with Paulina Firozi

Text messages to the federal government’s disaster distress hotline increased by more than 1,000 percent in April — a month most Americans spent under lockdown because of the novel coronavirus.

About 20,000 people texted the hotline last month, compared with 1,790 texts in April 2019, the Substance Abuse and Mental Health Services Administration confirmed to The Health 202. The hotline provides crisis counseling to people experiencing emotional distress related to any natural or human-caused disaster.

This is just one signal pointing to the toll isolation is taking on people, even as it protects them from the virus.

Quarantined Americans are seeking help for domestic violence, mental illness and substance abuse at higher rates than normal. Dozens of states and locally run distress hotlines have reported sizable increases in call volume. Sales of alcohol are surging. Nearly half of Americans sheltering in place have reported a worsening of their mental health.

President Trump has warned of “massive mental depression,” “tremendous suicides” and “drugs being used like nobody has ever used them before.” Those might be extreme terms, but he’s hardly the only public official warning of the toll on mental and physical health of weeks in isolation and fears of being sickened by a deadly disease. 

“It has caused serious mental health issues,” New York Gov. Andrew Cuomo (D) said at a briefing on Friday.

“You have anxiety, depression, insomnia, loneliness, that feeling of isolation,” he said. “We're seeing the use of drugs go up. We're seeing the use of alcohol consumption go up. This is a chronic problem.”

These are sobering side effects of asking people to lock down for weeks on end. Some officials are worried they’re not being sufficiently addressed amid the Trump administration’s larger scramble to address the pandemic’s most immediate demands, such as increasing testing and finding a vaccine.

“There’s no recognition that some of these policies are going to lead to very tragic consequences for Americans,” a senior Department of Health and Human Services official told me.

The consequences are especially glaring when it comes to victims of domestic violence. 

Women are told to stay at home with an abusive spouse or partner even though home isn’t always a safe place for them to be. Already-bad situations are further aggravated by the stress of job loss and children home from school and underfoot, advocates say.

“It is a unique situation,” said Deborah J. Vagins, president of the National Network to End Domestic Violence. “This is on a level that has been unseen.”

Weekly contacts to the National Domestic Abuse Hotline were up 12 percent at the end of April, its leaders said. Close to 5,000 phone calls, chats and texts received by the national hotline cited the coronavirus as part of the reason they were reaching out. A legal information service run by the National Network to End Domestic Violence said it received triple the number of emails mentioning the coronavirus in April compared to March. 

Cuomo said the state has seen a “dramatic increase” in domestic violence during the lockdown, saying reports of such incidents increased 15 percent in March and 30 percent in April.

The trend isn’t universal. Hotlines in some areas have reported declines in calls. That’s the case in New York City, even as shelters serving battered women report an uptick. 

But that doesn't mean violence is waning. It's more likely that those – mainly women – quarantined at home with an abusive partner feel less free to seek help, advocates say. They expect domestic violence complaints to increase even more once life starts looking more normal and people leave their homes more often.

It's a similar situation with kids who are being abused by caregivers. Reports of child abuse have plummeted since the virus arrived and schools shuttered, with no educators in close contact with kids to observe signs and report them.

“In the nation’s capital, hotline reports of abuse and neglect between mid-March and mid-April were 62 percent lower than in the same period last year,” my colleagues Samantha Schmidt and Hannah Natanson report. “Reports to child protective services in Maryland have fallen just as far, and in Virginia, referrals from school staffers have dipped by 94 percent.”

Other countries who peaked earlier in the pandemic have reported sizable increases in domestic violence.
  • France, where domestic violence reports have risen 30 percent, has provided hotel rooms for women who are beaten by their partners. Women there could also use a secret code word to discreetly seek help within pharmacies.
  • Spain’s national domestic violence hotline received 18 percent more calls in the country’s first two weeks of lockdown.
  • Advocates in the United Kingdom say domestic violence killings have tripled during lockdown.
  • In China’s Hubei province, where the outbreak started, domestic violence reports nearly doubled since the area was put on lockdown in late January, the founder of an anti-domestic violence nonprofit told the outlet Sixth Tone.

U.N. Secretary General António Guterres:

Quarantine presents a prime opportunity for abusers to try to exert control. Women reaching out to the hotline have described partners forcing them to wash their hands until they bleed or denying them use of antibacterial soap altogether, Crystal Justice, the national hotline’s chief development officer, told me. Some abusers prevent them from going to jobs deemed “essential” or force them outside the house for no reason.

“An abuser will use anything in their toolbox to exert that control and power dynamic,” Justice told me. “Because of the components of this pandemic, it has become one of the tools in the toolbox for many abusers.”

Have you had trouble accessing mental health services because of the coronavirus pandemic? We want to hear from you.

Ahh, oof and ouch

AHH: Trump has been seeking justification to pivot to where he prefers to be: cheering an economic revival rather than managing a health crisis. 

“The span of 34 days between March 29, when Trump agreed to extend strict social distancing guidelines, and this past week, when he celebrated the reopening of some states as a harbinger of economic revival, tells a story of desperation and dysfunction,”  Philip Rucker, Josh Dawsey, Yasmeen Abutaleb, Robert Costa and Lena H. Sun report in this must-read inside look at the White House push to restart the economy. 

“So determined was Trump to extinguish the deadly virus that he repeatedly embraced fantasy cure-alls and tuned out both the reality that the first wave has yet to significantly recede and the possibility of a potentially worse second wave in the fall.”

In late March, the White House looked to an econometric analysis from a team led by Kevin Hassett, a former chairman of Trump’s Council of Economic Advisers, for reopening the nation. By the end of April it was clear that model was falling short. 

Still, Trump could not be persuaded to change course. He and his son-in-law and senior adviser Jared Kushner began to declare a great victory against the virus while urging Americans to start reopening businesses and schools.

“It’s going to go. It’s going to leave. It’s going to be gone. It’s going to be eradicated,” the president said Wednesday, hours after his son-in-law claimed the administration’s response had been “a great success story.”

OOF: Elderly and disabled individuals who rely on home health aides are grappling with their own overlooked crisis. 

Patients are worried about letting aides into their homes out of fear they could contract the coronavirus from them. For that same reason, some aides fear going to work at all, Politico’s Alice Miranda Ollstein and Joanne Kenen report.

“A survey of more than 1,000 home health agencies in all 50 states by the National Association for Home Care and Hospice found that more than half had laid off staff — and 96 percent reported that at least some patients refuse services during the pandemic,” Alice and Joanne report. 

“The administration took steps last Thursday to expand home-based medical care, including more money for meal deliveries and telehealth — but it didn’t address the protective equipment and testing needs of home health agencies or their clients," they write. "Home care advocates say some of the drop-off in home care amid the pandemic could have been avoided if workers and patients were protected and had a way to track whether they have been exposed.” 

OUCH: Congressional leaders are girding for a huge fight over whether employers should be shielded from liability if their workers contract the virus.

Senate Majority Leader Mitch McConnell (R-Ky.) insists employers should be shielded, and he seems to have the support of top officials in the White House, Erica Werner and Tom Hamburger report. Democratic leaders say they're opposed to the idea.

“The battle has unleashed a frenzy of lobbying, with major industry groups, technology firms, insurers, manufacturers, labor unions, and plaintiffs' lawyers all squaring off,” they report. “The clash is a sharp departure from the past six weeks, when lawmakers from both parties came together to swiftly approve nearly $3 trillion in emergency funds as Americans hunkered down during the pandemic. Now, lawmakers are warring over what the rules should be when millions of Americans return to the workplace.”

The GOP-led Senate is preparing to reconvene today. Key Republican senators are circulating drafts of legislation to set up legal protections they say would give businesses the confidence to reopen without worrying about lawsuits.

“It seems intuitive to me that if you’re a marginal small business and you’re making the decision whether to hang in there and try to survive, or whether you’re just going to give up and either declare bankruptcy or just become insolvent, that this would around the margins, this could make the difference,” said Sen. John Cornyn (R-Tex.).

One of McConnell's biggest concerns appears to be the threat of lawsuits against businesses. He has described the potential for a “second pandemic” of litigation, and he and House Minority Leader Kevin McCarthy (R-Calif.) say discussion of liability protections will be “absolutely essential.” 

“Democratic leaders, however, have not expressed any interest in advancing such protections at a time when workers are risking their health by laboring at manufacturing jobs, grocery stores, hospitals and other businesses that have stayed open throughout the crisis,” our colleagues write.

State responses to coronavirus

As some states ease restrictions, others resist the pressure to do so. 

Gov. Larry Hogan (R) has resisted calls to lift Maryland’s stay-at-home orders, warning it’s too soon to reopen the state. 

“Hogan pointed to the crowds of people gathered at the Mall and in other public spaces to enjoy the weekend's temperate spring weather as cause for concern — an example of why he is reluctant to immediately lift measures designed to contain the deadly coronavirus,” Ann E. Marimow, Rebecca Tan and Erin Cox report. 

In an interview on CNN’s “State of the Union,” he pointed to similar struggles in other areas. 

“You see this happening around the country as states try to open in a safe way,” Hogan said. “Unfortunately, the pressure is to do it in a not-safe way, and that's something that we're very concerned about and one of the reasons we're being cautious, and trying to do things in a slow, safe and effective manner.”

The governor has a three-pronged approach for reopening the state, with the first phase early this month. 

In Virginia, Gov. Ralph Northam (D) said he would have guidance today on whether he intends to extend the Friday expiration date on the order closing most nonessential businesses. 

In states that have continued stay-at-home orders, some counties are going their own way. 

Three California counties, for example, are reopening parts of their economies despite a continued statewide restriction on nonessential business. 

“The acts of defiance illustrate the national struggle between local and state governments, between mayors and governors and between urban centers and less-populated counties,” Steven Goff reports. “And in some cases, municipalities are resisting the opportunity to begin returning to normal.”

Congress on coronavirus

Calls for better compensation for health-care and other front-line workers are growing.

Sen. Mitt Romney (R-Utah) wants qualifying essential workers to get hazard pay, a boost of up to $12 per hour for the next three months. The issue is the latest flashpoint emerging ahead of the next round of coronavirus relief, Seung Min Kim reports

“This is a proposal which I think is fiscally responsible but also recognizes the additional risk that people are taking,” Romney told The Post. 

“He noted that an essential worker who earns less than $22 per hour may ultimately be paid less than someone earning unemployment benefits that were bolstered by Congress in recent virus rescue packages,” Seung Min writes. “… The idea of hazard pay — additional compensation for those on the front lines of the pandemic — has broad conceptual support in Washington, yet neither lawmakers nor the Trump administration addressed the issue in the economic and health relief bill, totaling nearly $3 trillion, passed thus far.”

Coronavirus latest

And here are a few more headlines and developments to catch up on this morning:

The Trump administration’s response:
  • Trump replaced the top watchdog at HHS after the office found “severe shortages” of testing kits, delays in getting coronavirus results and “widespread shortages” of protective equipment at hospitals amid the pandemic, Lisa Rein reports.
  • The White House is blocking Anthony S. Fauci from testifying before a House subcommittee that is probing the response to the coronavirus pandemic, Erica Werner and Mike DeBonis report. It said it would be “counterproductive” for him to testify as he is involved with the administration’s continued response.
On the front lines: 
  • Mental health professionals are grappling with their own trauma and anxieties at the same time as their clients deal with coronavirus-fueled stress, the New York Times’s Sarah Maslin Nir reports.
What’s ahead: 
  • Former Food and Drug Administration commissioner Scott Gottlieb warned that if people “let their guard down,” there could be another large outbreak of coronavirus cases. “And then you can see this slow simmer explode into a new epidemic or large outbreaks,” he said in an interview on CBS News. “That's the concern, that if we don't snuff this out more and you have this slow burn of infection, it can ignite at any time.”
In the states: 
  • The seven states in the Northeast that have banded together on plans for reopening will also coordinate on buying critical medical supplies and equipment, Candace Buckner writes.
  • Leaders in a small city in Oklahoma are backing off a mandate that residents wear face masks inside stores and restaurants, citing concerns about threats of violence toward employees, Marisa Iati and Hannah Knowles report.
The fallout:
  • Many companies and students have had to get creative after summer programs and internships were canceled amid the pandemic, Lauren Lumpkin reports.
  • It was a quiet weekend at Churchill Downs, after the Kentucky Derby was postponed for the first time since 1945. Instead, the grounds were dotted with shimmering flowers and a number of journalists, including some who dressed for the would-be occasion, Ava Wallace and Roman Stubbs report.