with Alexandra Ellerbeck

The Trump administration has provided its fullest picture yet of how and when a coronavirus vaccine could be distributed.

Centers for Disease Control and Prevention officials released a detailed new plan laying out three phases for vaccine distribution, saying they've initiated a broad, coordinated effort among states and distributors. They're aiming to be able to start some vaccinations within 24 hours after a vaccine is approved, kicking off what is expected to be the largest vaccination effort in history.

It could have been a chance for President Trump to tout his pandemic response. 

Instead, he spent yesterday's press briefing repeatedly contradicting CDC Director Robert Redfield, in comments that made clear the president has little understanding of how a vaccine distribution timeline might work.

Trump said Redfield's assertion that a vaccine won't be widely available to the public until next spring or summer was wrong.

The president contradicted what Redfield had told Congress earlier in the day, saying the CDC director misspoke or “misunderstood the question” when he said a vaccine wouldn’t be broadly available until well into 2021.

“No, I think he made a mistake when he said that,” Trump said when asked about Redfield’s comments. “It’s just incorrect information. And I called him, and he didn’t tell me that. And I think he got the message maybe confused.”

The Washington Post's Cathleen Decker:

Trump said the vaccine “could be announced in October” and would be distributed “immediately” once it’s available.

“To the general public immediately — when we go, we go. We’re not looking to say, gee, in six months we’ll start giving it to the general public. No, we want to go immediately,” he said. “No, it was an incorrect statement. I saw the statement. I called him and I said, ‘What did you mean by that?’ And I think he just made a mistake.”

Stat News's Jason Ukman:

Trump also contradicted Redfield on the usefulness of masks. Redfield had said wearing a mask could be viewed as even more effective than a vaccine — and the president again said the CDC director was incorrect.

Trump said he called Redfield about that comment as well and that if someone were to ask Redfield now, he would “probably say he didn’t understand the question.”

“No, vaccine is much more effective than the masks,” he said.

Redfield tweeted this after Trump's remarks:

AP White House reporter Jon Lemire:

Earlier in the day, top health officials announced new details of how the administration plans to distribute a vaccine.

“Officials sent a strategy paper to Congress describing coronavirus vaccine distribution efforts, and a 57-page ‘playbook’ the CDC sent to states and localities giving additional guidance for the nuts-and-bolts preparations underway since August,” Lena H. Sun writes.

“Administration officials have told states to be ready to distribute a vaccine or vaccines as early as November on the assumption that one or more would be approved by the Food and Drug Administration by year’s end or early next year,” she adds.

The plan calls for three phases of vaccine distribution. 

In the first phase, vaccine supplies would be directed to “settings that can optimize reaching the target population,” it says. The target population could be medical workers or elderly Americans — two high-risk groups that have been identified by the National Academies of Sciences, Engineering, and Medicine as high priority for getting vaccinated first.

“I think health-care workers and first responders should be at the top,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told me. “They are our front-line people.”

This first phase of distribution could look different depending on whether the CDC prioritizes medical workers or residents of long-term care facilities and nursing homes — or some combination thereof. The idea is for states to get structures in place to deliver vaccines quickly to the first-priority population, said Tom Inglesby of the Johns Hopkins Bloomberg School of Public Health.

“I do think it’s going to be difficult for states and localities to lock down their plans unless we say people over 70 or people in the health-care system — who needs to get it first,” Inglesby said.

The plan says “final decisions about prioritization will not be made until closer to implementation.”

Redfield said the first phase could start in November or December.

In a hearing yesterday, Redfield told Congress a vaccine could be ready to distribute in limited doses in the final two months of 2020. He didn’t dismiss the possibility of a vaccine being approved before the Nov. 3 election — the time frame Trump has made clear that he wants.

But Redfield stressed a vaccine wouldn’t be widely available until six to nine months after it first receives emergency use authorization from the Food and Drug Administration.

“There will be a vaccine that will initially be available sometime between November and December, but very limited supply and will have to be prioritized,” Redfield said. “If you're asking me when is it going to be generally available to the American public so we can begin to take advantage of vaccine to get back to our regular life, I think we're probably looking at late second quarter, third quarter 2021. ”

In that second phase, vaccine doses would be shipped to a much wider network of distributors such as adult and pediatric health-care providers and pharmacies. The goals would be to ensure free and widespread access to the vaccine, and particularly boost uptake among the highest-risk people.

And in a third phase, the coronavirus vaccine could be integrated into routine vaccination programs, if epidemiologists determine that’s needed.

Redfield also warned that Congress has yet to provide about $6 billion to help states prepare for a massive vaccination campaign. 

Redfield said the CDC lacks critical funds states need for the distribution.

“Those state efforts include maintaining vaccines at temperatures of minus-70 Celsius (minus-94 Fahrenheit), which will require special freezers and dry ice, systems to ensure people get the correct doses at the right times — most vaccines will require two shots — and multiple scenarios for giving shots at hospitals, pharmacies, mobile clinics and doctors’ offices,” Lena writes.

“The CDC has about $600 million in dwindling relief money, but states urgently need additional resources, Redfield said, responding to questions from Sen. Roy Blunt (R-Mo.),” she adds.

Ahh, oof and ouch

AHH: The Trump administration squandered a crucial window for action during the early days of the pandemic.

Trump claims he took early action once warned of the virus, but “a detailed review of the 10-day period from late January, when Trump was first warned about the scale of the threat, and early February — when he acknowledged to author Bob Woodward the extent of the danger the virus posed — reveals a president who took relatively few serious measures to ready the nation for its arrival,” Ashley Parker, Josh Dawsey and Yasmeen Abutaleb write.

On Jan. 28, national security adviser Robert C. O’Brien warned Trump the virus “will be the biggest national security threat you face in your presidency.”

In the days following that dire warning, however, Trump repeatedly downplayed the virus in statements and public events. He spent the weekend golfing in Mar-a-Lago and hosting a Super Bowl party in Palm Beach, Fla.

In his State of the Union address delivered Feb. 4, Trump devoted only two lines to the virus, saying that the administration was taking “all necessary steps.” Instead he focused most of the speech on his upcoming impeachment trial. 

There were some public actions by the agency. On Jan. 29, Trump announced the formation of a coronavirus task force, initially led by Health and Human Services Secretary Alex Azar. But sources told The Post that the task force initially focused more on keeping the virus outside of the United States rather than preparing for the inevitable outbreak within the country.

The administration also issued restrictions on travel for foreign nationals who had been in China within a two-week period. But Trump had to be talked into the ban, which had wide exceptions for U.S. citizens.  

OOF: HHS official goes on medical leave after promoting conspiracy theories in a Facebook video.

“The Department of Health and Human Services’ top communications official is going on medical leave, three days after urging President Trump’s supporters to prepare for an armed insurrection and accusing scientists in his own agency of ‘sedition,’ HHS announced Wednesday,” Yasmeen, Josh and Lena report.

“Michael Caputo, assistant secretary for public affairs at HHS, leveled the accusations and promoted other conspiracy theories in a Facebook Live event on Sunday,” they write.

HHS said in a statement Caputo will take a 60-day leave of absence to “focus on his health and the well-being of his family,” returning to the agency only after the November election. 

Caputo said he was taking the medical leave to “pursue necessary screenings for a lymphatic issue discovered last week” and that he had been losing weight for months. He also said that threats against his family had increased his stress level.

HHS also announced that Paul Alexander, a top aide to Caputo, would leave the agency permanently. Alexander has come under fire in recent weeks over allegations that he interfered with scientific reports from the CDC.

OUCH: Many states don't track positive coronavirus antigen tests, creating blind spots in the pandemic.

“More than 20 states either don’t release or have incomplete data on the rapid antigen tests now considered key to containing the coronavirus, which has sickened more than 6 million Americans,” Kaiser Health News’s Rachana Pradhan, Lauren Weber and Hannah Recht report. “The lapses leave officials and the public in the dark about the true scope of the pandemic as untold numbers of cases go uncounted.”

Most coronavirus tests are conducted in a laboratory using PCR technology to look for pieces of the virus, but the federal government and companies have invested in producing tens of millions of antigen tests, which are somewhat less accurate but much faster than the lab-based tests. The problem is that, while most states keep updated public records of the number of positive cases detected through lab-based tests, many do not record the number of people who test positive for the virus using antigen tests.

KHN surveyed 50 states and D.C. on their collection of antigen test results. Of the 48 that responded, 21 states and D.C. do not report all antigen test results, and nearly half of states believe their antigen test results are underreported.

The lack of accurate information could skew public health measures, especially as antigen tests become more common.

“Relying on patchy data on COVID testing carries enormous consequences as officials decide whether to reopen schools and businesses: Go back to normal too quickly and risk even greater outbreaks of disease. Keep people at home too long and risk an even greater economic crisis,” Pradhan, Weber and Recht write.

Trump administration efforts

Trump tweeted that Republicans should support a pricier coronavirus relief bill with higher stimulus payments.

The call for a larger economic relief package comes as Senate Republicans have pushed for a more limited bill, Erica Werner and Rachael Bade report.

The president’s post on Wednesday “could reframe talks that have stalled for more than a month and put the focus on Senate Republicans at a moment when House Speaker Nancy Pelosi (D-Calif.) was under pressure from her caucus to come up with a new solution,” Werner and Bade write.

Senate Republicans and the White House rejected a $3 trillion relief bill passed by House Democrats in May. Since then, Republicans have countered with a $300 billion proposal that Democrats rejected out of hand as insufficient. Negotiations between the parties have remained stalled for more than a month.

Pelosi and Senate Minority Leader Charles E. Schumer (D-N.Y.) said in a statement that they were “encouraged” by Trump’s call for a larger economic package.

Pelosi and Treasury Secretary Steven Mnuchin spoke on the phone on Wednesday about a potential relief bill, but the window for action is dwindling, with Congress set to recess early next month and not return until after the election.

Trump blamed Democratic governors for the high coronavirus death toll. 

In a Wednesday news conference, Trump said that the death rate from the novel coronavirus in the United States would be low if not for the “tremendous death rates” from “blue states.”

While the president was clearly trying to deflect blame for the high U.S. death toll, it's true that a majority of covid-19 deaths have been in states with Democratic governors.

New York, New Jersey and California have had the highest death tolls, with nearly 64,000 deaths combined. Massachusetts, Illinois, Pennsylvania and Michigan rank sixth, seveth, eighth and ninth in deaths. Altogether, there have been 96,504 deaths in these seven states.

The Post's Philip Bump notes, however, that most recent deaths have been in red states. The most recent data, through Tuesday, indicates that about 53 percent of deaths have occurred in blue states — meaning that 47 percent have occurred in red ones.

Coronavirus latest

Dementia patients are dying from isolation amid the pandemic.

“People with dementia are dying not just from the virus but from the very strategy of isolation that’s supposed to protect them,” William Wan writes. “In recent months, doctors have reported increased falls, pulmonary infections, depression and sudden frailty in patients who had been stable for years.”

Beyond the staggering death toll from the coronavirus, at least 13,200 more people than expected have died of dementia since March, according to an analysis by The Post. These deaths are not directly attributable to the virus, but they may be the result of measures taken to contain it, as dementia patients suffer from isolation and depression that can worsen the disease. In many cases family members are not allowed to visit them in nursing homes.

“Social and mental stimulation are among the few tools that can slow the march of dementia. Yet even as U.S. leaders have rushed to reopen universities, bowling alleys and malls, nursing homes say they continue begging in vain for sufficient testing, protective equipment and help,” Wan writes.

Indirect effects of the coronavirus pandemic, including delays in care or lower hospital capacity, have caused more people to die from a number of medical conditions, but none so much as dementia.

“Among the sources of excess deaths, dementia has produced by far the most — more than the next two categories, diabetes and heart disease, combined,” Wan writes. 

Eli Lilly says an experimental drug shows promising results in protecting coronavirus patients.

“A single infusion of an experimental drug markedly reduced levels of the coronavirus in newly infected patients and lowered the chances that they would need hospitalization, the drug’s maker announced on Wednesday,” the New York Times’s Gina Kolata reports.

The new drug, known as a monoclonal antibody, is a manufactured version of antibodies produced by the body when it fights covid-19, the disease caused by the coronavirus. Interim results from a trial showed that 1.7 percent of those who received the antibody drug went to the hospital, compared to 6 percent for covid-19 patients receiving a placebo.

The data set — from 450 patients so far — is considered small, however, and the results have not been peer-reviewed.

Many scientists have been holding out hope for results from monoclonal antibodies. If further research confirms that the drug is successful, it may also offer a treatment option for patients with mild or moderate covid-19 symptoms. Most other treatments so far have targeted patients already hospitalized.

Earlier this week, the company said it had also seen promising results from the use of an anti-inflammatory drug, baricitinib, which is already used to treat arthritis, if delivered in conjunction with remdesivir. The results of that study have also not yet undergone peer review.

Obamacare back in the news

  • Trump has been promising over the past three years to release a health-care plan to replace the Affordable Care Act. He again claimed that a plan was forthcoming during a town hall event Tuesday, but during yesterday’s congressional hearing, top health officials, including Redfield, said that they were not aware of such a plan, CBS News’s Melissa Quinn reports.
  • Joe Biden has been gearing up for a $65 million advertising campaign that includes health-care ads targeting Trump’s attempts to repeal the Affordable Care Act. A pair of ads released Wednesday highlight families who have children with preexisting conditions.
  • An audit from the Government Accountability Office found that some health-care brokers are providing misleading information about health plans exempt from Affordable Care Act coverage requirements. The audit, requested by Senate Democrats, found that in 31 phone calls in which government officials posed as customers with preexisting conditions looking for health insurance, at least eight sales representatives “engaged in potentially deceptive marketing practices,” the Hill’s Jessie Hellman reports.

Sugar rush