tuesday that U.S. jour-
nalists from The Washington
Post, the New York Times and the
Wall Street Journal must hand
over press credentials, effectively
meaning they must leave the
country. The move is in retalia-
tion for recent restrictions on
U.S.-based Chinese state media
put in place by the Trump admin-
istration, b ut the newly hostile
public posturing also comes as
the health, economic and social
costs of the virus are skyrocket-
ing in the United States and have
already taken a toll on China.
At a time when public health
experts say the world needs clear
communication and cooperation
to contain the pandemic, two of
the globe’s leading powers are
butting heads as part of a nation-
alistic tit-for-tat over the corona-
virus — accusing each other of
mishandling the outbreak and
misrepresenting one another’s
roles in its rise.
“It seems to be we’re still in a
free fall, looking for the bottom,”
said Bonnie Glaser, a China ex-
pert at the Center for Strategic
and International Studies. “It’s
really amazing that in the face of
a global pandemic, the United
States and China are playing the
blame game, pointing fingers at
one another rather than looking
for some ways to cooperate.”
China has accused the United

States, and Trump in particular, of racism for trying to label the virus Chinese or Wuhan, the city where it first appeared. The Trump administration has accused China of disinformation and slander. Trump and political allies in and out of the administration frequently describe the crisis as Chinese-made, something public health professionals say is mean- ingless outside the lessons that can be learned from China’s ex- perience in responding to the outbreak. It is part of an effort to shift blame and characterize the outbreak as a foreign invader that has persisted even as Trump has shifted from dismissing the virus as a passing inconvenience to treating it as a threat to the nation. “The world is at war with a hidden enemy,” he tweeted Tues- day. “WE WILL WIN!” Trump and his allies have said that using the term “Chinese virus” is not aimed at exploiting xenophobic fears among some Americans. They say it counter- acts self-serving propaganda from Beijing. “China was putting out information which was false that our military gave this to them. That was false. A nd rather than having an argument, I said I had to call it where it came from. It did come from China,” Trump said Tuesday during a news conference at the White House. “So I think it’s a very accurate term.” A Chinese state television out- let had admonished Trump in English on Monday night. “Shall we call H1N1 ‘A merican flu’? No, we’d rather focus on saving lives,” @CGTNOfficial tweeted, adding the hashtags “#ChineseVirus? and #FightTheCOVID19.”

The Trump administration ac- cuses China of covering up the extent of the initial outbreak in Wuhan and making it worse for the rest of the world. The administration has angrily denounced official statements in China sug- gesting that the virus originated in the United States or was spread to China by the U.S. military. A spokesman for the Chinese foreign ministry, in a series of tweets last week, amplified a conspiracy theory that the virus did not originate in a Wuhan market, as experts believe, but rather was weaponized deliber- ately by U.S. troops taking part in an athletic competition in that city last year. A separate conspiracy theory circulating in the United States holds that the virus is a Chinese plot against the United States, and some Trump supporters have accused Democrats and the news media o f engineering a fake crisis to make Trump look bad. The State Department sum- moned China’s ambassador in Washington on Friday for a heat- ed confrontation, and Secretary of State Mike Pompeo com- plained a gain Monday in a phone call with his Chinese counter- part. Asked whether there is a “stigma” attached to labeling a global pandemic after a country or ethnicity, as Trump had done twice in a span of several hours Monday night and Tuesday morning, the president doubled down. “No, I don’t think so. No, I think saying that our military gave it to them creates a stigma,” he told reporters. He spoke before news of the journalists’ expulsion in China, but Pompeo addressed the development a short while later.

“They suggested somehow that the actions that we had taken here in America prompted this. This isn’t apples to apples,” Pompeo told reporters at the State Department. “I regret Chi- na’s decision today to further foreclose the world’s ability to conduct free press operations, which frankly would be really good for the Chinese people.” Pompeo also used his variant of “Chinese virus” as he accused the Chinese government of attempting to “shift responsibility.” “There will come a day when we will evaluate how the entire world responded. We know this much. We know that the first government to be aware of the Wuhan virus was the Chinese government,” Pompeo said. China’s foreign ministry said the three U.S. outlets, as well as Voice of America a nd Time maga- zine, will be designated as “foreign missions” and must report information about their staff, finances, operations and real es- tate in China. The statement did not men- tion pulling credentials for Time and VOA, but it was unclear whether China would take further action. The escalating blame game comes as Trump and Chinese President Xi Jinping have faced widespread criticism for their handling of the pandemic. Chi- na’s Communist Party failed to disclose early reports about the virus, intimidating local doctors who tried to sound alarms, and party leaders have blamed the Trump administration for spreading unnecessary panic in its decision to shut down flights from China in January. Trump played down the scale of the virus in the United States for weeks and offered contradic- tory and at times inaccurate

information to the public, before only recently shifting to a more robust government effort to scale up testing. The finger-pointing occurs as China and the United States are supposed to be moving toward an omnibus trade deal that tests Trump’s strategy of applying tar- iffs and then negotiating to re- move them. Trump insisted Tuesday that an initial U.S.-China trade agreement is intact and China will buy U.S. farm products as promised. “We have a good relationship with China. I have not received anything to that. No, we have a signed agreement. They’re going to be buying, and they have been buying a lot of product,” Trump said. As Trump and Xi play to their domestic audiences, analysts see competing incentives that are likely to exacerbate bilateral tensions, which have been on the rise for years, despite the an- nouncement of a “phase one” trade deal in early January. Glaser said Beijing is not only attempting to shift the blame for a domestic audience, but also eager to exploit the global uncer- tainty and bolster its argument that “China is a model for developing countries to copy and Chi- na should be a leader of global governance reform and portray- ing the United States as having failed in its governance model.” Trump had touted the trade deal as a sign that his personal relationship with Xi was paying off in tangible economic wins for the United States, an argument that was shaping up as a core of his 2020 reelection message. Be- fore the coronavirus began to make headlines in late January, the president had touted a possible upcoming summit with Xi to begin talks on a “phase two” deal.

On Jan. 15, Trump played host to a handful of senior Chinese officials in the East Room at the White House to announce the trade breakthrough in celebra- tory remarks with U.S. business officials. Ye t Gordon Chang, a China hawk who appears frequently on Fox Business Net- work, pointed out that by then, Xi a lready knew about the spread of the coronavirus in Wuhan. “These guys send their delega- tion into the East Room interact- ing with a good portion of the American leadership, and they were not even telling us they were potential disease carriers,” said Chang, who also questioned whether Beijing is prepared to abide by the terms of the trade package t hat was announced that day. In the news conference Tues- day, Trump said he expects Bei- jing to follow through on its to pledge to purchases $250 billion in U.S.-made goods despite the negative impact that the coronavirus has had on China’s econo- my. He added that Beijing has “every incentive” to ensure that supply chains on pharmaceuti- cals to the United States remain intact. Hudson Institute analyst Mi- chael Pillsbury, who informally advises Trump on China and trade, said he does not view Trump’s stepped up rhetoric about the “Chinese virus” as signaling that the president is ready to dramatically escalate tensions with Beijing. “I think it all depends on the implementation of the phase one agreement,” Pillsbury said. “It has a lot of deadlines in it.” [email protected] [email protected]

emily rauhala contributed to this report.

China’s expulsion of reporters e scalates battle with Trump administration

Washington Medical Center- Northwest on Monday, cars moved at a measured clip as four nurses wearing scrubs, gloves, surgical masks, and clear plastic eye shields tested health-care workers for covid-19, the disease caused by the coronavirus. Traffic cones marked the site, which was flanked by three white tents, bio- hazard disposal bins, a hand- washing station and heat lamps that warmed up the chilly garage. Alex Greninger, assistant d irec- tor of the virology division at the UW Medical Center in Seattle, said his lab has enough capacity to test about 1,800 people per day. But having received more than 2,300 specimens in one day last week, h e has had to figure out how to triage. “We are communicating with our clients — people who send tests to us — to prioritize inpa- tients, first responders, health- care workers, vulnerable popula- tions,” he said in a phone inter- view, a dding that they do not want requests from outside t he hospital to delay tests for patients. “That is the real worry here.” In the District of Columbia, George Washington University Medical Faculty Associates is lim- iting nearly all of its tests to patients with obvious symptoms consistent with the virus to con- serve the limited supply of kits and protective gear. “We would like to be able to test as many people as possible,” said William Borden, the group’s chief quality and population health officer. “Right now we have several hundred test kits. We’re trying to be judicious, that we’re using them for people who have a high likelihood of being positive.” Ryan Westergaard, chief medi-

cal officer for Wisconsin’s Bureau of Communicable Diseases, told reporters on Monday that state officials are optimistic they will expand their testing capacity but are not there yet. The state public health lab, where most coronavirus testing is taking place, has been running seven days a week and currently can process about 400 tests per day. He estimated that a handful of other hospitals a nd private labs in the state, which had 46 active cases of the coronavirus as of Monday, c an collectively t est up to another several hundred prospec- tive cases a day. “A t the present moment, t here’s not enough capacity to test every person — or even every person with respiratory symptoms,” Westergaard said. The FDA announced Monday that states could approve tests developed in laboratories in their states without getting the agency’s authorization in an effort to speed development. But even as major lab supply firms are ramping up production and the Trump administration says the effort will scale up quickly, laboratories a re constrained by limitations. Thermo Fisher Scientific, a lab supply giant, has 1.5 million tests ready to ship this week and expects to increase quickly to 2 million tests per week. But hospital labs still need time to set up a process for administering them. Thermo Fisher spokesman Ron O’Brien, whose company i s initially distributing its tests to 200 labs in the United States, said that could take a few days to a week. The tests must run on a specific laboratory instrument, which can process up to 846 tests per ma-

chine p er day if it is testing a round the clock. Thermo Fisher hopes to be able to ship 5 million tests per week by April, but it will depend on the availability of raw materi- als, including reagents used to extract the genetic material from samples. Roche, a pharmaceutical giant, can supply about 3.5 million tests per month, but these tests also must run on specific instruments in limited supply. There are fewer than 830 of these machines across the globe. As t esting ramps up, some laboratory industry officials are worried about a shortage of supplies, such as the swabs health-care workers use to collect samples from patients. Carmen Wiley, president of the American Associ- ation for Clinical Chemistry, said that the FDA requires swabs made by a single manufacturer and that some labs are running low. Wiley also said there r emains a shortage of RNA extraction kits, which are used by laboratories to extract the virus’s genetic material from the swabs. An FDA official said the agency has provided additional flexibility in using both kinds of supplies, but some industry officials say even those looser requirements won’t solve the problem. The shortage of testing kits from the federal government has triggered a race to come up with new techniques to detect the coronavirus. M ore than 60 researchers at Yale University and a nearby private firm called Homodeus are developing a test that people could a dminister at h ome, similar to a home pregnancy test. “So you can spit into a tube. And get results. N o lab. No t echni- cian. No expensive machines. No

wait,” said Jonathan Rothberg, an entrepreneur and genetics re- searcher l eading a team at t he Yale School of Medicine. Results would be available within half an hour. But Rothberg, who noted that the Bill and Melinda Gates Foun- dation is also working on a mail-in kit, said even his group’s high- speed efforts would be scaled up only if they were clinically v alidat- ed. On Tuesday, W hite H ouse Coro- navirus Response Coordinator Deborah Birx said experts were exploring “innovative solutions,” like self-swabbing, but did not have enough data yet. In some parts of the country, people are already getting better access to tests. Tony Dunn a nd his wife, both in their 60s, started showing symptoms last week and were initially unable to get tested because they had not traveled in- ternationally nor been in contact with a confirmed case of the coronavirus. On Monday, their doctor told them that drive-through t esting for the flu and t he coronavirus had just opened near their home in Flat Rock, N.C. They arrived an hour after the station opened to find 15 cars in line, Dunn said. Their coronavirus test results are due Friday. “Con- sidering that we live in a small town in western North Carolina, I’m fairly impressed by how quickly they got their act togeth- er,” Dunn said. [email protected] [email protected] [email protected] [email protected]

steven mufson, neena satija, Brady dennis and shane Harris in Washington and Gregory scruggs in seattle contributed to this report.

mArK ylen/AlBAny democrAt-HerAld/AssocIAted Press A team from the Oregon Health Authority waits Tuesday to test the staff of the Edward C. Allworth Veterans Home in Lebanon, Ore. The Food and Drug Administration said Monday that states could approve tests developed in state laboratories without agency authorization.

The Washington Post - 18.03.2020

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