THE PROGNOSIS

Officials have been slow to use the “P” word to refer to the spread of coronavirus.

Yes, that word: “Pandemic.”

For movie watchers, the word conjures up frightening images of an unstoppable, deadly illness prompting widespread panic and global chaos. I remember feeling freaked out while watching the 2011 film “Contagion,” in which Gwyneth Paltrow plays a character who dies of an unknown, rapidly spreading virus (the movie felt even scarier probably because I was watching it on a turbulent trans-Atlantic flight).

Paltrow referred to her role in this Instagram post:

The story of covid-19, the disease caused by the virus, isn't the same as a Hollywood thriller. But some health experts are frustrated by the hesitancy of officials to describe it as a pandemic, even though it checks just about every box of criteria.

“Personally, I think we're doing everyone a disservice by continuing this debate,” Lauren Sauer, director of operations for the Johns Hopkins Office of Critical Event Preparedness, told me. “It is creating more panic than just declaring it and moving on.”

A pandemic refers to an infectious disease spreading so rapidly across multiple countries that it can’t be contained. The World Health Organization defines “pandemic” this way: “The worldwide spread of a new disease” that sickens a large number of people because they don’t have immunity to it.

One could argue and most epidemiologists do the coronavirus is a pandemic under that definition; cases have been reported in more than 50 countries and on every continent (except Antarctica) and nearly 3,000 people have died from it. 

Japan and South Korea have shuttered their schools. China has dramatically scaled back its manufacturing under intensive quarantines. Heck, even the Louvre in Paris is closed.

When officials do use that term, it indicates they’re worried the virus has hit a tipping point where drastic actions such as closing schools, canceling public gatherings and urging people to stay at home are necessary. While containment is the goal under an epidemic — where a disease is spreading only regionally, not globally — mitigation becomes the goal under a pandemic.

There are growing signs that health officials around the world are viewing coronavirus as a pandemic even if they're not willing to state it yet directly.

— Last Tuesday, the U.S. Defense Department raised its “Risk of Pandemic” warning from “probable crisis” to “imminent crisis,” according to a document obtained by Newsweek. Officials expect the coronavirus will “likely” become a global pandemic within the next 30 days.

— Nancy Messonnier, a top official at the Centers for Disease Control and Prevention, said the following day the coronavirus has met two criteria of a pandemic: causing illness resulting in death and spreading person to person in a sustained way.

“The world moves closer toward meeting the third criteria — worldwide spread of the new virus,” Messonnier told reporters.

— And yesterday, the WHO director general used the word “pandemic” as he warned “the window of opportunity for containing it is narrowing.”

“We need to be preparing side by side for a pandemic,” Tedros Adhanom Ghebreyesus told CNBC.

In some regards, it doesn't matter much whether officials say they're dealing with a pandemic or not. Global authorities  are already responding to the novel coronavirus as though it’s the highest-level health threat, regardless of the terms used to describe its spread. 

President Trump, Vice President Pence and Health and Human Services Secretary Alex Azar all spoke out over the weekend, announcing new travel restrictions and urging people to stay calm, as the first two deaths on U.S. soil were reported. Health officials in Florida, New York and Rhode Island all announced their state's first or second likely case of the virus, resulting in a total of more than 80 patients nationally (check out The Post's live blog for all coronavirus updates).

Trump also continued boasting about his response to the virus:

WHO no longer uses “pandemic” as a term to classify the threat of infectious diseases. The agency changed its classification system after calling the 2009 swine flu outbreak a “pandemic.” At the time, it was accused of exaggerating the alarm for an illness that turned out milder than initially expected. 

But the agency has already given coronavirus its highest threat level — dubbing it a “Public Health Emergency of International Concern” — and its leaders have been wary of using the term pandemic casually. 

“Using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralyzing systems,” Ghebreyesus said last week.

But WHO spokesman Tarik Jasarevic told me this morning “we are at a critical juncture in the outbreak.”

“While we must continue efforts to contain covid-19 — focusing on strengthening surveillance, conducting thorough outbreak investigations to identify contacts and applying appropriate measures to prevent further spread — countries should also use this time to prepare for the possibility of wider transmission,” Jasarevic wrote in an email.

In public, top Trump administration officials are staying away from the term “pandemic” as they try to reassure Americans the threat of getting the virus is still low and do damage control after reports suggested the administration's response has been internally chaotic.

Pence said on CNN's “State of the Union” that the Trump administration is leading an aggressive, coordinated response, keeping the threat of the flulike illness at a low level for the average person.

“The good news is, of the 22 Americans that have contracted the coronavirus, more than half of them are almost fully recovered,” Pence said. “And I think it’s all a reflection of the fact that early on in this crisis, the president took the unprecedented step of suspending all travel from China and establishing a quarantining effect.” 

But inside the White House, there's a scramble to gain control of a rudderless response defined by bureaucratic infighting, confusion and misinformation, my colleagues Yasmeen Abutaleb, Ashley Parker and Josh Dawsey report.

“Since Trump touched down from a two-day trip to India early Wednesday morning, the administration struggled to cope with the fallout from the crisis — shaking up and centralizing its coronavirus response team under the leadership of Vice President Pence, floating plans to stabilize the markets and publicly seeking to minimize the threat posed by the potential pandemic,” they write.

By the time Trump landed at Joint Base Andrews, he was already furious over what he considered an alarmist response and his perception of unfair treatment by the media. When he stepped in front of the cameras, “he had not slept for a day-and-a-half, two-and-a-half” days, acting White House chief of staff Mick Mulvaney told a gathering of conservatives Friday morning.

Four senior officials said the decision to tap Pence and streamline all communication through the vice president’s office was primarily driven by a potent combination of a lack of leadership and structure inside the White House. Other factors at play were botched and conflicting messaging from senior health officials, and Trump’s obsession with the falling financial markets.

— The crisis has revealed some commonalities in the ways former New York mayor Mike Bloomberg and Sen. Elizabeth Warren (D-Mass.) campaign for president.

“Over the weekend, both candidates seized on the virus to draw a sharp contrast with President Trump, excoriating the administration’s response to the epidemic and highlighting what they would do differently,” our colleague Annie Linskey reports

Bloomberg responded to the ongoing crisis with a three-minute taped address that aired on two networks last night. “At times like this, it is the job of the president to reassure the public that he or she is taking all the necessary steps to protect the health and well-being of every citizen,” Bloomberg said in the spot. 

Bloomberg said he plans to bring back doctors who have been pushed out of the federal government, vowed to reverse Trump’s cuts to the Centers for Disease Control and Prevention and undo cuts to federal funds needed to prepare hospitals to treat epidemics.

And Warren told a Saturday crowd in Houston: “This is a time for honest leadership that respects science, that draws on serious experts and that delivers real results.” 

“This moment is a reminder of what qualities we need in a president — and what qualities are so sorely lacking in the one we have,” she added. “I’ve been at the center of this kind of crisis before.” 

The coronavirus has been circulating undetected and has possibly infected scores of people over the past six weeks in Washington state, The Post's Joel Achenbach, Katie Mettler, Lena H. Sun and Ben Guarino reported yesterday. 

Researchers conducted genetic sequencing of two virus samples. One is from a patient who traveled from China to Snohomish County in mid-January and was the first person diagnosed with the disease in the United States. The other came from a recently diagnosed patient in the same county, a high school student with no travel-related or other known exposure to the coronavirus.

The two samples look almost identical, genetically. Researchers say this strongly suggests there has been transmission in the state for the past six weeks – it just wasn't detected.

Trevor Bedford, a computational biologist at Fred Hutchinson Cancer Research Center in Seattle:

  • About 2 million tweets peddled conspiracy theories about the coronavirus over a three-week period as the outbreak began to spread outside China, according to a State Department report obtained over the weekend by my colleague Tony Romm. They floated a number of hoaxes — suggesting, for example, that the coronavirus had been created by the Bill and Melinda Gates Foundation or was the result of a bioweapon.
  • The virus is causing surprise medical bills for families put under government-mandated quarantine, the New York Times's Sarah Kliff reports. While the federal government has authority to quarantine and isolate patients if officials believe them to be a public health threat, it's often unclear who must foot the bill.
  • The Trump administration has ordered an independent investigation of the CDC lab in Atlanta, after a top federal scientist sounded an alarm about potential contamination, Axios reports.
  • The Post's Christopher Ingraham looks at 11 Google searches that jumped in popularity this past week. They include “Lysol” and “cancel trip.”
  • Shoppers in Silicon Valley stockpiled food and supplies over the weekend as Santa Clara County recorded the state’s second community transmission coronavirus case Friday afternoon.

ABC News reporter Lauren Martinez:

The Post's Sarah Pulliam Bailey, in New York City:

— Wondering what it's like to have the coronavirus? It's not that bad, according to one patient who contracted the virus on board the Diamond Princess cruise ship that was quarantined outside Yokohama for two weeks.

“I am in my late 60s, and the sickest I’ve ever been was when I had bronchitis several years ago,” Carl Goldman writes in a Post op-ed. “That laid me out on my back for a few days. This has been much easier: no chills, no body aches. I breathe easily, and I don’t have a stuffy nose. My chest feels tight, and I have coughing spells. If I were at home with similar symptoms, I probably would have gone to work as usual.” 

Late-night host Stephen Colbert:

AHH, OOF and OUCH

AHH: Health care was again a top issue for voters in South Carolina's primary. Forty-one percent of voters said it was their most important issue, according to exit polls conducted by Edison Media Research. 

Health care came out ahead of income inequality (21 percent of voters), race relations (17 percent of voters) and climate change (14 percent of voters), The Post’s Scott Clement, Emily Guskin, Dan Keating, Kevin Uhrmacher and Chris Alcantara report.

Former vice president Joe Biden, who won decisively on Saturday, triumphed among voters who said health care was their most important issue, capturing 50 percent of this group. Sen. Bernie Sanders (I-Vt.) had the second-highest support among those who prioritized health care, with 22 percent. 

Biden even won a plurality of South Carolina primary voters who support replacing all private insurance with a single government plan for everyone, even though that's Sanders's territory. The exit polls found 49 percent of voters support this transition — a group Biden won with 44 percent.

OOF: The House voted narrowly, 213 to 19,  on Friday to approve a bill to ban the manufacturing and sale of flavored e-cigarette and tobacco products in the latest push from lawmakers to address the youth vaping epidemic. 

The measure from Reps. Frank Pallone Jr. (D-N.J.) and Donna Shalala (D-Fla.) split House Democrats and drew opposition from Republicans, our Post colleague Mike DeBonis reports. The push comes months after Trump backed off a comprehensive ban on most flavored e-cigarettes, a move that had been favored by first lady Melania Trump.

Members of the Congressional Black Caucus criticized the House bill because of how it treats menthol cigarettes, which are popular among African American smokers. “Other Democrats raised concerns about restrictions on hookah, a method of smoking popular in Middle Eastern communities, as well as the fact that high-end cigars were carved out of a ban on online tobacco sales but not products used by less-affluent smokers,” Mike writes. 

OUCH: When Maine voters head to the polls on Super Tuesday, they will decide whether to get rid of a new law that eliminates nonmedical vaccine exemptions for schoolchildren. If the law goes into effect next year, Maine will join a handful of states that have recently limited exemptions from getting immunizations after a measles outbreak among unvaccinated kids.

The law is set to go into effect next year. It would also limit vaccine exemptions for health-care workers, nursery-school teachers and college students, the Wall Street Journal’s Jon Kamp reports. Gov. Janet Mills (D) is calling on Maine voters to keep it in place. 

While supporters of the law say it can help curb the rate of unvaccinated children and thus the growth of preventable diseases, opponents argue the law oversteps on parents’ rights and won’t do much for public health. 

— Opponents of Maine’s new law and those campaigning to get voters to sign the referendum have framed the debate as a fight against major pharmaceutical companies. Some advertisements across the state read: “Reject Big Pharma.” 

“But the referendum that Maine voters will decide on Tuesday, known as Question 1, has little to do with drug prices,” Stat’s Lev Facher reports. “… The advertisements, meanwhile, are funded in large part not by drug pricing activists but by a nationwide network of anti-vaccine groups.” 

HEALTH ON THE HILL

— Pete Buttigieg, the 38-year-old former mayor of South Bend, Ind., announced yesterday he would end his presidential bid. 

He saw a meteoric rise “from virtual unknown to top-tier contender and became the first openly gay candidate to make a high-profile presidential run,” our Post colleagues Chelsea Janes and Amy B Wang write. 

As part of that rise, Buttigieg sought to move into the moderate lane to try to carve out a middle ground between Biden and Sen. Elizabeth Warren (D-Mass.) “whom he targeted repeatedly over universal health care, arguing that his approach — adding a public option that he dubbed ‘Medicare for All Who Want It’ — was superior because it left ‘choice’ to the American people.

They add: “Buttigieg accumulated 26 delegates in the race — the most ever for an openly gay candidate, and far more than anyone expected him to accumulate at the beginning of his long-shot bid. After strong showings in predominantly white states, Buttigieg’s results began to diminish as the race moved to more diverse electorates. Ultimately, he decided they were unlikely to improve.” 

A thought on Buttigieg’s influence in the race, via Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation:

Meanwhile, Sanders said he would only tap a running mate, if he wins the Democratic nod, that embraces a Medicare-for-all plan.

 

 

— And here are a few more good reads:

AGENCY ALERT

Health
U.S. Preventive Services Task Force, which helps inform policies set by Medicare and insurance companies, cited insufficient evidence so far that tests are helpful.
Judith Graham

REPRODUCTIVE WARS

Four years after striking down a Texas law it said created an "undue burden" on abortion access, the Supreme Court is poised to take up a similar challenge from Louisiana.
ABC News
The Center for Reproductive Rights will argue in the first major Supreme Court case over abortion in the Trump era, which could gut Roe v. Wade.
BuzzFeed News
Health
“I felt like I was helping myself stay healthy.” Bike to Fight is placing exercise bikes on adolescent and young adult oncology floors in hospitals nationwide.
Ben Opipari

MEDICAL MISSIVES

Health
This bloodless high-tech procedure helped a retired dentist regain a steady hand to write, paint and play guitar.
Abdul-Kareem Ahmed

STATE SCAN

Health
Common approaches to managing rodents often fail to address the most important factor contributing to infestations: Our prolific waste of food.
Michael H. Parsons and Jason Munshi-South

DAYBOOK

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the U.S. response to the novel coronavirus on Tuesday. 
  • The House Energy and Commerce Subcommittee on Health holds a hearing on legislation to help patients with substance use disorders on Tuesday. 
  • The House Appropriations Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies holds a hearing on reducing childhood poverty on Tuesday. 
  • The House Veterans Affairs Subcommittee on Health holds a hearing “The Silver Tsunami: is VA Ready?” on Tuesday. 
  • The Senate Veterans Affairs and House Veterans Affairs Committees hold a joint hearing to examine the legislative presentation of multiple veterans service organizations on Tuesday. 
  • The House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies holds a hearing on the Veterans Affairs Fiscal Year 2021 budget request on Wednesday. 
  • The House Homelands Security Committee holds a hearing on “Perspectives on the Response to a Pandemic Threat” on Wednesday. 
  • House Appropriations Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies holds a hearing on the National Institutes of Health Fiscal Year 2021 budget request on Wednesday. 
  • The House Science, Space, and Technology holds a hearing on “Understanding the Spread of Infectious Diseases and Mobilizing Innovative Solutions” on Thursday. 
  • The House Appropriations Subcommittee on Defense holds a hearing on the Defense Health Program on Thursday. 
  • The House Veterans' Affairs Subcommittee on Technology Modernization holds a hearing on the “Challenges with the Go-live of Electronic Health Record Modernization” on Thursday. 

SUGAR RUSH