Vital medical supplies reach India as COVID deaths near 200,000

By Shilpa Jamkhandikar, Rupam Jain and Sanjeev Miglani

NEW DELHI (Reuters) – Vital medical supplies began to reach India on Tuesday as hospitals starved of life-saving oxygen and beds turned away coronavirus patients, and a surge in infections pushed the death toll close to 200,000.

A shipment from Britain, including 100 ventilators and 95 oxygen concentrators, arrived in the capital New Delhi, though a spokesman for Prime Minister Boris Johnson said Britain had no surplus COVID-19 vaccine doses to spare.

France is sending eight large oxygen-generating plants this week while Ireland, Germany and Australia are dispatching oxygen concentrators and ventilators, an Indian foreign ministry official said, underlining the crucial need for oxygen.

U.S. President Joe Biden reaffirmed U.S. commitment to helping India, saying he was expecting to send vaccines there while senior officials from his administration warned that the country was still at the “front end” of the crisis.

India’s first “Oxygen Express” train pulled into New Delhi, laden with about 70 tonnes of oxygen from an eastern state, but the crisis has not abated in the city of 20 million people at the epicenter of the world’s deadliest wave of infections.

“The current wave is extremely dangerous and contagious and the hospitals are overloaded,” said Delhi Chief Minister Arvind Kejriwal, adding that a large public area in the capital will be converted into a critical care hospital.

With frustration mounting, relatives of a recently deceased COVID-19 patient assaulted staff with knives at a hospital in the southeast of New Delhi, injuring at least one person, a hospital spokeswoman said.

A video posted on social media showed several people brawling with guards at the same hospital. Delhi High Court has advised local authorities to provide security at hospitals.

The World Health Organization said it was working to deliver 4,000 oxygen concentrators to India, where mass gatherings, more contagious variants of the virus and low vaccination rates have sparked the second major wave of contagion.

With vaccine demand outstripping supply in the country of 1.3 billion people, two U.S. drugmakers have offered support.

Gilead Sciences said on Monday it would give India at least 450,000 vials of its antiviral drug remdesivir. Merck & Co said on Tuesday it was partnering with five Indian generic drugmakers to expand production and access to its experimental COVID-19 drug molnupiravir.

India is also negotiating with the United States, which has said it will share 60 million doses of AstraZeneca’s COVID-19 vaccine with other countries. A senior official participating in the talks said Prime Minister Narendra Modi had been assured of priority for India.

Supply uncertainty could force Maharashtra, India’s hardest-hit state, to postpone inoculations for people aged between 18 and 45, a government official said.

Biden said he had spoken on Monday at length with Modi, including about when the United States would be able to ship vaccines to India, the world’s second most populous country, and said it was his clear intention to do so.

MOUNTING TOLL

India’s 323,144 new cases over the past 24 hours stood below a worldwide peak of 352,991 hit on Monday, and 2,771 new deaths took the toll to 197,894.

But the fewer confirmed infections were largely due to a drop in testing, according to health economist Rijo M John of the Indian Institute of Management in Kerala, a southern state.

“This should not be taken as an indication of falling cases, rather a matter of missing out on too many positive cases,” he said on Twitter.

The U.S. State Department’s coordinator for global COVID-19 response, Gayle Smith, warned India’s challenge will require a sustained effort: “We all need to understand that we are still at the front end of this. This hasn’t peaked yet.”

Dr. K. Preetham, an administrator at the Indian Spinal Injuries Centre, said patients there were having to share oxygen cylinders because of the oxygen shortage.

New Delhi is in lockdown, as are the southern state of Karnataka and Maharashtra, where the country’s financial capital Mumbai is situated.

An uneven patchwork of restrictions, complicated by local elections and mass gatherings such as the weeks-long Kumbh Mela, or pitcher festival, could trigger COVID-19 breakouts elsewhere.

About 20,000 devout Hindus gathered by the Ganges river in the northern city of Haridwar on the last auspicious day of the festival for a bath they believe will wash away their sins.

“We believe Mother Ganga will protect us,” said a woman on the riverbank, where people bathed with few signs of physical distancing measures.

India has turned to its armed forces for help with the pandemic. Even China, which is locked in a military standoff with India along their disputed Himalayan border, said it was trying to get medical supplies to its neighbour.

In some cities, bodies were being cremated in makeshift facilities in parks and parking lots. Television channels showed bodies crammed into an ambulance in the western city of Beed as modes of transport ran short.

SUPPLY UNCERTAINTY

India has converted hotels and railway coaches into critical care facilities to make up for the shortage of beds, but experts say the next crisis will be a lack of healthcare professionals.

Companies ranging from conglomerates such as Tata Group and Reliance Industries Ltd to Jindal Steel and Power have stepped forward to help supply medical oxygen.

The U.S. Chamber of Commerce has said India’s economy, the world’s sixth largest, could falter because of the spike in infections, creating a drag for the global economy.

Australia halted direct passenger flights from India until May 15, joining other nations taking steps to keep out more virulent variants of the virus.

India has an official tally of 17.64 million infections, but experts believe the real number runs much higher.

(Reporting by Anuron Kumar Mitra in Bengaluru, Rupam Jain and Shilpa Jamkhandikar in Mumbai, Amlan Chakraborty and Sanjeev Miglani in Delhi, Saurabh Sharma in Lucknow; additional reporting by Rajendra Jadhav in Satara and Sumit Khanna in Ahmedabad, Humeyra Pamuk, Steve Holland and David Brunnstrom in Washington; Writing by Himani Sarkar and Timothy Heritage; Editing by Clarence Fernandez and Mark Heinrich)

Oxygen leak kills 22 in Indian hospital as coronavirus infections mount

By Rajendra Jadhav and Neha Arora

SATARA, India, (Reuters) – At least 22 patients died on Wednesday in a hospital in western India after a disruption to their oxygen supply caused by a leaking tank, the health minister said, as a nationwide surge in coronavirus cases soaks up supplies of the gas.

The incident in the city of Nashik, one of India’s worst-hit areas, happened after the tank of oxygen leaked, said Rajesh Tope, the health minister of Maharashtra, the richest state, where the city is located.

“Patients who were on ventilators at the hospital in Nashik have died,” Tope said in televised remarks.

“The leakage was spotted at the tank supplying oxygen to these patients. The interrupted supply could be linked to the deaths of the patients in the hospital.”

The world’s second most populous nation reported 295,041 new infections on Wednesday – the biggest daily rise reported in any country – stretching its hospitals to breaking point, officials said.

Only the United States had a slightly higher one-day rise of 297,430 cases in January, though its tally has since fallen sharply. India’s 2,023 deaths were also its highest in the pandemic.

Adding to the sense of alarm, the Serum Institute of India, which manufactures the AstraZeneca COVID-19 vaccine, said it will be able to raise its monthly output to 100 million doses by July from 60-70 million now, later than its previous timeline of end-May.

The delay could slow India’s immunization drive, which the government has opened for all adults from next month to try to stem the deadly second wave.

Hospitals in Delhi, the capital, and elsewhere have been warning that their supplies of medical oxygen that are given to severely ill COVIOD-19 patients are running low as cases pour in.

Max Healthcare, the largest private sector healthcare provider in Delhi and its suburbs, said some of its hospitals had barely two hours’ worth of oxygen left.

“For the last few days the hospital has been facing serious difficulties in procuring adequate and regular supplies of oxygen,” it said in a statement.

“Presently, most of the hospitals in the network are working on dangerously low levels of oxygen supply, which can lead to a very serious adverse patient incident,” Max said.

Television showed images of people with empty oxygen cylinders crowding refilling facilities in the most populous state of Uttar Pradesh, as they scrambled to save stricken relatives in hospital.

The situation was so severe that some people had tried to loot an oxygen tanker, forcing authorities to beef up security, said the health minister of the northern state of Haryana.

“From now, I’ve ordered police protection for all tankers,” Anil Vij told Reuters partner ANI.

LOWERING THE GUARD

Health experts said India had let its guard down when the virus seemed to be under control during the winter, allowing big gatherings such as weddings and festivals.

India now faces a coronavirus “storm” overwhelming its health system, Prime Minister Narendra Modi said in a national address overnight, adding that authorities were working with states and private firms to deliver oxygen with “speed and sensitivity”.

Modi is himself facing criticism for addressing packed political rallies for local elections and allowing a religious festival to go ahead in which millions take a ritual bathe in the river Ganges, considered sacred by Hindus.

India has so far administered nearly 130 million doses of vaccine, the most in the world after the United States and China but still small relative to its population of 1.35 billion people.

Vaccine doses have already run short in many states though inoculations are currently restricted to frontline workers and those aged above 45.

(Additional reporting by Aditya Kalra, Devjyot Ghoshal and Krishna N.Das in New Delhi, Sachin Ravikumar in Bengaluru; Editing by Sanjeev Miglani)

Doctors in Hungary urge volunteers to join overwhelmed COVID-19 wards

BUDAPEST (Reuters) – An appeal went out on Monday for volunteers to join hospital staff treating coronavirus patients in northwestern Hungary, as doctors said COVID-19 wards were overwhelmed, with the pressure only set to mount during the next few weeks.

New infections are surging in Hungary, hard-hit by the third wave of the pandemic, despite vaccination rates at the top of European Union nations, as a proportion of population.

Hungary was the first nation in the bloc to buy and use Chinese or Russian vaccines, as it said shipments from Western suppliers lagged.

Monday’s call, posted on the Facebook page of the Hungarian Medical Chamber in the county of Gyor-Sopron, came just as the nation reported a record number of 11,276 patients in hospital, with 1,340 of them on ventilators.

“The COVID-19 departments in almost all the hospitals are hugely overburdened, there is a shortage of nurses and they are becoming increasingly exhausted,” Laszlo Szijjarto, the chairman of the county chamber, said in the request.

He called for motivated and reliable volunteers to enroll in a 3 hour to 4 hour training course to join hospital staff and assist in monitoring and caring for patients.

The spreading third wave presents a big challenge for nationalist Prime Minister Viktor Orban, who aims to get as many people immunized as quickly as possible to reopen the economy.

Hungary still had plenty of free beds to treat coronavirus patients, Orban said on Friday.

“We haven’t even reached half our capacity yet,” he said, referring to the tally of beds with ventilators, while adding that the number of those free, but without ventilators, exceeded 10,000.

“The question is always whether there are enough doctors and nurses to operate these,” Orban added, saying problems would be resolved.

With just over 1.589 million Hungarians inoculated, Orban said lockdown measures could start to ease once the figure reached 2.5 million, or a quarter of the population.

(Reporting by Krisztina Than; Editing by Clarence Fernandez)

NIH tests therapies to help cut hospital stays for COVID-19 patients

(Reuters) – The U.S. National Institutes of Health (NIH) has started a late-stage trial to evaluate if immune-modulating therapies from three drugmakers can help reduce the need for ventilators for COVID-19 patients and shorten their hospital stay.

The NIH said on Friday it has selected three agents for the study – Johnson & Johnson unit Janssen Research’s Remicade, Bristol Myers Squibb’s Orencia and Abbvie Inc’s experimental drug cenicriviroc.

The study will enroll up to 2,100 hospitalized adults with moderate to severe COVID-19 symptoms in the United States and Latin America.

Immune-modulating therapies are medications that alter the way the immune system works. Severe infections are believed to be triggered by an over-reaction of the immune system, known as a “cytokine storm,” and drugs that suppress certain elements of the immune system can play a role in arresting a rapid escalation of symptoms.

This can lead to acute respiratory distress syndrome and multiple organ failure, among other life-threatening complications.

The NIH said its clinical trial – ACTIV-1 Immune Modulators (IM) – will last six months, and the agency will study if the therapeutics can restore balance by modulating that immune response.

All patients will be given Gilead Sciences Inc’s antiviral drug remdesivir – the current standard of care – and also be randomly assigned to receive a placebo or one of the immune modulators as an add-on treatment, the NIH said in a statement.

Remdesivir was one of the drugs used to treat U.S. President Donald Trump’s coronavirus infection, and has been shown in previous studies to have cut time to recovery, though the European Union is investigating it for possible kidney injury.

(Reporting by Vishwadha Chander in Bengaluru, Editing by Sherry Jacob-Phillips)

The ventilators never came: How graft hampered Brazil’s COVID-19 response

By Gram Slattery and Ricardo Brito

RIO DE JANEIRO (Reuters) – As COVID-19 patients flooded Rio de Janeiro’s public health system from early April to late May, Dr. Pedro Archer found himself making gut-wrenching decisions.

People struggling to breathe needed ventilators, he said, but there weren’t enough to go around; those with a slim chance of recovery were passed over.

“Every shift it was like that,” said Archer, a surgeon at a municipal hospital in Rio de Janeiro, a metropolis of 6.7 million people anchoring a state of the same name. “Sometimes, I would give them sedatives just so that they didn’t suffer. Eventually, they would pass away.”

Some of those deaths, state and federal prosecutors now say, may have been avoidable. They allege that top officials here sought to pocket up to 400 million reais ($72.2 million) via corruption schemes that steered inflated state contracts to allies during the pandemic. The deals, they said, included three contracts for 1,000 ventilators, most of which never arrived.

Rio state Health Secretary Edmar Santos was arrested July 10 and charged with corruption in connection with those contracts. A lawyer for Santos did not respond to a request for comment. Santos admitted to participating in various illicit schemes involving rigged public tenders, according to confidential court documents prepared by federal investigators laying out the alleged scams, which were reviewed by Reuters. He is now a cooperating witness in the probe, the documents said.

Separately, a federal judge suspended Rio state Governor Wilson Witzel from office on August 28 out of concern he might interfere with the investigations. Witzel is also facing impeachment proceedings over alleged graft.

He denied wrongdoing in a statement to Reuters. Vice-Governor Claudio Castro, who took over for Witzel in August, did not respond to a request for comment.

Latin America has been hit hard by the pandemic, with over 8.9 million confirmed coronavirus cases as of September 24, according to a Reuters tally. Brazil alone has registered over 139,000 COVID-19 deaths, second only to the United States.

If the city of Rio were a country, its per capita mortality rate from the coronavirus would rank as the world’s worst, according to a Reuters calculation based on John Hopkins University data. More than 10,000 people have died from COVID-19 in this postcard city of sea and sand, and more than 18,000 statewide.

The region’s response to the pandemic has been hobbled by various factors, experts say, including poverty and crowded urban living conditions. Some leaders, including Brazil’s right-wing President Jair Bolsonaro, have played down the pandemic’s severity.

But the virus has also been aided by greed.

Similar to Brazil, investigators in Bolivia, Ecuador, Colombia and Peru have likewise alleged that officials there lined their pockets through pandemic-related graft schemes.

In court documents detailing the alleged scams in Rio, Brazilian prosecutors describe a series of inter-related criminal enterprises, in which emergency contracts for masks, coronavirus tests – even hand gel – were allegedly rigged.

Reuters reviewed hundreds of pages of prosecutors’ allegations, many confidential and not previously reported; and it interviewed more than a dozen medical professionals and good-government experts who condemned the opportunism they say has compounded coronavirus misery in Rio.

“The pandemic allowed governments to spend significant resources very quickly while internal controls were relaxed due to the emergency,” said Guilherme France, research director for Transparency International in Brazil. “It ended up creating a perfect storm for corruption.”

A representative of Witzel said the suspended governor increased internal controls in the Rio state government, adding that he had fired many public servants accused of “irregularities” during his time in power.

GHOST HOSPITALS

Rio state’s pandemic response called for seven field hospitals to treat COVID-19 patients. Officials at the state health ministry, known as SES, awarded contracts worth 836 million reais ($151 million) to a nonprofit health organization named IABAS to build the structures, which were to open by April 30. Just two have  opened so far, one in mid-May, the other in late June, well after the initial COVID-19 surge.

In late July, as the pandemic eased in Rio, one of those structures located in the working-class city of São Gonçalo was dismantled amid a lack of patients. All that remains is a large field, stripped of grass and littered with debris.

The IABAS contracts are part of an alleged kickback racket spearheaded by Mario Peixoto, a local entrepreneur arrested in May for reputedly defrauding the Rio state health system. Federal court documents submitted by prosecutors describe a complex scheme in which associates of Peixoto allegedly arranged for bribes to be routed to government officials to secure a variety of public health contracts, including the field hospitals.

Lawyers for Peixoto said he is innocent and did not participate in the field hospital deal. His trial is pending.

Federal prosecutors have not charged IABAS. But in confidential court documents they filed asking a judge to authorize the arrest of additional suspects, they said there was no “room for doubt” that IABAS’ winning bid was tainted by graft. Among the various irregularities cited by prosecutors: IABAS drafted its winning proposal before SES solicited offers.

IABAS told Reuters it won the hospital contracts by offering the lowest price. It said SES made frequent changes to the agreement, which slowed construction. IABAS said six of the seven structures were either completed or nearly finished in early June, when Rio state canceled its contract and took control of all the project sites.

In a statement to Reuters, SES disputed IABAS’ characterization of the progress it had made. It said four of the seven field hospitals were far from complete when the state took over.

SES declined to comment on IABAS’ allegation that the health ministry made frequent changes to the construction agreement. SES said it had saved more than 500 million reais ($90.3 million) by suspending payments to IABAS following the corruption allegations made by prosecutors. The ministry said it is cooperating with the investigation.

MISSING VENTILATORS

Prosecutors say Rio’s state government also rushed out ventilator contracts to three companies that had little or no relevant experience.

According to court documents summarizing prosecutors’ findings, Rio on March 21 awarded a little-known firm, Arc Fontoura, a contract worth 68 million reais ($12.3 million) to provide 400 ventilators for immediate delivery. State auditors have since determined Rio’s health ministry paid a nearly 200% markup from the market price.

Arc Fontoura had not previously contracted with the state, and tax documents indicated the firm’s annual revenue was no more than 4.8 million reais ($870,000), prosecutors said. The company’s registered address, Reuters found, is a small residence in a working-class part of the city.

When Rio received a small batch of the ventilators from the company at the end of March, hospital workers complained to SES that the machines lacked key components, prosecutors said in the court documents summarizing their findings. The documents did not make clear in which hospital the health workers were stationed.

Arc Fontoura did not respond to phone calls or e-mails or receive Reuters at its listed address.

On April 1, SES awarded contracts worth a combined 116 million reais ($20.9 million) to two other firms – MHS Produtos e Servicos and A2A Comercio – to supply 300 ventilators each.

Rio prosecutors quickly identified irregularities, according to court documents, starting with the timing of the companies’ bids.  The little-known enterprises submitted their proposals less than an hour after SES opened the tender, which was not advertised beforehand, a sign the firms had been tipped off, prosecutors said.

By May 8, Rio’s state health department said publicly that of the 1,000 ventilators it had ordered, just 52 had been delivered, all from Arc Fontoura. SES said in early May it had canceled its contract with A2A because of “the company’s inability to deliver” the ventilators. A2A did not respond to requests for comment.

MHS owner Glauco Guerra  denied wrongdoing. He said in an email that his company had significant experience providing services to federal agencies. He said he submitted his bid a day after the tender was opened, not within a few hours, as prosecutors had alleged. Guerra said SES entered his bid documents into its computer system in a way that led prosecutors to misinterpret the timeline.

He said 97 ventilators were delivered to SES on June 6, and that the agency later canceled the contract for the remainder. State prosecutors confirmed in public documents seen by Reuters that 97 ventilators ordered by MHS had arrived at a Rio airport in early June.

SES said in a statement to Reuters that all contracts signed “during the pandemic are being audited and revised,” adding that any irregularities will be punished. The ministry declined to comment on  MHS’ claim that its bid documents were entered into the SES system in a misleading fashion, citing ongoing investigations into the matter.

Archer, the surgeon, says his experience battling COVID-19 without enough ventilators has left him bitter.

During the peak of the pandemic in April and May, he said as many as 30 patients in his care were waiting for the machines. Many were too unstable to move to hospitals elsewhere and ultimately died, he said.

How many patients could have been saved, he wondered. How many did corruption kill?

“It’s very difficult to accept things you know are wrong,” Archer said.

(Reporting by Gram Slattery in Rio de Janeiro and Ricardo Brito in Brasília; Additional reporting by Rodrigo Viga Gaier in Rio de Janeiro; editing by Stephen Eisenhammer and Marla Dickerson)

Outbid and left hanging, U.S. states scramble for ventilators

By Nathan Layne

(Reuters) – On the final Thursday in March the Arkansas team in charge of procuring ventilators thought they had scored a coup: a vendor had agreed to sell them 500 of the breathing machines critical to keeping COVID-19 patients alive at $19,000 each.

The next day they were told the deal had vanished because a buyer representing New York was offering to purchase 10,000 units, pay cash upfront and double the price, a deal the vendor could not turn down. Reuters could not independently verify that New York bought the ventilators.

Either way, for Arkansas, the search for the machines goes on.

“We still want to purchase the 500,” said Dr. Steppe Mette, chief executive of UAMS Medical Center in Little Rock, who is helping oversee procurement of supplies for the state. “There are profiteers all over the place.”

Arkansas may never need those ventilators. It has 785 across the state, most of which are not currently in use, and data from New York and other hot spots in recent days suggest hospitalizations might be peaking.

In the past week Louisiana and Arizona scaled back their requests for ventilators from the federal government, while Oregon, Washington and California offered up spare units for use by other states.

But the episode illustrates how some states have been muscled aside in the scramble for equipment to combat a virus that has killed nearly 18,000 people in the United States, potentially leaving them vulnerable should the worst-case scenarios materialize or the virus return in subsequent waves.

The stakes are especially high when it comes to ventilators, which can be the difference between life or death for patients suffering from COVID-19, the respiratory illness caused by the novel coronavirus.

Reuters surveyed all 50 states about their ventilator needs. The 31 that either responded or have disclosed figures showed a collective intent to procure 70,000 units, including outstanding requests to the federal government and private sector.

(For an interactive graphic on ventilator inventories by state, click https://graphics.reuters.com/HEALTH-CORONAVIRUS/USA-VENTILATORS/jbyvrbjxveo/index.html)

The Federal Emergency Management Agency (FEMA) has acknowledged there aren’t enough ventilators in the Strategic National Stockpile to meet demand, and is distributing units to states most in need. According a FEMA spokesperson, the federal government has 8,644 ventilators available, including 8,044 in the stockpile and 600 from the Department of Defense.

Some states have criticized the federal government for crowding them out of the market. Rhode Island, which has 300 ventilators, one of the lower inventories among the states, said it is struggling to source the machines.

“Right now it’s almost impossible to procure ventilators,” Rhode Island Governor Gina Raimondo told reporters this week. “It’s really a very poorly organized system.”

SHANGRILA

Arkansas’ Mette said his procurement team had tried to buy the Shangrila 510S, a compact ventilator advertised on the website of the manufacturer, Beijing Aeonmed Co. Ltd. as “Ready to Confront COVID-19”, from a reseller of the machines.

The incident was significant enough that a report was given to Governor Asa Hutchinson, portions of which were read to Reuters. It says the order vanished in a matter of hours after buyers for New York secured a deal for 10,000 units, the maximum that could be produced in two months.

The office of New York Governor Andrew Cuomo did not respond to a request for comment. Cuomo has himself complained about receiving only 2,500 out of an order for 17,000 ventilators from China, with per-unit prices doubling since the outbreak.

Beijing Aeonmed said it had not applied for approval from the U.S. Food & Drug Administration (FDA) for the Shangrila 510S and that producing 10,000 units in such a short time was “unrealistic”.

Roger Biles, the head of a medical supplies company, InterMed Resources TN, helping Arkansas source ventilators from China, said the reseller told them it was New York that had bought the machines but there was no way to know for sure.

“If you snooze you lose in this environment. Product is going left and right,” Biles said. “We couldn’t get the money to them fast enough. They said they are all gone.”

Biles said the reseller provided certification that the Shangrila 510S could be sold in the United States because it had similar specifications to an approved machine, a common process to gain market access. The FDA did not respond to a request for comment.

The administration of President Donald Trump is working with Ford Motor Co and other manufacturers to produce 100,000 ventilators by the end of June, and FEMA has told states it will provide units 72 hours before any surge hits them.

Arkansas still wants a buffer, even with current projections showing it may now only need 300 ventilators at the apex of hospitalizations in the coming weeks, whereas a previous model indicated it may require 2,000 at peak.

“Prepare for the worst, hope for the best. We are still going on that philosophy,” Mette said.

(Reporting by Nathan Layne in Wilton, Connecticut and Roxanne Liu in Beijing; Editing by Paul Thomasch and Daniel Wallis)

U.S. has most coronavirus cases in world, next wave aimed at Louisiana

By Maria Caspani and Daniel Trotta

NEW YORK (Reuters) – The number of U.S. coronavirus infections climbed above 82,000 on Thursday, surpassing the national tallies of China and Italy, as New York, New Orleans and other hot spots faced a surge in hospitalizations and looming shortages of supplies, staff and sick beds.

With medical facilities running low on ventilators and protective masks and hampered by limited diagnostic testing capacity, the U.S. death toll from COVID-19, the respiratory disease caused by the virus, rose beyond 1,200.

“Any scenario that is realistic will overwhelm the capacity of the healthcare system,” New York Governor Andrew Cuomo told a news conference. He described the state’s projected shortfall in ventilators – machines that support the respiration of people have cannot breathe on their own – as “astronomical.”

“It’s not like they have them sitting in the warehouse,” Cuomo added. “There is no stockpile available.”

At least one New York City hospital, New York-Presbyterian/Columbia University Medical Center in Manhattan, has begun a trial of sharing single ventilators between two patients.

While New York was the coronavirus epicenter in the United States this week, the next big wave of infections appeared headed for Louisiana, where demand for ventilators has already doubled. In New Orleans, the state’s biggest city, Mardi Gras celebrations late last month are believed to have fueled the outbreak.

Louisiana Governor John Bel Edwards said New Orleans would be out of ventilators by April 2 and potentially out of bed space by April 7 “if we don’t flatten the infection curve soon.”

“It’s not conjecture, it’s not some flimsy theory,” Edwards told a press conference. “This is what is going to happen.”

Nurse Tina Nguyen administers a nasal swab at a coronavirus testing site outside International Community Health Services in the Chinatown-International District during the coronavirus disease (COVID-19) outbreak in Seattle, Washington, U.S. March 26, 2020. REUTERS/Lindsey Wasson

About 80% of Louisiana’s intensive care patients are now on breathing machines, up from the normal rate of 30-40%, said Warner Thomas, chief executive of Ochsner Health System, the state’s hospital group.

Scarcities of protective masks, gloves, gowns and eyewear for doctors and nurses – reports abound of healthcare workers recycling old face masks, making their own or even using trash bags to shield themselves – have emerged as a national problem.

“Our nurses across the country do not have the personal protective equipment that is necessary to care for COVID patients, or any of their patients,” Bonnie Castillo, head of the largest U.S. nurses union, National Nurses United, told MSNBC.

In an ominous milestone for the United States as a whole, at least 82,153 people nationwide were infected as of Thursday, according to a Reuters tally from state and local public health agencies. China, where the global pandemic emerged late last year, had the second highest number of cases, 81,285, followed by Italy with 80,539.

At least 1,204 Americans have died from COVID-19, which has proven especially dangerous to the elderly and people with underlying chronic health conditions, Reuters’ tally showed.

MORE BEDS NEEDED

For New York state, Cuomo said a key goal was rapidly to expand the number of available hospital beds from 53,000 to 140,000.

New York hospitals were racing to comply with Cuomo’s directive to increase capacity by at least 50%. At Mount Sinai Hospital’s Upper East Side location, rooms were being constructed within an atrium to open up more space for beds.

At Elmhurst Hospital in New York’s borough of Queens, about a hundred people, many wearing masks with their hoods pulled up, lined up behind barriers outside the emergency room entrance, waiting to enter a tent to be screened for the coronavirus.

The city coroner’s office has posted refrigerated trucks outside Elmhurst and Bellevue Hospital to temporarily store bodies of the deceased.

Deborah White, vice chair of emergency medicine at Jack D. Weiler Hospital in the city’s Bronx borough, said 80% of its emergency room visits were patients with coronavirus-like symptoms.

A ventilator shortfall and surge in hospitalizations has already raised the prospect of rationing healthcare.

Asked about guidelines being drafted on how to allocate ventilators to patients in case of a shortage, New Jersey Governor Phil Murphy told reporters such bioethical discussions “haunted him” but were unavoidable.

Outside New York and New Orleans, other hot spots appeared to be emerging around the country, including Detroit.

Brandon Allen, 48, was buying groceries in Detroit for his 72-year-old mother, who has tested positive and was self-quarantining at home.

“It’s surreal,” Allen said. “People around me I know are dying. I know of a couple people who have died. I know a couple of people who are fighting for their lives. Everyday you hear of another person who has it.”

RECORD UNEMPLOYMENT CLAIMS

Desperate to slow virus transmissions by limiting physical contact among people, state and local governments have issued stay-at-home orders covering about half the U.S. population. A major side effect has been the strangulation of the economy, and a wave of layoffs.

The U.S. Labor Department reported Thursday the number of Americans filing claims for unemployment benefits last week soared to a record of nearly 3.28 million – almost five times the previous weekly peak of 695,000 during the 1982 recession.

Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said warmer weather may help tamp down the U.S. outbreak as summer approaches, though the virus could re-emerge in the winter.

“We hope we get a respite as we get into April, May and June,” Fauci said on WNYC public radio.

Washington state Governor Jay Inslee said he may extend a stay-at-home order tentatively set to expire April 6, encouraged by what he called a “very modest improvement” in the Seattle area.

Washington experienced the first major U.S. outbreak of COVID-19 and has been among the hardest-hit states. As of Thursday the state reported about 3,200 cases and 147 deaths.

In California’s Coachella Valley, a region rife with retirees who are especially vulnerable, 25 members of the state’s National Guard helped a non-profit distribute food to people stuck in their homes, as most of the regular volunteers are senior citizens.

More than 10,000 troops have been deployed in 50 states to provide humanitarian aid during the pandemic.

(Reporting by Maria Caspani in New York and Daniel Trotta in Milan; Additional reporting by Gabriella Borter, Catherine Koppel, Lucia Mutikani, Doina Chiacu, Susan Heavey, Nathan Layne, Lisa Lambert, Michael Martina, Rebecca Cook, Barbara Goldberg, Rich McKay and Dan Whitcomb; Writing by Will Dunham and Steve Gorman; Editing by Howard Goller, Bill Tarrant, Cynthia Osterman and Daniel Wallis)

U.S. states, cities desperate for coronavirus help, military prepares

By Stephanie Kelly and Doina Chiacu

NEW YORK/WASHINGTON (Reuters) – U.S. governors and mayors on Monday became more desperate in their pleas for help from the federal government to fight coronavirus as the military prepared to set up field hospitals in New York and Seattle to ease the strain on creaking health services.

New York City Mayor Bill de Blasio urged U.S. lawmakers to approve an economic relief package and appealed for ventilators and medical equipment, even asking for help from private citizens.

“Anyone out there who can help us get these supplies, we have only days to get them in place. That is the reality,” de Blasio told CNN. New York, the most populous U.S. city, is now at the epicenter of the outbreak in the United States.

Karine Raymond, a nurse at Jack D. Weiler Hospital in New York’s Bronx borough, said most nurses were unable to get specialized N95 masks and even simpler surgical masks were in short supply. Nurses are being told to wear them for as long as possible, she said.

“We are the be all and end all and lifeline to these patients, and yet we are being contaminated and cross contaminating,” Raymond said.

As health authorities struggled to cope with the rising number of sick people and the U.S. Senate failed to advance an economic stimulus package, Defense Secretary Mark Esper said the U.S. military is preparing to deploy field hospitals to New York and Seattle.

The planned hospitals, essentially tent facilities that can be rapidly set up, can only handle a limited number of patients and are less suited to treating highly infectious people who need to be isolated. But they can relieve pressure on hospitals by treating patients with illnesses other than COVID-19.

The Army Corps of Engineers is preparing to convert hotels and dormitories into treatment facilities for sick patients as the number of U.S. coronavirus cases nationwide topped 40,000 on Monday, more than 500 of whom have died.

New York’s de Blasio urged U.S. lawmakers to provide more help.

“I want to appeal to everyone in the House and Senate, you have got to help cities, towns, countries, states, public hospitals, private hospitals. You’ve got to get all of them direct relief,” he said.

A far-reaching economic package for the coronavirus crisis failed to advance in the Senate after Democrats said it contained too little money for hospitals and not enough restrictions on a fund to help big businesses. Democrats predicted a modified version would win passage soon.

Both Democrats and Republicans say they are aware that failure to agree on the bill could have a devastating effect on states, cities and businesses, and trigger further heavy losses in U.S. stock markets.

The U.S. Federal Reserve rolled out an unprecedented new array of programs aimed at blunting the “severe disruptions” to the economy caused by the coronarvirus outbreak.

The central bank will back the purchases of corporate bonds and direct loans to companies. It will expand its asset holding by as much as needed to stabilize financial markets and roll out a program to get credit to small and medium-sized business.

The steps briefly lifted U.S. stock index futures more than 3% but share prices quickly dropped back into the red, putting the S&P 500 <.SPX> on pace for its worst month since World War Two.

With the addition of Maryland, Indiana, Michigan and Massachusetts on Monday, 15 out of 50 U.S. states have now imposed restrictions on people’s movements to curtail the virus, putting the country on a track similar to those of the most devastated European countries such as Italy and Spain.

The population affected by the state lockdowns amounts to more than 150 million people out of a U.S. total of about 330 million.

STAY AT HOME

In what appeared to send a conflicting message about the federal government’s efforts to combat the coronavirus health crisis, a senior White House advisor said that President Donald Trump is considering measures to reopen the U.S. economy.

Trump issued guidelines a week ago that he said aimed to slow the spread of the disease over 15 days. Late on Sunday, he tweeted: “We cannot let the cure be worse than the problem itself,” adding that at the end of the 15-day shutdown period, “we will make a decision as to which way we want to go.”

Trump senior economic adviser Larry Kudlow followed up on Monday, telling Fox News: “The president is right … We’re going to have to make some difficult trade-offs.”

A lack of coordinated federal action was causing chaos for states and municipalities, and even putting them in competition with each other for resources, the governors of New York, New Jersey and Illinois said.

The states “are all out looking for the same thing,” New Jersey Governor Phil Murphy told CNN on Monday.

Leaving states to fend for themselves has put them in bidding wars with the Federal Emergency Management Agency, other U.S. states and even against other countries, Illinois Governor J.B. Pritzker said.

“We’re competing against each other on what should be a national crisis where we should be coming together and the federal government should be leading, helping us,” Pritzker told the “Today” program.

New York Governor Andrew Cuomo called on Washington to put in place the federal defense production act to eliminate this “ad hoc” system. Trump on Sunday defended his decision to hold off using this power, on the grounds that nationalizing businesses “is not a good concept.”

General Motors Co <GM.N> and medical equipment maker Ventec are speeding up efforts under a partnership code-named “Project V” to build ventilators at a GM plant in Kokomo, Indiana, to help combat the coronavirus outbreak.

(Reporting by Stephanie Kelly, Susan Heavey, Doina Chiacu, Dan Levine and Nathan Layne; Writing by Daniel Trotta and Sonya Hepinstall; Editing by Howard Goller and Alistair Bell)

Ford, GM, Tesla getting ‘go ahead’ to make ventilators: Trump

Ford, GM, Tesla getting ‘go ahead’ to make ventilators: Trump
WASHINGTON (Reuters) – U.S. President Donald Trump said on Sunday that U.S. automakers Ford Motor Co, General Motors Co and Tesla Inc had been given the green light to produce ventilators and other items needed during the coronavirus outbreak.

“Ford, General Motors and Tesla are being given the go ahead to make ventilators and other metal products, FAST! @fema Go for it auto execs, lets see how good you are?” he said on Twitter.

(Reporting By Susan Heavey and Arshad Mohammed; Editing by Daniel Wallis)

NYC hospitals 10 days from crisis as coronavirus cases explode: mayor

By Jonnelle Marte and Barbara Goldberg

NEW YORK (Reuters) – The mayor of New York City, the epicenter of the nation’s coronavirus epidemic, on Sunday described the outbreak as the biggest domestic crisis since the Great Depression and called for the U.S. military to mobilize to help keep the healthcare system from becoming overwhelmed.

“If we don’t get more ventilators in the next 10 days people will die who don’t have to die,” said Mayor Bill de Blasio, as the nation’s most populous city saw COVID-19 cases top 8,000 and deaths hit 60.

Nationwide, cases have topped 29,000 with at least 385 dead, according to a Reuters tally.  The number of cases of the highly contagious respiratory illness in the United States and Spain are exceeded only by China and Italy. Italy reported record numbers of daily coronavirus deaths last week.

“This is going to be the greatest crisis domestically since the Great Depression,” de Blasio told CNN, referring to the economic crisis of the 1930s. “This is why we need a full-scale mobilization of the American military.”

Nearly one in four Americans, or 80 million, were under orders to shelter at home as New York, California, Illinois, Connecticut and New Jersey instituted statewide lockdowns.

Around the globe, billions are adapting to a new reality, with countries like Italy, Spain and France on lockdown and several South American nations taking similar measures to try to stay ahead of the contagion, as global cases exceeded 300,000 and deaths top 13,000.

The lockdown affecting large segments of the American public to try to curb the spread of the coronavirus is likely to last 10 to 12 weeks, or until early June, U.S. Treasury Secretary Steven Mnuchin said on Sunday.

Lawmakers in Washington are nearing a deal that could pump a record $1 trillion into the economy to limit the economic damage from the coronavirus.

Speaking on “Fox News Sunday,” Mnuchin said the package would give an average U.S. family of four a one-time payment of $3,000.

MEDICAL CRISIS

De Blasio said the city is not getting needed medical supplies from the federal government to contend with the rapid spread of the sometimes deadly illness.

“If the president does not act, people will die who could have lived otherwise,” de Blasio told NBC.

Hospitals are scrambling for protective equipment for healthcare workers and for ventilators as they brace for a wave of patients who will need help breathing as severe cases often lead to pneumonia and decreased lung function.

New York Governor Andrew Cuomo urged the federal government to take over acquisition of medical supplies so states do not have to compete with each other for desperately needed resources. He also repeated a request for the Army Corps of Engineers to build temporary hospitals.

Over the past week, U.S. President Donald Trump’s administration has been pushing for aggressive steps to stem the economic hit, after Trump spent several weeks downplaying the virus’ risks.

Trump said on Twitter on Sunday that U.S. automakers Ford Motor Co, General Motors Co and Tesla Inc had been given the green light to produce ventilators and other items in short supply during the coronavirus outbreak.

Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, on Sunday said the White House recognized the urgency of New York’s situation.

“Not only is New York trying to get resources themselves, but we’re going to be pouring it in from the federal government,” he told CBS News.

U.S. drugmaker Merck & Co Inc said it delivered 500,000 donated masks to New York City on Sunday morning.

The help is not coming quickly enough, Cuomo said.

“Time matters, minutes count, and this is literally a matter of life and death,” he said.

He also chastised New York residents who were congregating in parks and other places and not practicing social distancing. He noted 53% of the cases in New York are between the ages of 18 and 49.

“It’s insensitive, arrogant, self-destructive…and it has to stop, and it has to stop now,” he said. “This is not a joke and I’m not kidding.”

(Reporting by Jonnelle Marte and Barbara Goldberg in New York; Additional reporting by Andrea Shalal and Susan Heavey in Washington; Writing by Lisa Shumaker; Editing by Bill Berkrot)