Manufacturers are producing as many as they can to care for Covid-19 patients with breathing problems. Now the federal government is asking for even more.
Ventilators vary widely in cost and size, but their purpose is the same: They force oxygen into the patient’s lungs, usually through intubation.PHOTOGRAPH: RONALD BONSS/GETTY IMAGE
Gregory Barber reports for Wired
ERIC GJERDE, CEO of Airon Corporation, a small ventilator maker in Gainesville, Florida, has been getting far more business than he’d like in recent weeks. An Italian company asked him for 2,000 machines. His distributor in California, working with state officials there, asked for 500 more. Normally, his company sells 50 “in a good month,” Gjerde says, and they only keep so many parts on hand. He told the Italians no, and he told the Californians he’d do his best. “America has to come first,” he says.
On Monday, the California distributor came back to him: Could he send another 200? “Of course they want them today, and you just can’t do that,” Gjerde says. “Making ventilators is not a trivial process.” But again he said he’d do what he could.
As the number of Covid-19 cases surges, state governments and hospitals are clamoring for more ventilators and facing a dearth of supplies. The machines are a critical component in treating the most severe cases of the disease, in which inflammation restricts the amount of oxygen a person’s lungs can take up on their own. Ventilators vary widely in cost and size, from portable units used at home and in ambulances to much larger machines found in intensive care units, but their purpose is the same: They force oxygen into the patient’s lungs, usually through intubation.
Some estimates suggest demand for ventilators may quickly overwhelm US hospitals’ supply, which includes about 160,000 machines, plus 12,000 more in federal reserves, according to a recent tally by Johns Hopkins researchers. Not all of those machines are suited to critical care and, of course, many of them are already in use by people with other respiratory conditions.
Whether the nation will face a shortage depends on whether social distancing measures can flatten the curve, reducing the number of people who need hospitalization at the same time, says Craig Coopersmith, director of critical care at Emory University School of Medicine. “Right now we’re OK, but there will be shortages if the pandemic becomes severe enough,” he says. For a preview, doctors need only look to the hardest-hit parts of Italy and China.
Days after telling governors to fend for themselves in obtaining critical supplies like ventilators, President Donald Trump on Wednesday announced he would invoke the Defense Production Act to ramp up the manufacture of critical supplies, including ventilators. Passed in 1950 at the start of the Korean War, the act allows the federal government to step in to ensure the steady flow of goods, including military weapons but also food and health supplies.
On Tuesday, Secretary of Defense Mark Esper also announced that his agency would distribute 2,000 ventilators from their own reserve to the Department of Health and Human Services, but noted that these machines are different from ones normally used in civilian settings and would require special training from defense personnel.
It’s unclear what the immediate effect of Trump’s announcement will be, although it will allow federal agencies to order needed supplies from manufacturers. The question is whether new machines can be produced quickly enough. “The problem I have is that people have been seeing this coming for a long time and governments and hospitals just have not stockpiled,” Gjerde says. “These can sit in a box and never be touched.” For now, he’s had to say no to international orders, despite having distributors in Taiwan and Italy beg him for more.
Retooling a complex supply chain to build more machines quickly will be difficult. Airon relies on suppliers across the Midwest to make the valves and tubing, while another supplier in Washington makes each machine’s casing. A few parts come from China. Gjerde’s looking into whether he can get the circuit boards he needs produced locally.
More top-down coordination could potentially help, says Chris Brooks, chief strategy officer of Ventec, a ventilator maker based near Seattle. The company, which typically ships 100 machines per month, has seen immediate demand for thousands of machines. “Our hope is that we don’t need as many ventilators as people are saying,” he says.
In the United Kingdom, the British government is pushing for large manufacturers to switch from making cars and airplane engines to ventilator equipment. But Gjerde says that even the best engineering teams that are not used to making medical machinery will find it hard to reorient quickly. “They don’t know the nature of the beast,” says Gjerde, who’s received an offer of aid from an auto parts manufacturer in Canada. For certain components, it might be feasible, he says, but “it’s just too dangerous to be thrown into the hands of people who don’t know what they’re doing.”
In the meantime, some have taken to creative hacks, like open-sourcing schematics for the design of ventilator parts for 3D printing. In Italy, the approach was used to quickly produce much-needed valve replacements, reportedly over the objections of a ventilator manufacturer that threatened a patent lawsuit. On Twitter, ER doctors have traded tips on how to split ventilator tubes between multiple people.
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Health officials in New York, California and other hard-hit parts of the country are restricting coronavirus testing to health care workers and the severely ill, saying the battle to contain the virus is lost and the country is moving into a new phase of the pandemic response.
As cases spike sharply in those places, they are bracing for an onslaught and directing scarce resources where they are needed most to save people’s lives. Instead of encouraging broad testing of the public, they’re focused on conserving masks, ventilators and intensive care beds — and on getting still-limited tests to health-care workers and the most vulnerable. The shift is further evidence that rising levels of infection and illness have begun to overwhelm the health care system.
A similar message was hammered Saturday by members of the White House coronavirus task force, who said it was urgent to conserve scarce supplies and offered guidelines about who should get tested. Top priority, they said, should go to those who are hospitalized, along with health-care workers, symptomatic residents of long-term care facilities and people over 65 — especially those with heart and lung disease, which place them at higher risk.
“Not every single person in the U.S. needs to get tested,” said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. “When you go in and get tested, you are consuming personal protective equipment, masks and gowns — those are high priority for the health care workers who are taking care of people who have coronavirus disease.”
Health officials are now struggling with a complicated and shifting message. More people can get tested as drive-through sites open and more tests are finally available. Nevertheless, those with mild symptoms should stay home and isolate. And everyone should practice social distancing to preserve the health care system’s finite resources.
To convey those points clearly, many officials are speaking in increasingly blunt terms, saying that wide testing could jeopardize the lives of health care workers and the U.S. response by burning through precious supplies as a tidal wave of sick people descend on the system.AD
“In a universe where masks and gowns are starting to become scarce, every time we test someone who doesn’t need one, we’re taking that mask and gown away from someone in the intensive care unit,” said Demetre Daskalakis, deputy commissioner for the Division of Disease Control of the New York City Department of Health and Mental Hygiene.
The tactical and messaging shifts come after weeks of efforts to expand access to testing after the federal government’s botched rollout, which hampered states’ ability to know whether the virus was already circulating and to take steps to get ahead of it.
Millions more tests are now available. And the Food & Drug Administration on Friday approved the first coronavirus test that can deliver results in 45 minutes. The turnaround time is far faster than for current tests, which are typically sent to centralized labs and can take days to return results.AD
The FDA granted “emergency use authorization” to Cepheid, a California company that makes a rapid molecular test, for use in “patient care settings,” but the company and the FDA said initially it will be used in hospitals, emergency rooms and urgent care centers.
The test will “help alleviate the pressure” on health-care facilities by helping doctors find out quickly whether a patient has the disease and select the appropriate treatment, David Persing, Cepheid’s chief medical and technology officer, said in an interview.
Despite those developments, however, many health officials remain concerned that testing sites will be inundated and that the president’s previous assertions that anyone who wanted a test “could have one” will lead many with mild cases to squander finite resources.
“I’m just scared there’s going to be mass confusion when people find out there is a testing site, are worried about their covid status, and they’re going to mob the testing site,” said Michael Fraser, executive director of the association that represents state health directors. “It’s confusing to people to hear that testing is being made available in a much more convenient way, and they think, ‘Hey, this is great, let’s get tested.’ ”
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Gov. Phil Murphy on Saturday announced he’s putting New Jersey into a virtual lockdown to combat the spread of the coronavirus, ordering New Jerseyans to stay at home except for necessary trips and mandating that non-essential retail businesses closed until further notice and others have people work from home.
The measures will go into effect 9 p.m. Saturday, Murphy said while announcing that the state now has 1,327 confirmed cases of the virus that has infected hundreds of thousands across the globe. There have now been 16 known deaths from the virus in New Jersey.
The governor said the actions are needed to limit human interaction in an effort to help slow the spread of the virus, which causes the illness COVID-19.
“We can no longer maintain a sense of business as usual,” Murphy said during a news briefing at Rutgers-Newark. “Just as it is no time to panic, it is time to be smart, transparent, aggressive.
The governor said essential workers, such as emergency responders and health-care employees, are allowed to travel. And the general public can still go outdoors for exercise.
Businesses allowed to open include grocery stores, food banks, pharmacies, medical marijuana dispensaries, gas stations, auto mechanics and repair services, convenience stores, banks, hardware and home improvement stores, laundromats, dry cleaners, printing and office supply shops, pet stores, stores that sell supplies for young children, and mail and delivering shops.
Other businesses should allow people to work from home, if possible, the governor said.
Restaurants, bars, and liquor stores that provide takeout can remain open. Construction sites will not be closed.
Murphy said people can assume most retail is non-essential. “And we mean it,” he said.
The governor said he is also banning all public gatherings — which means no weddings, in-person services, or even parties.
“This decision is not an easy one, and it pains me that important life moments will not be celebrated the way we are accustomed to,” the governor said. ”Our singular goal is to make sure we get through this emergency so you can safely gather with family and friends later and enjoy many more wedding and birthdays to come.”
Murphy also said he wants people off the roads for non-essential travel 24 hours. He noted health workers, media, law enforcement, and federal officials who need to travel are exempt.
“We expect people to stay home,” Murphy said. “We want you off the roads. That’s now 24 hours. We don’t want you out there. Period.”
On those who may violate his orders, Murphy said: “If folks are monkeying around, we will take action.”
The governor also said people should not go to homes at the Jersey Shore.
“The local infrastructure, especially in offseason, is not prepared for the influx of part-time residents,” Murphy said.
When asked how long he expected his orders to remain in place Murphy said: “It’s somewhere measured in weeks to months. This is not next week. I wish it were.”
The state’s website said manufacturing, industrial, logistics, ports, heavy construction, shipping, food production, food delivery, and other commercial operations may continue operating, but stressed they must keep staff at a minimal level on site to make sure “essential operations can continue.”
Medical facilities can continue to operate, including any one “where a sick or injured person is given care or treatment, such as: doctor’s offices, hospitals, dentist offices, long-term care facilities, and other medical offices.”
Murphy’s move follows similar stay-at-home orders in recent days by the governors of California, New York, and Connecticut.
Murphy had already indefinitely closed public schools, indoor malls, movie theaters, casinos, gyms, barbershops, salons, libraries and more across the state. He banned dine-in areas of restaurants and previously limited public gatherings to fewer than 50 people. Plus, he has strongly suggested that people refrain from non-essential travel in New Jersey and called on people to stay home if they can.
But Murphy had allowed other retail businesses to remain open in recent days, as long as they adhere to social distancing guidelines and closed by 8 p.m. That is set to stop Saturday night.
“Social distancing is the key to stopping this,” state Health Commissioner Judy Persichilli said. “There’s nothing more sophisticated about it. We don’t have a vaccine.”
Officials expect the number of positive coronavirus tests in New Jersey to increase significantly in the coming days as testing expands and there is more evidence of “community spread.”
The state has not released how many negative tests have come back or how many people have recovered from the virus, which causes the illness COVID-19.
New Jersey opened its first state-run coronavirus testing site, at Bergen Community College in Paramus, on Friday. Thousands of people showed up, and the line was halted around noon. Testing resumed there Saturday at 8 a.m.
A second, similar site, at PNC Bank Arts Center in Holmdel, is set to open Monday.
The state on Saturday also announced a new website for information and answers on the state’s response to the virus: covid19.nj.gov/.
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Restrictions are dramatically ramping up amid the growing coronavirus pandemic, with Illinois and its 13 million residents — 10 million in the Chicago area — the latest to join California by moving closer to an effective lockdown. Meantime, New York told nonessential workers to stay home, Florida closed restaurants, bars and gyms amid spring-break revelry, and the U.S.-Mexico border is closing to nonessential travel. Restrictions are dramatically ramping up amid the growing coronavirus pandemic, with Illinois and its 13 million residents — 10 million in the Chicago area — the latest to join California by moving closer to an effective lockdown. Meantime, New York told nonessential workers to stay home, Florida closed restaurants, bars and gyms amid spring-break revelry, and the U.S.-Mexico border is closing to nonessential travel. Restrictions are dramatically ramping up amid the growing coronavirus pandemic, with Illinois and its 13 million residents — 10 million in the Chicago area — the latest to join California by moving closer to an effective lockdown. Meantime, New York told nonessential workers to stay home, Florida closed restaurants, bars and gyms amid spring-break revelry, and the U.S.-Mexico border is closing to nonessential travel.
Illinois Gov. J.B. Pritzker (D) on Friday ordered residents to stay at home for nonessential activity. The order will take effect Saturday evening 13 million people in the state, until the end of April 7. People will still be able to go to the grocery store, get food or gas, go running or hiking or get to work.
Here are some significant developments:
Italy announced another record-breaking death toll on Friday: 627, up from 427 the previous day. The country cited 9,600 people in one day for violating lockdown.
New York Gov. Andrew M. Cuomo ordered all workers in his state to stay home, except for those in essential services. The move came after California Gov. Gavin Newsom ordered 40 million residents to remain at home.
The U.S. tax filing deadline has been pushed back from April 15 to July 15. “All taxpayers and businesses will have this additional time to file and make payments without interest or penalties,” Treasury Secretary Steven Mnuchin said on Twitter.
More than 250,000 cases have been confirmed across the globe. The World Health Organization noted that it took more than three months to reach 100,000 cases worldwide — but only 12 days to log the next 100,000. The number of deaths and confirmed cases continues to surge in Spain and Iran.
For a second consecutive day, China reported no new local infections. But concerns are growing about a new wave of imported cases elsewhere in the region: Hong Kong reported its biggest daily jump in cases Friday, including many that involved recent travel.
Illinois residents ordered to stay at home except for essential activities
Illinois Gov. J.B. Pritzker (D) on Friday ordered residents to stay at home except for certain essential activities, enforcing a measure two other states have taken to blunt the spread of the coronavirus. The order will take effect Saturday evening for 13 million people in the state, until the end of April 7.
“To avoid the loss of potentially tens of thousands of lives, we must enact an immediate stay at home order for the state of Illinois,” Pritzker said.
The announcement follows similar decrees in New York and California.
Pritzker said he expects cases in the state to rise rapidly. He said he did not come to the decision easily.
“As this epidemic has progressed we’ve had to make some hard decisions,” he said. “But ultimately you can’t have a livelihood if you don’t have your life.”
Chicago Mayor Lori Lightfoot emphasized that the order was “not a lockdown or martial law,” noting many services will remain open. Officials said residents will still be able to go to the grocery store, get gas, get dinner from local restaurants and go running and hiking. Many will still be able to go to work, they said.
“Coronavirus will not go away by happenstance,” Lightfoot said. “We must be intentional about taking steps to ‘flatten the curve.’ ”
Municipalities will halt all evictions, authorities said. By Michael Brice-Saddler
3:57 p.m.
Florida governor closes all restaurants and gyms, allowing kitchens to open for takeout only
Florida Gov. Ron DeSantis (R) issued a new executive order Friday afternoon that all on-premises restaurant sales must cease, and all gyms and fitness centers must close. Restaurants can keep their kitchens open for takeout and delivery services only, a dramatic escalation from DeSantis’s announcement earlier this week that restaurants were permitted to stay open at 50-percent capacity.
Friday’s announcement comes three days after the governor restricted bars, pubs and nightclubs, closing them for 30 days, although scenes of spring break revelry in Fort Myers, Siesta Key and Clearwater Beach continued this week, albeit at a more subdued pace. On Thursday on “Fox & Friends,” the governor conveyed a strong message to sun-seeking tourists: “The message for spring breakers is the party is over in Florida.”
DeSantis, however, does see the need for blowing off steam in the face of the coronavirus pandemic: The new executive order lifts some restrictions on restaurants to allow for the sale of to-go sealed alcoholic beverages accompanying meals.
Florida law previously prohibited restaurants from the sale of alcohol for delivery, takeout or off-premises consumption. By Laura Reiley
3:46 p.m.
Army shutters all recruiting stations, shifting to virtual effort
The Army is closing all of its recruiting stations and will shift to virtual recruiting, officials said Friday, as the Pentagon finds its footing to keep a stream of new soldiers flowing during the coronavirus pandemic.
Thousands join the military every month, replacing troops who leave the service, but the logistical nightmare of sending recruits into confined spaces for months of training has sparked concern for some officials.
The Pentagon has said that training will continue, which was reiterated by Army Chief of Staff Gen. James C. McConville, in a news conference Friday, although additional screening and isolation measures have been put in place for recruits moving from hometowns to training sites.
But the digital shift in recruitment comes as the force reckons with how to socially distance in an inherently social institution. McConville said much recruiting is done through social media anyway. The Army, after sustained problems in meeting its recruiting goals, has looked online in recent years, for example creating its own esports league to reach pools of potential recruits.
Nearly two-dozen soldiers have tested positive for the novel coronavirus, along with eight family members, Army Secretary Ryan McCarthy said. McCarthy said he expects promising recruitment numbers this year will help offset reductions for now, but it is unclear at what point declining numbers will prompt concern. By Alex Horton
3:42 p.m.
AP tests canceled, K-12 standardized testing suspended; student loan holders get a break
The organization that oversees the Advanced Placement program said Friday that regular AP testing will be canceled because of the coronavirus crisis and replaced by shorter online versions of the exams that can be taken in 45 minutes at home. The College Board’s announcement reflected the extraordinary upheaval in education, with schools across the country closing in an effort to slow the spread of the virus.
AP tests ordinarily occur in May. But disruptions in classes are occurring in many states, with no end in sight, posing unprecedented obstacles for teachers and students. Students will be able to take the 45-minute exams on computers, tablets or smartphones.
“To be fair to all students, some of whom have lost more instructional time than others, the exam will only include topics and skills most AP teachers and students have already covered in class by early March,” the organization said.
President Trump also said Friday his administration is waiving all federal requirements for standardized tests for students in kindergarten through 12th grade because the coronavirus pandemic has forced most schools in the country to close for an indefinite period during annual testing season.
He also announced that borrowers with college loans can opt to suspend payments, a move designed to ease the financial turmoil caused by the pandemic.
All states have an annual federal mandate under the Every Student Succeeds Act to test students in most grades annually for accountability purposes. Some states had already declared they would not administer the tests.
“The Department of Education will not enforce standardized testing requirements, very importantly, for students in elementary through high school for the current year,” Trump said. “They’ve been through a lot. They’ve been going back and forth. Schools open. Schools not open.”
“I think a lot of the students will be extremely happy,” he said. “Some probably not. The ones that work hard — maybe not.”
Separately, the administration announced a week after promising to waive interest on federal student loans that Americans contending with the economic impact of the pandemic can opt to suspend their payments altogether.
“These are anxious times, particularly for students and families whose educations, careers, and lives have been disrupted,” Education Secretary Betsy DeVos said in a statement. “Right now, everyone should be focused on staying safe and healthy, not worrying about their student loan balance growing.”
For at least 60 days, the 42 million Americans holding $1.5 trillion in federal student debt can ask their loan servicer to allow them to temporarily postpone their payments. Anyone who was more than 31 days behind on their bill as of March 13, or who becomes that delinquent, will have their payments automatically suspended.
All federal student borrowers, regardless of whether they choose to postpone their payments, will automatically have the interest on their loans set at zero for at least 60 days.
The new interest rate will be retroactive to March 13.
People in public service jobs will have to think twice about postponing their payments. Opting out for two months will result in a longer path to debt cancellation for people working toward Public Service Loan Forgiveness. The federal program cancels the remaining balance of a borrower’s debt after 120 on-time monthly payments, but postponing the bill will lengthen the process. By Danielle Douglas-Gabriel, Valerie Strauss and Nick Anderson
3:32 p.m.
Drive-through testing location in Darien, Conn., changed after neighbors complain
A health worker administers a coronavirus test Friday at a drive-through testing location operated by Murphy Medical Associates at Cummings Park in Stamford, Conn. (John Moore/AFP/Getty Images)
Plans to conduct drive-through coronavirus tests outside Darien, Conn.’s town hall were canceled on Wednesday, four hours after the announcement sparked complaints from neighbors, the Darien Times reported.
A woman who said she lives near the town hall had written on the newspaper’s Facebook page that she was strongly opposed to the testing location because children live nearby and residents did not receive what she considered enough advance notice, according to the Darien Times. The comment appeared to have been deleted by Friday.
Other neighbors said they were also concerned about the testing spot being near their homes, the newspaper reported. When the cancellation was announced, dozens of people expressed frustration on Facebook and urged the town to reconsider.
First Selectman Jayme Stevenson wrote Thursday on Twitter that she was finalizing plans for a testing location “that will better handle vehicular traffics and queuing.”
On Friday, Darien officials announced that they had relocated the testing site to the town’s high school and that testing would begin Monday for people who have doctor’s orders and have passed an online screening process.
Darien, a town of roughly 21,000 people, was rated by Bloomberg News this year as the 10th wealthiest place in the country. By Marisa Iati
The latest information collected by the New Jersey Chamber of Commerce about how the outbreak is affecting New Jersey and your business.
Breaking News –Treasury Secretary Steven Mnuchin announced today that Tax Day will be moved to July 15 from April 15 because of the coronavirus outbreak. Cases in New Jersey – New Jersey officials announced 318 new coronavirus cases Thursday, increasing the statewide total to 742 positive tests with nine deaths as the outbreak continues to expand. More Closures – Gov. Murphy ordered the indefinite closure of all personal care businesses which cannot comply with social distancing guidelines, including barber shops, hair salons, spas, nail and eyelash salons, tattoo parlors, among others – and social clubs. No Foreclosures – Gov. Murphy also signed an executive order creating moratorium on removing individuals from their homes pursuant to an eviction or foreclosure proceeding. Murphy Talks to Trump – Gov. Phil Murphy had two asks when he talked to President Donald Trump on Thursday: Federal grants for the state and protective equipment for health care workers as New Jersey struggles with the coronavirus. Medical Equipment – N.J. has just a fraction of the equipment needed to handle the coronavirus Low-Interest Disaster Loans – U.S. Small Business Administration is offering disaster loans to small businesses in New Jersey. To apply for an SBA loan, click here.For guidance on SBA loans, click here. Note from the SBA about completing disaster loan applications:If you are having trouble first getting in after you put in business type, make sure you have entered your type of business AND clicked on EIDL and only EIDL under type of assistance seeking. N.J. small businesses hurt by coronavirus can now get low-interest federal loans. But should they? State Legislature Acts – Check out the N.J. Chamber of Commerce’s breakdown of bills passed by the state Legislature in response to the coronavirus emergency. U.S. Chamber’s Proposal – The U.S. Chamber of Commerce is calling on the Trump administration and Congress to take three critical steps to support America’s employers. A Word from the Grocery Stores – “PILE THEM HIGH AND WATCH THEM BUY” Life inside a grocery store: Restocking, staying clean, handling the rush — and changing its business model on the fly. Previous Executive Orders Business Closures – Gov. Murphy mandated the indefinite closure across New Jersey of 1) all indoor portions of retail shopping malls and 2) all indoor and outdoor places of public amusement. This supplements the list of facilities currently closed to members of the public, which includes casino gaming floors, racetracks, gyms and entertainment centers. Restaurants and Bars Can Partially Operate – Takeout and delivery are still an option at restaurants and bars (including those in malls that have a separate entrance) No Groups of 50 or More – The governor teamed with governors of New York and Connecticut to recommend the cancellation or postponement of in-person events consisting of 50 people or more. Resources New Jersey set up a website with information for businesses and the impact of coronavirus. To report a scammer or suspected price gouging, report it to N.J. Division of Consumer Affairs at (973) 504-6240 or at http://njconsumeraffairs.gov. Gov. Murphy set up a 24-hour hotline where trained healthcare professionals are standing by to answer questions about coronavirus. The number is 1-800-222-1222 and the call is free. If using an out-of-state phone line, call 1-800-962-1253. The Centers for Disease Control and Prevention has a good web page called guide for business and employers for dealing with the Coronavirus. The New Jersey Chamber of Commerce is staying on top of Coronavirus (COVID-19) developments. For news media requests, please email Scott Goldstein.
