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The Health 202: State legislatures could help America find its way out of the coronavirus pandemic

with Paulina Firozi

Some two dozen state legislatures are planning to convene this summer. If they do, it’ll be amid a tsunami of problems posed by the novel coronavirus pandemic.

States are grappling with plummeting revenues amid stymied economic activity. California released a report yesterday showing a $54 billion shortfall in its current budget year — a deficit more than three times the size of its rainy day reserve.

States are also burdened by an urgent need to test people for covid-19, the disease caused by the coronavirus, and do contact tracing to isolate those at risk. And many of their residents — particularly the elderly and those with preexisting medical conditions — require vigilant protection from a virus that quickly becomes deadly among vulnerable populations.

The spring legislative season is usually a busy time in state capitols as legislators prep budgets for fiscal years starting in July. But that was largely put on hold amid widespread lockdowns and growing coronavirus cases.

Nineteen states postponed their sessions, according to a count by FiscalNote. Other states have looked for creative solutions. Utah and North Carolina held virtual meetings. Pennsylvania and New Jersey have allowed members to vote remotely

Like Congress, states are under heavy pressure to respond to the pandemic even as meeting together carries significant risk. 

Between one-third and one-half of the states are eyeing some kind of legislative session this summer.

That’s according to a count by Emily Barson, executive director of United States of Care, a nonpartisan group founded by Andy Slavitt, who directed the Centers for Medicare and Medicaid Services during the final years of the Obama administration. United States of Care is urging lawmakers — if they do meet — to take specific actions to swiftly lessen the impact of the coronavirus on people’s daily lives.

The group has put together a set of recommendations for how states should respond to the pandemic, provided first to The Health 202. They include providing care and shelter for those at risk of contracting covid-19, loosening restrictions on the scope of what non-doctor medical professionals can do and fixing shortcomings with health insurance that often leave people with hefty bills. The report stresses that states would need additional federal aid to carry much of this out.

The pandemic provides an opportunity, Barson emphasizes, for states to tackle some longstanding ills within the health-care system, such as the high price of insulin for diabetic patients or funding shortfalls common to rural hospitals.

“This crisis has shined a light on many of the inequities within the system,” Barson told me. “While some of it might just be putting on a Band-Aid right now, what we’re trying to do is lay the groundwork for a system that serves people better going forward.”

Legislators will have more on their plates than ever before as they try to respond to the devastating pandemic that has now taken the lives of more than 75,000 Americans and plunged millions into economic uncertainty. But Barson explained legislators don’t have to start writing new policies and legislation from scratch.

Some states have already forged new pathways for stemming the spread of the virus and protecting the most vulnerable.

The United States of Care report highlights a number of state actions that legislators from elsewhere could look to. Some have taken action to protect nursing homes:

  • Kentucky has developed a covid-19 long-term care task force to protect vulnerable Kentuckians and the health-care workers who serve them.
  • Connecticut and Massachusetts have created covid-19-only skilled nursing facilities specifically for those recovering from covid-19.
  • Michigan is working with long-term care facilities across the state to establish covid-19-designated regional hubs, providing higher levels of care and services to treat patients with increased needs related to the disease.

Other states have worked to improve contact tracing, the practice of finding and informing people if they have been potentially exposed to the coronavirus and encouraging them to isolate for 14 days:

  • Alabama health officials built contact tracing efforts that will, in part, shift state employees into roles in which they can undertake such efforts.
  • Michigan’s Department of Health and Human Services announced the launch of a large-scale effort that expands contact tracing capacity through a public-private partnership, with more than 2,200 trained volunteers to aid local and state agencies in the endeavor.
  • North Dakota and South Dakota established partnerships with Care 19, a free mobile app that helps identify individuals who may have had contact with people who have tested positive.
  • Massachusetts partnered with Buoy Health to monitor individuals with positive results, provide people with information, check their symptoms and refer them for testing.

Still other states have limited out-of-pocket costs for covid-19 treatment and made it easier for patients to get care virtually. 

  • Michigan and New Jersey have legislation pending that would eliminate cost-sharing for covid-19 treatment.
  • New Jersey’s legislature passed a law requiring its Medicaid program, health insurance carriers, and the state and school employees health benefits programs to provide coverage and payment for expenses on services provided through telemedicine or telehealth during the public health emergency.
  • Massachusetts is partnering with Buoy Health to develop an online tool that screens people for covid-19 symptoms and connects them with appropriate health-care resources based on their responses.

Ahh, oof and ouch

AHH: The White House is calling for revisions to CDC guidance, meant to be published last week, on reopening public places.

The White House said a draft document from the Centers for Disease Control and Prevention offering advice on reopening public areas was “overly specific,” an official from the coronavirus task force told The Post. 

“Guidance in rural Tennessee shouldn’t be the same guidance for urban New York City,” said the official. 

They were responding to a report by the Associated Press saying the administration shelved the 17-page report, which was “researched and written to help faith leaders, business owners, educators and state and local officials as they begin to reopen.” It included detailed “decision trees” for local officials to use while thinking through opening different kinds of locations.

“The official insisted the document has not been ‘shelved' but that the White House is seeking revisions. The official added that the document was never cleared by CDC leadership. It was unclear as of Thursday, however, if or when a revised document would be released,” our colleagues report. 

Former Food and Drug Administration commissioner Scott Gottlieb weighed in: 

OOF: Doctors say the rollout of remdesivir, the first coronavirus treatment, has been marked by confusion and incomplete information.

“Demand for remdesivir exploded after the Food and Drug Administration, citing the results, made an emergency use authorization for the experimental drug. The Trump administration has maintained control of distribution of the drug, which is in limited supply,” Christopher Rowland and Laurie McGinley report

But numerous doctors have complained about a lack of access to the drug. Some don’t know how to obtain the drug for their patients, and other hospitals have been denied access without explanation.

“Doctors also complain that they have yet to see the full results of the National Institutes of Health clinical trial that cleared the way for the FDA’s emergency authorization of remdesivir — which means they still don’t know which patients stand to benefit the most from the drug,” Christopher and Laurie add. 

“What the situation requires us to do is make decisions without the information we need, so we are flying blind,” said Mark J. Siedner, an infectious-disease doctor at Massachusetts General Hospital.

OUCH: San Francisco’s health department is giving alcohol, tobacco, medical cannabis – as well as methadone – to a few dozen homeless people to prevent them from venturing out.

The city says it's applying a “harm reduction” approach to people who are quarantined or isolated in city-leased hotels, an effort to curb the spread of the coronavirus by stopping them from going out to get substances themselves. 

“The city-rented hotels have been reserved for individuals who either have COVID-19 or are at heightened risk of catching it, and who have no space of their own to safely self-isolate or quarantine. And some of those individuals have substance-abuse issues or are already on a methadone regimen,” the San Francisco Chronicle’s Dominic Fracassa and Kevin Fagan report. “… No taxpayer money was being used to administer the substances to hotel guests, Lane said, only private donations.”

The city is also making social workers and clinicians available to those who may want to start an addiction treatment program while they are isolated. 

“Eleven of those under isolation and quarantine have received alcohol from the health department and around 27 have received tobacco, Lane said. The health department helped five people coordinate delivery of medical cannabis to their hotels,” they add. “Alcohol abuse, which is widespread among the city’s homeless population due in part to its easy availability, is also a concern. So health department workers are calculating how much alcohol a hotel guest needs to stave off the effects of mild withdrawal.”

Officials in other cities are doing the same. “Alameda, Santa Clara and Contra Costa counties are also using a harm reduction approach in their hotels, administering medications to keep addicts stable, according to officials there,” they add. 

In the states

A Maryland nursing home that reported the state’s highest coronavirus-related death toll will be fined. 

Maryland regulators will penalize Sagepoint Senior Living $10,000 a day beginning March 30 for failing to use appropriate personal protective equipment, not separating residents with suspected or known covid-19 cases and not getting lab results in a timely manner, Rachel Chason reports

The fines will continue until the 165-bed facility complies with state regulations, according to a letter sent to the nursing home. A spokeswoman for Sagepoint said the facility plans to dispute the findings. 

“The fine marks the first civil penalty the state has levied against a nursing home since the pandemic began. There have been 34 covid-19 deaths among patients at Sagepoint, and one employee has died, according to state data,” Rachel writes. 

The Post reported Wednesday on staff, testing and supply shortages at Sagepoint and other nursing facilities in Maryland.

“Nurses and nursing assistants at Sagepoint were told not to wear masks when they requested them in March because it would scare residents,” Rachel writes. "They also said they were assigned untenable numbers of patients because of staff shortages, and frequently asked to move between wings with patients who had tested positive for the coronavirus and those who had not, raising concerns about exposing negative patients.”

New York City is offering hotel rooms to individuals with mild covid-19 cases. 

The isolation sites will have clinical staff to provide daily checkups and will have emergency services on hand. The patients will also have access to food, laundry service and a pharmacy, Drew Jones reports.

“As we move into this next phase of this crisis and as hospitalizations hopefully continue to decrease, hotels remain a key component of our test and trace plan,” the New York City mayor’s office said in a statement to The Post. “Our isolation hotel program currently provides for a range of needs, from supporting health-care workers on the front lines to individuals from congregate settings.”

Details from Mark Levine, chair of the New York City Council’s Health Committee:

This is where Americans are still staying at home the most. 

There was a week in early April (the week ending April 7) where people across the country hit a peak rate of staying at home. Since then, people have been spending less time at home, according to cellphone data, Kevin Schaul, Brittany Renee Mayes and Bonnie Berkowitz report

During that peak week, U.S. residents “spent a whopping 93 percent of their time at home, up from the early March averages of roughly 70 percent,” they write. “Some governors began relaxing restrictions meant to curb the spread of covid-19 at the end of April, after they were prodded by President Trump and cautioned by public health officials. But as of April 30, people were still at home an average of 89 percent of the time.” 

But the data varies based on where people live. While people in hard-hit areas, such as New York, Detroit and Chicago, are staying put more often, people in less-populated regions are leaving their homes more.

A Dallas salon owner was released from jail after she defied orders to keep her business closed. 

The Texas Supreme Court granted a motion to release Shelley Luther, who had been in jail since Tuesday after being sentenced to seven days for defying orders to keep her hair salon closed.

“The order came soon after Gov. Greg Abbott announced he was modifying his recent executive orders related to the coronavirus pandemic to eliminate jail time for Texans who violate the restrictions,” the Texas Tribune’s Cassandra Pollock reports. “The move by Abbott was an attempt to release Luther and prevent the jailing of others who have violated similar orders in recent weeks.”

Luther kept her business open even after receiving a cease-and-desist letter from Dallas County Judge Clay Jenkins and a temporary restraining order signed by state district Judge Eric Moyé, a Democrat. 

“Until Abbott's announcement Thursday, Texans who didn't obey the governor's executive orders related to the virus could have faced up to 180 days in jail. Abbott spokesperson John Wittman said Thursday that while jail time has been removed, other punishments such as fines or license suspensions, still apply,” Cassandra adds. 

Coronavirus latest

Here are a few more developments to catch up on before you head into the weekend: 

The administration’s response: 
  • The FDA withdrew approval for more than 60 mask makers in China that were set to export supplies after finding they did not meet N95 filtration standards, the Wall Street Journal's Austen Hufford and Mark Maremont report.
  • The FDA has given emergency authorization for a new CRISPR-based diagnostic tool to determine in an hour if someone is infected with the coronavirus, Joel Achenbach and Laurie report.
Good to know:
  • A new analysis of 2,733 coronavirus patients found blood thinners could potentially help boost patients' chances of survival, Ariana Eunjung Cha reports.
On the front lines: 
  • Darryl Fears profiles Kizzmekia Corbett, a 34-year-old prodigy leading the government’s search for a vaccine to end the coronavirus outbreak.
  • It’s been eight weeks since the pandemic shut down most of the nation. These are some of the people trying to get us to the other side, via Sarah Kaplan, Laura Reiley, Christopher Rowland, Rebecca Tan and Karen Weintraub. “They are the right people in the right place at the right moment, like physician-researcher Andre Kalil, a veteran of past epidemics trying to find a cure for this pandemic, and Anar Yukhayev, a New York obstetrician-gynecologist who was severely ill with covid-19 when he enrolled in a clinical trial for an untested treatment,” they write.
  • School psychologists have become “de facto” mental health service providers for many of the 50 million K-12 students across the country, the Wall Street Journal’s Elizabeth Koh reports. “With classrooms disrupted by statewide shutdowns and some students unlikely to return this academic year, districts have sought to rapidly adopt telehealth technologies, from video hangouts to old-fashioned phone calls,” she reports. “But many have run into issues with privacy in family settings and with students’ lack of internet connectivity at home — not to mention the limitations of establishing emotional rapport through a screen.”
The hardest hit: 
  • A 77 percent majority of laid-off or furloughed workers believe they will be rehired by their former employers once restrictions in their area ease, a Washington Post-Ipsos poll found, as Heather Long and Emily Guskin report.
  • In Brooklyn, police arrested 40 people for violating social distancing protocols. Of those, 35 people were black, four were Hispanic and one was white, the New York Times’s Ashley Southall reports. She cited information released by the Brooklyn district attorney’s office, the first prosecutor in the city to release social distancing enforcement statistics.
  • In Iowa, where more than 200,000 residents have filed for unemployment, the state called on reopening businesses to report employees who “refuse to return to work without good reason.” Now, thousands may have to choose between their health and getting a paycheck, Holly Bailey reports.

Sugar rush

After in-house productions were canceled, many shows are figuring out how to put together shows remotely. (Video: The Washington Post, Photo: ABC/The Washington Post)