Concerns about the need for domestic supplies to test and treat patients for COVID-19 led President Donald Trump on Wednesday to take the rare step of invoking the nation’s war powers authority. 

The Defense Production Act of 1950 gives the president broad powers to require manufacturers to boost production of critical supplies and equipment, including personal protective equipment, ventilators and respirator masks. 

The decision came after numerous Democrats called on Trump to use war powers to increase supplies because of shortages of personal protective equipment, needed for the testing and subsequent care of patients.

“In France, factories that once manufactured fancy perfumes are starting to churn out needed hand sanitizer instead. You can’t do these things overnight. … President Trump is finally taking needed steps, but we’ve got to do more,” Rhode Island Democrat Jack Reed, ranking member of the Senate Armed Services Committee, said in a statement after Trump’s announcement.

“Health officials have told the Trump Administration they do not have enough stockpiled medical equipment and the Administration has failed to sufficiently act. Invoking the DPA is a step in the right direction that will enable the federal government to team up with the private sector to increase the availability of needed health supplies.”

Hospitals stretched thin

While the Defense Department is providing 5 million N-95 respirators and 2,000 ventilators to the Health and Human Services Department, with 1 million available immediately, hospitals are stretched so thin that the Centers for Disease Control says on its website that in settings where face masks are not available, medical providers “might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort,” although it says such masks’ ability to protect against the disease is unknown.

[Trump drops payroll tax cut, wants stimulus checks]

On Tuesday, Ohio Sen. Sherrod Brown and 27 other Democrats said the Defense Department should work with states to assess the supplies and the Defense Logistics Agency should work on deploying needed equipment. Massachusetts Democratic Sen. Edward J. Markey introduced a resolution Monday urging Trump to direct suppliers to prioritize government contracts to restock the national stockpile, provide loans to manufacturers to help production and allow private sector businesses to coordinate their production of medical supplies. 

James Madara, executive vice president of the American Medical Association, in a letter to Vice President Mike Pence on Monday called for “a ‘Manhattan Project’ type effort to expand manufacturing capacity and produce the supplies needed to ensure the health security of our country during this national emergency.”

Trump referred to himself as essentially a wartime president in a news conference Wednesday in which he said he would sign the necessary paperwork to leverage war powers authority. Trump also said Wednesday that the Food and Drug Administration would look at authorizing “self-swab” tests that people could administer themselves and would free up health care workers and ease demands on protective equipment.

The unusual steps reflect the increasing concern that administration officials are expressing about the pandemic’s expanding reach and the shortages within the U.S. A lack of chemical agents needed for tests, swabs needed to obtain samples, containers to transport samples, and personal protective equipment could all be making it harder to translate testing capacity into processed tests. Even the self-swab tests would face issues with shortages affecting the ability to process tests, though.

The move comes after a series of administration actions designed to broaden testing. The FDA already gave labs that develop their own tests the ability to apply to the agency for approval after their tests have already gone into use, and then on Monday, FDA said states would be empowered to oversee this process themselves. Manufacturers that develop tests for use in existing systems, like F. Hoffmann-La Roche AG and Thermo Fisher Scientific, will be able to retroactively apply for FDA authorization as well. 

Getting the private sector more involved will offer a reprieve to the nation’s public health labs, which usually focus on higher-level testing activities, like seeing how a virus has mutated or conducting tests to support outbreak investigations, rather than individual patient testing. 

“This is a welcome relief to state and local public health laboratories who continue to shoulder the bulk of the diagnostic testing volume, thus allowing them to turn their attention to more COVID-19 surveillance testing,” said Scott Becker, CEO of the Association of Public Health Laboratories. 

Testing concerns

But it could still be weeks before the private segment of the nation’s testing infrastructure is fully up and running. 

Labs that develop their own tests still need to validate their tests internally. Thomas File, president of the Infectious Disease Society of America and chairman of infectious diseases at the Summa Health hospital system in Akron, Ohio, said it can take two weeks to validate a test once a lab has the equipment it needs to develop a test for existing systems. 

“It takes a little bit of time to gear up in most hospitals,” he said in an interview with CQ Roll Call. Meanwhile, as hospitals need to send tests to state public health labs, larger hospitals’ labs or other third-party labs, the wait for results is adding to supply chain pressures and uncertainty about who has the disease. 

“The fact that we can’t get really a rapid turnaround time is going to put further stress on our supply chain,” he said. “We’re going to have to use additional personal protective equipment for these patients that we might not otherwise have to if we have another diagnosis.” 

Private labs are expressing confidence they will soon be able to conduct massive numbers of tests. “Assuming there are no delays or shortages of necessary materials and supplies, commercial capacity is expected to exceed 280,000 tests per week by April 1,” Julie Khani, president of the American Clinical Laboratory Association, an industry trade group, said in a statement. 

So far, there still appears to be a gap between apparent testing capacity and the number of people actually being tested. The ACLA estimated that private labs would be able to conduct 20,000 tests per day this week. An American Enterprise Institute initiative run by former FDA Commissioner Scott Gottlieb estimates that private labs, hospital labs and public health labs can handle up to 36,000 patients per day. 

But only 58,000 tests have been conducted in the United States from the start of the crisis through Wednesday, according to researchers at The COVID Tracking Project, which monitors state-reported data.

Gottlieb noted in a tweet that while capacity is likely to increase with more rapid testing systems deployed at hospitals and labs, “any limitations will be the testing supply chain” such as the swabs, protective equipment and other supplies. 

“Shortages of these essential supplies are forcing physicians to severely restrict access to testing services, with significant concern that they will no longer be able to offer testing in the near future,” Madara of the AMA wrote to Pence.

Health and Human Services Assistant Secretary Brett Giroir, who coordinates the administration’s testing response, explained how much goes into conducting a test. 

“To do the test, a health care provider needs to dress in full personal protective equipment,” he said at a White House briefing Monday. “And there’s a swab that’s put in the back of the nose, all the way to the back of the throat,” which is put in a container for transportation, he added. “The next person who has to get tested, that health care provider has to change all the personal protective equipment.”

Khani previously expressed concerns about swab shortages but said an FDA decision last week to broaden the types of swabs allowed for use in testing would help.  

California Rep. Ted Lieu, a Democrat whose state faces one of the worst known COVID-19 outbreaks in the U.S., said in a letter to Pence on Tuesday that “many labs are operating without the chemical ingredients needed to process samples.” 

He said the scarcity of those reagents caused the Los Angeles County Public Health Department “to recommend that lab testing be restricted to individuals with severe disease.” 

“If the reagent shortage is not addressed quickly, we will continue to undercount infected patients and our efforts to contain the pandemic will be hindered,” Lieu said.