THE PROGNOSIS

President Trump insists the United States is “very, very ready” for dealing with the coronavirus. Yet two years ago, his administration undercut its own ability to respond to such an outbreak.

Trump announced in a news conference last night that Vice President Pence will lead the federal government's response to the deadly coronavirus, trying to reassure Americans amid growing concerns of a global health crisis that has led to tumbling stocks as the virus spreads around the world.

“We’ve had tremendous success, tremendous success beyond what many people would’ve thought,” Trump said, adding that the risk to America is “very low” and predicting a swift end to the outbreak.

Trump didn't mention that there's evidence the virus could now be spreading within the United States. A person in Northern California has contracted the coronavirus without traveling to regions hit by the outbreak or coming in contact with anyone known to have the infection, the Centers for Disease Control and Prevention reported last night.

“Trump’s positive message was at odds with the statements by top members of his administration in recent days who have warned of an unpredictable virus that could spread into communities and upend Americans’ daily lives,” my colleagues Toluse Olorunnipa, Josh Dawsey and Yasmeen Abutaleb report.

The Post's Philip Bump:

Sen. Patty Murray (D-Wash.):

And he didn't point to the history that is making his administration's response to this new outbreak more difficult. Two years ago, the administration disbanded two permanent groups formed by President Barack Obama to respond to the 2014 Ebola outbreak one within the White House National Security Council and another within the Department of Homeland Security.

The idea was that these groups could rapidly get multiple government agencies on the same page in the event of a biological crisis, avoiding the all-too-common problem of each agency operating only within its own silo.

Under a May 2018 reorganization by then-national security adviser John Bolton, Rear Adm. Timothy Ziemer abruptly stepped down from leading the NSC global health security panel, leaving no senior administration official focused solely on global health security.

Weeks earlier, Bolton had also pressured Tom Bossert, who led the DHS panel, to resign along with his team.

That’s not all Trump did. He also proposed cutting the parts of the budgets at NSC, DHS, and Health and Human Services designated for fighting global disease. And in early 2018, the Centers for Disease Control and Prevention dramatically downsized its epidemic prevention activities in 39 out of 49 countries because money was running out.

The Post's Josh Dawsey:

Trump has formed a “coronavirus task force” – but it was initially led by HHS Secretary Alex Azar, not a White House official with authority to lead across agencies.

Even Republicans have recommended that Trump reinstate the global health group at the White House. That was the No. 1 suggestion of a November report issued by a bipartisan group of lawmakers and experts convened by the Center for Strategic and International Studies to examine the country’s health security.

“Critical leadership gaps remain,” the report says. “It remains unclear who would be in charge at the White House in the case of a grave pandemic threat or cross-border biological crisis, whether natural, accidental, or deliberate.”

Steve Morrison, who directed the writing of the report, told me that dismantling the NSC panel was viewed as a “very big mistake” and has undermined the administration’s ability to respond to coronavirus in a coherent manner.

“Now we’re seeing the consequences,” Morrison said.

— Trump's Wednesday evening news conference on the coronavirus quickly turned into a political rant against Democrats, slamming them for criticizing his response to the outbreak and charging that House Speaker Nancy Pelosi (D-Calif.) isn't “thinking about the country.”

The president also had words for the Federal Reserve and major U.S. manufacturers, when asked why the stock market has plunged 2,000 in recent days. Trump said he thought the markets were suddenly worried that a Democrat will beat him in November (we hate to state the obvious, but the Democratic primary race has been going for more than a year).

“From the start of the news conference, Trump repeatedly sought to pat himself and his administration on the back, even as the scope and severity of the viral outbreak worldwide and in the United States is still coming into focus,” The Post's Aaron Blake writes.

“I think after I win the reelection, the stock market’s going to boom like it’s never boomed — just like it did, by the way, after I won the last election," he said.

— Trump gave all kinds of fuel to late-night hosts, who joined critics to slam his rambling speech and appointment of Pence. 

“We’re definitely all going to die,” said “Daily Show” host Trevor Noah. “Trump is great for jokes, but in times of crisis, Trump is the worst person to reassure the nation.”

“Now concerns of a global pandemic are growing, but fear not, the president knows he has a solemn duty to protect himself,” Stephen Colbert said on his CBS show.

“I look forward to that transcript being released,” Colbert joked, before impersonating Trump. “Hello, Ukraine? I need dirt on a ‘Hunter Coronavirus.’”

Trump has said plenty of misleading things about the novel coronavirus. But maybe the president a self-acknowledged germaphobe is setting a personal example of how to act.

“Trump is known to thrust out his hands for a pump of sanitizer after any hand-to-hand contact,” the Posts's Anne Gearan writes. “An aide carries a bottle at all times, according to former administration employees.” 

Trump — who shook dozens of hands during his visit to India this week — has said he washes his hands as often as possible and is known to do so before every meal. He has even called the practice of shaking hands “barbaric.” 

“I’m not a big fan of the handshake,” Trump said on “Later Today” in 1999. “I think it’s barbaric. I mean, they have medical reports all the time. Shaking hands, you catch cold, you catch the flu. You catch this, you catch all sorts of things. Who knows what you don’t catch? ”

Trump said this last night:

Yet the president had much more than his own health at stake as he dealt from afar with the spiraling consequences from the outbreak.

“Alarmed over the U.S. stock market slide and furious at criticism that his government’s response has been slow and inept, Trump spent some of the 36 short hours he was in India getting virus updates by phone and in person,” Anne writes. “He brought up the issue unbidden during a closing news conference Tuesday and tweeted in defense of the U.S. response as he flew home Tuesday night.”

Coronavirus was front-and-center on Capitol Hill yesterday, with several top health officials testifying in committee hearings and lawmakers beginning work on a large emergency spending package, my colleagues Erica Werner and Yasmeen Abutaleb report.

  • Azar disclosed there are now 60 confirmed cases of coronavirus in the U.S. That includes 15 people with the virus who weren't evacuees from abroad.
  • Azar said at a Wednesday morning hearing “we technically are in a state of containment in the United States” but didn't repeat that phrase several hours later before a different congressional committee, when he disclosed knowledge of one new case.
  • Noting most of the coronavirus patients in the U.S. were repatriated from abroad, Azar added: “While the immediate risks to the American public remain low, there is now community transmission in a number of places including outside of Asia which is deeply concerning. ”

Congressional reporter Michael McAuliff:

There appears to be a large disconnect between Congress and the White House on how much to spend. 

“Negotiators are eyeing packages of between $4 billion and $8.5 billion, though congressional aides cautioned that talks remained very fluid,” Erica and Yasmeen write. “The White House had publicly sought a much smaller amount, asking for $1.25 billion in new funds and the authority to redirect another $1.25 billion from other programs.”

Markets aren't happy as the virus continues to spread around the world, The Post's Adam Taylor, Rick Noack, Simon Denyer and Siobhan O'Grady report.

  • The Dow Jones industrial average endured its worst two-day slump in four years on Tuesday. On Wednesday, it was up 300 points shortly after open.
  • Economic alarms continued to flash on European and Asian financial markets.
  • Cases are growing rapidly across Europe; Spain confirmed eight new cases in 24 hours while new infections were reported in Germany, Greece, France, Croatia, Austria and Switzerland. France reported the first death of a French citizen.
  • Brazil has reported a case – the first known infection in Latin America.
  • “Although China announced a decline in new confirmed cases on Wednesday, the number of infected people soared in South Korea to more than 1,200, with more expected in the coming days as the state attempts to test 200,000 people,” my colleagues write.

— China, the epicenter of the coronavirus outbreak, manufactures many medications Americans rely on. The FDA is stepping up its monitoring of the drug supply for potential shortages, including 20 products that may be at risk due to the country's highly outsourced pharmaceutical supply chain, The Post's Laurie McGinley and Carolyn Y. Johnson report.

“The crisis highlights a growing vulnerability: Not only are many medications used in the United States manufactured overseas, but critical ingredients — and the chemicals used to make them — also are overwhelmingly made in China and other countries,” they write. “The supply chain’s roots now run so deep that it’s difficult to fully anticipate where critical shortages could emerge.”

At Ash Wednesday services, some pastors and ministers were even questioning whether to tweak the ritual of swiping ashes onto worshippers' foreheads, my colleague Sarah Pulliam Bailey reports.

“In the Philippines, Catholic priests were urged to sprinkle ashes on parishioners instead of marking their foreheads through direct contact. In Italy, several churches closed for Ash Wednesday. In South Korea, a secretive church that has been at the center of the virus’s spread was shut down by authorities,” Sarah writes.

Spokespeople for many of the largest Christian denominations in the U.S. said they haven't issued special directives for their churches but are closely monitoring guidance from government officials. “The Episcopal Diocese of Newark told clergy and lay leaders Tuesday that anyone administering Communion should wash their hands, preferably with an alcohol-based hand-sanitizer, and keep their distance during the greeting ritual known as the ‘passing of the peace,’” Sarah writes.

— Check out The Post's live blog for coronavirus updates 24/7.

AHH, OOF and OUCH

AHH: Epidemiology experts say that even as U.S. health officials warn the spread of coronavirus is inevitable, the most important way to prepare is by staying calm. 

“Don’t panic,” Timothy Brewer is a professor of epidemiology and medicine at UCLA’s Fielding School of Public Health told The Post’s Reis Thebault and Alex Horton. “There’s no value in panicking or telling people to be afraid. Don’t let fear and emotion drive the response to this virus. That can be extremely difficult because it is new, and we’re still learning about it, but don’t allow fear of what we don’t know about the virus to overwhelm what we do know.”

Other precautions are similar to what people need to do every day to stave off other respiratory diseases, like influenza. 

“You’ve seen the guidance before: Wash your hands regularly. Cover your nose and mouth when you sneeze. And when you’re sick, stay home from work or school and drink lots of fluids,” Reis and Alex write. 

And you don't need to wear a surgical mask unless you're sick. Common surgical masks block the droplets coming out of a sick person from getting into the air, but they don't prevent what’s already in the air from getting in. Here’s what the CDC writes on its website: “CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases.” 

OOF: CDC Director Robert Redfield is facing intensifying scrutiny within the administration for early stumbles related to the outbreak. 

“Hundreds of Americans were left stuck on a cruise ship that later became the single-biggest source of U.S. coronavirus cases — a CDC decision. Dozens of public health labs are still waiting for tests that will allow them to diagnose coronavirus — a CDC responsibility,” Politico’s Dan Diamond reports. “One of Redfield’s deputies on Monday urged businesses and schools to start preparing for the disease’s inevitable spread — stamping the CDC’s imprint on public fears and irking White House officials who worry about panicking Americans and driving down financial markets.”

Ten current and former administration officials and people close to the administration described to Dan “a leader facing the biggest management challenge of his four-decade career in public health.”

But an HHS spokesperson said this: “The CDC has been at the forefront ably working to protect the American people… The CDC plans and prepares for just these sorts of public health challenges. This is what they do.”

OUCH: The Partnership for America’s Healthcare Future – a health-care industry group – has launched a $200,000 television ad campaign in South Carolina targeting Medicare-for-all, as well as proposals for a Medicare buy-in and a public option, Politico’s Holly Otterbein and Maya King report

The group of pharmaceutical, hospital and health insurance lobbyists launched the six-figure effort to run television ads in Charleston and Columbia. They began on Tuesday during the debate and will run through Saturday and “underline the message that Medicare for All, the Medicare buy-in and the public option are costly and ineffective in practice,” Holly and Maya write. 

One ad says: “These one-size-fits all government health insurance systems could double everyone’s income taxes... Millions of American families could lose their employer provided coverage. Medicare-for-all, Medicare buy-in and the public option: You pay more to wait longer for worse care.”

HEALTH ON THE HILL

The top senators on the Senate Finance Committee sent a letter to Express Scripts threatening to subpoena the pharmacy benefit manager for not providing documents as part of the panel’s probe into insulin prices. 

Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and the committee’s top Democrat Sen. Ron Wyden (D-Ore.) wrote to president of Express Scripts, which is owned by Cigna, that it’s making a final request after initially requesting information nearly a year ago. 

“Since sending the letter, our staff has engaged with your counsel for almost a year to remedy our production-related concerns,” they wrote to Timothy Wentworth. “…However, no records have been produced and you have failed to cite any objections that would explain your non-compliance.” 

The letter notes the senators requested further information so the committee can “understand how Cigna’s practices impact the operation of these federal programs, the cost to taxpayers, and the out-of-pocket costs patients face.” 

The bipartisan pair began an investigation into spiking insulin costs in February 2019 and first sent a letter to Cigna in April 2019. 

OPIOID OPTICS

A nonprofit says it will open the nation’s first supervised injection facility in South Philadelphia next week after a federal court cleared the path for the opening.

“The court ruling was the culmination of a two-year battle to open a place where people in addiction can use drugs under medical supervision, be revived if they overdose, and access treatment,” the Philadelphia Inquirer’s Joseph A. Gamberdello reports. 

The U.S. Attorney’s Office in Philadelphia said it plans to appeal. 

The organization, Safehouse, formed in October 2018 with an aim to open such a facility in Philadelphia. The group says it also plans to open a second facility nearby after the first site is opened. 

“The city has also issued a public-safety plan for the area outside a site, and Safehouse has been training volunteer escorts, like those that abortion providers have used for years to protect women,” Joseph writes. “…But even though Safehouse’s backers plan to be welcoming clients next week, the legal battle over the site is not over."

— And here are a few more good reads:

INDUSTRY RX

Health Policy
The government’s quarantine powers are vast, and the only person who challenged them lost.
Derek Hawkins

STATE SCAN

Local
No one has tested positive in the state
Justin Wm. Moyer

TRUMP TEMPERATURE

Slowing the coronavirus is going to require remote work
Axios

AGENCY ALERT

Health care experts thought the battle was won against heart disease, measles, smoking, STDs and other life-threatening conditions and behaviors. Better think again.
Kaiser Health News

MEDICAL MISSIVES

Food and drink claims like “just a tad sweet” or “healthy” may mask high levels of added sugars.
New York Times
The 2016 document, obtained by STAT, details how data were to be shared as part of an artificial intelligence research project.
Stat

DAYBOOK

Today

  • The House Foreign Affairs Subcommittee on Asia, the Pacific and Nonproliferation holds a hearing on the U.S. and international response to coronavirus. 
  • The House Veterans Affairs holds a hearing on the Department of Veterans Affairs Budget Request for Fiscal Year 2021. 
  • The House Ways and Means Committee holds a hearing with HHS Secretary Alex Azar on the department’s proposed Fiscal Year 2021 budget.  
  • The House Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies holds a hearing on the HHS Office of Inspector General. 
  • The House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies holds a hearing on “Oversight of VA’s Electronic Health Record Modernization Implementation.” 

SUGAR RUSH