npr--2020-07-16--'Meaningless' FDA Certificates Are Used To Tout Dubious Face Masks

'Meaningless ' FDA Certificates Are Used To Tout Dubious Face Masks When the order of 100,000 masks arrived at an unnamed factory for use in protecting workers against COVID-19 , they were covered in dirt , dust and mysterious stains .
In short , they were `` not fit to be used , '' according to a complaint filed with the Food and Drug Administration in late March .
The masks came from Shenzhen Newstar Optical Electronic Technology , a company in Shenzhen , China , that appears primarily to make LED displays .
Because the report was filed in @ @ @ @ @ @ @ , the complainant 's name and other facts have been redacted .
`` When i started to question them , they provided me with a fda certificate ( dated april 7th 2020 ) in an attempt to silent [ sic ] me , '' the complainant wrote .
The certificate had a date in the future on it .
It was still March at the time .
When the COVID-19 pandemic left facilities scrambling for surgical masks , new manufacturers stepped up to meet demand and turn a profit .
But the mix @ @ @ @ @ @ @ led to confusion and concerns about quality .
Many sellers are touting FDA certificates of registration as evidence their masks can be trusted , said people who work in the health care supply chain .
They usually include an FDA logo and , often , a cartoon eagle .
The certificates are particularly popular with companies in China .
But the certificates are meaningless .
While the FDA requires makers of medical products to register their facilities with the agency so it can keep track of them , it does n't issue such @ @ @ @ @ @ @ are legitimate , they do n't mean a product or a facility has met any kind of regulatory standard .
Shenzhen Newstar Optical Electronic Technology did not respond to requests for comment .
FDA records indicate that it is a registered facility with the agency , but it has never been inspected and does n't hold any medical device clearances from the FDA .
`` There are a lot of manufacturers now in the industry because they were making , you know , hats , socks last week — teddy bears — and @ @ @ @ @ @ @ said Benjamin England , a consultant and attorney based in Maryland , who has several dozen clients who import products to the United States .
Nearly 80 % of imported surgical mask shipments from March until July 2 came from China or South Korea , according to an NPR analysis of bills of lading from ImportGenius.com .
Most mask shipments were co-signed by separate logistics companies , making it impossible to tell from which manufacturers the masks came .
Although FDA registration is mandatory for companies seeking to sell medical products in the @ @ @ @ @ @ @ getting in a phone book than anything else .
Information provided to officials is n't verified for accuracy .
But in China , manufacturers expect a regulatory certificate , said England , explaining that it is just part of the culture .
As a result , the consultants who help Chinese manufacturers get registered in the U.S. simply design one and print it out .
`` You come in and you see other certificates in the lobby , at the office or the waiting area , '' he said of manufacturing facilities in @ @ @ @ @ @ @ completely commercially meaningless , of absolutely no value whatsoever . ''
Most of the time , the certificates include fine print that says the FDA does n't create or honor such certificates .
For its part , the agency said in an FAQ : `` The FDA does not issue any kind of certification to demonstrate a manufacturer is in compliance with the FDA 's requirements . ''
A glance at a recent page of surgical masks offered for sale on the online commerce site Alibaba.com shows how common the certifications are .
@ @ @ @ @ @ @ listings on July 6 .
All 21 of them were posted by manufacturers based in China , and about half of them included an image of a certificate of registration with the FDA .
NPR found valid registrations for all of these facilities , but none had ever been inspected by the agency , and none had received FDA premarket clearance for selling surgical masks , according to FDA records .
Surgical masks typically need to go through FDA premarket clearance , which involves making sure they meet certain standards .
However , @ @ @ @ @ @ @ surgical mask manufacturers amid the current pandemic .
But with so many newcomers buying and selling surgical masks , what a certificate means — and what it does n't — often gets lost in the shuffle .
`` They use it to imply that the product is approved by FDA or the facility is somehow approved and inspected or compliant '' with quality standards , England said .
`` And when FDA discovers that , they consider that to be misbranding , clearly misbranding and fraudulent .
So many people are doing it @ @ @ @ @ @ @ .
They 're not really focusing on it . ''
Alibaba Group , the company that owns Alibaba.com , looked into the certificates on surgical mask listings after NPR inquired about them .
`` Merchants on Alibaba.com are required to meet the regulatory requirements for the markets in which their goods are sold , '' the company said in a written statement .
`` While these sellers are expected to act in good faith , a review of certain listings revealed some information that could be misconstrued .
We have removed such listings @ @ @ @ @ @ @ any information that could create confusion before relisting on our marketplace . ''
But Alibaba.com is n't the only place where sellers and buyers can connect , and there are more certificates out there .
Health care facilities , factories and even private citizens have encountered them searching high and low for personal protective equipment in recent months .
Some may not even point to a real FDA registration .
`` It is easy to believe the certificates are authentic because they appear to have the FDA logo , and they list company @ @ @ @ @ @ @ , '' said Pamela Anderson , who directs quality assurance and regulatory affairs for Vizient Inc. , a company that helps hospitals negotiate contracts for supplies .
Amid the pandemic , new suppliers have contacted hospitals offering to meet the increased demand for personal protective equipment and other things .
Some have touted FDA certificates .
Vizient has been helping hospitals review mask offers , including those for N95 respirators , which offer a higher level of protection than surgical masks and are more strictly regulated .
Of the nearly 1,700 offers the @ @ @ @ @ @ @ May , more than two-thirds were not even `` potentially appropriate for use in a health care setting , '' said Cathy Denning , a senior vice president involved in supply sourcing for Vizient .
Sixty-five of those offers were specifically for surgical masks , but only 39 offers included potentially acceptable products .
Fishy companies often sent the certificates and photos of the products but no samples .
Yet the suppliers required large down payments , Denning wrote in an email to NPR .
`` We had one hospital tell us that @ @ @ @ @ @ @ got to their dock , the quality was so poor they put them aside until the FDA issued a guidance that they could be used as a ASTM level 1 mask , '' she wrote , referring to the lowest level of protection a mask can offer .
This was for N95s .
Since March , the FDA has received at least 37 reports about malfunctions and injuries stemming from masks , according to an NPR analysis of data provided by Device Events , a website that tracks FDA 's medical device adverse @ @ @ @ @ @ @ masks as well as N95 respirators , KN95 respirators and face shields .
Reports cited masks that had holes , mold , disintegrating ear loops and were made of the wrong materials .
Five include allegations that sellers falsely told them their products had the FDA 's OK .
The reports , filed to FDA 's public database for medical device problems called MAUDE , are voluntary and therefore considered an underestimate .
`` The FDA acknowledges that there is some confusion about device registration and listing and clearance or approval of medical @ @ @ @ @ @ @ spokesperson Brittney Manchester wrote in an email to NPR , pointing to a webpage set up to help with some of that confusion .
Health care workers are n't often looped into how their hospitals and facilities go about buying masks , but they 've felt the effects .
In three decades as a nurse , Betsy Marville had never had any kind of reaction to a surgical mask .
But the organizer for 1199SEIU United Healthcare Workers East in Florida said the union started to get complaints about what nurses called `` @ @ @ @ @ @ @ pandemic .
`` They 've got some kind of fibers that are shedding off of them , '' she said .
`` They 're irritating their nose and eyes and their respiratory tract . ''
Marville asked the nurses for photos of the boxes in which the masks arrived .
Normally , these boxes are marked with lot numbers and other manufacturing information .
Not this time .
`` It just says , 'blue face mask , ' `` Marville said , adding that the word blue is comically large .
`` And @ @ @ @ @ @ @ And there 's no company .
There 's no lot number .
Just 'blue face mask . '
`` There were also yellow masks with a chemical smell that nurses said made them feel sick .
Westside Regional Medical Center in Plantation , Fla. , was one of the hospitals that got the masks , Marville said .
A hospital spokeswoman said it had n't received any complaints about them .
`` Early in the COVID-19 crisis , Westside Regional Medical Center implemented processes to review personal protective equipment ... to validate appropriate @ @ @ @ @ @ @ before the masks go into the facilities for use , '' Westside Regional Medical Center spokeswoman Bruna Doering wrote in an email to NPR .
Across the country in California , another nurse described something similar : The surgical masks she had begun wearing during her shifts were shedding small fibers .
By the weekend , she had `` extremely chapped skin '' on her face .
The nurse declined to be named for this story , fearing doing so would get her in trouble at work .
`` I 've been in @ @ @ @ @ @ @ .
I 've never had that happen from wearing a mask before , '' the nurse said , adding that the strange masks arrived during the pandemic as masks became scarce and alternative suppliers entered the market .
The box again said the masks were made in China , and there was a company name : Sunrise Industries Inc. , based in Albertville , Ala .
The company did not respond to requests for comment .
An FDA spokesperson said the agency has no record of a premarket clearance for Sunrise 's surgical @ @ @ @ @ @ @ intend to object '' to the distribution of certain masks during the pandemic as long as the masks `` do not create an undue risk . ''
In Auburn , Wash. , Greg Byrge , executive director at Wesley Lea Hill , a retirement community with varying levels of care , said that when the pandemic began , it became harder to purchase surgical masks .
His usual suppliers did n't have any , and the new suppliers sold products at higher prices and lower quality .
Some masks would n't even last @ @ @ @ @ @ @ Others , like the ones with ear loops made out of the wrong material , broke before his employees could even get them on their faces .
What 's more , masks cost the facility 75 cents apiece before the pandemic .
Now , they run up to $ 3 a mask .
In early June , the facility got a package of masks from the Federal Emergency Management Agency .
`` We received cloth masks that were white and black , '' he said .
`` They had the consistency and the @ @ @ @ @ @ @ opted not to use them .
Residents in the assisted living , skilled nursing and independent living parts of the retirement community sewed better masks and gave them to the staff .
You can contact NPR pharmaceuticals correspondent Sydney Lupkin at slupkin @ npr.org .

'Meaningless' FDA Certificates Are Used To Tout Dubious Face Masks
Enlarge this image toggle caption Aleksandr Zubkov/Getty Images Aleksandr Zubkov/Getty Images
When the order of 100,000 masks arrived at an unnamed factory for use in protecting workers against COVID-19, they were covered in dirt, dust and mysterious stains. In short, they were "not fit to be used," according to a complaint filed with the Food and Drug Administration in late March.
The masks came from Shenzhen Newstar Optical Electronic Technology, a company in Shenzhen, China, that appears primarily to make LED displays. Because the report was filed in the FDA database for medical device problems, the complainant's name and other facts have been redacted.
"When i started to question them, they provided me with a fda certificate (dated april 7th 2020) in an attempt to silent [sic] me," the complainant wrote. The certificate had a date in the future on it. It was still March at the time.
When the COVID-19 pandemic left facilities scrambling for surgical masks, new manufacturers stepped up to meet demand and turn a profit. But the mix of first-time manufacturers and first-time buyers has led to confusion and concerns about quality.
Many sellers are touting FDA certificates of registration as evidence their masks can be trusted, said people who work in the health care supply chain. They usually include an FDA logo and, often, a cartoon eagle. The certificates are particularly popular with companies in China.
But the certificates are meaningless.
While the FDA requires makers of medical products to register their facilities with the agency so it can keep track of them, it doesn't issue such certificates. Even when the registrations themselves are legitimate, they don't mean a product or a facility has met any kind of regulatory standard.
Shenzhen Newstar Optical Electronic Technology did not respond to requests for comment. FDA records indicate that it is a registered facility with the agency, but it has never been inspected and doesn't hold any medical device clearances from the FDA.
"There are a lot of manufacturers now in the industry because they were making, you know, hats, socks last week — teddy bears — and now they're making masks," said Benjamin England, a consultant and attorney based in Maryland, who has several dozen clients who import products to the United States.
Nearly 80% of imported surgical mask shipments from March until July 2 came from China or South Korea, according to an NPR analysis of bills of lading from ImportGenius.com. Most mask shipments were co-signed by separate logistics companies, making it impossible to tell from which manufacturers the masks came.
Although FDA registration is mandatory for companies seeking to sell medical products in the U.S., the listing is more like getting in a phone book than anything else. Information provided to officials isn't verified for accuracy.
But in China, manufacturers expect a regulatory certificate, said England, explaining that it is just part of the culture. As a result, the consultants who help Chinese manufacturers get registered in the U.S. simply design one and print it out.
"You come in and you see other certificates in the lobby, at the office or the waiting area," he said of manufacturing facilities in the country. "And they are completely commercially meaningless, of absolutely no value whatsoever."
Most of the time, the certificates include fine print that says the FDA doesn't create or honor such certificates. For its part, the agency said in an FAQ: "The FDA does not issue any kind of certification to demonstrate a manufacturer is in compliance with the FDA's requirements."
A glance at a recent page of surgical masks offered for sale on the online commerce site Alibaba.com shows how common the certifications are. NPR examined the top surgical mask wholesale listings on July 6. All 21 of them were posted by manufacturers based in China, and about half of them included an image of a certificate of registration with the FDA. NPR found valid registrations for all of these facilities, but none had ever been inspected by the agency, and none had received FDA premarket clearance for selling surgical masks, according to FDA records.
Enlarge this image toggle caption Alibaba.com/Screenshot by NPR Alibaba.com/Screenshot by NPR
Surgical masks typically need to go through FDA premarket clearance, which involves making sure they meet certain standards. However, the FDA is waiving this requirement for surgical mask manufacturers amid the current pandemic.
But with so many newcomers buying and selling surgical masks, what a certificate means — and what it doesn't — often gets lost in the shuffle.
"They use it to imply that the product is approved by FDA or the facility is somehow approved and inspected or compliant" with quality standards, England said. "And when FDA discovers that, they consider that to be misbranding, clearly misbranding and fraudulent. So many people are doing it now. The FDA is just busy. They're not really focusing on it."
Alibaba Group, the company that owns Alibaba.com, looked into the certificates on surgical mask listings after NPR inquired about them.
"Merchants on Alibaba.com are required to meet the regulatory requirements for the markets in which their goods are sold," the company said in a written statement. "While these sellers are expected to act in good faith, a review of certain listings revealed some information that could be misconstrued. We have removed such listings and are actively requiring sellers to delete any information that could create confusion before relisting on our marketplace."
But Alibaba.com isn't the only place where sellers and buyers can connect, and there are more certificates out there. Health care facilities, factories and even private citizens have encountered them searching high and low for personal protective equipment in recent months. Some may not even point to a real FDA registration.
"It is easy to believe the certificates are authentic because they appear to have the FDA logo, and they list company registration numbers, devices and certificate numbers," said Pamela Anderson, who directs quality assurance and regulatory affairs for Vizient Inc., a company that helps hospitals negotiate contracts for supplies.
Amid the pandemic, new suppliers have contacted hospitals offering to meet the increased demand for personal protective equipment and other things. Some have touted FDA certificates.
Vizient has been helping hospitals review mask offers, including those for N95 respirators, which offer a higher level of protection than surgical masks and are more strictly regulated.
Of the nearly 1,700 offers the company had reviewed by the end of May, more than two-thirds were not even "potentially appropriate for use in a health care setting," said Cathy Denning, a senior vice president involved in supply sourcing for Vizient. Sixty-five of those offers were specifically for surgical masks, but only 39 offers included potentially acceptable products.
Fishy companies often sent the certificates and photos of the products but no samples. Yet the suppliers required large down payments, Denning wrote in an email to NPR.
"We had one hospital tell us that they bought the products and when they got to their dock, the quality was so poor they put them aside until the FDA issued a guidance that they could be used as a ASTM level 1 mask," she wrote, referring to the lowest level of protection a mask can offer. This was for N95s.
Since March, the FDA has received at least 37 reports about malfunctions and injuries stemming from masks, according to an NPR analysis of data provided by Device Events, a website that tracks FDA's medical device adverse event data. The products include surgical masks as well as N95 respirators, KN95 respirators and face shields.
Reports cited masks that had holes, mold, disintegrating ear loops and were made of the wrong materials. Five include allegations that sellers falsely told them their products had the FDA's OK. The reports, filed to FDA's public database for medical device problems called MAUDE, are voluntary and therefore considered an underestimate.
"The FDA acknowledges that there is some confusion about device registration and listing and clearance or approval of medical devices during this pandemic," FDA spokesperson Brittney Manchester wrote in an email to NPR, pointing to a webpage set up to help with some of that confusion.
Health care workers aren't often looped into how their hospitals and facilities go about buying masks, but they've felt the effects.
In three decades as a nurse, Betsy Marville had never had any kind of reaction to a surgical mask. But the organizer for 1199SEIU United Healthcare Workers East in Florida said the union started to get complaints about what nurses called "hairy masks" that arrived during the pandemic.
"They've got some kind of fibers that are shedding off of them," she said. "They're irritating their nose and eyes and their respiratory tract."
Marville asked the nurses for photos of the boxes in which the masks arrived.
Normally, these boxes are marked with lot numbers and other manufacturing information. Not this time.
"It just says, 'blue face mask,' " Marville said, adding that the word blue is comically large. "And it says 'Made in China.' And there's no company. There's no lot number. Just 'blue face mask.' "
There were also yellow masks with a chemical smell that nurses said made them feel sick.
Westside Regional Medical Center in Plantation, Fla., was one of the hospitals that got the masks, Marville said. A hospital spokeswoman said it hadn't received any complaints about them.
"Early in the COVID-19 crisis, Westside Regional Medical Center implemented processes to review personal protective equipment ... to validate appropriate levels of coverage and check for defects before the masks go into the facilities for use," Westside Regional Medical Center spokeswoman Bruna Doering wrote in an email to NPR.
Across the country in California, another nurse described something similar: The surgical masks she had begun wearing during her shifts were shedding small fibers. By the weekend, she had "extremely chapped skin" on her face. The nurse declined to be named for this story, fearing doing so would get her in trouble at work.
"I've been in there for like 12, 13 years. I've never had that happen from wearing a mask before," the nurse said, adding that the strange masks arrived during the pandemic as masks became scarce and alternative suppliers entered the market.
The box again said the masks were made in China, and there was a company name: Sunrise Industries Inc., based in Albertville, Ala. The company did not respond to requests for comment.
An FDA spokesperson said the agency has no record of a premarket clearance for Sunrise's surgical mask. But it "does not intend to object" to the distribution of certain masks during the pandemic as long as the masks "do not create an undue risk."
In Auburn, Wash., Greg Byrge, executive director at Wesley Lea Hill, a retirement community with varying levels of care, said that when the pandemic began, it became harder to purchase surgical masks. His usual suppliers didn't have any, and the new suppliers sold products at higher prices and lower quality.
Some masks wouldn't even last a whole shift, he said. Others, like the ones with ear loops made out of the wrong material, broke before his employees could even get them on their faces. What's more, masks cost the facility 75 cents apiece before the pandemic. Now, they run up to $3 a mask.
In early June, the facility got a package of masks from the Federal Emergency Management Agency.
"We received cloth masks that were white and black," he said. "They had the consistency and the feel of underwear."
His staff opted not to use them. Residents in the assisted living, skilled nursing and independent living parts of the retirement community sewed better masks and gave them to the staff.
You can contact NPR pharmaceuticals correspondent Sydney Lupkin at slupkin@npr.org.


npr--2020-07-17--Doctors And Dentists Still Flooding U.S. With Opioid Prescriptions

Doctors And Dentists Still Flooding U.S. With Opioid Prescriptions Despite widespread devastation caused by America 's opioid epidemic , an investigation by NPR found that doctors and other health care providers still prescribe highly addictive pain medications at rates widely considered unsafe .
Public data , including new government studies and reports in medical literature , shows enough prescriptions are being written each year for half of all Americans to have one .
Patients still receive more than twice the volume of opioids considered normal before the prescribing boom began in the late 1990s .
`` We 're 5 % @ @ @ @ @ @ @ we consume 80 % of the world 's prescription opioids , '' said Dr. Jonathan Chen , a physician and researcher at Stanford University Medical Center who studies prescribing patterns .
Critics say the practice exposes tens of millions of patients each year to unnecessary risk of addiction , overdose and death .
It also floods communities with vast quantities of opioid medications that go unused , building up a deadly reservoir of drugs in home medicine cabinets that often wind up being abused .
`` It 's not just a handful of @ @ @ @ @ @ @ all are .
It 's become part of our culture that this is normal , '' Chen said .
His view reflects a growing body of research by doctors and scientists who have begun to voice alarm about the lack of progress in scaling back medical opioid consumption .
The peril for patients remains high .
In 2018 , the last year for which complete data is available , more than 1 in 5 Americans had an opioid prescription filled , according to the Centers for Disease Control and Prevention .
That same @ @ @ @ @ @ @ day after taking prescription opioids .
Experts say far more people are dying after developing an addiction to legal pain medicines , then shifting to far more dangerous opioids such as heroin and black-market Fentanyl .
Even without overdose and death , opioid addiction can be devastating , derailing lives , destroying families and disrupting whole communities .
`` We 've had an attitude about opioids that they are similar to antibiotics , where you can prescribe and forget , '' said Travis Rieder , a bioethicist at Johns Hopkins University .
`` @ @ @ @ @ @ @ medicine like opioids . ''
Rieder himself has struggled with opioid use disorder since being prescribed large quantities of pain pills following a motorcycle accident in 2015 .
`` I 'd just call the surgeon , and he 'd up the dose .
They kept writing the prescriptions , and I kept taking them , '' he said .
Big Pharma made the pills , but doctors were the gatekeepers The opioid epidemic has been blamed in large part on the pharmaceutical industry and high-profile companies like Purdue Pharma , which falsely marketed @ @ @ @ @ @ @ addiction-free .
As early as 2007 , drugmakers were paying out massive settlements for their role sparking a wave of addiction that left more than 450,000 Americans dead .
Thousands of communities have filed civil lawsuits hoping to recoup some of the staggering financial cost .
Doctors have faced far less scrutiny for their role in the crisis , but the medical profession has struggled for years to clean up its overprescribing culture .
In 2014 , the American Medical Association formed an opioid task force , charged in part with reforming physician @ @ @ @ @ @ @ had a role to play and we wanted to be part of the solution , '' said Dr. Patrice Harris , who heads the AMA 's effort .
`` Prescribing has been going down since 2012 , but we wanted to get the word out that physicians should be more judicious . ''
In 2016 , the CDC issued strongly-worded guidelines , urging doctors to avoid opioids or to minimize their use whenever possible .
Roughly half the states have implemented some form of regulation designed to curtail prescribing .
But scientists , @ @ @ @ @ @ @ by NPR say those efforts have fallen dangerously short .
A CDC study released in May found many physicians regularly ignore federal guidelines , prescribing large quantities of powerful opioid medications even when better treatment options are available .
`` It 's possible some clinicians just simply are n't aware of existing evidence-based recommendations , '' said Dr. Christina Mikosz , one of the CDC 's lead researchers studying opioid prescribing .
`` The other possibility is that they are aware and they just choose not to follow them . ''
Physicians still @ @ @ @ @ @ @ warnings Mikosz points to the way many doctors treat fibromyalgia , a condition that can cause severe and chronic pain .
Most experts now agree opioids are n't the safest or most effective treatment , but physicians continue to prescribe opioid pain pills aggressively anyway .
`` Patients with fibromyalgia were typically prescribed at least a full month supply of opioids , '' Mikosz said .
Remarkably , studies of prescribing practices reviewed by NPR show that physicians continue to regularly prescribe opioids even for relatively mild pain conditions , including lower back @ @ @ @ @ @ @ `` There was a study of people who go to the hospital with a twisted ankle , '' said Keith Humphreys , who teaches and studies opioid prescribing at Stanford University .
`` One in eight of them is coming out with opioids .
That 's crazy . ''
This is happening despite research that shows even a single prescription for opioid medications comes with significant risk .
A study published this year in Massachusetts found that between 1 % and 4 % of patients who are introduced to opioids develop opioid-use disorder @ @ @ @ @ @ @ millions of patients , and you have the makings of another wave of opioid addiction .
`` The number of adults that received any opioid prescription during the year was quite high , '' said lead researcher Laura Burke , an ER doctor who teaches at Harvard Medical School .
Burke said the impact of overprescribing is still painfully visible in the emergency rooms where she works .
`` Many many shifts , probably most , I see the devastating consequences of addiction and overdose and all the complications associated with opioid use @ @ @ @ @ @ @ Studies show doctors are n't the only medical professionals overprescribing .
Data released this year by researchers at the University of Pittsburgh showed as many as half of opioids given out by American dentists are unnecessary and inappropriate .
Often , powerful pain pills were prescribed following oral procedures associated with mild pain that experts say could be treated with Tylenol or an ice pack .
`` We found that over time , overprescribing of opioids by dentists actually increased , '' said Dr. Katie Suda , lead researcher on the project .
@ @ @ @ @ @ @ of medical opioids distributed in the U.S. each year are now prescribed by dentists .
One particular red flag turned up in her study : Dentists regularly give high-power opioid pills such as oxycodone to younger patients who are most vulnerable .
`` Dentists are the primary prescribers of opioids to adolescents and young adults , who are at high risk for opioid misuse , '' Suda said .
Another study published this year by researchers in Michigan found dentists regularly hand out opioids after routine wisdom teeth extractions , despite evidence that @ @ @ @ @ @ @ safer treatments .
There is some good news .
Data shows prescription rates overall have declined significantly from their peak in 2012 , with the steepest reductions coming in the last few years .
In some parts of the U.S. , health care workers have become far more cautious .
In those communities , opioid prescribing now resembles the safer approach seen in Europe , where physicians and dentists view medications such as oxycodone and Vicodin as a last resort rather than a first option .
In much of America , the opioid @ @ @ @ @ @ @ , however , medical experts warn that the total volume of opioid medications prescribed to patients nationwide remains perilously high and progress is stubbornly uneven .
CDC data shows clinicians in some parts of the U.S. still write opioid prescriptions at rates between two and six times the national average .
In 11 % of American counties , often in rural communities clustered in the South , enough opioid prescriptions are being written each year for every man , woman and child to have one .
Many of those doctors and dentists work @ @ @ @ @ @ @ opioid epidemic .
`` We found more prescribing in counties with a higher percent of white residents , with higher rates of un-insurance and unemployment , '' said Gery Guy , a CDC researcher who studies geographic disparities in opioid prescribing rates .
While highlighting overall progress cutting opioid prescribing , the AMA 's Harris said more focus is needed in areas where pills are being dispensed at a high rate .
`` We should go to those counties and look at what 's going on , '' she told NPR .
Experts @ @ @ @ @ @ @ important medication when used properly .
They say pain management is one of the most complicated and frustrating challenges physicians face .
Studies also suggest some of the overprescribing that continues in 2020 reflects a kind of hangover caused by past practices .
By some estimates , as many as 10 million Americans were improperly exposed to high doses of medical opioids and are now profoundly addicted .
`` They 've been on opioids for 15 years and probably should n't be , '' said Stanford researcher Keith Humphreys .
`` But if @ @ @ @ @ @ @ crash or experience horrible withdrawal or make a suicide attempt .
You have to manage that legacy . ''
Why is this still happening ?
But researchers say that does n't explain why so many doctors and dentists continue to prescribe pills aggressively to new patients and young people with no history of opioid dependency .
NPR found widespread debate , disagreement and even confusion over the reasons for this kind of overprescribing .
In some instances , the behavior seems almost cavalier .
One study found physicians often hand out a high @ @ @ @ @ @ @ simply because that 's the first option offered on the dropdown menu of their medical smart devices .
`` You just click a box and it 's 28 pills , '' Humphreys said .
`` Some studies show if you change that number and make it 12 pills , a lot of physicians pick 12 .
Which is a little scary . ''
Experts also say opioids remain temptingly convenient for doctors , whatever the long-term risk .
In a health care industry where patient consultations are measured in minutes and time pressure @ @ @ @ @ @ @ intense , it 's often easier to write a scrip for pain pills rather than engage in a complicated discussion of pain management .
Indeed , some studies suggest health care workers are actually writing prescriptions for more opioid pills because of time constraints , that 's because government regulations have made prescribing more complicated and time-consuming .
`` Dentists are prescribing just a couple more tablets , so they do n't have to rewrite the prescription '' during follow-up patient visits , said Suda at the University of Pittsburgh .
If that @ @ @ @ @ @ @ not matter .
But Suda 's study found dentists making that choice again and again with patients across the country , pushing roughly 14 million extra opioid tablets into circulation each year .
Surgeons , too , give out so many extra pills that as many as 70 % of tablets are never used for their prescribed purpose .
Experts say millions of these highly addictive tablets dispensed legally each year are eventually diverted and misused .
`` It 's remarkable this continues and that we put this much potentially deadly drug out @ @ @ @ @ @ @ that 's the situation we 're in , '' Humphreys told NPR .
Lack of training and resources appear to drive some decisions Physicians say another major factor causing them to overprescribe opioids is they often do n't have the resources to offer alternatives , especially in rural areas where physical therapists and pain specialists are in short supply .
In many cases , insurance companies are also willing to pay for opioid pills while sharply limiting coverage for non-opioid treatments that are safer and often more effective .
It 's also difficult @ @ @ @ @ @ @ co-pays and time off work needed for non-opioid pain treatments .
`` Doctors are absolutely willing to have alternatives if they are in the toolbox , '' said the AMA 's Harris .
`` We have to make sure the solutions , the alternatives to opioids , are equitably available . ''
But another major driver of overprescribing , cited most frequently by critics and researchers , is a cultural attitude among many American doctors , surgeons and dentists .
For two decades , front-line medical workers were trained to view pain as @ @ @ @ @ @ @ a condition that required immediate and aggressive treatment .
Studying in medical programs funded in part by the pharmaceutical industry , they learned to think of opioids as a convenient , safe solution .
Numerous studies reviewed by NPR suggest those attitudes remain deeply entrenched .
An article in March in the Rhode Island Journal of Medicine blamed America 's opioid epidemic , in part , on `` an inherent cultural ethos '' within the medical community that tends to favor high-power pain pills like oxycodone .
`` That 's the way I @ @ @ @ @ @ @ Stanford University .
`` If the patient tells you they 're in pain , it 's better to just believe what they say and give them enough medication until they say they feel better . ''
He said it took years before he realized this approach was dangerous .
`` I realized , wait a minute , I think I 'm actually contributing to the problem . ''
Many experts studying this problem told NPR that they believe the next generation of physicians and dentists will be more vigilant with opioids .
But @ @ @ @ @ @ @ be outraged that doctors practicing now keep getting this wrong .
`` They should be angry and at least some of them are , particularly people who 've buried loved ones , '' he said .
`` It is remarkable that medicine still has the trust that it does after these past 20 years . ''

Doctors And Dentists Still Flooding U.S. With Opioid Prescriptions
Enlarge this image toggle caption Tracy Lee for NPR Tracy Lee for NPR
Despite widespread devastation caused by America's opioid epidemic, an investigation by NPR found that doctors and other health care providers still prescribe highly addictive pain medications at rates widely considered unsafe.
Health Medical Professionals Still Prescribing Dangerously High Amounts Of Opioids In U.S. Medical Professionals Still Prescribing Dangerously High Amounts Of Opioids In U.S. Listen · 6:56 6:56
Medical Treatments NPR Investigation: Opioids Are Still The King For Many Doctors, Dentists NPR Investigation: Opioids Are Still The King For Many Doctors, Dentists Listen · 4:43 4:43
Health How Medical Professionals Can Fix Opioid Overprescribing How Medical Professionals Can Fix Opioid Overprescribing Listen · 5:40 5:40
Public data, including new government studies and reports in medical literature, shows enough prescriptions are being written each year for half of all Americans to have one.
Patients still receive more than twice the volume of opioids considered normal before the prescribing boom began in the late 1990s.
"We're 5% of the world's population, but we consume 80% of the world's prescription opioids," said Dr. Jonathan Chen, a physician and researcher at Stanford University Medical Center who studies prescribing patterns.
Critics say the practice exposes tens of millions of patients each year to unnecessary risk of addiction, overdose and death. It also floods communities with vast quantities of opioid medications that go unused, building up a deadly reservoir of drugs in home medicine cabinets that often wind up being abused.
"It's not just a handful of doctors doing it. We kind of all are. It's become part of our culture that this is normal," Chen said.
His view reflects a growing body of research by doctors and scientists who have begun to voice alarm about the lack of progress in scaling back medical opioid consumption.
A lot of pills, a lot of deaths
The peril for patients remains high. In 2018, the last year for which complete data is available, more than 1 in 5 Americans had an opioid prescription filled, according to the Centers for Disease Control and Prevention.
That same year, roughly 40 Americans died each day after taking prescription opioids.
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Experts say far more people are dying after developing an addiction to legal pain medicines, then shifting to far more dangerous opioids such as heroin and black-market Fentanyl.
Even without overdose and death, opioid addiction can be devastating, derailing lives, destroying families and disrupting whole communities.
"We've had an attitude about opioids that they are similar to antibiotics, where you can prescribe and forget," said Travis Rieder, a bioethicist at Johns Hopkins University. "That's a crazy view for a medicine like opioids."
Rieder himself has struggled with opioid use disorder since being prescribed large quantities of pain pills following a motorcycle accident in 2015.
"I'd just call the surgeon, and he'd up the dose. They kept writing the prescriptions, and I kept taking them," he said.
Big Pharma made the pills, but doctors were the gatekeepers
The opioid epidemic has been blamed in large part on the pharmaceutical industry and high-profile companies like Purdue Pharma, which falsely marketed the powerful medications as safe and relatively addiction-free.
As early as 2007, drugmakers were paying out massive settlements for their role sparking a wave of addiction that left more than 450,000 Americans dead. Thousands of communities have filed civil lawsuits hoping to recoup some of the staggering financial cost.
Doctors have faced far less scrutiny for their role in the crisis, but the medical profession has struggled for years to clean up its overprescribing culture. In 2014, the American Medical Association formed an opioid task force, charged in part with reforming physician practices.
"Physicians feel like we had a role to play and we wanted to be part of the solution," said Dr. Patrice Harris, who heads the AMA's effort. "Prescribing has been going down since 2012, but we wanted to get the word out that physicians should be more judicious."
Health Coronavirus Pandemic Compounds Another Ongoing Crisis: The Opioid Epidemic Coronavirus Pandemic Compounds Another Ongoing Crisis: The Opioid Epidemic Listen · 9:31 9:31
In 2016, the CDC issued strongly-worded guidelines, urging doctors to avoid opioids or to minimize their use whenever possible. Roughly half the states have implemented some form of regulation designed to curtail prescribing.
But scientists, government officials and front-line medical workers interviewed by NPR say those efforts have fallen dangerously short.
A CDC study released in May found many physicians regularly ignore federal guidelines, prescribing large quantities of powerful opioid medications even when better treatment options are available.
"It's possible some clinicians just simply aren't aware of existing evidence-based recommendations," said Christina Mikosz, one of the CDC's lead researchers studying opioid prescribing.
"The other possibility is that they are aware and they just choose not to follow them."
Physicians still prescribe opioids heavily, despite research and warnings
Mikosz points to the way many doctors treat fibromyalgia, a condition that can cause severe and chronic pain. Most experts now agree opioids aren't the safest or most effective treatment, but physicians continue to prescribe opioid pain pills aggressively anyway.
"Patients with fibromyalgia were typically prescribed at least a full month supply of opioids," Mikosz said.
Law Over 20 State Attorneys General Reject $18 Billion Opioid Settlement Proposal Over 20 State Attorneys General Reject $18 Billion Opioid Settlement Proposal Listen · 3:54 3:54
Remarkably, studies of prescribing practices reviewed by NPR show that physicians continue to regularly prescribe opioids even for relatively mild pain conditions, including lower back pain, muscle strain and headaches.
"There was a study of people who go to the hospital with a twisted ankle," said Keith Humphreys, who teaches and studies opioid prescribing at Stanford University. "One in eight of them is coming out with opioids. That's crazy."
This is happening despite research that shows even a single prescription for opioid medications comes with significant risk. A study published this year in Massachusetts found that between 1% and 4% of patients who are introduced to opioids develop opioid-use disorder.
Multiply that risk times tens of millions of patients, and you have the makings of another wave of opioid addiction.
Enlarge this image toggle caption Chip Somodevilla/Getty Images Chip Somodevilla/Getty Images
"The number of adults that received any opioid prescription during the year was quite high," said lead researcher Laura Burke, an ER doctor who teaches at Harvard Medical School.
Burke said the impact of overprescribing is still painfully visible in the emergency rooms where she works.
"Many many shifts, probably most, I see the devastating consequences of addiction and overdose and all the complications associated with opioid use disorder," she told NPR.
American dentists also prescribing opioids at dangerous levels
Studies show doctors aren't the only medical professionals overprescribing. Data released this year by researchers at the University of Pittsburgh showed as many as half of opioids given out by American dentists are unnecessary and inappropriate.
Often, powerful pain pills were prescribed following oral procedures associated with mild pain that experts say could be treated with Tylenol or an ice pack.
"We found that over time, overprescribing of opioids by dentists actually increased," said Katie Suda, lead researcher on the project. She noted that up to 10% of medical opioids distributed in the U.S. each year are now prescribed by dentists.
One particular red flag turned up in her study: Dentists regularly give high-power opioid pills such as oxycodone to younger patients who are most vulnerable.
"Dentists are the primary prescribers of opioids to adolescents and young adults, who are at high risk for opioid misuse," Suda said.
Another study published this year by researchers in Michigan found dentists regularly hand out opioids after routine wisdom teeth extractions, despite evidence that patients experienced equal relief using other, safer treatments.
There is some good news. Data shows prescription rates overall have declined significantly from their peak in 2012, with the steepest reductions coming in the last few years. In some parts of the U.S., health care workers have become far more cautious.
In those communities, opioid prescribing now resembles the safer approach seen in Europe, where physicians and dentists view medications such as oxycodone and Vicodin as a last resort rather than a first option.
In much of America, the opioid boom never ended
Even with those gains, however, medical experts warn that the total volume of opioid medications prescribed to patients nationwide remains perilously high and progress is stubbornly uneven.
CDC data shows clinicians in some parts of the U.S. still write opioid prescriptions at rates between two and six times the national average.
In 11% of American counties, often in rural communities clustered in the South, enough opioid prescriptions are being written each year for every man, woman and child to have one.
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Many of those doctors and dentists work in communities already hard hit by the opioid epidemic.
"We found more prescribing in counties with a higher percent of white residents, with higher rates of un-insurance and unemployment," said Gery Guy, a CDC researcher who studies geographic disparities in opioid prescribing rates.
While highlighting overall progress cutting opioid prescribing, the AMA's Harris said more focus is needed in areas where pills are being dispensed at a high rate.
"We should go to those counties and look at what's going on," she told NPR.
Experts interviewed by NPR agree opioids are an important medication when used properly. They say pain management is one of the most complicated and frustrating challenges physicians face.
Studies also suggest some of the overprescribing that continues in 2020 reflects a kind of hangover caused by past practices. By some estimates, as many as 10 million Americans were improperly exposed to high doses of medical opioids and are now profoundly addicted.
"They've been on opioids for 15 years and probably shouldn't be," said Stanford researcher Keith Humphreys. "But if you take it away, they could crash or experience horrible withdrawal or make a suicide attempt. You have to manage that legacy."
Why is this still happening?
But researchers say that doesn't explain why so many doctors and dentists continue to prescribe pills aggressively to new patients and young people with no history of opioid dependency.
NPR found widespread debate, disagreement and even confusion over the reasons for this kind of overprescribing.
In some instances, the behavior seems almost cavalier. One study found physicians often hand out a high number of opioid pills to their patients simply because that's the first option offered on the dropdown menu of their medical smart devices.
"You just click a box and it's 28 pills," Humphreys said. "Some studies show if you change that number and make it 12 pills, a lot of physicians pick 12. Which is a little scary."
Experts also say opioids remain temptingly convenient for doctors, whatever the long-term risk.
In a health care industry where patient consultations are measured in minutes and time pressure in emergency rooms and surgery units is intense, it's often easier to write a scrip for pain pills rather than engage in a complicated discussion of pain management.
Indeed, some studies suggest health care workers are actually writing prescriptions for more opioid pills because of time constraints, that's because government regulations have made prescribing more complicated and time-consuming.
"Dentists are prescribing just a couple more tablets, so they don't have to rewrite the prescription" during follow-up patient visits, said Suda at the University of Pittsburgh.
If that happened once or twice, it might not matter.
But Suda's study found dentists making that choice again and again with patients across the country, pushing roughly 14 million extra opioid tablets into circulation each year.
Surgeons, too, give out so many extra pills that as many as 70% of tablets are never used for their prescribed purpose.
Experts say millions of these highly addictive tablets dispensed legally each year are eventually diverted and misused.
"It's remarkable this continues and that we put this much potentially deadly drug out on the street every year. But that's the situation we're in," Humphreys told NPR.
Lack of training and resources appear to drive some decisions
Physicians say another major factor causing them to overprescribe opioids is they often don't have the resources to offer alternatives, especially in rural areas where physical therapists and pain specialists are in short supply.
In many cases, insurance companies are also willing to pay for opioid pills while sharply limiting coverage for non-opioid treatments that are safer and often more effective.
It's also difficult for some patients to afford the multiple co-pays and time off work needed for non-opioid pain treatments.
"Doctors are absolutely willing to have alternatives if they are in the toolbox," said the AMA's Harris. "We have to make sure the solutions, the alternatives to opioids, are equitably available."
But another major driver of overprescribing, cited most frequently by critics and researchers, is a cultural attitude among many American doctors, surgeons and dentists.
For two decades, front-line medical workers were trained to view pain as "the fifth vital sign," a condition that required immediate and aggressive treatment.
Studying in medical programs funded in part by the pharmaceutical industry, they learned to think of opioids as a convenient, safe solution.
Numerous studies reviewed by NPR suggest those attitudes remain deeply entrenched. An article in March in the Rhode Island Journal of Medicine blamed America's opioid epidemic, in part, on "an inherent cultural ethos" within the medical community that tends to favor high-power pain pills like oxycodone.
"That's the way I was taught," acknowledged Chen at Stanford University. "If the patient tells you they're in pain, it's better to just believe what they say and give them enough medication until they say they feel better."
He said it took years before he realized this approach was dangerous. "I realized, wait a minute, I think I'm actually contributing to the problem."
Many experts studying this problem told NPR that they believe the next generation of physicians and dentists will be more vigilant with opioids. But Stanford's Keith Humphreys said Americans should be outraged that doctors practicing now keep getting this wrong.
"They should be angry and at least some of them are, particularly people who've buried loved ones," he said. "It is remarkable that medicine still has the trust that it does after these past 20 years."


npr--2020-07-17--Coronavirus World Map: Tracking The Spread Of The Outbreak

Coronavirus World Map : Tracking The Spread Of The Outbreak Since the new coronavirus was first reported in Wuhan , China , in December , the infectious respiratory disease COVID-19 has spread rapidly within China and to neighboring countries and beyond .
The first confirmed coronavirus cases outside China occurred on Jan. 20 , in Japan , Thailand and South Korea .
On Jan. 21 , the first case in the U.S. was identified in Washington state .
On Jan. 24 , the first two European cases were confirmed in France .
By Feb. 1 , eight European nations had @ @ @ @ @ @ @ month later that count had risen to 24 countries with at least 2,200 cases , most of them in Italy .
On March 11 , Italy eclipsed 10,000 cases and the World Health Organization declared the outbreak a pandemic — the first since H1N1 in 2009 .
That 's also when China , the original epicenter , began seeing drops in daily counts of new cases .
March also saw exponential spread of the virus throughout the U.S. , with all 50 states reporting cases by March 17 .
This particular virus , @ @ @ @ @ @ @ the third strain of coronavirus known to frequently cause severe symptoms in humans .
The other two strains cause Middle East respiratory syndrome and severe acute respiratory syndrome .
Click here to see the state-by-state breakdown of cases in the United States .
This story was originally published on March 30 , 2020 .

Coronavirus world map: We've now passed the 600 million mark for infections
Editor's note: This page is no longer being updated. The last update was Sept. 5, 2022. For current data about COVID-19 cases and deaths around the world, Johns Hopkins University and Our World in Data are useful resources.
In late January 2020 only a few dozen COVID-19 infections had been identified outside of China. A year later, the world tallied its first 100 million cases. It took the globe just 7 more months to pass the 200 million mark— then another 5 months to hit 300 million, according to researchers at Johns Hopkins University. Now the virus has spread to every corner of the globe and has been blamed for more than 6 million deaths.
The United States, India and Brazil in that order have had the most COVID cases and the three nations collectively account for almost half of all recorded infections so far in the pandemic.
Explore the chart below to find a country-by-country breakdown of new and total cases since January 2020.
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Explore how the number of coronavirus cases have shifted in different parts of the world over time. The first chart compares each continent to each other, while the next charts highlight the number of cases in select countries by region.
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This story was originally published on March 30, 2020.


npr--2020-07-17--Tracking The Pandemic: Are Coronavirus Cases Rising Or Falling In Your State?

Tracking The Pandemic : Are Coronavirus Cases Rising Or Falling In Your State ?
More than 3 million people in the U.S. have tested positive for the coronavirus and more than 130,000 have died .
Though growth in new cases slowed in late spring , by mid-June new cases began to trend upward nationally .
In the graphics below , explore the trend in new cases in your state to see whether cases are rising , falling or staying level .
You can view the data via a heat map ( immediately below ) , a curve chart and a @ @ @ @ @ @ @ case trends over the last three weeks .
Or to see states ' total cases and deaths on a map , click here .
The following chart displays states ' trends in new daily case counts , total cases , and per capita totals .
To compare state outbreaks , the trend lines for average new daily cases are graphed against each state 's total case count to date .
This highlights a state 's daily growth relative to the overall size of its outbreak .
When both new and total case counts @ @ @ @ @ @ @ .
As cases slow , the curve levels or bends down .
In New York , site of the country 's largest outbreak , the state 's curve rose sharply before reaching over 170,000 total cases in April .
Since then , new cases have fallen from about 10,000 per day in mid-April to fewer than 700 per day in late June .
Some states , such as Hawaii , have declined to just a dozen new cases per day , while others are growing .
Arizona , which had leveled off at @ @ @ @ @ @ @ saw a sudden sharp spike in new cases in June .
The coronavirus has hit some states much harder than others .
For much of the pandemic , a large share of U.S. cases have been centered around New York City .
As of early June , New York state , Connecticut and New Jersey accounted for about 30 % of total cases in the nation and 42 % of deaths , although new cases have been dropping in these three states .
Across the country , other large , populous states such @ @ @ @ @ @ @ high totals as well .
Some smaller states have had a heavy burden of disease relative to their population size , such as Nebraska and Iowa , which have high case counts per capita , and Louisiana and Michigan which have a high death count per capita .
Explore the map below to see totals and per capita figures around the country .
Click here to see a global map of confirmed cases and deaths .
For more detail on your state , the table below shows the change in average new cases @ @ @ @ @ @ @ over week .
States marked in shades of red are showing growth , those in shades of green , are showing declines .
The graphics on this page pull from data compiled by the Center for Systems Science and Engineering at Johns Hopkins University from several sources , including the Centers for Disease Control and Prevention ; the World Health Organization ; national , state and local government health departments ; 1point3acres ; and local media reports .
The JHU team automates its data uploads and regularly checks them for anomalies .
This @ @ @ @ @ @ @ this page as the JHU team resolves anomalies and updates its feeds .
State-by-state recovery data are unavailable at this time .
There may be discrepancies between what you see here and what you see on your local health department 's website .
Figures shown do not include cases on cruise ships .
In early June , Michigan health authorities started including probable cases in its totals .
This resulted in a brief spike in the state 's daily numbers until the JHU team was able to reconcile the historical data .
On @ @ @ @ @ @ @ previously-unreported probable deaths in its totals , resulting in a spike in the state 's daily death numbers .
This story was originally published on March 16 , 2020 .
Elena Renken was a co-author on that version .
Sean McMinn contributed to and Carmel Wroth edited this story .

Tracking the coronavirus around the U.S.: See how your state is doing
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Note: This page was last updated on Feb. 1, 2023. It will no longer be updated. For current data on COVID cases and deaths, demographics, and hospitalizations, consult the Centers for Disease Control and Prevention.
As of Feb. 1, there have been more than 101 million confirmed coronavirus infections in the U.S. and more than 1 million people have died of COVID-19. In the graphics below, explore the trends in your state.
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The above charts show average new cases per 100,000 people for each state over the last 12 months.
Note: Actual cases may be substantially higher, since many who test positive with at-home tests don't report their cases.
For additional data about COVID-19 in the U.S, including cases and deaths, demographics, and hospitalizations, consult the Centers for Disease Control and Prevention website.
To show trends, the table below shows the change in average new cases per day in each state, week over week for the last 28 days. States marked in shades of red have growing outbreaks; those in shades of green, are declining.
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Methodology
The graphics on this page pull from data compiled by the Center for Systems Science and Engineering at Johns Hopkins University from several sources, including the Centers for Disease Control and Prevention; the World Health Organization; national, state and local government health departments; 1point3acres; and local media reports.
The JHU team automates its data uploads and regularly checks them for anomalies. This may result in occasional data discrepancies on this page as the JHU team resolves anomalies and updates its feeds. There may be discrepancies between what you see here and what you see on your local health department's website. Figures shown do not include cases on cruise ships.
Fluctuations in the numbers may happen as health authorities review old cases, process testing backlogs or update their methodologies. The JHU team maintains a list of such changes.
This story was originally published on March 16, 2020. Elena Renken was a co-author on that version. Sean McMinn and Audrey Carlsen contributed to this story. Carmel Wroth edited this story.


npr--2020-07-17--Pro Sports Are Returning. Their COVID-19 Testing Is Top Notch, But Is It Ethical?

Pro Sports Are Returning .
Their COVID-19 Testing Is Top Notch , But Is It Ethical ?
Florida continues to see record coronavirus cases and , at the same time , delays in getting test results .
But that 's not the case for NBA and Major League Soccer athletes playing in the Orlando area .
Their season restarts have included frequent and quick COVID-19 testing .
The discrepancy is raising ethical questions about the process .
Florida Gov .
Ron DeSantis has been criticized for his handling of the coronavirus outbreak , including opening the state early , in @ @ @ @ @ @ @ week , he 's been sounding the alarm about delays residents are experiencing from the time they 're tested , to when they get the results .
`` If you have somebody go through one of the [ testing ] sites and then they get a result back ten days later , that is not really going to be very helpful , '' DeSantis said Wednesday .
`` Any delay in test results is another day that you , a normal person , can be walking around thinking you 're negative when you @ @ @ @ @ @ @ Binney , an epidemiologist at Oxford College of Emory University .
`` You could be going to work as an essential worker while you 're positive .
You could be spending time around your family before you know you 're positive .
And so any delay , y'know even a few [ days ] , could have an impact on somebody 's health . ''
Major League Soccer 's restart tournament rolled on this week in front of TV cameras but not fans .
These athletes , and NBA players , are both @ @ @ @ @ @ @ the Orlando area .
They 've been getting daily or every-other-day testing with very quick results .
For the NBA an average turnaround time of about 12 to 15 hours .
For MLS , 12 to 24 hours .
It 's not a good look , considering the delays outside the bubbles .
`` I do n't care about [ the ] optics , '' Binney said , `` I care about ethics . ''
Binney would like to hear more from the leagues than their oft-repeated assurance that they , and the @ @ @ @ @ @ @ taking away testing capacity from the public .
`` I would like to see a little bit of a deeper explanation of why they think that 's not the case , '' Binney said , `` when the same lab that 's conducting MLS 's tests , just a week ago , was saying that they were n't turning around some tests for six days on average . ''
BioReference Laboratories does the testing for MLS and the NBA , and many Florida residents .
The lab 's executive chairman , Dr. Jon @ @ @ @ @ @ @ `` [ The lab ] experienced a significant uptick in PCR COVID-19 testing demand , '' Cohen said , `` which caused delays in turnaround times for results throughout June .
In the beginning of July , BioReference cleared their backlog and stabilized the turnaround times from 5-7 days to 72 hours or less . ''
Still , the rapid returns with pro athletes stand out .
Asked whether those athletes are a priority , Cohen does n't answer directly `` yes '' or `` no . ''
Instead , he says his @ @ @ @ @ @ @ each client .
`` It 's no different in my mind than a hospital that needs patients tested within a certain period of time , '' he said , `` which is not different than nursing homes that may need a certain turnaround time . ''
The sports leagues needed fast turnaround times so they could get up and running quickly , with narrow windows to complete their truncated seasons .
And while many insist these young , rich , low risk [ for COVID-19 ] athletes are getting preferential treatment , Cohen @ @ @ @ @ @ @ than the athletes .
`` I consider MLS , the NBA , large employers , '' he said .
`` Literally thousands of people work for these leagues .
So we 're supporting , in some sense , the economic return of the country when we support large employers .
Whether it 's a sports franchise , or a retailer , or large manufacturer , or a food service organization .
`` A lot of people want to say , 'oh , this is about special testing ' or whatever you want to @ @ @ @ @ @ @ that .
For us , it 's about how do we support this industry so that people can return to work .
And there are real jobs at stake here . ''
Cohen insists BioReference 's commitment to pro sports leagues in Florida does n't take away from its work with the public .
`` We 're testing an enormous amount for the general public , '' Cohen said .
`` We have quite honestly put more resources into Florida , brought more analyzers to Florida , our hospital clients , urgent care @ @ @ @ @ @ @ as they 're needed , [ have ] increased in the last several weeks .
We have delivered on those needs . ''
The NBA adds that the tests administered to its players , staff and other personnel were `` brought in '' for the restart .
According to a league representative , `` the tests would n't have been in the community if the NBA were n't there . ''
Still , the NBA and MLS appear sensitive to the criticism .
Next week , the NBA plans to launch a mobile @ @ @ @ @ @ @ event for the public .
MLS is working with BioReference to provide antibody testing for the Orlando community .
The ethical questions and moral judgments on who gets what , when ... .
ultimately are a symptom of a larger issue - the country 's patchwork approach to the pandemic .
Questions and judgments might fade if there were sufficient tests and enough testers to process them quickly .
`` The problem is not one versus the other [ when it comes to testing ] , '' Cohen said .
`` The issue @ @ @ @ @ @ @ a day and we probably should be doing two million tests a day .
So that 's the question .
How do we get from 700,000 to two million ? ''

Pro Sports Are Returning. Their COVID-19 Testing Is Top Notch, But Is It Ethical?
Enlarge this image toggle caption Michael Reaves/Getty Images Michael Reaves/Getty Images
Florida continues to see record coronavirus cases and, at the same time, delays in getting test results.
But that's not the case for NBA and Major League Soccer athletes playing in the Orlando area. Their season restarts have included frequent and quick COVID-19 testing.
The discrepancy is raising ethical questions about the process.
Not helpful, and potentially dangerous
Florida Gov. Ron DeSantis has been criticized for his handling of the coronavirus outbreak, including opening the state early, in the beginning of May.
But this week, he's been sounding the alarm about delays residents are experiencing from the time they're tested, to when they get the results.
"If you have somebody go through one of the [testing] sites and then they get a result back ten days later, that is not really going to be very helpful," DeSantis said Wednesday.
In fact, it's potentially dangerous.
"Any delay in test results is another day that you, a normal person, can be walking around thinking you're negative when you're actually positive," said Zach Binney, an epidemiologist at Oxford College of Emory University. "You could be going to work as an essential worker while you're positive. You could be spending time around your family before you know you're positive. And so any delay, y'know even a few [days], could have an impact on somebody's health."
Ethics not optics
Major League Soccer's restart tournament rolled on this week in front of TV cameras but not fans. These athletes, and NBA players, are both living and playing in protective bubbles in the Orlando area. They've been getting daily or every-other-day testing with very quick results. For the NBA an average turnaround time of about 12 to 15 hours. For MLS, 12 to 24 hours.
It's not a good look, considering the delays outside the bubbles.
"I don't care about [the] optics," Binney said, "I care about ethics."
Binney would like to hear more from the leagues than their oft-repeated assurance that they, and the labs they're using, are not taking away testing capacity from the public.
"I would like to see a little bit of a deeper explanation of why they think that's not the case," Binney said, "when the same lab that's conducting MLS's tests, just a week ago, was saying that they weren't turning around some tests for six days on average."
BioReference Laboratories does the testing for MLS and the NBA, and many Florida residents. The lab's executive chairman, Dr. Jon Cohen, acknowledges the turnaround delays.
"[The lab] experienced a significant uptick in PCR COVID-19 testing demand," Cohen said, "which caused delays in turnaround times for results throughout June. In the beginning of July, BioReference cleared their backlog and stabilized the turnaround times from 5-7 days to 72 hours or less."
Still, the rapid returns with pro athletes stand out.
Asked whether those athletes are a priority, Cohen doesn't answer directly "yes" or "no." Instead, he says his company customizes testing to the needs of each client.
"It's no different in my mind than a hospital that needs patients tested within a certain period of time," he said, "which is not different than nursing homes that may need a certain turnaround time."
The sports leagues needed fast turnaround times so they could get up and running quickly, with narrow windows to complete their truncated seasons. And while many insist these young, rich, low risk [for COVID-19] athletes are getting preferential treatment, Cohen disagrees and notes the leagues are more than the athletes.
"I consider MLS, the NBA, large employers," he said. "Literally thousands of people work for these leagues. So we're supporting, in some sense, the economic return of the country when we support large employers. Whether it's a sports franchise, or a retailer, or large manufacturer, or a food service organization.
"A lot of people want to say, 'oh, this is about special testing' or whatever you want to call it. It's not about that. For us, it's about how do we support this industry so that people can return to work. And there are real jobs at stake here."
Cohen insists BioReference's commitment to pro sports leagues in Florida doesn't take away from its work with the public.
"We're testing an enormous amount for the general public," Cohen said. "We have quite honestly put more resources into Florida, brought more analyzers to Florida, our hospital clients, urgent care clients, physician clients in Florida, as they're needed, [have] increased in the last several weeks. We have delivered on those needs."
A person with knowledge of the NBA's testing program adds that the tests administered to the league's players, staff and other personnel were "brought in" for the restart. "The tests wouldn't have been in the community if the NBA weren't there."
Still, the NBA and MLS appear sensitive to the criticism.
Next week, the NBA plans to launch a mobile testing site and host a drive-through testing event for the public. MLS is working with BioReference to provide antibody testing for the Orlando community.
The ethical questions and moral judgments on who gets what, when.... ultimately are a symptom of a larger issue - the country's patchwork approach to the pandemic. Questions and judgments might fade if there were sufficient tests and enough testers to process them quickly.
But demand still outpaces supply.
"The problem is not one versus the other [when it comes to testing]," Cohen said. "The issue is the country's doing 700,000 tests a day and we probably should be doing two million tests a day. So that's the question. How do we get from 700,000 to two million?"


npr--2020-07-17--EU Leaders Meet In Hopes Of Closing Divisions Over COVID-19 Relief Package

EU Leaders Meet In Hopes Of Closing Divisions Over COVID-19 Relief Package European Union leaders were going into their first face-to-face meeting in months on Friday , hoping to hammer out details of a 1.85 trillion euro ( $ 2.1 trillion ) EU budget and COVID-19 recovery plan amid a global pandemic that has touched off the worst recession in the bloc 's history .
The urgency of the crisis has caused the leaders of the 27-nation grouping to abandon a series of video conference summits in favor of looking one another in the eyes — albeit from across a @ @ @ @ @ @ @ divided between members eager for a proposed 750 billion euro ( $ 855 billion ) stimulus package to offset the economic pain of the pandemic , such as Spain and Italy , and northern European nations whose economies have been less affected .
The economies of the so-called `` Frugal Four '' — Netherlands , Sweden , Denmark and Austria — are expected to be spared the worst of the economic carnage .
They are determined that no bailout be approved without strict conditions requiring heavily indebted members to carry out economic reforms @ @ @ @ @ @ @ Commission .
Germany , too , is expected to fare better than many of the other EU states , but Chancellor Angela Merkel nonetheless finds herself in the unusual position of aligning with Europe 's poorer southern states , despite her hard-line fiscal prudence during the long-running European debt crisis .
Repayment of the common recovery fund would fall on the entire bloc — an approach that Germany had previously resisted but that would promote greater European integration .
The 19 economies that use the euro currency are expected to contract by 8.7 @ @ @ @ @ @ @ Italy , France and Croatia taking the biggest hits .
`` The crisis brought about by this pandemic , with all of its economic and social consequences , is the most severe we have had to face since the Second World War , '' European Council President and summit host Charles Michel said late Thursday .
Even with the return of face-to-face meetings , leaders are making concessions to the ongoing pandemic , choosing to congregate in a massive meeting room designed to fit 330 people rather than the intimate space in their @ @ @ @ @ @ @ .
French President Emmanuel Macron arrived on Thursday to meet with Dutch Prime Minister Mark Rutte , whose opposition to the bailout is expected to be a major obstacle to getting agreement at the two-day meeting .
But Latvia 's Prime Minister Arturs Karins said that the summit could go longer if it meant a deal was possible .
`` We want a result and we will continue working until we get that result , '' he said , suggesting that the meeting could go through Sunday .
The rescue package is not @ @ @ @ @ @ @ out – the bloc 's trillion-euro seven-year budget is also pending .
Yet another point of contention could involve efforts to make EU budget contingent on member states respecting the rule of law – a move that is likely to anger states such as Hungary and Poland , which are taking heat from other EU members over their alleged drift toward authoritarianism .
Upon his arrival in Brussels , Hungarian Prime Minister Viktor Orbán said he would fight any such conditions .
`` The Hungarian position is clear : Hungarians should decide about @ @ @ @ @ @ @ .

EU Leaders Meet In Hopes Of Closing Divisions Over COVID-19 Relief Package
Enlarge this image toggle caption John Thys/AFP via Getty Images John Thys/AFP via Getty Images
European Union leaders were going into their first face-to-face meeting in months on Friday, hoping to hammer out details of a 1.85 trillion euro ($2.1 trillion) EU budget and coronavirus recovery plan amid a global pandemic that has touched off the worst recession in the bloc's history.
The urgency of the crisis has caused the leaders of the 27-nation grouping to abandon a series of video conference summits in favor of looking one another in the eyes — albeit from across a large room.
The EU is deeply divided between members eager for a proposed 750 billion euro ($855 billion) stimulus package to offset the economic pain of the pandemic, such as Spain and Italy, and northern European nations whose economies have been less affected.
The economies of the so-called "Frugal Four" — Netherlands, Sweden, Denmark and Austria — are expected to be spared the worst of the economic carnage. They are determined that no bailout be approved without strict conditions requiring heavily indebted members to carry out economic reforms under the watchful eye of the European Commission.
Germany, too, is expected to fare better than many of the other EU states, but Chancellor Angela Merkel nonetheless finds herself in the unusual position of aligning with Europe's poorer southern states, despite her hard-line fiscal prudence during the long-running European debt crisis.
Repayment of the common recovery fund would fall on the entire bloc — an approach that Germany had previously resisted but that would promote greater European integration.
The 19 economies that use the euro currency are expected to contract by 8.7% this year, with Spain, Italy, France and Croatia taking the biggest hits.
"The crisis brought about by this pandemic, with all of its economic and social consequences, is the most severe we have had to face since the Second World War," European Council President and summit host Charles Michel said late Thursday.
Even with the return of face-to-face meetings, leaders are making concessions to the ongoing pandemic, choosing to congregate in a massive meeting room designed to fit 330 people rather than the intimate space in their Europa center headquarters where they normally gather.
French President Emmanuel Macron arrived on Thursday to meet with Dutch Prime Minister Mark Rutte, whose opposition to the bailout is expected to be a major obstacle to getting agreement at the two-day meeting.
But Latvia's Prime Minister Arturs Karins said that the summit could go longer if it meant a deal was possible. "We want a result and we will continue working until we get that result," he said, suggesting that the meeting could go through Sunday.
The rescue package is not the only thorny issue to be ironed out – the bloc's trillion-euro, seven-year budget is also pending.
Yet another point of contention could involve efforts to make the EU budget contingent on member states respecting the rule of law — a move that is likely to anger states such as Hungary and Poland, which are taking heat from other EU members over their alleged drift toward authoritarianism.
Upon his arrival in Brussels, Hungarian Prime Minister Viktor Orban said he would fight any such conditions.
"The Hungarian position is clear: Hungarians should decide about Hungarians' money," Orban said.