By Paige Winfield Cunningham
Paige Winfield Cunningham
National reporter focused on health-care policy

THE PROGNOSIS

Vice President Pence speaks during a coronavirus task force meeting at the Department of Health and Human Services on Thursday. REUTERS/Carlos Barria

The coronavirus outbreak showcases the Trump administration’s daily struggle to get both its messaging — and its messengers — all on the same page.

Just look at all the mixed messages from the White House, even as the deadly virus continues spreading around the world and stoking fears of an unstoppable pandemic. U.S. markets plunged more than 1,100 points yesterday in one of the worst weeks since the 2008 financial crisis, quickly erasing recent gains and threatening world economies.

Podcast host Joe Weisenthal:

Andy Slavitt, former head of the Centers for Medicare and Medicaid Services under President Obama:

The contradictory messaging was there almost from the start.

On Feb. 10, Trump suggested the coronavirus outbreak would subside by the springtime.

“A lot of people think that goes away in April with the heat — as the heat comes in. Typically, that will go away in April,” he said.

Two days later, Nancy Messonnier, director of the Cenet for Disease Control’s National Center for Immunization and Respiratory Diseases, cautioned against “overinterpreting it.” 

“I’m happy to hope that it goes down as the weather warms up, but I think it’s premature to assume that," she said. "And we’re certainly not using that to sit back and expect it to go away.”

On Monday, Trump promised coronavirus was “under control” and that the stock market was on the upswing:

And White House National Economic Council Director Larry Kudlow told CNBC "we have contained this. I won’t say airtight, but pretty close to airtight.”

But on Tuesday, Messonnier had this to say: “Ultimately, we expect we will see community spread in the United States. It’s not a question of if this will happen, but when this will happen, and how many people in this country will have severe illnesses.”

More contradictions between Trump and his top health officials emerged in a Wednesday night press conference.

Trump said a coronavirus vaccine “is coming along well.” “In speaking to the doctors, we think this is something that we can develop fairly rapidly,” he said.

Minutes later, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, asserted that a vaccine won't be ready until next year (something we also explained in this Health 202).

“If this virus — which we have every reason to believe it is quite conceivable that it will happen — will go beyond just a season and come back and recycle next year — if that’s the case, we hope to have a vaccine,” Fauci said.

HHS Secretary Alex Azar gives a news conference with Trump at the White House on Wednesday. REUTERS/Carlos Barria/File Photo

And it's still not entirely clear who will actively lead the U.S. response. 

Trump set up a coronavirus task force in January, headed by Health and Human Services Secretary Alex Azar. But on Wednesday, Trump said Vice President Pence will oversee the whole response effort while Azar will technically remain the head of the task force. 

That announcement quickly prompted criticisms of how Pence, as Indiana's governor, handled the state's worst HIV outbreak back in 2015. U.S. Surgeon General Jerome Adams defended Pence, saying his efforts became a “model” for other jurisdictions.

Then yesterday, the administration announced Ambassador Debbie Birx will serve as coordinator for the task force, reporting directly to Pence. Birx, who is widely respected in the public health community, has played a lead role since 2014 in global HIV/AIDS prevention efforts.

Per the LA Times's Jennifer Haberkorn:

Trump appears deeply concerned about the effects of the coronavirus spread – if only because it could hurt his releection prospects. But his attempt to show leadership on the issue has had “a slapdash quality," The Post's Ashley Parker and Philip Rucker write.

“Reports of infighting among Trump’s top staffers, including health secretary Alex Azar, leaked into the news media,” they report. “And the president’s announcement that he was deputizing Vice President Pence to oversee all handling of the outbreak blindsided administration officials, including those deeply involved in the response.”

Azar insisted to members of Congress that he was consulted about the Pence pick, calling it a “genius” decision while testifying on Capitol Hill on Thursday.

S&P Global News reporter Donna Young:

The administration added Kudlow, Adams and Treasury Secretary Steven Mnuchin to the task force yesterday, which now numbers 16 officials across several government agencies including the CDC, the main agency tasked with monitoring and mitigating infectious disease outbreaks.

Pence tried to project a sense of steady control over the coronavirus response while presiding over a Thursday task force meeting. The meeting was held at HHS headquarters, in part to ensure Azar did not feel sidelined, my colleagues Toluse Olorunnipa, Josh Dawsey and Yasmeen Abutaleb report. Pence had met privately with Azar Wednesday night to plan for how they could work together. 

“My presence here today, and working with you each and every day in the days ahead, I hope gives evidence of the priority the president has placed on this work,” Pence said at the Thursday meeting. “He has tasked us to take every step necessary to protect the health of the American people.”

The White House has set up strict parameters for unified messaging. It has directed all government officials — even someone as senior as Fauci himself — to coordinate all statements and public appearances with Pence's office. 

“The move came after Trump grew frustrated about some of the public statements made by government officials warning the public, which the president viewed as overly alarmist, according to the officials,” my colleagues write.

Former Obama administration official Ron Klain:

Jason Ukman, managing editor of Stat News:

The whole episode has prompted endless mocking by the administration's critics:

— California officials won't say how many people may have crossed paths with a Solano County woman, who is the first person in the U.S. to develop the new covid-19 disease without traveling to a virus hotspot or having close contact with someone who did, The Post's Lenny Bernstein, Laurie McGinley, Geoffrey Fowler and Lena H. Sun report. The woman wasn’t tested for the disease for four days, despite an immediate request to the CDC, because she didn’t meet the strict criteria for the test.

Officials “acknowledged the woman was living and working in the community and showing symptoms of the disease before she was admitted to a local hospital,” my colleagues write. “That is a worrisome prospect because the virus is highly transmissible, especially when someone with the disease has symptoms. They did not share any details about the woman’s family, work and social contacts, citing patient privacy.”

California Gov. Gavin Newsom (D) said the state is monitoring 8,400 people who may have been exposed to the coronavirus after traveling to Asia. They're among thousands of people in the U.S. who have been requested to self-isolate or check themselves for coronavirus symptoms.

Cases in the U.S., not including several dozen people evacuated from the Diamond cruise ship in Japan:

— HHS officials sent more than a dozen workers to receive the first Americans evacuated from the outbreak's epicenter of Wuhan, China without proper training for infection control or appropriate protective gear, according to a whistleblower complaint reported by Lena and Yasmeen Abutaleb.

The whistleblower – who is a senior HHS official who oversees workers at the Administration for Children and Families – is seeking federal protection because she alleges she was unfairly and improperly reassigned after raising concerns about the safety of these workers to agency officials. She was told Feb. 19 that if she does not accept the new position she would be terminated.

The whistleblower's 24-page complaint, which her lawyers provided to the Post, alleges that HHS staff were “improperly deployed” and were “not properly trained or equipped to operate in a public health emergency situation.” 

“The complaint also alleges that the workers were potentially exposed to coronavirus because appropriate steps were not taken to protect them, and staff were not trained in wearing personal protective equipment, even though they had face-to-face contact with returning passengers,” Lena and Yasmeen write. “The workers were in contact with passengers in an airplane hangar where evacuees were received and on two other occasions: when they helped distribute keys for room assignments and hand out colored ribbons for identification purposes.”

Governments are ramping up their emergency responses and international financial markets are slumping as the coronavirus spreads. Some of the latest developments (check out The Post's live blog here):

  • Amazon has barred more than 1 million products from sale in recent weeks that inaccurately claimed to cure or defend against the coronavirus, Reuters reports.
  • Facebook canceled its largest annual gathering Thursday amid growing global panic. The F8 conference was scheduled for May 5 to 6 in San Jose, Texas.
  • Japan told schools to close through the spring break, which typically means early April. Australia’s leader warned a pandemic was inevitable, and an Iranian lawmaker said he has tested positive for the virus.
  • Northern Ireland announced its first patient with coronavirus, saying the patient had traveled from northern Italy via Dublin Airport to Belfast.
  • Azar told Congress that “at least 40” public health labs “should now be able” to perform the test with [CDC] test kits, while a “newly manufactured CDC test” was expected to be sent to 93 public health labs “as soon as Monday.”
  • Pelosi and Senate Minority Leader Chuck Schumer (D-N.Y.) issued a statement saying they're “ready to work in a bipartisan fashion” with the administration to achieve the goal of addressing coronavirus in a “smart, strategic and serious way.”

Wondering what “zoonotic” and “asymptomatic” mean? The Post's William Wan has you covered with a glossary of key terms being used to explain the outbreak.

AHH, OOF and OUCH

Secretary of Veterans Affairs Robert Wilkie. (Bill O'Leary/The Washington Post)

AHH: The Veterans Affairs inspector general is looking into allegations that Secretary Robert Wilkie sought information to discredit a Democratic aide after she said she was sexually assaulted at a VA hospital, our colleague Lisa Rein reports.

House Veterans Affairs Committee Chairman Mark Takano (D-Calif.) and Sen. Patty Murray (D-Wash.) demanded an investigation after Takano’s staff received information this month from a senior official at the agency that Wilkie sought to discredit the adviser, Andrea Goldstein, after she reported that a man groped and propositioned her in the lobby of the VA’s D.C. Medical Center. 

Inspector General Michael Missal called the investigation a “high priority for our office," in letters to Takano and Murray.

“Inspector General Michael Missal, after a preliminary review of Wilkie’s conduct following the woman’s report last fall, told lawmakers on Capitol Hill Thursday that he has decided to move forward with a full-blown inquiry,” Lisa writes. “…Wilkie, who previously ran the Pentagon’s personnel and readiness operation, has denied making inquiries about the woman.”

Democratic presidential candidate, former New York City mayor Mike Bloomberg. (Joe Raedle/Getty Images)

OOF: As the embattled billionaire family behind Purdue Pharma dealt with its public relations predicament for its role in the opioid crisis, it turned to Mike Bloomberg for help.

Mortimer D.A. Sackler, the son of a company co-founder, reached out to the former New York City mayor and philanthropist, as Hannah Dreier – now a reporter at The Washington Post – reveals in this investigation for ProPublica.

“Previously undisclosed emails, including some filed in lawsuits against Purdue and others provided by sources, reveal a little-known relationship, forged in part by mutual philanthropic interests, between the Sacklers and Michael Bloomberg,” she writes. “They show that when the Sacklers were facing critical media coverage, they looked to Bloomberg and his news and philanthropic organizations for help.” 

The news comes as Bloomberg's public life and business history come under intense scrutiny amid his bid for the Democratic presidential nomination.

A Bloomberg spokesman told Hannah the Sacklers tried to use their relationship with Bloomberg for the family’s benefit, but were mostly unsuccessful. 

But Sackler family spokesperson suggested Bloomberg is now trying to distance himself from communications which did occur.  Mortimer, the spokesperson said, “saw Bloomberg as a very smart person in media” and “sought his advice on how Purdue should communicate its position with respect to the opioid crisis. It is therefore disappointing, in the context of current public controversies, to see those who embraced these meetings now attempting to distance themselves from efforts that were undertaken with the best of intentions.” 

Former New York City Mayor Mike Bloomberg and Sen. Bernie Sanders on video screens in the media filing center during the ninth Democratic debate in Las Vegas. (Reuters/David Becker/File Photo)

OUCH: Bloomberg’s campaign released new information about the candidate’s heart health, disclosing the details from a health exam in July. 

The campaign also called on Sen. Bernie Sanders (I-Vt.) to do the same in “a clear attempt to bring the issue of the Democratic frontrunner's health to the forefront in the 2020 race for the White House,” CNN’s MJ Lee reports. 

A letter from Dr. Stephen Sisson at Johns Hopkins University following a cardiac stress test and stress echocardiogram noted: “Bloomberg's left ventricular ejection fraction was ‘normal’ at 60-65%; his left ventricular cavity size and left ventricular function were also deemed ‘normal’; and his exercise capacity was described as ‘excellent.’”

Here’s what Bloomberg spokesman Stu Loeser said in a separate statement to CNN, calling on the Sanders campaign to release his left ventricular ejection fraction data: "Releasing this single scientific number about heart health could start to put to rest any concerns about Senator Sanders' secrecy about his recent heart attack…Mike Bloomberg's doctor shared Mike's number. Will Senator Sanders ask his doctor to do the same?"

HEALTH ON THE HILL

Sen. Josh Hawley (R-Mo.) speaking to members of the media. Photographer: Andrew Harrer/Bloomberg

— Lawmakers trying to appear responsive to the coronavirus outbreak are rolling out bills left and right. 

Sen. Elizabeth Warren (D-Mass.) announced a bill to at once help fight coronavirus and defund Trump's border wall efforts. It would immediately transfer money used for the border wall to combat the spread of the disease. “Rather than use taxpayer dollars to pay for a monument to hate and division, my bill will help ensure that the federal government has the resources it needs to adequately respond to this emergency,” she said in a statement.

A measure from Sen. Josh Hawley (R-Mo.) would require drug manufacturers to report imminent or forecasted shortages of lifesaving or life-sustaining medical devices to the FDA, as they currently must do for pharmaceuticals. 

Sen. Angus King (I-Maine) introduced a bill to create a permanent, presidentially-appointed global health security adviser to manage outbreak response efforts and authorize annual funding to advance health security goals. The measure would essentially restore a position the Trump administration made vacant two years ago (Health 202 wrote about that here).

Cigarettes displayed on a store shelf in New York. (AP Photo/Mark Lennihan, File)

— A comprehensive House tobacco bill was expected to come to to the floor today but leaders are scrambling to save it after Democratic opposition, even from Majority Whip James Clyburn (D-S.C.).

“Top Democrats are making a last-minute push to corral support for a bill to ban flavored tobacco, including menthol, before it reaches the floor Friday. But a coalition of Democrats, including those who represent communities of color and rural areas as well as others with concerns about government overreach, have warned that it goes too far,” report Politico's Sarah Ferris, Heather Caygle, Sarah Owermohle and Melanie Zanona.

“Objections over the bill have risen to such a level that Speaker Nancy Pelosi of California and House Majority Leader Steny Hoyer of Maryland have stepped in to whip up support among the caucus, according to multiple Democrats. Pelosi gave an impassioned speech both privately to her caucus on Thursday and publicly at her news conference … Democratic leaders believe the bill will ultimately pass.”

There’s been a resurrected a discussion over whether to limit nicotine levels in cigarettes. 

“Nicotine caps aren't actually in the legislation which would ban flavored tobacco, including menthol,” Politico’s Owermohle reports. “But the way in which the Democratic bill goes further than the Trump administration's dialed-back vaping ban is focusing attention on what public health advocates say is a broader White House retreat from regulating tobacco.” 

Former FDA commissioner Scott Gottlieb sought to establish a nicotine cap in 2017 as part of an ambitious tobacco agenda, but she wrote it has “largely fallen off the Trump administration's regulatory agenda.” 

House Energy and Commerce Chairman Frank Pallone (D-N.J.), who is sponsoring the tobacco bill alongside Rep. Donna Shalala (D-Fla.), wrote to FDA Commissioner Stephen Hahn, calling it “disappointing that FDA appears willing to shelve this critically important solution instead of working towards specific regulatory actions that could result in significant public health benefits.” 

Sarah adds: Pallone and Shalala “did not include nicotine caps in their bill because they want FDA to set the appropriate limit, an aide said.” 

— Rep. Robin Kelly (D-Ill.) has introduced a bill to increase access to federal resources for programs to support first responders across the country. She cited a spike in the number of police officers and firefighters that have taken their own lives in the last five years. 

“This bill will ensure that no department is forced to make this impossible choice between responder wellness and public safety," Kelly said in a statement. 

Jeff Dill, founder of the Firefighter Behavioral Health Alliance – which tracks and validates first responder deaths by suicide – said it’s “clear that a greater focus on resources for behavioral health issues, from PTSD and anxiety to addiction and suicide, will benefit all departments, firefighters, EMS, their families and our communities.” 

— And here are a few more good reads:

TRUMP TEMPERATURE

Top Trump advisers discuss GOP need to act on health care at retreat with senators
Two top advisers to President Trump on Wednesday discussed with GOP senators the need for Republicans to lower drug prices and act on health care costs ahead of the election, according to people familiar with the meeting. 
The Hill

AGENCY ALERT

Coronavirus threat gives strapped state health agencies a new crisis
The fragile state of public health defenses became clear this week.
Politico

MEDICAL MISSIVES

Piled Bodies, Overflowing Morgues: Inside America’s Autopsy Crisis
Medical examiners provide crucial insights into public health and safety. What happens when we don’t have enough of them?
New York Times

INDUSTRY RX

Psychedelics-Drug Startup Raises $24 Million Ahead of IPO
Mind Medicine Inc., maker of an experimental psychedelics-derived drug therapy backed by Shark Tank’s Kevin O’Leary, closed a $24.2 million funding round ahead of plans to go public next week.
Wall Street Journal
Clorox Hits Record With Wall Street Betting on Sanitizer Sales
Clorox Co. eked out a fifth straight gain to reach a record high amid the broad market’s dramatic declines, as investors bet on increased demand for the company’s hand sanitizers and disinfectants after U.S. officials warned that the new coronavirus could spread widely.
Bloomberg

STATE SCAN

Abbott says the homeless need mental health care. Advocates say Medicaid expansion would help.
Abbott has long opposed extending state-funded health coverage to 1.5 million Texans under the Affordable Care Act. But a spokesman for the governor did not rule out a possible coverage expansion under a new Trump administration block grant policy.
Texas Tribune

DAYBOOK

Coming Up

  • The House Appropriations Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies holds a hearing on reducing childhood poverty on March 3. 
  • The Senate Health, Education, Labor and Pensions Committee holds hearings to examine an emerging disease threat, focusing on how the United States is responding to COVID-19 on March 3. 

SUGAR RUSH