with Paulina Firozi
The Trump administration has issued a key criterion for states to meet before reopening their economies: They should see a decline in new daily cases for full two weeks. Few governors are abiding by it.
The federal guidelines are taking a back seat in both Republican and Democratic states, as economic pain from the coronavirus lockdowns and the political pressure to lift them become too excruciating.
“Governors, without regard to political party, have been put in this position that we gotta get society back up, as just a matter of cultural and economic survival,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told me. “We just decided not to talk about the public health data anymore.”
Only about a dozen states may be “bending the curve,” even though more than 40 are moving to reopen.
That's according to data compiled by 91-DIVOC, a visualization project created by University of Illinois professor Wade Fagen-Ulmschneider using coronavirus case numbers from Johns Hopkins University.
The states with a general downward trajectory in daily cases include Alaska, Connecticut, Hawaii, Louisiana, Michigan, Nevada, New Jersey, New York, North Dakota, Rhode Island, South Carolina, West Virginia and Wyoming.
It's unclear whether even all those states meet the guidance from the Centers for Disease Control and Prevention. The CDC says that a state should see a “sustained reduction” of confirmed infections within a 14-day period before “proceeding to a phased comeback.” Almost none of these states saw a reduction in daily confirmed cases every single day before reopening.
States do have another alternative to a 14-day decline: The CDC recommends they see a reduction in positive tests as a percentage of total daily tests, thus indicating a state is testing enough people to capture most covid-19 cases.
Public health officials are warning of dire consequences if states ignore federal guidelines.
Anthony Fauci warned senators at a hearing yesterday that Americans will see “suffering and death that could be avoided” if states reopen too quickly.
The nation’s top infectious disease official said that the United States risks new coronavirus outbreaks and possibly a broad nationwide resurgence of the disease, my colleagues report. Failing to follow the guidelines, Fauci said, “would actually set us back on our quest to return to normal.”
“If some areas, cities, states or what-have-you, jump over those various checkpoints and prematurely open up without having the capability of being able to respond effectively and efficiently, my concern is that we will start to see little spikes that might turn into outbreaks,” said Fauci, the director of the National Institutes of Allergy and Infectious Diseases. “I have been very clear in my message — to try, to the best extent possible, to go by the guidelines, which have been very well thought-out and very well-delineated.”
There’s some general good news on that second CDC criterion for reopening: The rate of positive tests is declining nationally.
From Scott Gottlieb, former commissioner of the Food and Drug Administration:
Nationally, the positivity rate for covid19 continues to decline while the number of people tested continues to grow. In the last week the U.S. ran an average of 270,000 tests a day, with a total of more than 2 million tests run. pic.twitter.com/iCNEMl5sUJ— Scott Gottlieb, MD (@ScottGottliebMD) May 10, 2020
Gottlieb also noted that nationally, the pandemic seems to be slowing.
Nationwide excluding New York region which had sustained declines in new covid cases, hospitalizations, and deaths for weeks; nationally we were seeing steady increases. But trend over past two weeks is now declining. The national epidemic is slowing. Doubling time is now 45 days pic.twitter.com/2AN8rQwDC6— Scott Gottlieb, MD (@ScottGottliebMD) May 13, 2020
But it's not fully clear even to experts what a consistent downward trajectory of new daily cases even means.
For example: If a downward trend in a state’s cases is interrupted by a sudden spike, does that negate the state’s progress? What if confirmed cases mostly go in a downward direction – but it's a wobbly line? And what if a state sees little change at all in its daily cases – but there are only, say, a couple hundred of them, which could indicate the risk is low?
“The million-dollar question is what is reasonable – with the scientific assumptions, with the changing state of the world,” said Brett Boval, with the group Covid Act Now, which compiles coronavirus data. “I don’t think anybody will have the perfect answer.”
Scott Ganz, an economist at the American Enterprise Institute, concluded New York is the only state meeting the criteria among eight states he analyzed using data from April 23 to May 6. He used a framework allowing for small swells in the number of confirmed daily cases as long as the overall 14-day trend was downward.
Under this framework, which he feels is a reasonable way of interpreting the CDC guidance, a state wouldn’t qualify as having a sustained decline in cases if it saw any dramatic spikes over the 14-day stretch. That would mean California, Florida, Massachusetts, North Carolina, Pennsylvania, Rhode Island and Texas didn’t exhibit sufficient progress during that time period, he said.
“We don’t want to see at any point in time during those 14 days a spike,” he told me. “That’s going to indicate to me that we’re not seeing sustained decline for 14 days. You maybe want to restart the clock.”
New York, for its part, is one of the few states that has remained largely closed. Even as its cases decline, the total cases in the state remain relatively high compared to others.
Gov. Andrew Cuomo (D) has announced that three upstate regions will be allowed to reopen in phases beginning this week. Shutdowns will stay in place longer in the state’s hot spots of New York City and Long Island.
“In my point of view, we’re on the other side of the mountain,” Cuomo said Monday. “We have abated the worst by what we’ve done and now we can intelligently turn toward reopening.”
The interpretation of these benchmarks has so far been left up to governors.
Ganz said he’s trying to bring some clarity for governors facing hugely consequential decisions with unclear federal benchmarks.
“Despite its intuitive appeal, this heuristic criterion has proven surprisingly vague, because different interpretations of what characterizes a ‘sustained reduction’ have yielded inconsistent guidance for policymakers,” he wrote.
And governors themselves are largely not addressing the question of whether they have met the CDC criteria. They're also not laying out what they'd do if cases start spiking again. It's a troubling question, especially considering some countries that had already opened up are closing down again after renewed spikes in infections, as my colleagues Liz Sly and Loveday Morris report.
Osterholm said he's not aware of any governors who have laid out criteria for how they'd reestablish closures should there be a sudden burst in cases.
“We need much more clarity in how we make decisions,” he said. “The public is growing increasingly confused and even angry about not knowing what we’re doing and for what reason and they want clarity. We owe the public straight talk.”
There's a domino effect as states reopen.
The pressure on governors quickly mounted as some states eased their social distancing restrictions. Georgia, for example, received much attention when its governor, Republican Brian Kemp, allowed many businesses to open in late April. But just a week later, he had been joined by governors all over the country who started allowing limited numbers of people to go back to work or visit retailers, salons and gyms previously deemed nonessential.
In Minnesota — where hospitalizations and deaths are still on the rise — Gov. Tim Walz (D) is allowing most businesses to offer curbside pickup and delivery, after allowing golf courses, bait shops, outdoor shooting ranges and marinas to reopen in mid-April.
California Gov. Gavin Newsom (D) has allowed lower-risk businesses to reopen with social distancing guidelines as the second stage of his four-phase plan to reopen the state. But individual counties have leeway to chart their own course, with some moving faster or slower.
Breaking: Los Angeles County’s stay-at-home orders will “with all certainty” be extended for the next three months, Los Angeles County Public Health Director Barbara Ferrer acknowledged during a Board of Supervisors meeting on Tuesday https://t.co/jswRcZ5FkS— Los Angeles Times (@latimes) May 12, 2020
Washington policymakers — and the president – are raring to go.
“Fauci’s comments came during a contentious Senate hearing as lawmakers of both parties pressed him and other federal health officials on whether the country is ready to reopen,” John Wagner, Mike DeBonis, Yasmeen Abutaleb and Laurie McGinley write. “The panel’s chairman and all four witnesses appeared remotely because they all recently came into contact with people with confirmed infections — a testament to how the virus has transformed life even within the corridors of power.”
The officials cautioned that neither a vaccine nor surefire treatments would be available when schools are slated to reopen in the fall. They also said the U.S. death toll from the coronavirus is probably higher than the 80,000 reported to date.
Yet President Trump has given little regard to the specifics of the CDC guidance, instead emphasizing in news conferences and on Twitter his desire for states to reopen as quickly as possible and proclaiming victory in national testing goals that are still unrealized.
CBS News correspondent Weijia Jiang:
Dr. Fauci reminds Americans there are "very well thought out" federal guidelines for reopening, and warns against prematurely open up:"My concern is we will start to see little spikes that will turn into outbreaks." Trump has encouraged states that are not following guidelines.— Weijia Jiang (@weijia) May 12, 2020
Ahh, oof and ouch
AHH: House Democrats unveiled a massive and sprawling coronavirus relief bill which Republicans pledged to quash.
The massive 1,800-page bill would dole out $3 trillion for health systems; state, local, territorial and tribal governments; and a second round of stimulus checks to millions of Americans. It would also bolster the Postal Service with more funding, extend essential worker hazard pay and include provisions to require people to wear masks on planes and on public transit, Erica Werner reports.
Republicans dismissed the bill as a liberal wish list that would have no legs in the Senate, which they control. The legislation, which was put together by House Speaker Nancy Pelosi (D-Calif.) and her top lieutenants, would be the fifth coronavirus relief bill from Congress.
“For example, the bill would suspend a tax provision for two years that limits tax breaks for upper-income households in high-tax states, something Democrats have tried to change for several years,” Erica reports. “Senate Majority Leader Mitch McConnell (R-Ky.) said he was at work on crafting liability protections for businesses instead.”
The House is expected to vote on Friday on the measure. The four coronavirus relief bills were the result of urgent bipartisan compromise in the early days of the pandemic. But “now the two sides aren’t even talking and are moving in radically different directions. It’s unclear when they will come together to produce another bipartisan response, but some Republicans suggested it might not be anytime soon,” Erica writes.
OOF: The pandemic-caused lockdowns are taking a massive toll on America’s small businesses.
Economists project that more than 100,000 small businesses have already shuttered for good. A study by researchers at University of Illinois, Harvard Business School, Harvard University and the University of Chicago suggests at least 2 percent of small businesses are gone, Heather Long reports.
“Analysts warn this is only the beginning of the worst wave of small-business bankruptcies and closures since the Great Depression. It’s simply not possible for small businesses to survive with no income coming in for weeks followed by reopening at half capacity, many owners say,” Heather writes. “The result is likely to further shift the balance of power — and jobs — toward big businesses that have a better chance of surviving the uncertain year ahead by borrowing money or drawing on large cash reserves.”
The pandemic continues to pose an existential threat to the types of businesses that in the 1980s and 1990s employed more than half of American workers.
OUCH: An analysis of six different covid-19 models underscores the difficulties in predicting coronavirus deaths.
Six different models from infectious disease researchers found six different predictions for how many people will die in the coming weeks, according to an analysis by FiveThirtyEight’s Ryan Best and Jay Boice, with help from the University of Massachusetts at Amherst’s Reich Lab.
These are the averages and ranges of deaths projected by the half-dozen models for U.S. deaths by May 30.
- The Massachusetts Institute of Technology’s model is projecting between 110,000 and 114,000 deaths by the end of the month, with an average of 112,000.
- The University of Washington's Institute for Health Metrics and Evaluation is projecting between 97,000 and 133,000, with an average of 109,000.
- Northeastern University’s model is projecting between 93,000 and 121,000, with an average of 105,000.
- Columbia University’s model is projecting between 95,000 and 116,000, with an average of 103,000.
- The University of Texas's model is projecting between 96,000 and 115,000, with an average of 103,000.
- The Los Alamos National Laboratory’s model is projecting between 87,000 and 121,000, with an average of 99,000.
The models vary because each “makes different assumptions about properties of the novel coronavirus, such as how infectious it is and the rate at which people die once infected,” Ryan and Jay write. “They also use different types of math behind the scenes to make their projections. And perhaps most importantly, they make different assumptions about the amount of contact we should expect between people in the near future.”
But all these forecasts can explain what is possible and help leaders make decisions that will hopefully lead to best-case possibilities, they add.
Congress on coronavirus
The House Energy and Commerce Committee will investigate Blue Flame Medical, a company founded by two well-connected Republican operatives.
The committee said it launched a probe after multiple states canceled contracts with Blue Flame, the Wall Street Journal’s Brody Mullins and Susan Pulliam report.
“We are deeply concerned by the numerous reports regarding Blue Flame Medical LLC’s failure to deliver on contracts with state and local governments to provide critical medical supplies,” the chairman of the committee, Rep. Frank Pallone (D-N.J.) said in a statement.
The Justice Department has already launched a criminal investigation into the company, focusing on at least two now-canceled contracts for medical masks and other critical equipment with Maryland and California.
Moving toward reopening the economy
A majority of Americans expect they won’t be able to have gatherings of 10 or more until July or later, according to a new Washington Post-University of Maryland poll.
Nearly a quarter of Americans are taking an even longer view, saying it will not be safe until 2021 or later for such events.
“The findings provide more evidence that Americans remain worried about the threat of the virus and cautious about efforts to lift stay-at-home restrictions and to reopen businesses, even as many governors have begun to move in that direction,” Dan Balz and Scott Clement write. “In the face of plans in many states to gradually ease those limitations, significant majorities of Americans continue to emphasize the need for social distancing and other safety measures.”
The poll also surveyed Americans about social distancing and face covering practices. It found 8 in 10 say it’s necessary for people in their community to wear a mask when they’re outside, and more than 8 in 10 say it’s important for people to stay at least six feet apart from other people when in public. Three-quarters of Americans also say people in their communities should avoid gathering with friends outside their households.
“The widespread belief that people should wear masks and restrict their contact with people outside their homes is striking,” said Michael Hanmer, a professor of government and politics at the University of Maryland who co-directed the survey. “This stands in stark contrast to the handful of crowds in close spaces that have gained media attention.”
The small town of Danville, Pa. is the unlikely home of one of the country’s highest concentrations of hospital workers.
That means a few things: Social distancing has come fairly easy to its residents, and there’s an arsenal of workers readying for a medical battle, Todd C. Frankel writes — “akin to the feeling of a military town on war footing.”
But so far, there’s been little need for aggressive mobilization. The area had just 50 covid-19 cases and no deaths as of Tuesday.
“This rare combination shows how the push to reopen the economy and the need to control a deadly virus can coexist, with fewer of the tensions that have popped up across the country, such as an anti-quarantine protest that drew hundreds to Harrisburg, Pa., just 65 miles away,” Todd writes.
“It might sound strange,” said Gustaaf de Ridder, a pathologist with Geisinger Medical Center, “but it helps when you have so many health-care workers in the region giving the message directly. There’s less resistance. Less suspicion. Because we want this to go right, too.”
In other news
The Health and Human Services Office of Civil Rights is taking action against West Virginia.
The state was accused of denying an adoption request by someone being treated for opioid abuse.
According to the complaint, an aunt and uncle seeking to adopt their young niece and nephew were denied based on the uncle's long-term use of doctor-prescribed suboxone as part of a medication-assisted treatment program. The couple said that despite receiving a favorable home study finding, social workers determined they weren't an appropriate placement for either child, citing the uncle’s history of taking prescribed suboxone. He hadn't tested positive for illegal drugs during the course of his treatment.
Under a voluntary resolution agreement provided first to The Health 202, West Virginia health officials are now creating a new disability rights training plan and updating nondiscrimination policies.
“People in recovery from opioid use disorder should never be stigmatized for seeking appropriate medical treatment that can save their lives,” OCR Director Roger Severino said in a statement. “OCR commends West Virginia’s willingness to update its policies and procedures to make sure individuals with disabilities do not face unlawful discrimination based on either misinformation or stereotypes in its state’s child welfare system.”
Here are a few more stories to catch up on this morning:
The Trump administration’s response:
- The Department of Health and Human Services is purchasing $645 million worth of face coverings for critical workers and federal agencies, Bloomberg Law’s Shira Stein reports.
- White House trade adviser Peter Navarro is declining to testify before the House Energy and Commerce subcommittee on health about a whistleblower complaint from ousted vaccine official Rick Bright that mentions Navarro at length, Robert Costa reports.
It’s still an election year:
- Presumptive Democratic presidential nominee Joe Biden defended his decision to campaign from home amid the pandemic, chiding the president who he said “should follow the rules instead of showing up at places without masks,” Sean Sullivan reports.
- The Democratic Party’s rules and bylaws committee unanimously voted to make room for the possibility of remote delegate voting for its presidential convention this summer, Michael Scherer reports. If passed by the full Democratic National Committee, there could be a scaled-back event or virtual convention in August.
Around the world:
- China has suspended a significant portion of beef imports from Australia and signaled it could introduce agricultural tariffs, a move that comes as Australian officials plan to propose an international investigation into the origins of the coronavirus, Gerry Shih reports.
- China appears to be delaying international efforts to find the source of the coronavirus, the Wall Street Journal’s Jeremy Page and Natasha Khan report.