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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Experts weigh in on when the public health emergency should end

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

It's Alex, your Health 202 researcher checking in. Last week, we heard from coronavirus experts about what risks they were taking in their own lives. This week, we'll get their take on some big picture questions about how the pandemic ends.

After that, our colleague Dan Diamond tells us the inside story of how Tom Price's health department fell in love with charter jets. 

How long should the U.S. be under a public health emergency? Seven experts weigh in

The United States has been in a declared state of public health emergency since late January 2020, shortly after the Centers for Disease Control and Prevention confirmed the nation's first coronavirus case.

The public health emergency, which allows for emergency authorization of vaccines and deployment of the military trauma care providers, among other powers, has already been extended six times. It's likely to remain in place at least through the end of 2021 — and possibly beyond. (States have their own emergency orders, although some have let them expire).

But at some point, the pandemic emergency — both in its legal designation and its intense impact on daily life — will have to end. The U.S. is learning to live with an endemic virus, albeit one whose worst effects are blunted by the protection of vaccines and prior immunity. 

The Health 202 asked experts via email to reflect on the following questions:

  • At what point will we be able to declare the state of public health emergency over?
  • What indicator will tell us when we’ve reached that goal?
  • When can we ease up on public health restrictions?
  • Are there any restrictions that may stick around?

Carlos del Rio,  professor of medicine and global health at Emory University: “I think if we get back to < 10 new cases per 100,000 population and < 100 deaths per day we will be in ‘good shape.’ … Not much is going on now in the U.S. as far as ‘public health restrictions.’ We have some very limited masking in some places but little in most. I personally think that masking should remain for the foreseeable future in certain situations. For example, I would wear a mask riding the subway or seeing patients. I also think that asking for proof of vaccination will become the new normal.” 

Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security: “To me, the public health emergency was premised on the ability of the virus to put a hospital into crisis. When enough high-risk people are immune through vaccination or natural infection and hospitals no longer have to worry about capacity, the public health emergency is over although Covid will still be present.”

Natalie Dean, assistant professor of biostatistics at Emory: “The goal is to reduce sickness and death to levels below which people feel safe resuming normal activities. … Easing up on restrictions will be a constant readjustment, as the virus can continue to throw curveballs at us. I can see vaccine mandates, vaccine passports, and routine testing sticking around for a while, as well as masks in crowded public indoor spaces while transmission levels are high.”

Joseph Allen, director of the Healthy Buildings program at Harvard T.H. Chan School of Public Health: “I wouldn’t call it a restriction by any means, but one thing that should not go away is higher ventilation and better filtration. Healthy buildings should be the norm going forward, not the exception.”

Shira Doron, infectious-disease physician at Tufts Medical Center: “In many places there are no restrictions right now, and there isn't widespread agreement on what the criteria for having restrictions are. Certainly when hospitals are becoming overwhelmed by COVID cases, I believe there should be rules in place to protect people. I think that once we have seen a true de-coupling of infections from hospitalizations, where rising cases no longer translate into rising hospitalizations, we can stop paying so much attention to the case numbers and begin to live more normal lives.”

Monica Gandhi, physician and infectious diseases expert at the University of California San Francisco: “The public health emergency should be declared over based on hospitalization rates around our country (not case rates which fluctuate based on extent of testing). We had proposed in a Washington Post article (back in April) calling the public health emergency over when hospitalization rates were <5/100,000 population. I think hospitalization metrics such as this are appropriate to ease restrictions in each county or state (mainly just masks at this point).”

Leana Wen, former Baltimore health commissioner: “I’d see lifting the state of emergency as being challenging as long as there is so much spread and a substantial proportion of the population — young children — who are not yet eligible to be vaccinated. As to when restrictions can be lifted later, this isn't straightforward. It will depend on what level of infection and suffering we can tolerate, and what price we are willing to pay to reduce it.”

On the Hill

Democrats begin to narrow differences on the size of the social spending bill

Liberals on Oct. 3 were split over the total cost for President Biden's infrastructure plan as the bill awaits a House vote. (Video: Alexa Juliana Ard/The Washington Post)

The race to find a compromise has begun, as liberals indicate they’re open to concessions on the scope of the party’s sweeping economic package, our Post colleagues report.

Biden suggested the top-line number for his economic package could range from $1.9 trillion to $2.2 trillion in a virtual meeting with a dozen liberal Democrats — a significant decrease from the initial $3.5 trillion proposal. That could mean key health-care priorities are funded for just a short period of time, instead of permanently. 

Rep. Pramila Jayapal (D-Wash.), leader of the Congressional Progressive Caucus, countered with a range of $2.5 trillion to $2.9 trillion.

  • “The gap between Biden’s maximum and Jayapal’s minimum marks a striking narrowing of differences from just last week,” The Post’s Sean Sullivan, Seung Min Kim and Marianna Sotomayor report.

Worth watching: Some progressives, like Sen. Bernie Sanders (I-Vt.), are still pushing for the full $3.5 trillion. On the opposite end of the spectrum, Sen. Joe Manchin (D-W.Va.) has said his preferred number is $1.5 trillion, although he hasn't ruled out voting for something larger.

The other side: Key House Republicans are requesting that congressional scorekeepers release projections on the cost of Democrats' health-care proposals. 

CNN's Manu Raju:

Ask a reporter

Bad weather and a delayed flight in April 2017 began the story of how Trump’s health department fell in love with charter jets. HHS officials vowed never again to wait on a commercial airline’s schedule, our colleagues Dan Diamond and Carol D. Leonnig report.

The pair obtained documents shedding new light on the strategy of shuttling former Health Secretary Tom Price across the country at the expense of taxpayer dollars — a move that eventually cost him his job. 

Back in 2017, Dan and colleague Rachana Pradhan broke the story on Price’s use of charter planes in Politico. So, we asked him some questions:

You’ve chronicled this effort for years now. What did you find most surprising in this new tranche of documents? 

How quickly HHS officials pivoted from a single request to find a charter jet, ASAP — because Price wanted to attend a Los Angeles-area conference but his flight was delayed — to relying on charter jets as a de facto travel option. We knew that Trump's HHS had spent hundreds of thousands of dollars on the charter flights, but we hadn't previously seen their internal, real-time rationalizations for doing it.

Why did HHS officials book charter flights without objecting?

Well, career officials did raise occasional questions, like whether Price really needed a more expensive Gulfstream jet to fly to Asia. But for the most part, Trump appointees seemed to overlook the taxpayer spending — even as some of them joined Price on the charter flights. One official who wrote memos to help justify Price's trips in 2017 told us that he now regrets it.

Price eventually resigned. How did his ouster reshape the federal health department? 

It created new cracks that never got patched up. HHS was already plagued with tensions in 2017 — as Trump loyalists, Bush alums and other cadres jockeyed for influence — and Price's sudden departure left a void that further destabilized the department. A lot of health officials' infighting during the pandemic can be traced back to feuds that were sparked or worsened with Price's ouster. 

Industry Rx

Facebook whistleblower: Company structure prevents it from stopping vaccine misinformation

Frances Haugen told lawmakers that the social media giant is ill-equipped to stop the spread of medical misinformation, which has drawn major scrutiny from Capitol Hill Democrats, our Technology 202 colleague Cristiano Lima reports. 

  • A blunt assessment: “I do not believe Facebook [as it's] currently structured has the capability to stop vaccine misinformation because they are overly reliant on artificial reliant systems,” Haugen told a Senate Commerce subcommittee yesterday.

Haugen, a former product manager at Facebook, revealed herself Sunday evening as the source of thousands of pages of internal company research, leaked to the Securities and Exchange Commission and the Wall Street Journal. She also said the company has misled the public about the extent to which its products harm children and stoke political divisions. 

  • Those documents included findings from researchers that Instagram makes body issues worse for 1 in 3 teen girls.


Here's what else we're watching:

  • A top FDA vaccine official says booster shots may be warranted for everyone over 18, The Post’s Laurie McGinley reports.
  • Nearly 200,000 at-home coronavirus tests from the Australian company Ellume were recalled after the manufacturer found an increased chance of false positives, The Post’s Marisa Iati reports.
  • Anxiety and depression among U.S. adults peaked during last winter's coronavirus surge, Marisa writes, citing a CDC study.
  • In Tennessee, many kids remain unmasked and unvaccinated. Only 17 percent of those ages 12 to 17 across the state have been immunized, The Post's Laura Meckler and Dan Keating report.

Sugar rush

Thanks for reading! See y'all tomorrow.