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The Health 202: Shortages are forcing Louisville's biggest hospital system to cut back on covid testing

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with Paulina Firozi

Louisville’s biggest hospital system is cutting back on coronavirus testing because it can’t get enough supplies.

The predicament faced by Norton Healthcare illustrates a broader problem with the nation’s testing effort: Nearly seven months since the first recorded coronavirus case in the United States, the daily test rate is trending downward, not upward.

In a July 23 email sent to Norton, obtained by The Health 202, its supplier Hologic blamed the shortage on a directive from the White House coronavirus task force to funnel supplies to southern states where infections had surged – an assertion the task force disputes.

Two Norton employees were told by Hologic that the hospital system would receive just 20 percent of the testing supplies it had ordered for the following week. A Hologic employee attributed it to a directive from Adm. Brett Giroir, the White House task force member who is in charge of ramping up testing.

“The task force and Admiral Giroir has directed Hologic to send thousands of extra tests to Southern border states for the next couple of weeks,” Hologic account executive Chip Thornbury wrote on July 23. “When extra is sent to hotspots, everyone not in those area’s numbers go down.”

Norton charges the task force is hurting Louisville’s efforts to contain the virus by allocating scarce resources to pandemic hot spots.

Kentucky hasn’t seen a surge in cases like the ones in Arizona, Texas and California. Its rate of daily new infections has risen only slightly over the past month, although the state is still averaging 500 new cases a day.

But the situation – which has unfolded over the past three weeks – has deeply frustrated Norton executives, who say persistent testing is crucial for keeping Louisville clear of cases. 

The company, which operates more than 40 clinics and hospitals in the Louisville area and is the city’s fourth-largest employer, says it has conducted about 65 percent of the area’s covid-19 testing. In April, it launched a drive-in testing site where 700 patients were tested daily and could view their results via an online portal.

Norton’s complaints also underscore the ongoing struggle to secure adequate testing supplies and process samples quickly. Some people are having to wait days or even weeks for their results, crippling public health officials' efforts to stem the tide of new cases that emerged over the summer in the south and the west.

A spokesperson for the Department of Health and Human Services disputed Hologic’s story. 

The spokesperson said it is “not true that there was any reallocation from Louisville.” She acknowledged there was a small reallocation of Hologic’s testing supplies, but said it was from New York and New Jersey to New Orleans to support that city’s outbreak.

The spokesperson also said there is no official guidance or rules on where test supplies are distributed.

“While there may be instances where the Federal government requests help to assist areas of high prevalence of covid-19, there is no official guidance or rules on prioritized distribution of covid-19 instruments or tests to manufacturers such as Hologic by the White House Coronavirus Task Force, or by federal leads at HHS,” the spokesperson said.

When I asked Hologic about Thornbury's email, spokeswoman Suzanne Clancy provided this statement:

Hologic is one of the largest providers of molecular tests for COVID-19 in the United States.  As such, we are in regular contact with the Federal Coronavirus Task Force as well as many State officials. Because these groups have important information about both disease prevalence and availability of other testing supplies, they can help us identify geographic areas of the greatest need, and we try to accommodate these needs as much as possible.

This much is clear: there’s a supply chain problem.

In an email to Steven Stack, Kentucky’s commissioner of public health, Norton said it’s now forced to send all samples to national labs instead of doing in-house processing. Before the reallocation it was processing nearly 750 tests per day internally and sending another 250 tests to the lab, Norton wrote. 

“The federal allocation and limited national testing has put the Louisville community at risk,” Norton wrote. “If Norton Healthcare cannot get more access to testing, improved turnaround times or changes to the federal reallocation, it will be necessary for us to suspend our large volume of community testing.”

Sending samples to a national lab for processing means customers often must wait up to two weeks for results. Testing companies such as LabCorp, Quest Diagnostics and BioReference have publicly acknowledged delays, my colleague Erin Cox reported.

Norton also sent emails to Kentucky’s health secretary, as well as Senate Majority Leader Mitch McConnell (R-Ky.) and Rep. John Yarmuth (D-Ky.), accusing the federal government of steering testing supplies away from Louisville.

“Each time we make a financial investment in a platform for testing to maintain services for the State of Kentucky we find ourselves at the mercy of the Federal Government moving these supplies to other states,” Norton wrote to Yarmuth.

Giroir promised Congress the nation would be performing 40 to 50 million monthly tests by September.

But the testing rate is about half that right now – and hasn’t been improving over the past few weeks. Roughly 700,000 tests are being performed in the U.S. every day, a rate held relatively steady since early July.

Riggs Lewis, vice president for health policy at Norton, said throughout the spring the hospital chain was short on protective equipment such as gloves, masks and gowns. Now the issue is testing supplies.

“Today’s supply chain break is reagents – that is our new broken supply chain,” Lewis said.

“As demand has surged, it has created backlogs and choke points at almost every step of the testing chain,” my colleagues Rachel Weiner, William Wan and Abigail Hauslohner reported last month.

“It’s not shortages of any one thing. It’s now spot shortages of all of them,” said Scott Becker, chief executive of the Association of Public Health Laboratories. “Clinical labs need more swabs, chemical reagents, viral transport media, test kits, machines to process the tests, staffing to run the machines.”

NOTE: The Health 202 is bidding a fond farewell to Paulina Firozi, who has researched for the newsletter since it launched in 2017. She's heading to The Post's General Assignment news desk, equipped with endless knowledge about things like pharmacy benefit managers and Medicare payment models. But she's not gone forever! We're looking forward to featuring her future work right here.

Correction: This piece is updated to reflect the correct timeframe the U.S. has been grappling with coronavirus. It's been nearly seven months, not five, since the country's first recorded case. 

Ahh, oof and ouch

AHH: President Trump urged the U.S. to reopen as covid-19 deaths reached the highest level in a single day since mid-May.

The president contined pressing for the nation’s schools to bring children into classrooms, for businesses to open and for athletes to go on with their seasons, Brady Dennis and Jacqueline Dupree write.

“We’ve got to open up our schools and open up our businesses,” Trump said at an evening news conference at the White House, adding that he wanted to see college football this fall. “Let them play,” he said.

“The president also made his latest concerted push to get students back into U.S. schools, saying that ‘99.9 percent’ of deaths from the coronavirus pandemic involve adults,” they write. “He threatened to divert federal money from schools that don’t open, and warned of the intellectual damage that could result if children remain at home indefinitely.”

“When you sit at home in a basement looking at a computer, your brain starts to wither away,” Trump said, adding that “all schools should be making plans to resume in person classes as soon as possible.”

Nearly 1,500 people died in the U.S. yesterday from the coronavirus. The country's seven-day average of newly reported deaths has remained above 1,000 for 17 consecutive days.

OOF: Members of a federal health advisory committee say they're worried the new coronavirus database is hurting the collection of covid-19 data.

Nearly three dozen current and former members, including nine who were appointed or reappointed to the Healthcare Infection Control Practices Advisory Committee by Health and Human Services Secretary Alex Azar, wrote in a letter that the new system places an undue burden on hospitals and will have “serious consequences on data integrity," the New York Times's Sheryl Gay Stolberg reports.

“The letter was made public as both hospital officials and independent data experts around the country were reporting kinks in the new system, which critics say is undermining the government’s ability to understand the course of the pandemic,” Sheryl writes. "The Covid Tracking Project, a respected and widely used resource, identified “major problems” with the new Department of Health and Human Services system in late July, and reported this week that “the federal data continue to be unreliable.”

Azar ordered last month that hospitals must report data about coronavirus cases to a private vendor that transmits the data to a central database, bypassing the Centers for Disease Control and Prevention.

“The order raised alarm that the data could be politicized or withheld from the public,” Sheryl writes. “But the authors of the letter expressed additional concerns. They said that the transition from the C.D.C. to the private vendor, TeleTracking Technologies, has left hospitals ‘scrambling to determine how to meet daily reporting requirements’ and that C.D.C. data experts had been sidelined.”

OUCH: Covid relief talks are at a standstill – again.

“A new attempt to restart economic relief negotiations between the White House and Democrats ended just minutes after it began on Wednesday, with President Trump appearing to cast doubt on the whole process by announcing a deal is ‘not going to happen,’ The Post's Erica Werner and Jeff Stein write.

Talks collapsed last week as Republicans refused to give in to Democrats' demands for more relief dollars overall and unrelated measures such as funding for election preparations and the U.S. Postal Service.

“The bill’s not going to happen because they don’t even want to talk about it, because we can’t give them the kind of ridiculous things that they want that have nothing to do with the China virus,” Trump said at the White House during an evening news briefing.

“His comments came hours after House Speaker Nancy Pelosi (D-Calif.) and Treasury Secretary Steven Mnuchin spoke for the first time since the talks fell apart last week,” Erica and Jeff write. “But their conversation did not break the impasse, instead leading to another round of finger-pointing.”

Pelosi and Senate Minority Leader Chuck Schumer issued a statement after Pelosi’s conversation with Mnuchin, accusing the administration of “refusing to budge.” Then Mnuchin followed with a statement accusing Pelosi of mischaracterizing their conversation and proclaiming that Democrats “have no interest in negotiating.”

Sugar rush