with Paulina Firozi
Over a nearly three-week span in March, most state governors across the nation locked down their states because of the novel coronavirus.
Gradually opening things up will take even longer — and probably will vary considerably from state to state.
Governors are feeling pressure from two sides. Many troubling questions about the coronavirus remain unanswered, such as how to get more Americans tested and whether the United States even has enough capacity to track and isolate virus cases. At the same time, they’re feeling immense pressure to restart economic activity, with tens of millions of Americans out of work and the country stuck in a deepening economic crater.
As governors weigh when and how to reopen public gathering spots, there are several road maps they could look to.
Yesterday the National Governors Association released a 10-point guide for states. The first point is to make coronavirus testing broadly available. It urges states to improve surveillance to detect outbreaks, ensure hospitals are equipped to respond to surges and create a plan to reopen in stages.
The plan also warns states against opening prematurely.
“Opening without the tools in place to rapidly identify and stop the spread of the virus … could send states back into crisis mode, push health systems past capacity and force states back into strict social distancing measures,” it says.
Then there’s guidance from the Trump administration, which says states should first see a decrease in confirmed coronavirus cases over a 14-day period. That guidance is in line with what public health experts have recommended — although Trump has also frequently suggested he’d like to see states open sooner.
So far, governors vary widely in how they’re approaching the issue.
Some, like Trump, are chomping at the bit. Georgia Gov. Brian Kemp (R) is allowing businesses including gyms and barber shops to reopen on Friday. Colorado Gov. Jared Polis (D) has said some businesses may reopen on Monday, and retailers can have a limited number of in-store shoppers starting May 1.
Other governors are much more cautious. Virginia Gov. Ralph Northam (D), for example, has issued a stay-at-home order in effect until June 10. California Gov. Gavin Newsom (D) declined yesterday to name a date for easing restrictions, saying the state hasn't reached its six goals before reopening the economy.
Newsom, however, did indicate progress has been made with his detailed playbook for reopening the state. After a phone conversation with Trump, the governor said the two had agreed to significantly ramp up testing across California, with hundreds of thousands of new swabs on the way and 86 new testing sites opening.
But virtually every governor is working on plans, some in coordination with other governors, on how to shape the post-quarantine world.
Here are the states opening things up first:
Georgia: Certain businesses may open on Friday; theaters and restaurants can reopen on Monday. Bars, nightclubs and music venues will remain closed; schools have been closed through the end of the school year.
Kemp explained his decision to reopen tanning salons, barber shops, massage parlors and bowling alleys, saying on Monday: “I see the terrible impact of covid-19 on public health as well as the pocketbook.” Kemp said he will urge businesses to take precautions, such as screening for fevers, spacing workstations apart and having workers wear gloves and masks “if appropriate,” my Washington Post colleagues William Wan, Carolyn Y. Johnson and Joel Achenbach report.
“Georgia, according to some models, is one of the last states that should be reopening,” they write. “The state has had more than 830 covid-19 deaths. It has tested fewer than 1 percent of its residents — low compared with other states and the national rate. And the limited amount of testing so far shows a high rate of positives, at 23 percent.”
Trump blasted Kemp's decision during his briefing last night, saying it violates his administration's phase 1 guidelines for when to reopen.
The New York Times's Maggie Haberman:
NEW - The president says he told Kemp he disagrees "very strongly" with his decision to reopen portions of the state's businesses. "I think it's too soon," he says.— Maggie Haberman (@maggieNYT) April 22, 2020
Colorado: Polis is allowing the state's stay-at-home order to expire Sunday, after which the state will gradually reopen businesses. Starting May 4, nonessential offices may have 50 percent of their workforce at the site, although large workplaces will be advised to conduct symptom and temperature checks.
Polis has warned the restrictions won't all be lifted at the same time.
“The virus will be with us,” he said earlier this month. “We have to find a sustainable way that will be adapted in real time to how we live with it.”
South Carolina: Gov. Henry McMaster (R) said Monday he was allowing nonessential businesses such as department stores and retailers to open, followed by beaches on Tuesday.
But businesses must follow three rules for operating: They must limit the number of customers in the store; require patrons to be six feet apart; and follow sanitation guidelines from the Centers for Disease Control and Prevention.
“I urge everyone to remember we are still in a very serious situation,” McMaster said at a news conference. “We know that this disease, this virus, spreads easily, and we know it is deadly. So we must be sure that we continue to be strict and disciplined with our social discipline and taking care not to infect others.”
Tennessee: Gov. Bill Lee (R) said he plans to allow some businesses to reopen once his “safer-at-home” order expires in one week. But the state's biggest cities will make their own reopening determinations. Lee has appointed a 30-member economic recovery group to create a plan.
Lee, along with Kemp and McMaster, have met with the governors of Mississippi, Alabama and Florida to consider how to reopen their economies in a coordinated way in the country's southeast region. The number of new cases and deaths in Florida has leveled off somewhat — something the state's governor, Ron DeSantis (R), has been pointing to as he urges a speedy reopening in his state.
Flattening the curve was necessary to prevent our hospital system from being overwhelmed. FL has dramatically increased its hospital bed and ICU bed capacity since the start of the pandemic. pic.twitter.com/5YDOpDEpcw— Ron DeSantis (@GovRonDeSantis) April 21, 2020
Ahh, oof and ouch
AHH: CDC Director Robert Redfield confirmed comments he made to our colleague Lena H. Sun after Trump claimed he'd been “misquoted."
The president took issue with the portrayal of comments from Redfield following an interview with our Post colleague Lena H. Sun. In that interview, Redfield warned that a second wave of the coronavirus could be worse than the current one.
“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” Redfield told Lena. He added: “We’re going to have the flu epidemic and the coronavirus epidemic at the same time.”
Trump tweeted this the next morning:
CDC Director was totally misquoted by Fake News @CNN on Covid 19. He will be putting out a statement.— Donald J. Trump (@realDonaldTrump) April 22, 2020
The president again repeated the claim at his daily White House coronavirus task force briefing – this time, with Redfield standing awkwardly next to him.
Redfield then said this: “I’m accurately quoted in The Washington Post.”
But Redfield also sought to “soften his words as the president glowered next to him,” Lena, Ashley Parker, Josh Dawsey and Yasmeen Abutaleb write.
“The remarkable spectacle provided another illustration of the president’s tenuous relationship with his own administration’s scientific and public health experts, where the unofficial message from the Oval Office is an unmistakable warning: Those who challenge the president’s erratic and often inaccurate coronavirus views will be punished — or made to atone,” they write.
It's apparent “Trump is again bristling at a health official offering too dire a scenario," our colleague Aaron Blake writes. He points out that Trump was set off a previous time when another top CDC official warned in February that the spread of the coronavirus was inevitable.
OOF: The former head of the U.S. agency pursuing a coronavirus vaccine says he was ousted for opposing efforts to promote hydroxychloroquine, a drug Trump has insistently touted as a weapon against the virus despite a lack of scientific proof.
Rick Bright, previously the director of the Biomedical Advanced Research and Development Authority, said he was dismissed and pushed into a narrower role after he called for strictly vetting supposed treatments like anti-malarials repeatedly embraced publicly by the president.
“I believe this transfer was in response to my insistence that the government invest the billions of dollars allocated by Congress to address the Covid-19 pandemic into safe and scientifically vetted solutions, and not in drugs, vaccines and other technologies that lack scientific merit,” Bright said in a statement, according to the New York Times’s Michael D. Shear and Maggie Haberman.
He added: “I am speaking out because to combat this deadly virus, science — not politics or cronyism — has to lead the way.”
The Post's White House reporter Josh Dawsey:
Rick Bright, a top HHS official, says he was demoted for resisting efforts to "fund potentially dangerous drugs promoted by those with political connections" & opposing hydroxychloroquine. Says he wants an IG probe & has hired a whistleblower lawyer. First reported by @maggieNYT— Josh Dawsey (@jdawsey1) April 22, 2020
The president was asked about Bright during last night’s briefing and whether the official was pushed out.
“Maybe he was and maybe he wasn’t. I don’t know who he is,” Trump responded.
OUCH: There were early missteps by Health and Human Services Secretary Alex Azar that bogged down the government’s response to the virus.
In late January, days after the first coronavirus case was confirmed in the United States, Azar told Trump in a meeting the coronavirus spread was “under control," the Wall Street Journal’s Rebecca Ballhaus and Stephanie Armour report. Azar also told the president more than a million diagnostic tests would be available in weeks and that it was the “fastest we’ve ever created a test."
These promises didn't pan out.
“Six weeks after that Jan. 29 meeting, the federal government declared a national emergency and issued guidelines that effectively closed down the country,” Rebecca and Stephanie write. “Mr. Azar, who had been at the center of the decision-making from the outset, was eventually sidelined.”
There were numerous factors that slowed the administration’s initial coronavirus response, but “interviews with more than two dozen administration officials and others involved in the government’s coronavirus effort show that Mr. Azar waited for weeks to brief the president on the threat, oversold his agency’s progress in the early days and didn’t coordinate effectively across the health-care divisions under his purview,” they report.
Earlier this year, Azar tapped an aide to lead HHS’s day-to-day coronavirus response who had joined the agency after running a dog-breeding business for six years.
The aide, Brian Harrison, was derisively called “the dog breeder” by some within the White House, Reuters’s Aram Roston and Marisa Taylor report.
“Azar’s optimistic public pronouncement and choice of an inexperienced manager are emblematic of his agency’s oft-troubled response to the crisis,” they add. “… Harrison, 37, was an unusual choice, with no formal education in public health, management, or medicine and with only limited experience in the fields. In 2006, he joined HHS in a one-year stint as a ‘Confidential Assistant’ to Azar, who was then deputy secretary. He also had posts working for Vice President Dick Cheney, the Department of Defense and a Washington public relations company.”
Politico's Dan Diamond summed up the day:
Since lunchtime— Dan Diamond (@ddiamond) April 22, 2020
— WSJ details missteps by Azar
— Vaccine expert tells NYT he was forced out over malaria drug fight
— Reuters digs into Azar’s chief of staff
— CDC director, Trump now dispute WashPost interview
Just an extraordinary day on the health politics beat.
There's much we don't know about the coronavirus
Scientists say a mysterious blood-clotting complication may be causing a number of the coronavirus-related deaths.
Doctors are learning that covid-19, once believed to be a straightforward respiratory virus, is much more frightening. Since the earlier waves of coronavirus cases, doctors have learned that the disease attacks not just lungs but kidneys, the heart, intestines, liver and the brain. Autopsies also have shown that some coronavirus patients lungs were filled with hundreds of microclots, our Post colleague Ariana Eunjung Cha reports.
“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” said Lewis Kaplan, a University of Pennsylvania physician and head of the Society of Critical Care Medicine. “We don’t know. And therefore, we are scared.”
“In hindsight, there were hints blood problems had been an issue in China and Italy as well, but it was more of a footnote in studies and on information-sharing calls that had focused on the disease’s destruction of the lungs,” Ariana writes.
New data provide troubling statistics about coronavirus patients on ventilators.
A study found 88 percent of 320 coronavirus patients on ventilators in New York state’s largest health system died.
It’s an uptick from pre-pandemic figures. “That compares with the roughly 80 percent of patients who died on ventilators before the pandemic, according to previous studies — and with the roughly 50 percent death rate some critical care doctors had optimistically hoped when the first cases were diagnosed,” Ariana reports.
The research, published in the journal JAMA, also notes many of the hospitalized had other conditions.
“The paper also found that of those who died, 57 percent had hypertension, 41 percent were obese and 34 percent had diabetes, which is consistent with risk factors listed by the Centers for Disease for Control and Prevention,” she adds. “Noticeably absent from the top of the list was asthma. As doctors and researchers have learned more about covid-19, the less it seems that asthma plays a dominant role in outcomes.”
The economic fallout
If there’s a recovery from the current economic downswing this year, it could be temporary, economists warn.
There’s a growing chance of a second economic downturn if there’s another surge of the coronavirus or if there’s an increase in bankruptcies and defaults, our Post colleague Heather Long reports.
Instead of a V-shaped recovery, economists say, it is increasingly likely that the recovery will be W-shaped, in which there are improvements before another downturn later this year or in the following year. That possibility is “in part because creating a vaccine is likely to take at least a year and millions of Americans and businesses are piling up debt without an easy ability to repay it,” Heather writes.
“It could be triggered by reopening the economy too quickly and seeing a second spike in deaths from covid-19, the disease the coronavirus causes,” she adds. “… This could cause many businesses, which were barely hanging on, to close again. Many Americans could become even more afraid to venture out until a vaccine is found.”
“Pretending the world will return to normal in three months or six months is just wrong,” said Diane Swonk, chief economist at Grant Thornton, told The Post. “The economy went into an ice age overnight. We’re in a deep freeze. As the economy thaws, we’ll see the damage done as well. Flooding will occur.”
Here are a few more developments to catch up this morning:
In the nation’s capital:
- Top Republican leaders want lawmakers to return to Capitol Hill and resume business as usual, even as public health officials warn that reopening parts of the nation could have dire consequences, our Post colleagues Mike DeBonis and Paul Kane report.
The Trump administration’s efforts:
- The Trump administration said it will start paying hospitals and doctors for the care of uninsured coronavirus patients, with a plan to have providers submit bills directly to the government to be reimbursed at Medicare rates, the Associated Press’s Ricardo Alonso-Zalvidar reports.
- White House economic adviser Larry Kudlow says businesses should not be held liable if employees or customers contract the coronavirus once business start to reopen, Politico’s Myah Ward reports.
The hardest hit:
- American prisons, where thousands of inmates are getting sick and guards are spreading the virus to the larger community, have become coronavirus incubators, our Post colleague Hannah Dreier reports.
On the front lines:
- With supply chains breaking down, 3-D printing is starting to fill a gap to churn out needed medical equipment, The Post’s Steven Mufson, Craig Timberg and Nitasha Tiku report.
In the states:
- A federal appeals court is allowing Arkansas to ban most surgical abortions during the ongoing pandemic, the Associated Press’s Andrew DeMillo reports.