with Paulina Firozi

Former health wonks from the Obama and Trump administrations are color-coding all 50 states to indicate how well they’re combating the novel coronavirus. 

The bad news: Only North Dakota and Kentucky are “green,” indicating they have met the Trump administration's criteria for starting to end shutdowns, according to the new site, CovidExitStrategy.org. North Dakota began reopening on May 1; Kentucky is starting to reopen next week. 

The slightly better news: 30 states are “yellow,” indicating progress is being made. 

The remaining 18 states are “red,” with a long way to go before they meet the standards the Centers for Disease Control and Prevention recommend for a safe reopening. 

The project's creators aim to provide a central clearinghouse of state coronavirus information.

Governors, facing intense economic and political pressure, are undertaking the exceedingly tricky task of figuring out how and when to end lockdowns. The website's creators hope their data crunch and visualization will help policymakers and regular Americans get a better sense of how states are progressing toward the ultimate goal of safely ending the lockdowns that have resulted in massive unemployment and deep revenue losses for states.

The website pulls data on coronavirus testing, confirmed cases and deaths from the COVID Tracking Project and data on hospital capacity and influenza-like illness from the CDC. 

“It’s supposed to be the progress bar for the country,” Ryan Panchadsaram, former deputy chief technology officer at the Department of Health and Human Services, told me.

Panchadsaram partnered with the groups United States of Care and Resolve to Save Lives, along with the Duke-Margolis Center for Health Policy, on the project. The organizers, some of whom worked together on fixing HealthCare.gov during its flubbed rollout in 2013, spent the last few weeks pulling the data and organizing it into readable charts that allow states to be compared across a variety of metrics.

The data include several key metrics for reopening laid out by the CDC and the White House.

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.” Or, testing should be ramped up enough that states should reduction in positive tests as a percentage of total daily tests.  

The new website details how confirmed new cases are trending and how many tests out of total tests are showing up positive. But because the officially released federal guidance is still vague, the creators had to make a number of their own calls about when to award a state red, yellow or green in particular categories.

For example, a state gets a green rating if its daily confirmed cases have decreased more than 5 percent during the previous 14-day period. The rating is yellow if there’s less than a 5 percent change in either direction. And it’s red if the cases increase more than 5 percent. 

To make those calculations, the creators used the seven-day average of confirmed cases — a practice that helps smooth out the data and shows trends better than relying on incremental changes every day. 

The need for such a website underscores several distressing realities in the United States. 

Many states are still struggling to tamp down the virus even after people spent weeks avoiding workplaces, schools, churches and places of business. 

And many different factors play into how well states can contain the virus and protect their health-care systems after ending lockdowns. These factors include each state's number of daily tests and how many hospital ICU beds are empty. 

It’s exceedingly difficult to measure and compare how all the states are doing on these fronts. As I wrote in yesterday’s Health 202, the lack of detailed federal guidance has left many states scrambling to make decisions on their own. 

The CDC had prepared more extensive and detailed guidance on the metrics states should use in reopening, but the White House never released it. Based on that shelved guidance, "no one who is reopening meets the criteria for reopening," a senior CDC official told CNN yesterday.

And governors – whose states have seen revenue collections drop between 20 and 50 percent during the lockdowns – are moving to reopen without necessarily explaining what their benchmarks are.

“I do think we’re seeing states reopen in response to economic pressures,” said Caitlin Rivers, an assistant professor at the Johns Hopkins School of Public Health. “Governors, I think, are trying to balance the public health guidance and the need to act on the economy, and it’s a difficult choice. I do have sympathy for the position they’re in.”

Ahh, oof and ouch

AHH: Doctors have put together a limited and imperfect set of tools to help them treat covid-19 patients.

After scrambling in the dark just a few weeks ago, now doctors are pointing to some drugs and therapies that can help give patients a bit of a chance, Ariana Eunjung Cha reports, although she notes none of the therapies have proved capable of killing or stopping the pathogen. 

“They range from protocols to diagnose and treat dangerous, but sometimes invisible, breathing problems that can be an early warning of covid-19 in some people, to efforts to reduce the illness’s severity or length,” Ariana writes. “At this stage, they are still experimental approaches by doctors desperate to find ways to help gravely ill people and throwing everything they can think of at the problem.” 

The therapies include the blood plasma of those who have recovered from covid-19, drugs to suppress the body’s immune response, anticoagulants and antivirals.

“Randomized clinical trials are necessary to confirm early anecdotal data, with the results probably months away. But doctors say they believe they are seeing some positive results from these and other things they have learned through trial and error these past 10 weeks,” she adds. 

OOF: An ousted top vaccine official will warn lawmakers the “darkest winter in modern history” is possible if the federal coronavirus response doesn't improve. 

Rick Bright, former director of the Biomedical Advanced Research and Development Authority, will testify before a House Energy and Committee subcommittee that the “window of opportunity is closing.” 

He said it’s crucial to be “truthful with the American people.”

“If we fail to develop a national coordinated response, based in science, I fear the pandemic will get far worse and be prolonged, causing unprecedented illness and fatalities,” Bright said in a prepared testimony submitted to the subcommittee. 

“While it is terrifying to acknowledge the extent of the challenge that we currently confront, the undeniable fact is there will be a resurgence of the COVID19 this fall, greatly compounding the challenges of seasonal influenza and putting an unprecedented strain on our health care system. Without clear planning and implementation of the steps that I and other experts have outlined, 2020 will be darkest winter in modern history.”

“His appearance adds to a dramatic week of testimony on Capitol,” John Wagner writes. “On Tuesday, Anthony S. Fauci, the nation’s top infectious disease expert, and other Trump administration health officials warned the United States risks new coronavirus outbreaks and possibly a broad resurgence nationwide if states and cities reopen too quickly.”

OUCH: Hospitals across the U.S. lost tens of billions of dollars as they had to cancel non-essential procedures.

One example: Griffin Hospital in Derby, Conn., which has been a fixture of the state’s lower Naugatuck Valley for more than a century. The hospital is part of the community, running a program of 10 weeks of free lectures and a medical library for the public. But it may not be prepared to deal with the pandemic’s financial shock, Amy Goldstein reports. 

“To care for people of the valley who would get infected, Griffin invested in expensive preparations as the virus approached. During three weeks in March, the hospital spent $1.7 million — more than half its capital budget for the year — including for a crash renovation of East B, a shuttered medical unit,” Amy writes. 

“The hospital made these investments as the usual patients were vanishing,” she adds. "Visits to Griffin’s physician practices fell to 2,300 from mid-March through mid-April from 4,200 the month before. Endoscopies were down 90 percent in April. Even trips to the emergency department plummeted from a normal rhythm of about 120 a day to three dozen on a good day. The bottom line: Griffin is missing $6 million of its usual $15 million in monthly income.” 

The hospital’s fate depends on how long the virus lingers in Connecticut, as well as how much it can get from congressional aid for affected hospitals and whether the state pitches in any funds. It's far from the only hospital in such straits.

“U.S. hospitals will have lost a total of $50.7 billion a month from March through June,” Amy writes. “Some are better buffered to absorb a financial shock than the 115-bed community hospital on its own in working-class Derby, Connecticut’s smallest-size city.”

Industry efforts

The coronavirus test from Abbott Laboratories used by the White House missed a large number of positive results.

That's according to a preliminary study by a New York University group that found the test meant to determine whether an individual has the coronavirus in minutes missed a third of positive cases that were caught by diagnostic company Cepheid when using nasopharyngeal swabs and more than 48 percent when using dry nasal swabs, Carolyn Y. Johnson and Steven Mufson report

Abbott disputed that its test had any major issues and suggested the samples in the study may not have been tested correctly. It said the company’s reported false negative rate is 0.02 percent. 

There had been concerns about the Abbott test, which Trump hailed as a “whole new ballgame,” even before the NYU study. “Before a Senate committee last week, National Institutes of Health director Francis Collins testified that the rapid Abbott test had a 15 percent false negative rate, an apparent reference to unpublished data from Cleveland Clinic,” Carolyn and Steven write.

Genetics giant 23andMe announced it will recruit the sickest covid-19 patients as it researches how genetics plays a role in coronavirus cases. 

The company will seek help from hospitals to expand the study that was launched last month, Stat News’s Rebecca Robins reports. The study previously only included individuals who have opted in to participating in 23andMe’s research. 

Now it wants to recruit up to 10,000 new participants who have been hospitalized with the disease to understand why some cases require severe measures.

“The new arm of the company’s Covid-19 study will be limited to people who are not already 23andMe customers,” Rebecca reports. “… New participants will be mailed a spit kit so they can send 23andMe a sample of their genetic material, which the company can then analyze. They’ll also be asked to fill out the same survey about their symptoms and family members that 23andMe’s customers who participated in the research were asked to complete.”

Coronavirus latest

In the states: 
  • Maryland Gov. Larry Hogan (R) announced the state will gradually reopen beginning this weekend. Barbershops and nail salons will be able to reopen, with some conditions, while non-essential stores and houses of worship will be allowed to open at 50 percent capacity, unless local governments find it unsafe, Fenit Nirappil, Erin Cox and Ovetta Wiggins report.
  • Meanwhile, D.C. Mayor Muriel E. Bowser (D) announced the extension of the district’s stay-at-home order and closure of nonessential businesses through June 8.
  • The Wisconsin Supreme Court struck down Democratic Gov. Tony Evers’s administration’s decision to extend stay-at-home orders, Colby Itkowitz reports.
  • Los Angeles County Public Health Director Barbara Ferrer backpedaled her remarks that the county’s stay-at-home order would continue for three months, Meryl Kornfield writes in The Washington Post’s live blog.
  • New Mexico Gov. Michelle Lujan Grisham (D) announced face masks will be required in all indoor and outdoor public settings starting on Saturday, except for eating, drinking and exercising, Samantha Pell writes.
  • New York Gov. Andrew Cuomo (D) announced some of the state’s northernmost counties had met the standards to begin gradually reopening, which will allow construction, manufacturing, agriculture, forestry and fishing to restart Friday, as well as retail for curbside pickup and drop-off or in-store pickup, the Wall Street Journal reports. New Jersey Gov. Phil Murphy (D) said construction firms will resume nonessential operations on Monday.
Congress on coronavirus: 
  • House Majority Leader Steny H. Hoyer (D-Md.) unveiled a pair of historic rule changes that could allow lawmakers to vote remotely if they cannot be at the Capitol for “reasons beyond our control” related to the coronavirus, Paul Kane reports. The House is expected to approve the measure on Friday.
The economic fallout:
  • Federal Reserve Chair Jerome H. Powell warned the U.S. economy could face a multiyear recession if Congress and the White House don’t provide additional relief, Heather Long and Erica Werner report.
There’s still more to lean about the coronavirus: 
  • Ordinary human speech can emit droplets that can remain in the air for at least eight minutes, a new study has found. The experiment, which used laser light to assess how many droplets are generated by human speech, could “explain why infections of the coronavirus so often cluster in nursing homes, households, conferences, cruise ships and other confined spaces with limited air circulation,” Joel Achenbach reports.