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The Health 202

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

Biden promised more coronavirus tests but the surge is now

The Health 202

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

Welcome to The Health 202, where we can confidently say we wouldn't be as chipper as Sen. Tim Kaine (D-Va.) sounded if we spent an unexpected 27 hours in a car.

Today, doctors are frustrated over a short supply of pills to treat covid-19, and the CDC doubles down on its isolation and quarantine guidance. But first: 

The administration is under fire for testing crunch

Demand for coronavirus tests exploded as Americans returned from their holiday travel – but the Biden administration is still scrambling to make half-a-billion tests it promised quickly available.

White House officials say the plan is to begin delivering the tests this month – but there are a slew of unanswered questions and logistical hurdles the administration needs to hammer out as it works to stand up the program. That includes critical details like creating a new government website and determining how many tests each person can get. 

“We need these tests produced quickly, and we need to get them out to people quickly,” said Lori Tremmel Freeman, the CEO of the National Association of County and City Health Officials (NACCHO), citing predictions that omicron could soon reach its peak.

The demand for coronavirus tests has surged along with the country’s rising case count. Americans’ scramble for tests over the holidays further exposed the country’s testing shortfall — a years-long problem President Biden has vowed to fix. 

“I know this remains frustrating — believe me, it’s frustrating to me — but we’re making improvements,” Biden said in brief remarks yesterday before a meeting with his coronavirus advisers.

What needs to happen

White House officials are in the throes of awarding contracts for the 500 million rapid-test program, which, once finalized, could begin to fill in some of the details. The request for proposal to the industry closed yesterday, and the administration anticipates movement on some of the awards this week. 

Testing experts and state and local officials are eagerly awaiting more information on how the program would work. Among the questions: How many tests will each American be allowed to receive? Can they order tests multiple times? When will all 500 million tests be available?

One lingering question is how to ensure those who can’t afford to buy tests — and who lack Internet access — can get them. 

  • “You can do that in a number of ways by prioritizing the Zip codes based on the social vulnerability index that CDC has,” said Andrew Sweet, managing director of covid-19 response and recovery at the Rockefeller Foundation.
  • Freeman, of NACCHO, said her group is pushing for local health departments to have access to the free tests to help distribute them to vulnerable populations, such as the homeless.

Meanwhile, the administration is planning to make the tests available through a federal website, where Americans can sign up to order their kits. Creating the new site may be a tall order, reports The Technology 202’s Cristiano Lima.

“If history is any indication, though, the portal’s launch could face some of the same technological stumbling blocks that have plagued similar projects in the past,” Cristiano writes.

How we got here
  • Seeking to recast the pandemic fight, Biden announced a plan late last year to ship a half-billion tests to Americans’ homes, which people will be able to order through that federal website.
  • But public health experts have questioned why the administration hadn’t done more to avoid the testing shortfall seen during the holidays.
  • A White House spokesperson defended the administration’s approach, saying that January is when it had the capacity to execute such a big purchase. “That is thanks to the [$]3 billion investment we’ve made that has quadrupled the market, continued use of [Defense Production Act] style actions that have moved up production timelines, and the NIH program that has helped get two at-home tests through FDA in just December.”


Doctors are frustrated over limited supply of antiviral pills

President Biden on Jan. 4 said that the national supply of the coronavirus treatment pills will “ramp up over the coming months." (Video: The Washington Post)

Promising treatments for covid-19 were authorized just before Christmas and hailed as a potential turning point in the fight against covid-19. But doctors say a limited supply of the pills — especially Pfizer’s five-day treatment course — means they’re unlikely to alleviate the strain hospitals are facing as omicron surges, our colleague Katie Shepherd reports.

  • “I don’t think they’ll end up being the game-changers we want them to be,” because of scant supply, said Shelley Schmidt, a critical-care physician and pulmonologist in Grand Rapids, Mich. She doesn’t expect to have access to the antiviral pills for her patients until mid-January.

Biden acknowledged the drugs’ scarcity in remarks yesterday, but said the government was doubling its order of Pfizer’s pill to 20 million treatment courses this year.

  • Due to the complex chemistry … to make the pill, it takes months literally to make a pill,” he said. But he stressed the medication is “already saving lives.”

Following confusion, the CDC doubles down on its isolation and quarantine guidelines

The Centers for Disease Control and Prevention clarified the rationale behind its decision to shorten isolation and quarantine recommendations after coming under fire from public health experts who thought a negative test should be required.

The health agency reaffirmed that people who were infected but asymptomatic can leave isolation and return to work or school without testing after five days. But the agency clarified that anyone who has access to a test — and wants to take it — can do so. If they receive a positive test result, they should continue to isolate for five additional days, The Post’s Meryl Kornfield reports.

David Paltiel, a health policy professor at Yale School of Public Health, told The Health 202 that even if testing after isolation is ideal, requiring testing would be unworkable given the national shortage in tests.

  • “[T]hey can’t very well make that recommendation so long as antigen tests remain in such short supply. I mean, how elitist would it look if the only people who could follow federal guidance were well-heeled Ivy League colleges and individuals who have sufficient disposable income to buy a stockpile of these tests,” Paltiel said.

Meanwhile, some health experts raised concern about the complicated guidance. Here's a sampling of what we saw on Twitter yesterday post-announcement:

Here's what else you need to know:

  •  A fourth coronavirus shot led to a fivefold jump in antibodies a week after the vaccine, according to The Post’s Steve Hendrix, who reports on preliminary results of a study made public by the Israeli government.
  • A CDC study reaffirmed that coronavirus vaccines are safe for pregnant women, finding no increase in preterm birth among vaccinated women.
  • Some GOP leaders are refusing to join public health officials in calling for people to get boosters, per The Post's Hannah Knowles and Lateshia Beachum.
  • Hospitals are filling up as coronavirus cases surge, but a smaller proportion of cases appear to be ending up in the ICU, The New York Times's Emily Anthes and Azeen Ghorayshi report.
  • Texas Gov. Greg Abbott (R) said he would sue the Biden administration to stop the military’s vaccination mandate from being enforced within his state’s National Guard, The Post’s Brittany Shammas reports.
  • Health workers have left the profession during the pandemic, but claims that 1 in 5 health workers quit the field appear to overstate the problem, The Post’s Dan Diamond wrote on Twitter.

State scan

In South Dakota: A constitutional amendment to expand Medicaid will have a place on voters’ ballots in November after the secretary of state validated signatures on advocates’ petition drive. South Dakota is one of a dozen states that hasn't yet expanded Medicaid under the Affordable Care Act. 

  • So far, voters in six red states have circumvented Republican officials and approved referendums to extend Medicaid to tens of thousands of poor residents. The measure to start a program is yet to lose at the ballot box, underscoring just how popular the Obamacare provision has become even in the face of GOP opposition.

In Mississippi: The state legislature is expected to take up medical marijuana during its 2022 legislative session, which kicked off yesterday. Leadership in both chambers agreed to the text of a bill for a medical marijuana program, but Gov. Tate Reeves (R) refused to call a special session last year to consider it. 

  • Mississippi voters in 2020 approved a state ballot initiative establishing a medical marijuana program, but the state’s Supreme Court overturned the initiative.

In California: Deep pocketed interests are already gearing up for several health care related fights in California, Kaiser Health News's Samatha Young reports. Here are some of the issues expected to appear on the state’s 2022 ballot in November:

  • A decision on whether to overturn the state’s ban on flavored tobacco products
  • A potential increase on the cap for medical malpractice awards

Advocates are also pushing to get other health care issues in front of voters, including:

  • A proposal to effectively legalize psychedelic mushrooms
  • A measure to regulate dialysis clinics
  • An initiative to limit restrictions on businesses during public health emergencies
  • A proposal to increase taxes to fund the state's public health system


Change of schedule: The Senate health committee’s hearing to advance the nomination of Robert Califf for FDA commissioner will now take place next Wednesday.

Happening today: A panel of CDC advisers will consider whether 12-to-15-year-olds should have access to boosters of the Pfizer-BioNTech shot.

Health reads

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Sugar rush

Thanks for reading! See y'all tomorrow.