STEVE INSKEEP, HOST:
The Chinese city of Wuhan gave the world a preview of the severity of the coronavirus.
RACHEL MARTIN, HOST:
Is it now giving a preview of what might happen once restrictions are lifted? As the city reopens, six new cases have alarmed authorities. And you might be thinking to yourself, but it's only six cases. But when there's no vaccine, it just takes a few to kick off another outbreak. Chinese authorities are taking a dramatic step in response.
INSKEEP: NPR's Emily Feng is in Beijing to report on that next step. Hi there, Emily.
EMILY FENG, BYLINE: Hey. Good morning.
INSKEEP: First, how did the extra six people get sick?
FENG: It all comes down to one 89-year-old man who says he did not leave his home because he's quite old. He had COVID-like symptoms on and off since mid-March. But because they would go away, he never got tested. When he finally did last week, it turns out he had COVID. And he'd actually infected his wife and four neighbors, none of whom had symptoms. And so Wuhan's reaction has been to say they're testing all 11 million people who live in the city starting Tuesday.
INSKEEP: Wow.
FENG: They're supposed to do it within 10 days. But that actually exceeds the amount of testing capability they have. So they've said today that they'll stagger the amount of tests they do each day.
INSKEEP: And it's a staggering number, 11 million people.
FENG: Yeah.
INSKEEP: What makes authorities that concerned?
FENG: China can't afford to have another Wuhan. The way the political and health systems there broke down for a few weeks in early February were catastrophic to the image of China's ruling Communist Party. And so authorities now have swung the opposite direction. They're very willing to impose strict lockdowns over just a handful of cases because they want to avoid any accusation that they were slow to react or even covered up new outbreaks. And they've seen a number of small, localized clusters. Last month, there were about 500 new cases where Chinese travelers were coming back from Russia. China reacted by closing down more than 4,000 kilometers of land border with Russia and putting a total lockdown on one of the border towns. And just today, a major city in China's northwest has basically sealed itself off because it saw six new cases. Here's the mayor of that city - it's called Jilin - today describing the situation.
GAI DONGPING: (Non-English language spoken).
FENG: She's saying, the current COVID-19 situation is quite complex and severe. There's a huge risk of further spread of the virus. And they're not going to take any chances. To leave that city now, you've got to show you have a negative COVID test that you took no more than two days ago.
INSKEEP: There do seem to be lessons here for the United States as American states and different businesses begin to reopen.
FENG: There is. First is the difficulty of catching these asymptomatic cases, people who exhibit no symptoms whatsoever. Five of the six new cases in Wuhan reported this week were very difficult to detect because they'd had no symptoms whatsoever. The other is, even with extensive testing, as they are doing in China, it can be difficult to reach the right people. This was an elderly man who was in his home. And so local officials did not test him despite the fact that he felt sick for the last two months.
And even when lockdowns are lifted, there are still going to be people coming in and out of borders, traveling. And so I would not expect to see international travel to return to normal anytime soon. What China has done is implement extensive testing and digital contact tracing. And the hope is they can catch new outbreaks quickly.
INSKEEP: Emily, thanks for the update.
FENG: Thanks, Steve.
INSKEEP: That's NPR's Emily Feng.
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INSKEEP: All right. We know that millions of Americans have lost work during the pandemic. How many people have lost their health insurance?
MARTIN: A new analysis from the Kaiser Family Foundation puts the number at nearly 27 million. That's in part because so many people get their insurance through their employers. The 27 million figure isn't far behind the number of people who are newly unemployed.
INSKEEP: NPR health policy reporter Selena Simmons-Duffin joins us now. Good morning.
SELENA SIMMONS-DUFFIN, BYLINE: Good morning, Steve.
INSKEEP: OK. Another awful number, 27 million. Although, I should ask, does this mean that 27 million people will all join the ranks of the uninsured?
SIMMONS-DUFFIN: So probably not. In fact, the report found that most people are eligible to get health insurance somewhere else, mostly by enrolling in Medicaid, which is essentially free for people who are eligible, or a plan on the Obamacare insurance exchanges with a tax subsidy to make the premiums more affordable. So the report authors estimate about 6 million people do not have those options and are likely to join the ranks of the uninsured. But even though a lot of people could get coverage, a big question mark here is how many actually will. Health insurance is complicated. Signing up is hard. Here is what one of the authors of the report, Larry Levitt, told me.
LARRY LEVITT: There's a lot of stressors on people right now. You may be unemployed. You might be sick. You might be quarantining. And, you know, there's just a limit to how many life things you can deal with at once.
SIMMONS-DUFFIN: Even though it's overwhelming, there is a time crunch here. If you lost coverage, that's what's called a qualifying life event. So you can go to healthcare.gov if your state uses that for its insurance exchange and show you've lost coverage and enroll in a new plan. But that all needs to happen within 60 days of losing coverage. So for people who lost coverage at the beginning of when all of this started in early March, the clock is ticking for them.
INSKEEP: OK. First, thanks for telling us the clock is ticking and what some of the options are. Is the U.S. government actively telling people the clock is ticking and what they can do?
SIMMONS-DUFFIN: So not really. Of course, the Affordable Care Act, which set up these exchanges, is President Obama's trademark law. And President Trump has made getting rid of Obamacare a major priority during his first campaign and as president. So now, the Trump administration is arguing before the Supreme Court that the law should be struck down. Funding for navigators who can help people sign up and advertising for these insurance exchanges has been dramatically cut.
And the White House decided not to pull a big lever it could use to get more of these millions of newly uninsured people into the ACA exchanges by creating a federal special enrollment period so that, no matter where you live, you don't need a qualifying event. You can just sign up. The decision not to do that could really impact how many people access this coverage and how many people become uninsured longer-term.
INSKEEP: If the government isn't helping there, is the government doing anything?
SIMMONS-DUFFIN: Yeah. The federal government says it plans to pay hospitals directly for the care of uninsured people with COVID-19. But Larry Levitt of the Kaiser Family Foundation points out, that's only for the treatment of COVID-19. Here's what he said.
LEVITT: While COVID-19 is a very present risk right now in a lot of people's minds, you know, people have health care needs that go beyond the coronavirus.
SIMMONS-DUFFIN: If you end up with cancer, for instance, or a burst appendix and you are uninsured, that can be financially ruinous. And that's why health policy experts are always urging people to enroll in health insurance if at all possible. And that's all the more true during a pandemic like this.
INSKEEP: Oh, my goodness. And even more important now when people are putting off a lot of doctor's visits and hospital visits, suggesting that when they finally do get medical care, their problems could be more serious and more expensive. Selena, thanks.
SIMMONS-DUFFIN: Yeah, that's true. Thank you.
INSKEEP: NPR's Selena Simmons-Duffin.
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INSKEEP: All right. What will it take to reopen this country's economy? Yesterday, the chairman of a Senate committee hearing made it clear what he thinks.
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LAMAR ALEXANDER: All roads back to work and school go through testing.
MARTIN: But coronavirus testing depends on medical supplies like swabs. And there aren't enough of them. This week, the White House said it would get more supplies to states in order to expand testing. So how could there be a shortage of something that sounds so basic like a swab?
INSKEEP: Yeah. NPR's Sacha Pfeiffer has been looking into that and is on the line. Good morning.
SACHA PFEIFFER, BYLINE: Good morning, Steve.
INSKEEP: It's a little stick with a little bit of soft material on the end. How could we end up, in America, with a shortage of that?
PFEIFFER: I know. That's the question, isn't it? Well, these are actually considered medical devices. They have to be long and flexible enough to go through your nose to the back of your throat. They also have to be made with a synthetic material like polyester because cotton, which has its own genetic material, could interfere with test results. And turns out, before the pandemic, there were only two major manufacturers of these - one in Maine, one in Italy. When COVID-19 hit, they got overwhelmed. Here's Timothy Templet, a spokesman for the company in Maine called Puritan Medical Supplies (ph).
TIMOTHY TEMPLET: I don't think the United States was prepared. That includes us, Puritan. And it includes our customers. And it includes the government. And now it gets really nerve-racking to think that we may be in this for another couple of years.
INSKEEP: Which, I guess, we could be. They're talking about wanting to do 40 or 50 million tests a month by the fall. Could the government have done something sooner to prepare?
PFEIFFER: It could have been stockpiling them, but it was not. Swabs are not part of the Strategic National Stockpile of medical supplies. The government does have the Defense Production Act, which the Trump administration used to require General Motors to produce more ventilators. That happened in March. But the administration did not act as quickly to use that tool for swap shortages. That's even though people like Washington Governor Jay Inslee were advising that. He told NPR that he urged President Trump more than a month ago to invoke the Defense Production Act for that purpose.
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JAY INSLEE: To convert some of their production to swabs and contact vials and machines that can do analysis. And he did not agree with that assessment. And we lost weeks, frankly.
INSKEEP: Did the president or other people around the president receive warnings even earlier than that discussion in March?
PFEIFFER: We know that in mid-February, a group of health experts told a U.S. Senate committee that the country had a testing supply problem. More than a month later, former FDA Commissioner Scott Gottlieb put out a tweet that said, swabs could be a weak link in broadening testing. And in mid-March, there were other public distress calls about supply shortages.
INSKEEP: Although, of course, the president has been saying, in recent days, we've met the moment. We have triumphed. How has the government responded over the last couple of months to those warnings?
PFEIFFER: In mid-March, the government did start flying shipments of swabs from Italy to the U.S. But that still did not meet demand. And in mid-April, complaints were still coming. So President Trump said he would use the Defense Production Act to ramp up swab production. On April 29, the government said Puritan in Maine would get $75 million to do that. And this week, the White House promised to get supplies to help states meet testing goals. Although, the government said it wants to focus on high-risk communities like nursing homes.
INSKEEP: Are the efforts now in place enough to meet demand?
PFEIFFER: Hard to say because it's difficult to get consensus on how much coronavirus testing should be happening and how many swabs are needed. But the FDA has approved more types of swabs. And a Ohio company is converting a plant to make swabs. The FDA has also approved a saliva test that does not require a swab. This week's promise by the administration may still be fairly limited. And so it's unclear if it will be enough to give the public confidence that the U.S. economy can reopen safely.
INSKEEP: NPR's Sacha Pfeiffer. Thanks so much.
PFEIFFER: You're welcome. Transcript provided by NPR, Copyright NPR.
