with Juliet Eilperin and Paulina Firozi

Getting tested for coronavirus may soon become as simple as spitting in a tube.

Two states – Oklahoma and New Jersey – are starting to offer saliva testing to determine whether patients are infected with the novel coronavirus. 

This collection method could ultimately prove safer for medical workers at risk of catching coronavirus by swabbing the noses and throats of infected patients – and help conserve valuable personal protective equipment that's in high demand.

It may also be simpler and more convenient for patients: People can collect their own sample by simply spitting into a collection vessel, avoiding the more invasive swabbing that some find uncomfortable. 

Officials in Oklahoma — one of the states allowing some businesses to reopen — will announce a 30-day plan this week to use saliva testing in 150 long-term care facilities with 17,500 residents. New Jersey officials are also planning to deploy saliva tests in group homes, including state-run facilities for people with developmental disabilities and nursing homes in South Jersey.

The U.S. government is interested in saliva testing as part of the solution. 

This way of collecting samples has already attracted interest from the White House and officials from New York, Illinois and other states seeking to ramp up testing quickly, said Andrew Brooks, chief operating officer at Rutgers University’s RUCDR Infinite Biologics, where the approach was pioneered.

“You will see a lot of it really soon,” Brooks told me, adding that he’s also gotten inquiries from people in South Korea and China on the subject.

Saliva is already widely used in genetic testing.

The swabs needed for nasal and throat testing have been in such short supply that President Trump has used the Defense Production Act to compel an unnamed company to produce them. 

Collecting saliva samples, which can then be analyzed using the same equipment used for swab testing, could help reduce the need for more swabs.

Rutgers researchers developed a saliva-based test that detects infections of the SARS-CoV-2 virus, using saliva collection devices similar to those used by genetic testing companies such as such as 23andMe and Ancestry.com. 

And Oklahoma noticed. The state was already working with Oklahoma State University’s diagnostic laboratory to expand its testing capacity.

Elizabeth Pollard, who spent her career working on genetic testing before becoming Oklahoma’s deputy secretary of science and innovation earlier this year, saw Brooks discussing the test on the news and reached out.

“I chuckled, because Dr. Brooks had been a long-term friend and colleague,” Pollard told my colleague Juliet Eilperin in a phone interview Friday. “We didn’t need to re-create the wheel.”

The OSU lab has now independently validated the test first created at Rutgers and has applied for emergency use authorization from the Food and Drug Administration, so the test can be conducted more broadly. Pollard said she expects the state will get approval soon, telling Juliet it “will certainly open up our testing options and make it easier to test within nursing homes.”

Brooks predicted the saliva testing will allow three times as many people to be tested in a day and reduce the need for personal protective equipment by 90 percent. 

In New Jersey, home to Rutgers, saliva testing is already being administered at several screening sites. The expanded testing will first be offered to 1,238 residents and around 4,300 employees at the five state-run developmental centers. 

Saliva testing could make it easier to get biological samples, especially for vulnerable groups. 

Using nasal and throat swabs can be particularly difficult with older people and those who are on oxygen or hooked up to other equipment. It’s “not a pleasant way to test,” Pollard noted.

“It isn’t the best strategy, if we can come up with other options,” she said.

Big-picture: There’s some good news on the testing front in the United States.

Daily testing numbers in the United States rose in recent days. The U.S. had been testing around 140,000 each day for the past few weeks, and is now testing in the low 200,000s – an upward trajectory experts say is needed for the country to safely reopen. About 1.7 percent of the country’s population has now been tested for the virus. 

Beyond the saliva testing, Oklahoma also plans to administer antibody testing for long-term care medical workers, as well as an additional 250 medical workers in Tulsa, Oklahoma City and Ponca City. These cities were chosen due to having a larger number of positive cases when the virus first appeared in Oklahoma, which should allow antibodies to now be present in people’s system.  

Several drug and pharmacy executives joined Trump at a briefing last night, as the president announced a “blueprint” for increasing testing capacity. The executives promised a rapid rollout of more testing in the coming weeks (although their previous promises haven't always panned out).

“Among the companies, Quest Diagnostics plans to increase the number of diagnostic tests it analyzes each day from 50,000 now to 100,000 by the end of May, and has reduced its turnaround time to between 24 and 48 hours,” Juliet and Mike DeBonis write. “LabCorp will ramp up from 60,000 diagnostic tests a day and begin offering a take-at-home test to consumers across the country.”

Walgreens said it expects to have 23 drive-through testing locations across 15 states by the end of the week. And CVS chief executive Larry Merlo said his chain of pharmacies plans to expand coronavirus testing to nearly 1,000 locations by the end of May and process as many as 1.5 million tests a month. 

“Beginning in May, we will install testing capabilities in up to 1000 CVS pharmacies,” Merlo said at the White House press conference. “We'll be using our drive-through's and our parking lots with swab testing."

Ahh, oof and ouch

AHH: Trump’s intelligence briefings in January and February repeatedly cited the novel coronavirus. 

Warnings about the virus were included in more than a dozen classified briefings prepared for the president in those months, Greg Miller and Ellen Nakashima report. Still, in that time, Trump downplayed the threat. The briefings are meant to call attention to significant global developments and security threats. 

Officials said the attention to the coronavirus in the briefings is comparable to periods when analysts tracked active terrorism threats or conflicts overseas. 

“For weeks, the PDB — as the report is known — traced the virus’s spread around the globe, made clear that China was suppressing information about the contagion’s transmissibility and lethal toll, and raised the prospect of dire political and economic consequences,” our colleagues write. “But the alarms appear to have failed to register with the president, who routinely skips reading the PDB and has at times shown little patience for even the oral summary he takes two or three times per week.”  

OOF: More Americans could have died of covid-19 in the early weeks of the epidemic than previously known.

An analysis of federal data found the number of deaths then far exceed the number that were at the time publicly attributed to covid-19, Emma Brown, Andrew Ba Tran, Beth Reinhard and Monica Ulmanu report

There were 15,400 excess deaths in March and through April 4. At the time, 8,128 coronavirus deaths were publicly reported. 

“The excess deaths are not necessarily attributable directly to covid-19, the disease caused by the coronavirus. They could include people who died because of the epidemic but not from the disease, such as those who were afraid to seek medical treatment for unrelated illnesses, as well as some number of deaths that are part of the ordinary variation in the death rate,” our colleagues report. “The count is also affected by increases or decreases in other categories of deaths, such as suicides, homicides and motor vehicle accidents.” 

The analysis of federal data was conducted by the Yale School of Public Health. 

“It’s really important to get the right numbers to inform policymakers so they can understand how the epidemic is evolving and how severe it is in different places,” said Daniel Weinberger, a Yale professor of epidemiology and the leader of the research team.

“The national tally also shapes the public’s perception of how serious the disease is, and therefore how necessary it is to continue social distancing despite economic disruption,” they add. “The figure has political implications for President Trump, who initially played down the threat of the virus and whose administration failed to ramp up covid-19 testing quickly, allowing the virus to spread undetected for weeks.” 

OUCH: The Centers for Disease Control and Prevention has reported six new symptoms coronavirus patients are repeatedly experiencing. 

The addition of the symptoms signals that health experts are still learning about the virus and how it affects people. The CDC says these symptoms — chills, repeated shaking with chills, muscle pain, headache, sore throat or new loss of taste or smell — could show up two to 14 days after exposure. Previously, the CDC had listed just shortness of breath, cough and fever as known symptoms.

“The additions confirm what patients and doctors have been reporting anecdotally for weeks,” Angela Fritz, Michael Brice-Saddler and Maura Judkis report. “In particular, the loss of taste or smell has been known to appear in patients since at least mid-March when a British group of ear, nose and throat doctors published a statement amid growing concern that it could be an early sign someone is infected but otherwise asymptomatic.” 

Knowing there are additional symptoms could help individuals decide when to request a test. It could also help doctors know when patients need to be tested or be told to self-isolate if it’s assumed they have the virus, they add. 

Making moves toward reopening the nation

The White House is finalizing expanded guidance on reopening the country. 

The guidelines include the phased reopening of schools, camps, child-care programs, workplaces, restaurants, houses of worship and mass transportation, Lena H. Sun and Josh Dawsey report

The 17-page guidance, based on documents being reviewed by administration officials, has not been officially released but has been received by members of the White House coronavirus task force. There may still be changes, and the guidelines could be released within days. 

It’s the “most detailed guidance to date on the administration’s plan to gradually reopen key sectors of society and comes as business groups lobby to lift stay-at-home orders and protesters flock to state capitols to demand their end,” our colleagues write. The guidelines are already fueling debates within the administration, and between public health experts and other officials. 

“Among the most contentious issues are the guidelines for faith communities and restaurants. While sharing menus, passing the offering plate and crowding members of a choir together raise the risk for transmission, some officials said the guidelines are likely to be controversial,” they add. 

New research finds many states don’t have the testing levels necessary to safely reopen. 

To consider easing restrictions after May 1, more than half of country will need a marked uptick in coronavirus testing, Stat News’s Sharon Begley reports, citing an analysis from Stat and researchers at Harvard. 

According to the review, “31 states and the District of Columbia were doing too little testing last week to identify most infected people in a timely manner. Ten states would need to increase their daily testing totals by at least 10,000 to do so by May 1. New York, for instance, would have to perform more than 100,000 more tests a day, and New Jersey 68,000 more. Nineteen states — all but two in the South or the western half of the country — are already doing enough testing.” 

Numerous states announced dates when certain businesses could reopen.

  • Texas Gov. Greg Abbott (R) said measures to protect vulnerable residents will stay in place, but retailers, movie theaters, museums, libraries and some health-care businesses will reopen at limited occupancy starting Friday, Meryl Kornfield writes.
  • Michigan Gov. Gretchen Whitmer (D) introduced a plan to begin reopening state businesses at an “incremental” pace.
  • Wisconsin Gov. Tony Evers (D) said he would allow some nonessential businesses to do curbside drop-off, which could allow dog groomers and repair shops to reopen.
  • Ohio Gov. Mike DeWine (R) announced some health-care services will reopen Friday. Other businesses including construction sites, and manufacturing and distribution companies, will reopen on Monday. Other retailers will reopen on May 12.
  • In Iowa, 77 of the state's 99 counties that have had no coronavirus cases or have seen a downward trend of cases in the past two weeks will start to open with limited capacity on Friday.

Hard-hit New York is moving toward easing restrictions, too. 

New York Gov. Andrew M. Cuomo (D) said the state, which has the most confirmed cases in the nation, is “turning the valves on reopening.” Cuomo said he wants to partially “unpause” starting on May 15. 

“Cuomo said officials devising reopening measures should ensure that they meet the Centers for Disease Control and Prevention’s guidelines, consider how industries and businesses permitted to reopen will physically distance and monitor workers, and evaluate the capacity their local health systems will have during the flu season,” Anne Gearan and John Wagner write. “Local officials should also think about their testing, tracing and isolating facilities, Cuomo said.”

In other news

The Supreme Court ruled the federal government must pay billions to ACA insurers. 

The high court said the government must subsidize insurance companies for offering lower premiums to at-risk individuals. Funding for this “risk corridor” program had fallen far short, and the federal government was arguing it didn't have to make up the difference.

Justice Sonia Sotomayor wrote the 8-to-1 decision reflects “a principle as old as the nation itself: The government should honor its obligations.” She added that Congress “created a rare money-mandating obligation requiring the federal government to make payments.” 

Insurers say they’re owed $12 billion, under provisions of the 2010 Affordable Care Act.

“The case had marked the Supreme Court’s fifth look at President Barack Obama’s signature domestic success. Unlike others — and another one the court will hear in the fall — it did not challenge the law’s underpinnings,” Robert Barnes reports. “The question instead was whether Congress had encouraged insurance companies into offering the kinds of policies that were instrumental to making the ACA work, and then reneged on a pledge to share the cost.” 

Coronavirus latest

Here are a few more notable stories to catch up on this morning:

Work continues in the nation’s capital: 
  • Congressional leaders on either side of the aisle have conflicting priorities for the next coronavirus relief bill, Erica Werner and John Wagner report. Democrats are seeking wage protections, while Republicans want to protect companies from employee-led lawsuits.
  • The National Association of Medicaid Directors sent a letter to the Department of Health and Human Services calling on the agency to work with state Medicaid agencies to understand funding needed to keep providers afloat and ways congressionally appropriated funds can be best distributed. “Medicaid is at the forefront of states’ COVID-19 response efforts, providing critical coverage to vulnerable populations and fiscal resources to a wide array of providers,” wrote the association's president and president-elect in a letter to HHS Secretary Alex Azar.
What will a new normal look like? 
  • The American education system may soon look very different. It could include one-way hallways, students and teachers in masks, temperature readings and lunch inside classrooms, Laura Meckler, Valerie Strauss and Moriah Balingit report.
  • Nobel Prize-winning economist Paul Romer says the only way to return to normal life this summer is if everyone in the United States is tested once every two weeks, while infected patients are isolated, Heather Long reports. That could cost $100 billion.
Good to know: 
  • Scientists at Oxford University’s Jenner Institute have had a jump-start on tests for a coronavirus vaccine. They say the first few million doses of the vaccine — which tests show to be effective in monkeys — may be available by September, the New York Times’s David D. Kirkpatrick reports.
On the front lines: 
  • A top Manhattan emergency room doctor who treated coronavirus patients died by suicide. “She tried to do her job, and it killed her,” Dr. Lorna M. Breen's father told the New York Times. “…She’s a casualty just as much as anyone else who has died.” 
The hardest hit: 

Sugar rush