Mask shortage for most health-care workers extended into May, Post-Ipsos poll shows

https://www.washingtonpost.com/health/mask-shortage-for-most-health-care-workers-extended-into-may-post-ipsos-poll-shows/2020/05/20/1ddbe588-9a21-11ea-ac72-3841fcc9b35f_story.html?fbclid=IwAR3rcjsPTuDjJODTBeJTRCqqJ4RbMTmWTih5jP91Vy9pn_S4NzWcVErobbY&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Feds uncover an alleged scheme to fraudulently sell 39 million N95 ...

Front-line health-care workers still experienced shortages of critical equipment needed for protection from the coronavirus into early May — including nearly two-thirds who cited insufficient supplies of the face masks that filter out most airborne particles, according to a Washington Post-Ipsos poll.

More than 4 in 10 also saw shortages of less protective surgical masks and 36 percent said their supply of hand sanitizer was running low, according to the poll. Roughly 8 in 10 reported wearing one mask for an entire shift, and more than 7 in 10 had to wear the same mask more than once.

The dire shortage of personal protective equipment for health-care workers emerged in March as one of the earliest signals of the country’s lack of preparation for the coronavirus pandemic. Nurses and others have said they were forced to put their own health at risk caring for highly infectious patients because they lacked adequate supplies, in particular N95 masks, which filter out 95 percent of airborne particles.

Image without a caption

State governments and medical facilities went to extraordinary lengths to obtain, preserve, sanitize and reuse masks designed to be disposed after a single use if necessary. Health authorities asked a frightened public not to worsen the shortage by snapping them up.

The Post-Ipsos poll may provide the clearest nationwide measure to date of the shortages during those weeks, when the virus surged through parts of the country, overwhelming some hospitals in New York City and placing others across the nation under tremendous strain. The survey interviewed a national sample of 8,086 U.S. adults, including 278 people who work with patients in health-care settings, such as doctors’ offices, clinics, hospitals and nursing homes. The poll was conducted from April 27 to May 4; results among health workers have a 6.5-point margin of sampling error.

“Covid hit like a tidal wave. We went from nothing to insanity,” said Ronnie Dubrowin, a certified nurse midwife from Connecticut who responded to the poll. “It was like one week no one had heard of this disease and the next week everybody had it.”

Dubrowin, who sees obstetric patients in two hospitals and one office setting, said masks were in such short supply during the early days of the outbreak that she resorted to heating hers in an oven to kill the virus.

“Getting protective gear was difficult for everybody,” Dubrowin said. “It became a mission of so many people in hospital settings to get protective gear for their employees.”

Despite shortages, 75 percent of the health-care workers said their employer was doing enough to ensure their safety. They also gave high marks to state officials, with 71 percent approving of their governor’s handling of the crisis.

They had much less confidence in President Trump. A 59 percent majority disapproved of his handling of the coronavirus pandemic, while 41 percent approved.

Nearly a third of health workers said they believe restrictions were being lifted too quickly in late April and early May. A slim majority, 53 percent, said state governments are handling the pandemic about right, and 15 percent felt restrictions are not being lifted quickly enough. Those views are roughly similar to those of the general public, as are the ratings of Trump and governors.

Long Vinh, a pediatrician who works in the neonatal intensive care units at two San Francisco-area hospitals, said at the beginning of the outbreak some steps were taken to preserve masks, out of fear there might be a shortage. Now, he says there are no shortages of masks, gowns or other protective equipment at those hospitals: California Pacific Medical Center and Mills-Peninsula Medical Center.

“I really feel that being in the Bay Area, we were blessed and fortunate to have both a wealth of hospital capacity and resources and political leadership that took the crisis seriously,” he said.

Vinh said that while he had some concerns of an overall shortage early on, “I never felt like I was put into a situation where I might have a covid exposure where I wouldn’t have all the protection I need.”

The survey showed that more than 7 in 10 health-care workers expressed concern about exposing members of their household to the virus after coming in contact with it at work, and roughly half were regularly changing out of clothing before entering their homes. About a third said someone at their workplace has been infected by the coronavirus. A 58 percent majority said it is likely they have been exposed at work.

One woman, who works in a small, residential mental-health treatment center in Minnesota, said she and other workers are not provided masks, though they are seeing adults who come from hospitals and elsewhere and who could be infected.

The woman, a counselor who spoke on the condition of anonymity to discuss decisions made by her employer, said she is concerned about bringing the virus home to her young child.

“We have some capacity to social-distance . . . but with the size of our facility and the office space availability, I’d say 80 percent of the time that’s not possible,” she said.

More than three-quarters of health workers felt that people appreciated their efforts, and a similar proportion said someone has thanked them for their work since the outbreak began.

Just over 1 in 10, or 12 percent, of health-care workers said they do not have health insurance themselves. More than 6 in 10 have paid sick leave, though over 3 in 10 do not and the rest were not sure.

And the financial outlook for many is shaky. Nearly half of health-care workers, 48 percent, were at least somewhat concerned about paying their bills.

The Post-Ipsos poll was conducted through Ipsos’s KnowledgePanel, a large online survey panel recruited through random sampling of U.S. households.

 

 

 

All 50 states have partially reopened; U.S. death toll surpasses 90,000

https://www.washingtonpost.com/nation/2020/05/20/coronavirus-update-us/?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most

NC coronavirus update May 18: Wake County leaders meet to discuss ...

Ready or not, the United States is reopening. All 50 states have started easing coronavirus-related restrictions — even though many of them do not meet federal benchmarks — leading public health experts to warn that a new surge of infections could be imminent.

As the U.S. death toll surpassed 90,000, White House officials continued to defend the push to reopen and optimistically predicted a swift economic recovery. As part of the focus on states’ efforts to revive their economies, Vice President Pence on Wednesday traveled to Florida while Trump was set to host the governors of Arkansas and Kansas at the White House.

Here are some significant developments:

  • Trump ramped up his rhetoric against China, claiming on Twitter that the nation’s “incompetence” was responsible for “this mass Worldwide killing!” Secretary of State Mike Pompeo also denounced China as a “brutal authoritarian regime” and described its relationship with the director of the World Health Organization as “troubling.”
  • A worker at a mink farm in the Netherlands may have contracted the novel coronavirus from an animal there, the country’s agricultural minister said. If confirmed, this is would be first recorded incident of animal-to-human transmission. 
  • A church in Houston and another in Georgia are closing for a second time after faith leaders and congregants tested positive for the virus shortly after the two churches reopened.
  • The president drew criticism for saying Tuesday it’s “a badge of honor” that America leads the world with more than 1.5 million confirmed cases of the novel coronavirus because “it means our testing is much better.” The United States has more than 30 percent of the world’s known coronavirus infections but accounts for less than 5 percent of the global population.
  • The Centers for Disease Control and Prevention laid out a detailed, delayed road map for reopening schools, child-care facilities, restaurants and mass transit, weeks after governors began opening states on their own terms.
  • The president privately expressed opposition to extending unemployment benefits for workers affected by the pandemic.

 

 

 

 

Fitch Q2 outlook for nonprofit hospitals: ‘worst on record’

https://www.healthcaredive.com/news/fitch-analysts-hospital-worries-FY-2020/577875/

Nicklaus Children's Health System Receives A+ Rating from Fitch ...

From the Mayo Clinic to Kaiser Permanente, nonprofit hospitals are posting massive losses as the coronavirus pandemic upends their traditional way of doing business.

Fitch Ratings analysts predict a grimmer second quarter: “the worst on record for most,” Kevin Holloran, senior director for Fitch, said during a Tuesday webinar.​

Over the past month, Fitch has revised its nonprofit hospital sector outlook from stable to negative. It has yet to change its ratings outlook to negative, though the possibility wasn’t ruled out.

Some have already seen the effects. Mayo estimates up to $3 billion in revenue losses from the onset of the pandemic until late April — given the system is operating “well below” normal capacity. It also announced employee furloughs and pay cuts, as several other hospitals have done.

Data released Tuesday from health cost nonprofit FAIR Health show how steep declines have been for larger hospitals in particular. The report looked at process claims for private insurance plans submitted by more than 60 payers for both nonprofit and for-profit hospitals.

Facilities with more than 250 beds saw average per-facility revenues based on estimated in-network amounts decline from $4.5 million in the first quarter of 2019 to $4.2 million in the first quarter of 2020. The gap was less pronounced in hospitals with 101 to 250 beds and not evident at all in those with 100 beds or fewer.

Funding from federal relief packages has helped offset losses at those larger hospitals to some degree.

Analysts from the ratings agency said those grants could help fill in around 30% to 50% of lost revenues, but won’t solve the issue on their own.

They also warned another surge of COVID-19 cases could happen as hospitals attempt to recover from the steep losses they felt during the first half of the year.

Anthony Fauci, the nation’s top infectious disease expert, warned lawmakers this week that the U.S. doesn’t have the necessary testing and surveillance infrastructure in place to prep for a fall resurgence of the coronavirus, a second wave that’s “entirely conceivable and possible.”

“If some areas, cities, states or what have you, jump over these various checkpoints and prematurely open up … we will start to see little spikes that may turn into outbreaks,” he told a Senate panel.

That could again overwhelm the healthcare system and financially devastate some on the way to recovery.

“Another extended time period without elective procedures would be very difficult for the sector to absorb,” Holloran said, suggesting if another wave occurs, such procedures should be evaluated on a case-by-case basis, not a state-by-state basis.

Hospitals in certain states and markets are better positioned to return to somewhat normal volumes later this year, analysts said, such as those with high growth and other wealth or income indicators. College towns and state capitols will fare best, they said.

Early reports of patients rescheduling postponed elective procedures provide some hope for returning to normal volumes.

“Initial expectations in reopened states have been a bit more positive than expected due to pent up demand,” Holloran said. But he cautioned there’s still a “real, honest fear about returning to a hospital.”

Moody’s Investors Service said this week nonprofit hospitals should expect the see the financial effects of the pandemic into next year and assistance from the federal government is unlikely to fully compensate them.

How quickly facilities are able to ramp up elective procedures will depend on geography, access to rapid testing, supply chains and patient fears about returning to a hospital, among other factors, the ratings agency said.

“There is considerable uncertainty regarding the willingness of patients — especially older patients and those considered high risk — to return to the health system for elective services,” according to the report. “Testing could also play an important role in establishing trust that it is safe to seek medical care, especially for nonemergency and elective services, before a vaccine is widely available.”

Hospitals have avoided major cash flow difficulties thanks to financial aid from the federal government, but will begin to face those issues as they repay Medicare advances. And the overall U.S. economy will be a key factor for hospitals as well, as job losses weaken the payer mix and drive down patient volumes and increase bad debt, Moody’s said.

Like other businesses, hospitals will have to adapt new safety protocols that will further strain resources and slow productivity, according to the report.​

Another trend brought by the pandemic is a drop in ER volumes. Patients are still going to emergency rooms, FAIR Health data show, but most often for respiratory illnesses. Admissions for pelvic pain and head injuries, among others declined in March.

“Hospitals may also be losing revenue from a widespread decrease in the number of patients visiting emergency rooms for non-COVID-19 care,” according to the report. “Many patients who would have otherwise gone to the ER have stayed away, presumably out of fear of catching COVID-19.”

 

 

 

States brace for ‘nearly certain’ Medicaid budget shortfalls amid COVID-19

https://www.healthcaredive.com/news/states-brace-for-nearly-certain-medicaid-budget-shortfalls-amid-covid-19/578120/

Coronavirus updates: Virus reaches all 50 states, stock futures fall

Dive Brief:

  • Most states with budget projections expect Medicaid shortfalls due to rising spending as more people lose jobs and enroll into the safety net insurance for low-income Americans due to the COVID-19 pandemic, according to a new Kaiser Family Foundation survey.
  • Almost all states with enrollment projections and more than half with spending projections expect program growth to surpass pre-pandemic estimates. Nearly all states anticipate growth will accelerate even more in the 2021 fiscal year, KFF found. As a result of that growth, 17 of 19 states with budget projections report a shortfall is “nearly certain” or “likely” for the upcoming fiscal year.
  • The survey comes as Congress once again considers raising the federal match rate for Medicaid in the $3 trillion Health and Economic Recovery Omnibus Emergency Solutions Act, passed by the House of Representatives on Friday.​

Dive Insight:

Medicaid is often the top line spending item in state budgets, sending states scrambling for ways to reduce spend in the safety net health insurance program, including controversial block grants for funding.

At the start of the 2020 fiscal year, states anticipated modest Medicaid spending growth, and flat enrollment growth due to the strong economy. That forecast quickly shifted as the coronavirus spread in the U.S., which lost some 21 million jobs in April as businesses shutter their doors in compliance with stay-at-home orders, sending the unemployment rate to 15%.  

Because the U.S. generally couples coverage to employment, skyrocketing job loss could make an estimated 17 million people newly eligible for Medicaid and 6 million eligible for subsidies in the Affordable Care Act marketplaces by January 2021.

Medicaid officials from 38 states shared their budget projections with KFF for the survey. States that did not respond were still gathering data about the coronavirus or didn’t have updated enrollment or spending projections for the 2020 or 2021 fiscal years, KFF researchers Robin Rudowitz and Elizabeth Hinton said.

Thirty-two of 34 states with enrollment projections think enrollment will exceed initial projections in 2020, and 30 of 31 states anticipate that growth in 2021 will outpace the current fiscal year.

States are more mixed on spending projections. Over half of states with projections, 18 of 32, expect 2020 Medicaid spending to exceed pre-pandemic estimates. Eight states anticipate no change, and the remaining six project slightly lowered spending due to lower healthcare utilization as non-essential services have largely ground to a halt.

State Medicaid officials are more in lockstep when it comes to 2021 spending projections. Nearly all states with projections — 29 of 30 — think Medicaid spending rates in 2021 will increase over 2020.

Without greater support from the federal government, the survey hints states will face significant spending cuts for Medicaid for the upcoming fiscal year, which begins July 1 for most states. Multiple groups, including the National Governors Association and the National Association of State Medicaid Directors, have called for a higher federal match rate.

One of the first legislative packages designed to mitigate the fallout of COVID-19, the Families First Coronavirus Response Act passed March 18, authorized a 6.2 percentage point increase in the rate for Medicaid if states meet certain requirements. States can’t increase premiums or restrict eligibility standards and must cover COVID-19 testing and treatment without cost-sharing.

The HEROES Act passed by Democrats in the House on Friday would increase the match rate by 14 percentage points from July 1, 2020, through June 30, 2021, along with benchmarking an additional $100 billion for providers.

However, Senate Majority Leader Mitch McConnell, R-Ky., and President Donald Trump have said they’re in no rush to pass another round of legislation adding to the more than $3 trillion Congress has approved so far.

 

 

 

 

Jay Powell warns US recovery could take until end of 2021

https://www.ft.com/content/2ed602f1-ed11-4221-8d0b-ef85018c96ea

Fed Makes Second Emergency Rate Cut to Zero Due To Coronavirus ...

Fed chair says economy may not fully bounce back until virus vaccine is available.

Federal Reserve chair Jay Powell has warned that a full US economic recovery may take until the end of next year and require the development of a Covid-19 vaccine.

“For the economy to fully recover, people will have to be fully confident. And that may have to await the arrival of a vaccine,” Mr Powell told CBS News on Sunday. A full revival would happen, he said, but “it may take a while . . . it could stretch through the end of next year, we really don’t know”.

He added: “Assuming there is not a second wave of the coronavirus, I think you will see the economy recover steadily through the second half of this year.”

Mr Powell told CBS it was likely there would be a “couple more months” of net job losses, with the unemployment rate climbing to as high as 20-25 per cent. But he said it was “good news” that the “overwhelming” majority of those claiming unemployment benefits report themselves as having been laid off temporarily, meaning they are expecting to go back to their old jobs.

Oil prices and stocks in Asia rose on Monday despite the gloomy outlook. West Texas Intermediate, the US crude benchmark, climbed 4.4 per cent to take it above $30 a barrel for the first time in two months. Brent crude, the international benchmark, rose 3.6 per cent to $33.67 a barrel. Japan’s Topix was up 0.4 per cent and China’s CSI 300 index of Shanghai- and Shenzhen-listed stocks added 0.6 per cent.

Donald Trump, US president, said last week that he hoped to have a vaccine ready by the end of 2020. But public health experts, including Anthony Fauci, the head of the US National Institute of Allergy and Infectious Diseases, and Rick Bright, the recently ousted head of the US Biomedical Advanced Research and Development Authority, have warned that the process is likely to take longer.

Dr Fauci, a high-profile member of Mr Trump’s coronavirus task force, has said he expects the search for a vaccine to take at least a year to 18 months. But Dr Bright has said that was too optimistic.

Some world leaders have also raised doubts about the immediate prospects for a vaccine. Giuseppe Conte, prime minister of Italy, said at the weekend that his country could “not afford” to wait for a vaccine, while Boris Johnson, UK prime minister, warned that a vaccine “might not come to fruition” at all.

Mr Powell said that while lawmakers had “done a great deal and done it very quickly”, Congress and the Fed may need to do more “to avoid longer-run damage to the economy”.

The Fed chair said fiscal policies that “help businesses avoid avoidable insolvencies and that do the same for individuals” would position the US economy for a strong recovery post-crisis.

Mr Powell also reiterated his position against using negative interest rates, something Mr Trump has called for. The Fed chair told CBS that the Federal Open Market Committee had eschewed negative interest rates after the last financial crisis in favour of “other tools” such as forward guidance and quantitative easing.

The US Congress has already approved nearly $3tn of economic relief measures intended to support struggling businesses and individuals, but there is growing consensus in Washington that more fiscal stimulus will be needed — even if Democrats and Republicans are divided over how to dole out federal funds.

Late on Friday, the Democrat-controlled House of Representatives passed Nancy Pelosi’s plan for $3tn in new stimulus spending.

Mr Trump has repeatedly called for the next stimulus to include a cut to payroll taxes — deductions for entitlements such as social security and Medicare. Last week, Larry Kudlow, the top White House economic adviser, suggested that lower corporate taxes and looser business regulation should be part of any future relief package.

The Trump administration has taken a more bullish stance on the US economic recovery than Mr Powell, with White House officials repeatedly insisting that the economy will bounce back before the end of the year.

Mr Powell told CBS it was a “reasonable expectation that there will be growth in the second half of the year” but “we won’t get back to where we were by the end of the year”.

 

 

 

 

 

Fed’s Powell warns unemployment could reach Depression-level 25 percent

https://www.politico.com/news/2020/05/17/powell-unemployment-depression-25-percent-264500

Fed's Powell warns unemployment could reach Depression-level 25 ...

The Fed chief expressed hope that the economy would come out of recession in the second half of the year.

Federal Reserve Chair Jerome Powell on Sunday warned that the nation’s unemployment rate could soar to 25 percent during the worst of the coronavirus crisis, though he said the economy should recover more quickly than during the Great Depression, when joblessness last reached those levels.

“Those numbers sound about right for what the peak may be,” Powell said on CBS’ “60 Minutes” after reporter Scott Pelley asked whether unemployment could reach 20 percent or even 25 percent.

His remarks came just days after the central bank released a survey showing that one in five American workers lost their jobs in March — including almost 40 percent of those in lower-income households.

The Fed chief expressed hope that the economy would come out of recession in the second half of the year, but cautioned that a second outbreak of the coronavirus could derail that path.

“This economy will recover,” he said. “We’ll get through this. It may take a while. … It could stretch through the end of next year. We really don’t know.”

The central bank has taken extraordinary measures to rescue the economy since the pandemic began sweeping through the country — slashing interest rates to zero, rolling out trillions of dollars in lending programs for financial markets, and taking the unprecedented step of bailing out state and city governments.

“There’s really no limit to what we can do with these lending programs,” Powell said. “There’s a lot more we can do to support the economy, and we’re committed to doing everything we can as long as we need to.”

He said the economy stands a good chance of bouncing back more quickly than in the 1930s.

“When the Depression, well, when the crash happened and all that, the financial system really failed,” Powell said. “Here, our financial system is strong.”

But he took the opportunity to again warn that Congress will need to spend more to prevent long-lasting damage, even after U.S. lawmakers have shelled out trillions of dollars for American businesses and consumers.

The most important policy objectives should be to “keep workers in their homes, keep them paying their bills,” he said. “Keep families solvent so that when this comes, we come out the other end of this, we’re in a position to have a strong recovery.”

 

 

 

 

The coronavirus economy could make a Medicare buy-in more popular

https://www.axios.com/coronavirus-economy-unemployment-medicare-health-insurance-85d23c97-4ad6-486d-b081-a46bdd2b894b.html

Coronavirus-driven layoffs may boost calls for a Medicare buy-in ...

The economic disruption caused by the coronavirus pandemic could help create a much stronger push to let some older Americans buy into Medicare.

By the numbers: 2.4 million adults between the ages of 55 and 64 lost their jobs just since March, bringing the unemployment rate in this group to 12.5% — up from 3.4% in March.

Between the lines: Many of these people will struggle to find affordable coverage, and a slow recovery will leave many without job-based health coverage for a long time.

  • Medicaid will cover many of the newly uninsured, though not in states that haven’t expanded the program. The Affordable Care Act will help many others maintain coverage, but those plans often come with high deductibles. COBRA is available to people who lost jobs that offered insurance, but it’s often prohibitively expensive.

Millions of uninsured 55-65 year-olds could add new urgency to calls for a Medicare buy-in if Democrats control the White House and Congress in 2021.

  • Narrower options consistently poll better than more sweeping expansions of public coverage, and older adults are a politically powerful group.

Where it stands: The leading Medicare buy-in plan in Congress would allow people who are older than 50 to purchase Medicare coverage, with a subsidy for low-income enrollees similar to the subsidies in the Affordable Care Act.

  • Former Vice President Joe Biden has proposed a different twist: He would simply lower Medicare’s eligibility age from 65 to 60, without a buy-in.

Yes, but: All the old fault lines would still be at play if such an effort got serious consideration.

  • Some Democrats prefer Medicare for All. Republicans and hospitals have typically opposed all Medicare expansions.

The bottom line: The more dire the economic and health insurance circumstances of 55-64 year olds turns out to be, the greater the urgency for an early -in to Medicare is likely to become.

 

 

 

 

Cartoon – 100% Tax Cut Today

Recruiting. Talent Management | HENRY KOTULA

Quantifying the massive blow to hospital volumes

https://mailchi.mp/f4f55b3dcfb3/the-weekly-gist-may-15-2020?e=d1e747d2d8

Even after hearing dozens of reports from health systems about how steep their COVID-related volume losses have been, we were still floored by this analysis from healthcare analytics firm Strata Decision Technology, documenting a 55 percent drop in patients seeking hospital care across the country.

The report, which analyzed data from 228 hospitals in 51 health systems across 40 states, found that no clinical service line was immune from steep volume losses. The graphic below shows volume loss by service line in March-April 2020 compared to the same period in 2019.

Unsurprisingly, ophthalmology, gynecology, ortho/spine and ENT—all specialties with a high portion of elective cases, and heavily dependent on procedures—saw volume declines of greater than 70 percent. But even obstetrics and neonatology (which we expected to be “pandemic proof”) and infectious disease (which we thought might be busier in the throes of COVID-19) saw losses of 20-30 percent.

Looking at specific procedures, complex elective surgeries like spinal fusion and hip and knee replacements were almost completely obliterated. Precipitous declines in encounters for chronic diseases like coronary heart disease and diabetes (down 75 and 67 percent, respectively) and cancer screenings (a 55 percent decline in breast health and a 37 percent decline in cancer care overall) point to the likelihood of worrisome disease exacerbations, and a future full of more complex patients.

The volume losses, plus a 114 percent rise in uninsured patients, led to average two-week losses of $26.5M per health system across the study’s cohort. Strata will continue to track and publish volume changes, but this early snapshot paints a bleak picture of staggering financial hits, and “lost” patient care that will carry lasting ramifications for the health of communities nationwide.

 

 

 

 

Seven weeks into coronavirus lockdowns, Fed has a new, darker message

https://www.yahoo.com/news/seven-weeks-coronavirus-lockdowns-fed-182614531.html

Seven weeks into coronavirus lockdowns, Fed has a new, darker ...

One Thursday morning seven weeks ago, Federal Reserve Chair Jerome Powell made a rare appearance on NBC’s “Today Show” to offer a reassuring message to Americans dealing with economic fallout from measures to contain the coronavirus outbreak.

There is “nothing fundamentally wrong with our economy,” Powell told viewers, while pointing out the U.S. central bank’s outsized ability to take on lending risk and provide a financial “bridge” over the temporary economic weakness the country was experiencing.

Speaking after the Fed cut interest rates to near zero and rolled out a plan to backstop credit for small- and mid-sized companies, Powell emphasized the first order of business was to get the virus under control.

“The sooner we get through this period and get the virus under control, the sooner the recovery can come,” said Powell, echoing remarks made the day before by Anthony Fauci, a top U.S. health official helping to coordinate the federal government’s response to the coronavirus crisis.

At the time, Powell said he expected economic activity would resume in the second half of the year, and maybe even enjoy a “good rebound.”

But on Wednesday, he offered a much more sober outlook.

In an interview webcast by the Peterson Institute for International Economics, Powell warned of an “extended period” of weak economic growth, tied to uncertainty about how well the virus could be controlled in the United States. “There is a sense, growing sense I think, that the recovery may come more slowly than we would like,” he said.

Fauci, the director of the National Institute of Allergy and Infectious Diseases, was similarly somber when he told lawmakers earlier this week that the country was by no means in “total control” of the outbreak.

“There is a real risk that you will trigger an outbreak that you may not be able to control and, in fact, paradoxically, will set you back, not only leading to some suffering and death that could be avoided, but could even set you back on the road to try to get economic recovery,” Fauci said.

The pandemic has killed more than 83,000 people in the United States so far, and many epidemiological models now point to a death toll that will surpass 100,000 in a matter of weeks.

Overall new cases of the virus continue to climb as well, as states end lockdowns and reopen local economies without the widespread, uniform testing and contact tracing policies that helped stamp out initial outbreaks in South Korea and Germany.

UNCERTAIN FUTURE

Powell’s remarks on Wednesday mirrored warnings this week from a clutch of regional Fed presidents who outlined the country’s uncertain future.

U.S. central bank officials, and especially the Fed chief, historically choose their words carefully, to avoid alarming or exciting investors or causing swings in financial markets, making their universally dour outlook more remarkable.

St. Louis Fed President James Bullard said the situation could lead to a new Great Depression, with millions of so-far temporary job losses becoming permanent, and businesses failing “on a grand scale.”

“We have to get better at this and get more risk-based with our health policy,” Bullard said.

The U.S. economy can return to growth in the second half of the year, Cleveland Fed President Loretta Mester said on Tuesday, with more testing and contact tracing. If that happens, she said, “as some of the stay-at-home restrictions are lifted, the economy will begin to grow again in the second half of this year and unemployment will begin to move down.”

However, a more pessimistic scenario, in which a surge in infections requires businesses to shut down again or the crisis leads to more bankruptcies or instability in the banking sector, is “almost as likely,” she said.