The House on Wednesday passed the mammoth $1.9 trillion COVID-19 relief package, which President Biden is expected to sign Friday.
The House approved the relief package in a starkly partisan 220-211 vote, sending the legislation to the White House and clinching Democrats’ first big legislative victory in the Biden era. No Republicans voted for the package and all but one House Democrat—Rep. Jared Golden of Maine—supported it. The Hill’s Cristina Marcos has more here.
The political split: Unlike the previous relief measures enacted last year, Democrats barely bothered to negotiate with Republicans and pushed the relief package through Congress along party lines using the budget reconciliation process. That allowed them to go as big as they wanted to go without running into a Senate GOP filibuster.
Republicans argue the use of a process dodging the filibuster shows Biden wasn’t serious about bringing unity, and House GOP lawmakers on Wednesday warned of the bill’s total cost.
But Democrats think Republicans will pay for their opposition to the popular bill and argued that they would oppose anything Biden proposed.
What’s in the $1.9T COVID-19 relief package: Along with $1,400 direct payments to households, an extension of expanded unemployment benefits, and aid for state and local governments, the package is loaded with other provisions intended to speed up the recovery from the recession and help struggling families fight the impact of COVID-19.
Tax credits: The bill increases the child tax credit for households below certain income thresholds for 2021 and makes it fully refundable, and also expands the earned income tax credit for the year.
Child care: $15 billion for grants to help low-income families afford child care and increases the child and dependent care tax credit for one year.
Pensions: $86 billion to bailout struggling union pension funds.
Transportation: $30 billion to bolster local subway and bus systems, $8 billion for airports, $1.5 billion for furloughed Amtrak workers, and $3 billion for wages at aerospace companies.
Housing: $27.4 billion in emergency rental assistance, another $10 billion to help homeowners avoid foreclosure, $5 billion in vouchers for public housing, $5 billion to tackle homelessness and $5 billion more to help households cover utility bills.
Small businesses: The American Rescue Plan broadens eligibility guidelines for the Paycheck Protection Program, allowing more nonprofit entities to be eligible, adds $15 billion in emergency grants and also sets aside more than $28 billion in funding for restaurants.
ObamaCare subsidies and Medicaid expansion: The bill increases ObamaCare subsidies through 2022 to make them more generous, a longtime goal for Democrats, and opens up more fully subsidized plans to individuals. It also would provide extra Medicaid funding to states that expand the program and have yet to do so.
The Centers for Disease Control and Prevention (CDC) on Friday released long-awaited guidance on safely reopening schools, emphasizing the importance of having schools open as long as proper safety precautions are followed.
The guidance states it is “critical for schools to open as safely and as soon as possible,” given the benefits of in-person learning.
The top recommendations for doing so safely are universal wearing of masks by students, staff and teachers as well as distancing so that people are six feet apart.
Vaccination of teachers should be prioritized, the agency said, but “should not be considered a condition” of reopening schools.
Schools can adjust whether they are fully in-person or hybrid depending on the level of spread in the surrounding community and mitigation measures in place.
Schools are encouraged to use “podding” to separate students into smaller groups to help make contract tracing easier.
Congressional leaders have reached an agreement on a $900 billion COVID-19 relief package and $1.4 trillion government funding deal with several healthcare provisions, according to Senate Majority Leader Mitch McConnell, R-Ky., and Minority Leader Chuck Schumer, D-N.Y.
Here are seven things to know about the relief aid and funding deal:
1. Congressional leaders have yet to release text of the COVID-19 legislation, but have shared a few key details on the measure, according to CNBC.Becker’s breaks down the information that has been released thus far.
2. The COVID-19 package includes $20 billion for the purchase of vaccines, about $9 billion for vaccine distribution and about $22 billion to help states with testing, tracing and other COVID-19 mitigation programs, according to Politico.
3. Lawmakers are also expected to include a provision changing how providers can use their relief grants. In particular, the bill is expected to allow hospitals to calculate lost revenue by comparing budgeted revenue for 2020. Hospitals have said this tweak will allow them to keep more funding.
4. The agreement also allocates $284 billion for a new round of Paycheck Protection Program loans.
5. The COVID-19 relief bill also provides$600 stimulus checks to Americans earning up to $75,000 per year and $600 for their children, according to NBC. It also provides a supplemental $300 per week in unemployment benefits.
6. The year-end spending bill includes a measure to ban surprise billing. Under the measure, hospitals and physicians would be banned from charging patients out-of-network costs their insurers would not cover. Instead, patients would only be required to pay their in-network cost-sharing amount when they see an out-of-network provider, according to The Hill.The agreement gives insurers 30 days to negotiate a payment on the outstanding bill. After that period, they can enter into arbitration to gain higher reimbursement.
7. Lawmakers plan to pass the relief bill and federal spending bill Dec. 21.
On her day off not long ago, emergency room nurse Jane Sandoval sat with her husband and watched her favorite NFL team, the San Francisco 49ers. She’s off every other Sunday, and even during the coronavirus pandemic, this is something of a ritual. Jane and Carlos watch, cheer, yell — just one couple’s method of escape.
“It makes people feel normal,” she says.
For Sandoval, though, it has become more and more difficult to enjoy as the season — and the pandemic — wears on. Early in the season, the 49ers’ Kyle Shanahan was one of five coaches fined for violating the league’s requirement that all sideline personnel wear face coverings. Jane noticed, even as coronavirus cases surged again in California and across the United States, that Levi’s Stadium was considering admitting fans to watch games.
But the hardest thing to ignore, Sandoval says, is that when it comes to coronavirus testing, this is a nation of haves and have-nots.
Among the haves are professional and college athletes, in particular those who play football. From Nov. 8 to 14, the NFL administered 43,148 tests to 7,856 players, coaches and employees. Major college football programs supply dozens of tests each day, an attempt — futile as it has been — to maintain health and prevent schedule interruptions. Major League Soccer administered nearly 5,000 tests last week, and Major League Baseball conducted some 170,000 tests during its truncated season.
Sandoval, meanwhile, is a 58-year-old front-line worker who regularly treats patients either suspected or confirmed to have been infected by the coronavirus. In eight months, she has never been tested. She says her employer, California Pacific Medical Center, refuses to provide testing for its medical staff even after possible exposure.
Watching sports, then, no longer represents an escape from reality for Sandoval. Instead, she says, it’s a signal of what the nation prioritizes.
“There’s an endless supply in the sports world,” she says of coronavirus tests. “You’re throwing your arms up. I like sports as much as the next person. But the disparity between who gets tested and who doesn’t, it doesn’t make any sense.”
This month, registered nurses gathered in Los Angeles to protest the fact that UCLA’s athletic department conducted 1,248 tests in a single week while health-care workers at UCLA hospitals were denied testing. Last week National Nurses United, the country’s largest nursing union, released the results of a survey of more than 15,000 members. About two-thirds reported they had never been tested.
Since August, when NFL training camps opened, the nation’s most popular and powerful sports league — one that generates more than $15 billion in annual revenue — has conducted roughly 645,000 coronavirus tests.
“These athletes and teams have a stockpile of covid testing, enough to test them at will,” says Michelle Gutierrez Vo, another registered nurse and sports fan in California. “And it’s painful to watch. It seemed like nobody else mattered or their lives are more important than ours.”
Months into the pandemic, and with vaccines nearing distribution, testing in the United States remains something of a luxury. Testing sites are crowded, and some patients still report waiting days for results. Sandoval said nurses who suspect they’ve been exposed are expected to seek out a testing site on their own, at their expense, and take unpaid time while they wait for results — in effect choosing between their paycheck and their health and potentially that of others.
“The current [presidential] administration did not focus on tests and instead focused on the vaccine,” says Mara Aspinall, a professor of biomedical diagnostics at Arizona State University. “We should have focused with the same kind of ‘warp speed’ on testing. Would we still have needed a vaccine? Yes, but we would’ve saved more lives in that process and given more confidence to people to go to work.”
After a four-month shutdown amid the pandemic’s opening wave, professional sports returned in July. More than just a contest on television, it was, in a most unusual year, a symbol of comfort and routine. But as the sports calendar has advanced and dramatic adjustments have been made, it has become nearly impossible to ignore how different everything looks, sounds and feels.
Stadiums are empty, or mostly empty, while some sports have bubbles and others just pretend their spheres are impermeable. Coaches stand on the sideline with fogged-up face shields; rosters and schedules are constantly reshuffled. On Saturday, the college football game between Clemson and Florida State was called off three hours before kickoff. Dodger Stadium, home of the World Series champions, is a massive testing site, with lines of cars snaking across the parking lot.
Sports, in other words, aren’t a distraction from a polarized nation and its response to a global pandemic. They have become a constant reminder of them.And when some nurses turn to sports for an attempt at escape, instead it’s just one more image of who gets priority for tests and, often, who does not.
“There is a disconnect when you watch sports now. It’s not the same. Covid changed everything,” says Gutierrez Vo, who works for Kaiser Permanente in Fremont, Calif. “I try not to think about it.”
Sandoval tries the same, telling herself that watching a game is among the few things that make it feel like February again. Back then, the coronavirus was a distant threat and the 49ers were in the Super Bowl.
That night, Sandoval had a shift in the ER, and between patients, she would duck into the break room or huddle next to a colleague checking the score on the phone. The 49ers were playing the Kansas City Chiefs, and Sandoval would recall that her favorite team blowing a double-digit lead represented the mightiest stress that day.
Now during shifts, Sandoval sometimes argues with patients who insist the virus that has infected them is a media-driven hoax. She masks up and wears a face shield even if a patient hasn’t been confirmed with the coronavirus, though she can’t help second-guessing herself.
“Did I wash my hands? Did I touch my glasses? Was I extra careful?” she says.
If Sandoval suspects she has been exposed, she says, she doesn’t bother requesting a test. She says the hospital will say there aren’t enough. So instead she self-monitors and loads up on vitamin C and zinc, hoping the tickle in her throat disappears. If symptoms persist, which she says hasn’t happened yet, she plans to locate a testing site on her own. But that would mean taking unpaid time, paying for costs out of pocket and staying home — and forfeiting a paycheck — until results arrive.
National Nurses United says some of its members are being told to report to work anyway as they wait for results that can take three to five days. Sutter Health, the hospital system that oversees California Pacific Medical Center, said in a statement to The Washington Post that it offers tests to employees whose exposure is deemed high-risk and to any employee experiencing symptoms. Symptomatic employees are placed on paid leave while awaiting test results, according to the statement.
“As long as an essential healthcare worker is asymptomatic,” Sutter’s statement read, “they can continue to work and self-monitor while awaiting the test result.”
Sandoval said employees have been told the hospital’s employee health division will contact anyone who has been exposed. Though she believes she’s exposed during every shift, Sandoval says employee health has never contacted her to offer a test or conduct contact tracing.
“If you feel like you need to get tested, you do that on your own,” she says. Sandoval suspects the imbalance is economic. In September, Forbes reported NFL team revenue was up 7 percent despite the pandemic. Last week Sutter Health reported a $607 million loss through the first nine months of 2020.
Sandoval tries to avoid thinking about that, so she keeps heading back to work and hoping for the best. Though she says her passion for sports is less intense now, she nonetheless likes to talk sports when a patient wears a team logo. She asks about a star player or a recent game. She says she is looking forward to the 49ers’ next contest and the 2021 baseball season.
Sometimes, Sandoval says, patients ask about her job and the ways she avoids contracting the coronavirus. She must be tested most every day, Sandoval says the patients always say.
And she just rolls her eyes and chuckles. That, she says, only happens if you’re an athlete.
As we navigate the greatest health crisis of our lifetimes, it turns out that many aspects of our experiences in 2020 aren’t as “unprecedented” as we may think. The widely varied pandemic responses by local and state officials (and resulting political polarization) occurring today also transpired over 100 years ago during the Spanish Flu.
Lessons from a century ago may be worth revisiting: the left side of the graphic above details the health and economic case for public health mitigation strategies.Cities that enacted “longer interventions” (including mask mandates, closures, business capacity restrictions, and social distancing measures) in 1918 experienced fewer deaths per capita, as well as higher employment gains through 1919, compared to “similar” cities that enacted “shorter interventions.” For example, Los Angeles, which declared a state of emergency and banned all public gatherings early in the pandemic, had 25 percent fewer deaths per capita, and a 27 percentage-point greater gain in subsequent employment than San Francisco, which mainly focused on urging residents to wear masks in public.
Fast forward to today, when we’re also seeing significant differences between COVID containment policies at the state level. The right side of the graphic shows thatstates with the weakest overall pandemic containment policies are currently experiencing the worst outbreaks, measured here by hospitalizations per capita. States like Hawaii and New York, which maintained many of the strict mitigation strategies first put into place in the spring, are seeing those restrictions pay off with fewer hospitalizations during the latest spike.
Conversely, Iowa and the Dakotas have fewer, and less stringent, public health measures, and are now seeing the highest surges in the country today. (New Mexico shows that state-level policy decisions don’t explain everything—it’s currently battling a serious outbreak despite maintaining some of the strongest containment measures over the course of the pandemic.)
As we head into the worst COVID wave so far, the debate over whether saving “lives” or “livelihoods” should dominate the pandemic response rages on.History shows that higher levels of public health intervention can both save lives and result in stronger economic recovery.
Sioux Falls, S.D.-based Sanford Health President and CEO Kelby Krabbenhoft shared his thoughts about having COVID-19 and why he won’t be wearing a mask in an email to health system staff, according to the Grand Forks Herald.
In the 1,000-word email sent Nov. 18, Mr. Krabbenhoft said he had COVID-19, but he’s now back in his office working without a mask. He said he won’t be wearing a mask because doing so would only be a “symbolic gesture.” He considers himself immune from the virus.
“The information, science, truth, advice and growing evidence is that I am immune for at least seven months and perhaps for years to come, similar to that of chicken pox, measles, etc. For me to wear a mask defies the efficacy and purpose of a mask and sends an untruthful message that I am susceptible to infection or could transmit it,” Mr. Krabbenhoft wrote. “I have no interest in using masks as a symbolic gesture when I consider that my actions in support of our family leave zero doubt to my support of all 50,000 of you. My team and I have a duty to express the truth and facts and reality and not feed the opposite.”
The CDC says those who have had COVID-19 should take steps to reduce the risk of spreading the virus, including wearing a mask in public places and staying at least 6 feet away from other people.
In his email, Mr. Krabbenhoft argues the “on-again, off-again” use of masks is absurd. “Masks have been a symbolic issue that frankly frustrates me,” he wrote.
“On the other hand, for people who have not contracted the virus and may acquire it and then spread it … it is important for them to know that masks are just plain smart to use and in their best interest,” Mr. Krabbenhoft wrote.
The health system CEO concluded his letter by sharing his optimism for the future, noting that some Sanford Health workers would be among the first to get a COVID-19 vaccine once it is available.
Sanford Health didn’t respond to Becker’s Hospital Review‘s request for comment by deadline.
Read the Grand Forks Herald article here, which includes full text of the email Mr. Krabbenhoft sent to employees.
Coronavirus cases reported in the United States passed 11 million on Sunday, as the nation shatters records for hospitalizations and daily new infections and as leaders turn to new, painful restrictions to stem the pandemic’s long-predicted surge.
The milestone came one week after the country hit 10 million cases, a testament to just how rapidly the virus is spreading — the first 1 million cases took more than three months. This new wave has increased covid-19 hospitalizations past the peaks seen in April and July, straining health-care systems and pushing some reluctant Republican governors to enact statewide mask mandates for the first time.
Other states are reenacting stay-at-home orders and store closures. Michigan Gov. Gretchen Whitmer (D) on Sunday announced sweeping new limits on gatherings for three-weeks — including a ban on indoor dining at restaurants and bars, and a halt to in-person classes at high schools and colleges. Washington Gov. Jay Inslee (D) also laid out a slew of new rules, which prohibit indoor social gatherings with people outside one’s household and indoor service at restaurants, bars and more.
“As hard as those first months were for our state, these next few are going to be even harder,” Whitmer said at a news conference, as health experts fear that winter weather driving people indoors will accelerate the crisis.
Inslee acknowledged that slowing the virus would come at a steep price for struggling businesses, even as the state works to distribute millions more in aid. He and Whitmer both appealed to the federal government to step in with more help. Congress remains deadlocked on a stimulus package, and President Trump — still denying his election loss — has largely tuned out the pandemic’s surge; his refusal to concede is also stalling the transition to a new administration, including the formal transfer of information on the nation’s pandemic response.
Whitmer said that Trump has “an opportunity to meet the needs of the people of this country” and emphasized the importance of his final months in office. Inslee was already looking ahead to the administration of President-elect Joe Biden.
“All of us who feel, as I do, the pain of the small-business people ought to be pounding the doors of the Congress and the new president, who I’m glad we’re going to have, to really get this job done,” Inslee said.
Washington’s restrictions are not as tough as its stay-at-home order issued in March but extend into nearly every aspect of daily life. Wedding and funeral receptions are forbidden. Religious services and in-store retail are forced to operate at reduced capacity. Even outdoor social gatherings must be kept to a maximum of five people from outside one’s household.
Inslee and other leaders in the state emphasized the need to intervene early amid spiraling statistics, even as Washington posts some of the lowest numbers for new coronavirus infections in the country. The number of hospital patients with covid-19 recently rose about 40 percent in a week, officials said, and Seattle’s mayor said that nearly a fifth of the city’s cases have come just in the past two weeks.
Clint Wallace, an ICU nurse in Spokane, joined Inslee at Sunday’s news conference to plead with residents for their help. He called the ICU “as busy as I’ve seen it.”
“We are exhausted,” Wallace said of health-care workers around the state.
State and local officials nationwide are reinstating restrictions to fight the virus. New Mexico and Oregon on Friday ordered extensive new statewide shutdowns, while the Navajo Nation — devastated early on by the virus — reissued its stay-at-home order for at least three weeks. The Navajo Nation said cases threaten to swamp the health system on the southwestern reservation without immediate action.
North Dakota Gov. Doug Burgum (R) on Friday issued a statewide mask mandate and new capacity limits on businesses, less than a week after Utah Gov. Gary R. Herbert (R) announced a similar mask order in the face of overwhelmed hospitals warning that they might have to ration care.
“Our situation has changed, and we must change with it,” Burgum said in a late-night video message.
But state rules are just one piece of the puzzle, and some leaders are looking to Congress and the incoming president to take stronger action.
Ron Klain, Joe Biden’s incoming chief of staff, said Sunday it’s critical for the president-elect’s transition team to start working with Trump administration officials to ensure “nothing drops in this change of power” that could imperil the distribution of a potential coronavirus vaccine.
“Joe Biden is going to become president of the United States in the midst of an ongoing crisis. That has to be a seamless transition,” Klain said on NBC News’s “Meet the Press.”
President Trump’s White House is blocking the administration from formally cooperating with Biden, forcing the president-elect’s transition team to continue preparations with recently departed government officials and other experts. That means Biden’s team has not heard from Trump’s about vaccine development and other work to combat the pandemic.
A health expert on Biden’s covid-19 advisory board said there’s “a lot of information that needs to be transmitted. It can’t wait until the last minute.”
It is in the nation’s interest that the transition team get the threat assessments that the team knows about, understand the vaccine distribution plans, need to know where the stockpiles are, what the status is of masks and gloves,” said Atul Gawande, a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School, on ABC News’s “This Week.”
Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases, compared the process Sunday to “passing a baton in a race.”
“I’ve been through multiple transitions now, having served six presidents for 36 years, and it’s very clear that transition process that we go through … is really important in a smooth handing over of the information,” Fauci said on CNN’s “State of the Union.”
“Of course it would be better if we could start working with them,” he added when asked whether working with Biden’s team would serve the public interest.
On “Meet the Press,” Klain said there is “not that much Joe Biden can do right now to change things,” because he is not yet president.
“Right now we have a crisis that’s getting worse,” Klain said. “We had never had a day with 100,000 cases in a single day until last week. By next week, we may see 200,000 cases in a single day.”
On the morning of November 7, major news networks starting with CNN called the presidential election for Joe Biden. Although the election has yet to be officially certified, Biden and Vice President-elect Kamala Harris have wasted no time preparing their response to the rapidly worsening coronavirus pandemic.
Over the past week, the US has averaged more than 150,000 new COVID-19 cases per day, an increase of 81% from the average on November 1. The US had a record 181,200 new reported cases on November 13. Over 11 million Americans have been infected, and the nation is nearing a grim milestone of 250,000 deaths. Experts warn that the worst is yet to come. As temperatures drop and family-centric holidays approach, people are likely to spend more time socializing indoors with non-household members, increasing the risk for COVID-19 transmission.
Mitigating the spread of the coronavirus and preventing more deaths are top priorities for the incoming Biden-Harris administration. Biden’s campaign team published a seven-point plan to beat COVID-19, and on November 9, the Biden-Harris transition team named a COVID-19 Advisory Council tasked with guiding the federal response to the pandemic immediately after the inauguration.
The council “will be consulting with state and local officials to gauge public-health steps needed to bring the virus under control,” Evan Halper and Noam Levey reported in the Los Angeles Times. “The board will also focus on racial and ethnic disparities in how, where, and how quickly the virus is spreading.”
Innovative Plan: Tell the Truth
The Biden-Harris plan sets a new tone for the nation’s coronavirus response, using federal powers and leadership to centralize the acquisition and distribution of personal protective equipment (PPE), along with the coordination of testing and contact tracing, instead of leaving those vital resources to be led in 50 different ways by state governors. It emphasizes evidence-based guidance and empowers public health officials and scientists to guide and revise the nation’s reopening strategy as the pandemic evolves.
“You’ll immediately see a change of tone, a change in communication,” Ezekiel Emanuel, MD, PhD, the vice provost for global initiatives at the University of Pennsylvania, told Politico.“This is the stuff of real leadership: telling the truth, modeling the right behaviors like wearing a mask, only having small crowds, putting the scientists out there.”
The first priority in the plan is to ensure that all Americans have access to regular, reliable, and free coronavirus testing. Rapid testing is vital for identifying, isolating, and treating new cases of COVID-19, but the US has been crippled by continuing test shortages and long lag times before results are reported. Biden plans to double the number of drive-through testing sites while scaling up next-generation solutions like home tests.
Contact tracing goes hand-in-hand with testing in the public health response to COVID-19, and the plan would establish a US Public Health Job Corps to train and mobilize 100,000 Americans to perform culturally competent contact tracing in communities most affected by COVID-19.
The second priority is to fix the nation’s PPE problems. N95 masks, gloves, gowns, and other PPE used by health care staff are still in short supply. AARP reported that one in four nursing homes ran short of PPE between August 24 and September 20. (Nursing homes continue to be a hot spot for coronavirus transmission.) Biden would use the Defense Production Act to increase production of PPE and distribute the supply to states instead of leaving states to fend for themselves.
For the third priority, Biden would tap the nation’s wealth of science experts to provide clear public guidance on how communities should navigate the pandemic. The US Centers for Disease Control and Prevention (CDC) would lead this effort, with an emphasis on helping communities determine when it is safe to reopen schools and various types of businesses.
Navigating Hurdles to Safe, Effective, Accepted Vaccine
Although the pharmaceutical company Pfizer announced on November 9 that its coronavirus vaccine trial showed positive early results, the road to vaccinating all Americans is tortuous. Pfizer still needs to seek emergency use authorization from the Food and Drug Administration (FDA) and ramp up vaccine production to meet the global need. In the meantime, Biden plans to invest $25 billion in a vaccine manufacturing and distribution plan that ensures every American can get vaccinated for free. This fourth priority would make the vaccine accessible to all people and communities regardless of income or any other factor.
The fifth priority is to protect Americans who are at high risk of getting seriously ill or dying from COVID-19. This includes people over 65, nursing home residents, and people living in neighborhoods with higher rates of COVID-19. Biden would establish a COVID-19 Racial and Ethnic Disparities Task Force (PDF) to report on disparities in COVID-19 infection, hospitalization, and death rates, as well as to provide recommendations to Congress and the Federal Emergency Management Agency on how best to distribute resources and relief funds to combat these disparities. The plan also calls for strengthening the Affordable Care Act to ensure that during the pandemic, Americans have health insurance coverage.
During the presidential campaign, Biden called for a national mask mandate based on the growing body of evidence that mask-wearing can considerably reduce the transmission of respiratory viruses like the one that causes COVID-19. Biden plans to coordinate with governors and mayors to convince Americans to wear a mask when they are around people outside their household. Currently, 34 states and the District of Columbia mandate face masks in public, but there is no nationwide requirement.
Finally, the plan takes the long view on pandemic threats by rebuilding and reinvesting in defenses that will help the world predict and prevent future pandemics. The Biden administration has declared that the US will rejoin the World Health Organization, restore the White House National Security Council Directorate for Global Health Security and Biodefense, which was eliminated by the Trump administration in 2018, and shore up CDC’s global corps of disease detectives.
Public Health Experts at the Helm
The newly announced COVID-19 Advisory Council is a who’s who of public health experts, former government officials, and doctors, including several from California. The panel currently comprises 13 members, but Biden has said it may be expanded.
The three cochairs of the advisory board are former surgeon general Vivek Murthy, MD; former FDA commissioner David Kessler, MD, a UCSF professor of pediatrics, and of epidemiology and biostatistics; and Marcella Nunez-Smith, MD, MPH, an associate professor of internal medicine, public health, and management at Yale University whose research focuses on health disparities.
The other members appointed so far include:
Luciana Borio, MD, vice president at the venture capital firm In-Q-It. Borio served in multiple leadership roles in the Trump and Obama administrations in the National Security Council and FDA.
Rick Bright, PhD, director of the Biomedical Advanced Research and Development Authority under Trump and Obama. Bright resigned from the government in October after being removed from his vaccine development role by President Trump.
Ezekiel Emanuel, MD, PhD, the vice provost for global initiatives at the University of Pennsylvania. Emanuel served in the Obama administration as special advisor for health policy to Peter Orszag, PhD, the former director of the Office of Management and Budget.
Atul Gawande, MD, MPH, a professor at Harvard Medical School and the Harvard T.H. Chan School of Public Health. Gawande is a staff writer covering health and medicine at the New Yorker and served in the Clinton administration as senior adviser in the Department of Health and Human Services.
Eric Goosby, MD, a professor of medicine at UCSF. Goosby, an expert on HIV/AIDS, led policy work in this field under Clinton and Obama.
Celine Gounder, MD, a clinical assistant professor of internal medicine and infectious diseases at New York University.
Julie Morita, MD, executive vice president of the Robert Wood Johnson Foundation and former commissioner of the Chicago Department of Public Health.
Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Loyce Pace, MPH, president and executive director of the Global Health Council.
Robert Rodriguez, MD, a professor of emergency medicine at UCSF.
Public health experts are sounding the alarm about the trajectory of the pandemic in the United States as the coronavirus spreads through the country largely unabated and officials muse aloud about the possibility of fresh lockdowns.
The experts use different language to underscore the situation’s urgency: Former Centers for Disease Control and Prevention director Tom Frieden said the nation is experiencing a “dangerous time.” CNN chief medical correspondent Sanjay Gupta called the crisis a “humanitarian disaster.” Epidemiologist Michael Osterholm, who was recently named to President-elect Joe Biden’s coronavirus task force, described the situation bluntly as “covid-hell.”
Their warnings come amid widespread fatigue with restrictions, even as the virus is nowhere near finished rampaging across the country. Although several states implemented new mitigation measures this week, many people have been letting down their guards or, in some cases, vowing outright to ignore the rules.
Fourteen states, mostly in the Midwest, had reported record numbers of hospitalizations by midday Thursday as the seven-day average number of cases reached highs in 23 states, from Nevada to Maryland, according to data tracked by The Washington Post. Hospital officials predicted that they could soon face excruciating decisions about how to prioritize care as they run short on beds and staff.
“Our hospitals are full,” Megan Ranney, an emergency medicine professor at Brown University, said in an interview. “Our workers are getting sick. And it is simply overwhelming the system.”
The rapid rise in hospitalizations could foreshadow a long period of rising deaths,said Scott Gottlieb, former director of the Food and Drug Administration. Although improvements in care have pushed the mortality rate below 1 percent in the United States, 1,549 people died of the virus Wednesday, the highest toll since April.
The distribution of hospitalizations across the country means it will be hard for health-care workers from one region of the country to serve as backup in another area, Gottlieb wrote on Twitter. The only slightly reassuring news is that most hospitals have not entered true crisis mode, he said Thursday on CNBC’s “Squawk Box.”
“Every hospital system is a little pressed right now,” Gottlieb said. “There’s only a handful that are really overwhelmed: Wisconsin, parts of Texas, Utah, South and North Dakota.”
But the trends suggest that that could change. Osterholm said ballooning numbers of infections nationwide mean more hospitals could soon look like those in El Paso, where health-care workers are bringing in mobile morgues and airlifting patients to other cities.
“We have to tell the story of what’s coming; people don’t want to hear that El Paso isn’t an isolated event,” he told Yahoo Finance on Thursday. “It will become the norm.”
Frieden tweeted that the United States has entered “the exponential phase” of virus spread and that the situation will worsen significantly before it improves. But he emphasized that policy decisions have an impact, and throwing in the towel is the wrong solution.
“Not all of the US is experiencing the same rate of Covid spread — some states are doing much better than others,” he wrote. “For example, South Dakota (the state with the highest rate) has 100 times more spread than Vermont right now.”
Individual decisions also make a difference, Gottlieb said, especially as people prepare to travel and visit people outside their household for Thanksgiving. The transmission of the virus tracks closely with people’s movement in their communities.
“If people on the whole just go to the store one less time a week, you could substantially reduce spread,” Gottlieb said on “Squawk Box.”
The lack of that kind of self-sacrifice is one factor that Ranney said she believes is contributing to the virus surging to a far greater extent than it did in the spring. New rules from local and state governments, such as curfews, have been relatively mild compared to the widespread shutdowns of March and April.
The holiday season, meanwhile, is a looming danger that Ranney expects will lead to a “deadly” spike in infections. The virus’s prevalence across the country means that this is the worst time for people to increase their risk of transmission by attending family-centric celebrations, she said.
The likelihood that there will be an easily available vaccine next year is the light at the end of the tunnel. But in the meantime, Ranney said people need to fight the urge to pretend that life is normal and instead seek ways to socialize more safely — outdoors, at a distance and while wearing masks.
“A vaccine is coming. This is not forever,” she said. “But right now, we’ve got to stop this chain of transmission.”
HENRY KOTULA 