Category Archives: Health Policy

Testing Falls Woefully Short as Trump Seeks an End to Stay-at-Home Orders

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Coronavirus Testing Falls Woefully Short as Trump Seeks to Reopen ...

As President Trump pushes to reopen the economy, most of the country is not conducting nearly enough testing to track the path and penetration of the coronavirus in a way that would allow Americans to safely return to work, public health officials and political leaders say.

Although capacity has improved in recent weeks, supply shortages remain crippling, and many regions are still restricting tests to people who meet specific criteria. Antibody tests, which reveal whether someone has ever been infected with the coronavirus, are just starting to be rolled out, and most have not been vetted by the Food and Drug Administration.

Concerns intensified on Wednesday as Senate Democrats released a $30 billion plan for building up what they called “fast, free testing in every community,” saying they would push to include it in the next pandemic relief package. Business leaders, who participated in the first conference call of Mr. Trump’s advisory council on restarting the economy, warned that it would not rebound until people felt safe to re-emerge, which would require more screening.

And Gov. Andrew M. Cuomo of New York reiterated his call for federal assistance to ramp up testing, both for the virus and for antibodies.

“The more testing, the more open the economy. But there’s not enough national capacity to do this,” Mr. Cuomo, a Democrat, said at his daily briefing in Albany. “We can’t do it yet. That is the unvarnished truth.”

As the governor spoke, a PowerPoint slide behind him said, “WE NEED FEDERAL SUPPORT.”

At his own briefing later in the day, Mr. Trump boasted of having “the most expansive testing system anywhere in the world” and said that some states could even reopen before May 1, the date his task force had tentatively set. Twenty-nine states, he added, “are in good shape.”

From the beginning of the coronavirus crisis, lapses by the federal government have compromised efforts to detect the pathogen in patients and communities. A diagnostic test developed by the Centers for Disease Control and Prevention proved to be flawed. The F.D.A. failed to speed approval for commercial labs to make tests widely available. All of that means that the U.S. has been far behind in combating the virus.

Whether in New York City, with its densely packed 8.4 million residents, or Nebraska, with fewer than two million spread across mostly rural expanses, widespread diagnostic and antibody testing will be crucial for determining a number of factors: How many in a community are infected but asymptomatic? Who has the protective antibodies that might allow them to go about their lives without fear? Are workplaces and schools safe?

“It is great that we are flattening the curve,” said Dr. Mark McClellan, director of the Margolis Center for Health Policy at Duke University, who worked in the George W. Bush administration and is advising state and federal policymakers on the virus response.

“But for this next phase, where we are really aiming to detect and stamp out smaller outbreaks before they get so big, testing is critical for that,” he said. “So we have to plan ahead now for much larger capacity.”

By the end of May, he added, “we will maybe be up to two million tests a week, but we are definitely not at that level now.”

Nationally, an average of 145,000 people have been tested for the virus each day over the past week, according to the Covid Tracking Project, which reported a total of nearly 3.1 million tests across the United States as of Tuesday night.

State health officials and medical providers around the country say they are unable to test as many people as they would like. Many of them say the biggest challenge is getting not the diagnostic tests themselves but the supplies to process them, including chemical reagents, swabs and pipettes. Manufacturers are facing a huge global demand as every country fights the pandemic, with many attempting the widest-scale testing they have ever undertaken.

“We’re at a really critical juncture and the supply chain has not yet caught up,” Scott Becker, chief executive of the Association of Public Health Laboratories, said on Wednesday.

Yet even as people waited hours for drive-through testing in California, Florida, New Jersey and elsewhere, some laboratories reported having ample capacity.

Two weeks ago, officials at University of California San Diego Health rushed to scale up testing, setting up a second laboratory devoted only to Covid-19. “You know the saying, ‘If you build it, they will come’?” said Dr. David T. Pride, director of the molecular microbiology laboratory there. “We built it and nobody has come. ” He said confusion over which laboratories were accepting tests, and “convoluted” systems connecting providers to labs, meant his facilities were running about 200 to 300 tests per day when they could handle 1,000.

Quest Diagnostics, one of the nation’s biggest testing laboratories, said on Wednesday that it could now process more tests than it was receiving, and that it was reaching out to state health departments, doctors and nursing homes. After dealing with backlogs for weeks, the company said it was returning results in less than two days for ordinary patients, and in less than one day for priority patients.

In Nebraska, as of Wednesday afternoon, 11,757 people had been screened for Covid-19, and of those, 901 were positive, according to state health data.

Peter C. Iwen, director of the Nebraska Public Health Laboratory, said that chemicals and equipment needed to run the tests were going to places like New Orleans and New York. “We’re trying to compete with those people, and we’re just not getting the reagents sent to us,” he said in an interview with the Omaha television station KETV.

The nonprofit Community Health of South Florida is operating three drive-through sites in the Miami area and the Florida Keys, where it has provided free testing to 1,300 people.

Tiffani Helberg, the group’s vice president for communications, said a tight supply of testing swabs as well as staffing numbers meant the nonprofit was not screening as many people as it would like.

“Is it a struggle every day? Absolutely,” she said.

The lack of testing is hitting minority communities especially hard, according to Dr. James E.K. Hildreth, president and chief executive of Meharry Medical College in Nashville, one of the nation’s largest historically black medical schools.

“Testing should be a priority for vulnerable populations — that would be prisons, nursing homes, assisted living facilities and, last but not least, minorities and disadvantaged communities,” said Dr. Hildreth, an infectious disease expert. “Because in those communities, we know there are many individuals with underlying conditions, and they are more likely to get severe disease and die.”

But even as short supplies are limiting who can get tests, some laboratories say they have extra capacity.

The American Clinical Laboratory Association, a trade group representing large diagnostic companies like LabCorp and Quest, has recently reported a dip in the daily testing volumes of its members. On Monday, its members processed 43,000 tests, the lowest number since March 20. At one point in early April, members were processing more than 100,000 a day.

“They are reaching out to providers to make sure they know that we have more testing capacity,” said Julie Khani, president of the lab association.

But even as testing for active coronavirus infections is struggling to meet demand, public health officials and major laboratories say they are gearing up for the next wave: antibody testing. A well-designed antibody test will detect whether someone has been exposed to the virus and generated an immune response, and whether the person may be protected from further illness.

“Antibody testing is not a cure-all,” Gov. Doug Ducey of Arizona, a Republican, said on Tuesday as he announced a partnership with the University of Arizona to provide antibody tests for 250,000 health care workers and emergency responders. “But learning more about it is an important step to identifying community exposure, helping us make decisions about how we protect our citizens and getting us to the other side of this pandemic more quickly.”

Most of the available antibody tests can say only whether someone has antibodies, not how many they have or how powerful they are at fighting the virus. Many of the tests are also flawed and signal the presence of antibodies even when there are none. The F.D.A. has granted emergency approval to three companies to begin selling the tests, but dozens more have entered the market after the agency loosened the guidelines in March.

“We have to to make sure it’s an accurate test with good specificity,” said Dr. Rachel Levine, Pennsylvania’s health secretary. “And we really need to know that antibodies are truly protective and how long-lasting they are.”

Dr. Jon R. Cohen, the executive chairman of BioReference Laboratories, which is processing tests at drive-through sites in New York and New Jersey and other locations around the country, said he was still evaluating different antibody tests but planned to begin offering them soon. Other large laboratories said the same.

“It’s a huge factor, we believe, in terms of people regaining confidence and jump-starting the economy,” he said. “To me, it’s an absolute moral imperative.”

 

 

 

 

 

 

Another 5.2 million jobless claims filed last week amid coronavirus crisis

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Arrow

Another 5.2 million Americans filed for unemployment last week, the Labor Department announced Thursday.

Why it matters: With the more than 16 million jobless claims filed over the past three weeks, more jobs have now been lost in the last month than were gained since the Great Recession.

The big picture: The weekly unemployment filings report has become a must-watch for Wall Street and economists. It offers the timeliest glimpse into how efforts to contain the coronavirus outbreak are ravaging the job market.

  • And economists say that as bad as these weekly numbers look on the surface, they’re likely even higher. There are widespread complaints that state labor departments are having trouble processing the never-before-seen wave of jobless filings.

The bottom line: In just one month, the coronavirus economic shutdown has caused a staggering 22 million Americans to lose their jobs.

 

 

 

Medical supply scramble continues

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What's Really To Blame For Drug Shortages

The U.S. is still scrambling to get health care workers the personal protective equipment, ventilators and lab testing materials that they need.

Between the lines: President Trump has repeatedly said that governors are responsible for obtaining supplies for their states, but industry groups are asking the federal government to play a larger role.

  • The American Medical Association asked FEMA to create a national system to acquire and distribute personal protective equipment, in light of ongoing shortages.
  • David Skorton, president and CEO of the Association of American Medical Colleges, wrote a letter to coronavirus task force coordinator Deborah Birx asking for more federal help with diagnostic testing supply shortages.

Meanwhile, the private sector is shifting into gear on its own and in partnership with the government.

  • The Trump administration and 20 major health care systems launched a new ventilator loan program that will allow hospitals to ship unused machines to areas where they are needed most to fight the coronavirus pandemic, Axios’ Joann Muller reports.
  • General Motors started manufacturing ventilators on Tuesday under a $489.4 million federal contract. But it will take until August to produce all 30,000 the government ordered under the Defense Production Act.
  • Space-focused organizations around the U.S. are now looking to manufacture ventilators and other much-needed health equipment to aid the pandemic relief effort, Axios’ Miriam Kramer reports.

1 scary stat: Prescription drugs needed by patients on ventilators are being filled only 53% of the time so far in April, as demand has skyrocketed, according to Vizient, a health care purchasing group.

 

 

 

 

Newly uninsured can turn to stable ACA market

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Stable costs but more uninsured as 'Obamacare' sign-ups open

People losing their employer-based health insurance in the coronavirus economy would find a pretty stable Affordable Care Act market if they need it — not that the Trump administration is advertising that fact, Bob writes.

Why it matters: ACA plans will be an important backstop for some newly uninsured people, many of whom could likely find affordable coverage on the law’s insurance marketplaces.

Where it stands: The average monthly premium for ACA coverage was down 3% in this year’s enrollment period, compared with 2019, according to a federal report that was released earlier this month but not publicly promoted.

  • That average monthly premium is $595, but the overwhelming majority of enrollees get a subsidy to help cover those costs — and people who have just lost a job could be eligible for those.
  • Some people “could get paid to buy ACA plans” right now because of looming insurance company rebates, according to Duke University health insurance researcher David Anderson.

Yes, but: You won’t hear much about those options from the Trump administration, which has been consistently hostile to the ACA and has declined to open up a special enrollment window that would let anyone who has been disrupted by the economic shutdown to buy coverage.

 

 

 

 

California governor unveils roadmap for relaxing coronavirus lockdowns

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California governor unveils roadmap for relaxing coronavirus ...

California Gov. Gavin Newsom released a roadmap on Tuesday that will guide how he will make the decision to relax the stay-at-home policies his state implemented to combat the spread of the coronavirus.

The big picture: While there is no timeline for modifying the stay-at-home order, Newsom’s office said California would use a “gradual, science-based and data-driven framework” to determine when it would be safe to do so. Newsom indicated efforts to flatten the curve in California “have yielded positive results.”

  • California had 24,421 confirmed cases of COVID-19 as of Tuesday afternoon, per the LA Times.
  • On Monday, Newsom announced California would create a task force with Oregon and Washington to coordinate the reopening of the regional economy. Northeastern states have announced a similar plan.

Details: Newsom said California would use six indicators to determine when to relax social distancing measures:

  1. “The ability to monitor and protect our communities through testing, contact tracing, isolating, and supporting those who are positive or exposed.”
  2. “The ability to prevent infection in people who are at risk for more severe COVID-19.”
  3. “The ability of the hospital and health systems to handle surges.”
  4. “The ability to develop therapeutics to meet the demand.”
  5. “The ability for businesses, schools, and child care facilities to support physical distancing.”
  6. “The ability to determine when to reinstitute certain measures, such as the stay-at-home orders, if necessary.”

Newsom’s roadmap also notes that life will be different even after stay-at-home orders are eased. For example, restaurants will likely reopen with fewer tables and face coverings will be more common in public.

What he’s saying: “While Californians have stepped up in a big way to flatten the curve and buy us time to prepare to fight the virus, at some point in the future we will need to modify our stay-at-home order,” Newsom said.

  • “As we contemplate reopening parts of our state, we must be guided by science and data, and we must understand that things will look different than before.”
  • “There is no light switch here. Think of it as a dimmer. It will toggle between less restrictive and more restrictive.”

 

 

 

 

We can’t just flip the switch on the coronavirus

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The end of the coronavirus lockdown won't be like flipping a ...

It feels like some big, terrible switch got flipped when the coronavirus upended our lives — so it’s natural to want to simply flip it back. But that is not how the return to normalcy will go.

The big picture: Even as the number of illnesses and deaths in the U.S. start to fall, and we start to think about leaving the house again, the way forward will likely be slow and uneven. This may feel like it all happened suddenly, but it won’t end that way.

What’s next: Nationally, the number of coronavirus deaths in the U.S. is projected to hit its peak within the next few days. But many big cities will see their own peaks significantly later — for them, the worst is yet to come.

  • The White House is eyeing May 1 as the time to begin gradually reopening the economy. But that also will not be a single nationwide undertaking, and it will be a halting process even in the places where it can start to happen soon.
  • “In principle it sounds very nice, and everyone wants to return to normalcy. I think in reality it has to be incredibly carefully managed,” said Claire Standley, an infectious-disease expert at Georgetown University.

The future will come in waves — waves of recovery, waves of more bad news, and waves of returning to some semblance of normal life.

  • “It’s going to be a gradual evolution back to something that approximates our normal lives,” former Food and Drug Administration Commissioner Scott Gottlieb said.

What the post-lockdown world will look like:

  • Some types of businesses will likely be able to open before others, and only at partial capacity.
  • Stores may continue to only allow a certain number of customers through the door at once, or restaurants may be able to reopen but with far fewer tables available at once.
  • Some workplaces will likely bring employees back into the office only a few days a week and will stagger shifts to segregate groups of workers from each other, so that one new infection won’t get the whole company sick.
  • Large gatherings may need to stay on ice.

And there will be more waves of infection, even in areas that have passed their peaks.

  • “Everything doesn’t just go down to zero” once a city or region gets through its initial crush of cases, said Janet Baseman, a professor of epidemiology at the University of Washington.
  • This is happening now in Singapore, which controlled its initial outbreak more effectively than almost any other country in the world but is now seeing the daily number of new cases climb back up.

This is all but inevitable in the U.S., too, especially as travel begins to pick back up. Some places may need to shut down again, or at least tighten back up, if these new flare-ups are bad enough.

  • Part of the reason to lock down schools, businesses and workplaces is to prevent an outbreak from overwhelming the local health care system. If new cases start to pile up too quickly, leaders may need to pump the brakes.
  • “If you go back to normal too fast, then cases start to go up quickly, and then we end up back where we started,” Baseman said.
  • The good news, though, is that hospitals should have far more supplies by the fall, thanks to the coming surge in manufacturing for items like masks and ventilators.

What we’re watching: We’ll still need a lot more diagnostic testing to make this process work. Public health officials need to be able to identify people who might be spreading the virus before they begin to feel sick, and then identify the people they may have infected.

  • Most of the U.S. does not seem prepared for that undertaking, at least on any significant scale.
  • Another kind of test — serology tests, which identify people who have already had the virus and may be immune to it — will also help. We can’t test everyone, but identifying potential immunity could be important in knowing who can safely return to work in high-risk fields like health care.

The real turning point won’t come until there’s a proven, widely available treatment or, even better, a widely available vaccine.

  • A vaccine is still about a year away, even at a breakneck pace and if everything goes right. A treatment isn’t likely to be available until the fall, at the earliest.
  • In the meantime, all we can do is try to manage a slow recovery, using a less aggressive version of the same tools that are in place today.

The bottom line: “I’m not going back to Disneyland, I’m not going to take a cruise again, until we have a very aggressive testing system or we have very effective therapeutics or a vaccine,” Gottlieb said.

 

 

 

 

Bill Gates, in rebuke of Trump, calls WHO funding cut during pandemic ‘as dangerous as it sounds’

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Bill Gates: Trump halting funding to World Health Organization ...

Microsoft co-founder Bill Gates criticized President Trump’s decision to suspend funding to the World Health Organization as “dangerous,” saying the payments should continue particularly during the global coronavirus pandemic.

“Halting funding for the World Health Organization during a world health crisis is as dangerous as it sounds,” Gates tweeted early Wednesday. “Their work is slowing the spread of COVID-19 and if that work is stopped no other organization can replace them. The world needs @WHO now more than ever.”

The United States, the organization’s largest donor, has committed to provide the WHO with $893 million during its current two-year funding period, a State Department spokesperson told The Washington Post.

The Bill & Melinda Gates Foundation, the family’s giant philanthropy, is the next biggest donor to WHO after the U.S., accounting for close to 10 percent of the United Nations agency’s funding.

As The Washington Post’s Anne Gearan reported, the president said on Tuesday that the halt in U.S. funding would continue for a period of 60 to 90 days “while a review is conducted to assess the World Health Organization’s role and severely mismanaging and covering up the spread of the coronavirus.”

“We have not been treated properly,” Trump said at the Tuesday news briefing. He added, “The WHO pushed China’s misinformation about the virus.”

It remains unclear whether the United States will cut off money to the main international organization, or if Trump is setting conditions for a resumption of U.S. payments at a later date, The Post reported.

The announcement looms as a potentially devastating blow to the agency during the coronavirus pandemic, as the United States’ donations make up nearly 15 percent of all voluntary donations given worldwide.

The criticism from Gates, whose foundation has committed up to $100 million as part of the global response to the pandemic, comes as Trump has attempted to deflect blame for the administration’s failure to respond vigorously and early to the deadly novel coronavirus.

Also defending the WHO was U.N. Secretary General António Guterres, who, while not naming Trump, said it was “not the time to reduce the resources for the operations of the World Health Organization or any other humanitarian organization in the fight against the virus.”

“Now is the time for unity and for the international community to work together in solidarity to stop this virus and its shattering consequences,” he said.

Others, such as the American Medical Association, called Trump’s announcement to cut WHO funding “a dangerous step in the wrong direction.”

“Cutting funding to the WHO — rather than focusing on solutions — is a dangerous move at a precarious moment for the world,” the organization said in a statement. “The AMA is deeply concerned by this decision and its wide-ranging ramifications, and we strongly urge the President to reconsider.”

While some of Trump’s conservative allies are focusing on the WHO as complicit in a Chinese coverup of the outbreak, others have urged the president to hold off on moving forward on suspending funding.

“If the president wants to genuinely hold the WHO accountable, counter Chinese efforts to shift blame for COVID-19, and reform the WHO to better respond to the next pandemic, he should not cut funding — at least not yet,” wrote Brett D. Schaefer, an expert at the conservative Heritage Foundation and member of the U.N.’s Committee on Contributions.

It isn’t the first time that Gates has questioned the country’s response to the pandemic. In a TED interview last month, Gates, while not mentioning Trump by name, suggested the push to relax social distancing to reopen the country was reckless.

“There really is no middle ground, and it’s very tough to say to people: ‘Hey, keep going to restaurants, go buy new houses, ignore that pile of bodies over in the corner. We want you to keep spending because there’s maybe a politician who thinks GDP growth is all that counts,’” Gates said. “It’s very irresponsible for somebody to suggest that we can have the best of both worlds.”

In a March 31 op-ed for The Post, Gates emphasized that while the U.S. lost valuable time in getting out ahead of its response, there was still a path forward for recovery through decisions made by “science, data and the experience of medical professionals.”

“There’s no question the United States missed the opportunity to get ahead of the novel coronavirus. But the window for making important decisions hasn’t closed,” Gates wrote. “The choices we and our leaders make now will have an enormous impact on how soon case numbers start to go down, how long the economy remains shut down and how many Americans will have to bury a loved one because of covid-19.”

 

 

 

 

Hospitals will need a Bailout

Posted on by • Posted in 2020 Election Issues, Cash, Cash Reserves, Cash-Flow Improvements, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Economy, Health Policy, Health System, Hospital, Hospital Bailout, Hospital Bankruptcy, Hospital Closure, Hospital Industry, Operating Expenses, Operating Income, Operating Margin, Operating Performance, Operating Revenue, Pandemic • Leave a comment

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We Tracked the Last Time the Government Bailed Out the… — ProPublica

The CEO of Kaleida Health in Buffalo, N.Y., said hospitals will likely need a bailout due to COVID-19, according to local news station WGRZ.

Kaleida Health President and CEO Jody Lomeo highlighted parallels between hospitals and U.S. automakers during the Great Recession. 

“I would think there’s gonna have to be some reimbursement on some level and we’ve seen some of that already with the [recent federal] stimulus bill. We’re gonna need support,” he told WGRZ. He added that his health system “can survive for a couple of months; after that I would be really nervous.”

While federal stimulus funds have begun flowing to hospitals nationwide, hospital CEOs are blasting HHS’ decision to distribute the first $30 billion in emergency funding based on Medicare fee-for-service revenue. HHS said April 10 it would allocate money to hospitals and providers based on their historical share of revenue from the Medicare program, rather than the burden caused by the coronavirus or number of uninsured patients treated.

 

 

 

 

Trump sparks GOP backlash with claim of ‘total’ power to reopen the country

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Constitution, Coronavirus, Crisis, Crisis Management, Governance, Health Policy, Leadership, Pandemic, Public Health, Public Safety, State Governors, System of Checks and Balances, Total Authority • Leave a comment

Trump sparks GOP backlash with claim of ‘total’ power to reopen the country

Yes, Undocumented Students Have Rights Under the U.S. Constitution ...

President Trump‘s claim that he has “total” authority to decide when and how to reopen parts of the country shuttered by the coronavirus is sparking congressional backlash, including from members of his own party.

Trump, speaking during a White House press briefing Monday, said he has the “authority” to force governors, who have been issuing the stay-at-home orders, to reopen schools, businesses and other institutions in their state.

But GOP lawmakers, as well as Democrats, fired back Tuesday, sending a warning shot to Trump that under the Constitution he does not have unlimited powers. They also warned against overreaching.

“The constitution doesn’t allow the federal gov’t to become the ultimate regulator of our lives because they wave a doctor’s note,” Sen. Rand Paul (R-Ky.) tweeted Tuesday.

“Powers not delegated are RESERVED to states & the PEOPLE. If we dispense with constitutional restraints, we will have more to worry about than a virus,” added Paul, who has also been critical of governors he views as going too far during the pandemic.

Sen. Marco Rubio (R-Fla.) said that while the Centers for Disease Control and Prevention (CDC) and the White House would be providing guidelines, the Constitution and “common sense” dictate that decisions about when to reopen shuttered parts of the country are made at the state level.

“It’s going to be the governors that are going to make decisions about when certain activities are allowed. …That is the appropriate place where I think some of these orders will begin to be modified,” Rubio said, adding that the federal guidance would be “influential.”

Rep. Liz Cheney (R-Wyo.) didn’t directly mention Trump but tweeted on Monday night that “the federal government does not have absolute power.”

Republicans were joined by Democrats, and some governors, as well as Rep. Justin Amash (I-Mich.), who left the Republican Party last year.

Amash and Democratic Reps. Tom Malinowski (N.J.) and Dean Phillips (Minn.) unveiled a one-page resolution on Tuesday that states “when someone is the president of the United States, their authority is not total.”

“State governments are not local branches of the federal government; they have different powers and functions. Putting one government in charge of everything does not strengthen our system; it weakens our system and makes everyone more vulnerable to serious errors,” Amash added in a tweet.

When, and how, to reopen shuttered parts of the country has emerged as a key point of debate within the government.

Trump has appeared eager to reopen the country sooner rather than later as the coronavirus has wrecked havoc on the U.S. economy months before the 2020 election.

He’s expected to announce a panel on Tuesday that will be tasked with determining the criteria for lifting coronavirus restrictions.

Governors of six northeast states announced on Monday they were forming a group to create joint recommendations on how to reopen their economies.

Democratic senators are planning to introduce legislation to create a 10-15 member panel that would be responsible for coming up and implementing a plan to reopen closed parts of the country.

 

 

 

 

Fauci at center of conservative storm

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Fauci at center of conservative storm

Health Official condemns Senator Ron Johnson's false equivalency ...

Criticism of Anthony Fauci from the right has picked up in recent days, with some conservatives calling for Trump to dump the infectious disease expert after he made comments about how imposing social distancing rules earlier could have slowed the spread of the novel coronavirus in the United States.

Fauci has become a national name with his regular presence at the daily coronavirus task force briefings and in other media appearances, and poll numbers show he’s trusted by a majority of Americans. It would set off a political storm if Trump were to sideline him in the middle of a pandemic.

Yet the criticism of Fauci by two conservative lawmakers in a Saturday op-ed and Trump’s own retweet of a conservative’s call to “#FireFauci” were unmistakable signs that the public health official is coming under pressure from some on the right to be loyal to the president. 

Tensions between Fauci and Trump have been evident at times in recent weeks. The doctor put his head in his hand at one March briefing where the president quipped about the “Deep State Department,” and Trump stepped in at a briefing this month before Fauci could give his opinion on hydroxychloroquine.

The president had publicly praised Fauci as “extraordinary” and dismissed speculation about a rift between the two, joking on Friday that Fauci is so popular he could run against Rep. Alexandria Ocasio-Cortez (D-N.Y.) and “win easily.” For the most part Fauci has seemed to successfully walk the line between contradicting Trump without outright criticizing him. 

But Trump’s tweet on Sunday marked a shift and coincided with a fresh groundswell of conservative push-back toward the doctor as Trump comes under intense criticism for his slow response to the virus.

Some of the more pointed criticism of Fauci came after he said on CNN Sunday that more lives could have been saved if stay-at-home measures were implemented earlier than mid-March.

The comments irked Trump allies who viewed them as revisionist history given how Fauci’s own public statements evolved throughout January and February as scientists learned more about the virus and it spread through the U.S.

Jason Miller, a former Trump adviser who now hosts a radio show focused on the pandemic, said Fauci must be careful with how he talks about the crisis, but also described “finger pointing” as media chatter seeking to pull the administration apart.

“This talk of potential removal from the team is unnecessary media chatter trying to draw a divide where one doesn’t exist,” Miller said.

“I think what this is about is about the accuracy with which Dr. Fauci is communicating with both the president and the American people,” he added. “It’s critical as the lead scientist and health expert advising the president on the coronavirus pandemic that he be spot on with his details. I think the recent finger pointing and revisionist history whether intentional or accidental doesn’t help anybody.”

One source close to the administration said, while some inside would like to see Fauci gone, most recognize there is more value to keeping him on.

“I don’t sense there’s a monolithic view,” the person said. “There are some who dislike him and want him out of the [administration] but I think most recognize it’s better for him to be in the tent than outside of it.” 

Fauci’s CNN remarks followed a New York Times article detailing how Trump ignored early warnings about the virus and initially resisted recommendations to implement social distancing recommendations, reporting that Trump has dismissed as “fake.”

One of Trump’s many tweets Sunday night defending his response quoted a former GOP congressional candidate who said it was “time to #FireFauci,” citing his Feb. 29 comments that there was not yet a need for Americans to alter their day-to-day lives.

Fauci has been clear that his realm of expertise is public health, and he has suggested at times that social distancing guidelines will be needed for weeks or months to limit the spread of the virus.

Others inside and outside the administration are advocating that it take steps to open up the economy soon, and emphasizing that health experts can’t be the only voices involved in the decision.

“Anthony Fauci should be deferring to the President when answering questions about timing of economic reopening,” Fox News host Laura Ingraham tweeted on Sunday.

Reps. Andy Biggs (R-Ariz.) and Ken Buck (R-Colo.) penned an op-ed in the Washington Examiner over the weekend arguing that Fauci should not be a primary voice speaking on the coronavirus outbreak after the public health official late last month described social distancing as an “inconvenient” from societal and economic standpoint.

The criticism of Fauci comes amid a concerted effort among Trump and his supporters to shift blame away from the White House for its handling of the coronavirus, which has infected more than 557,000 people in the U.S. and killed more than 22,000 in the country. The president has at various points blamed governors for failing to prepare for the pandemic, deflected criticism toward the World Health Organization (WHO) and accused Democrats of using impeachment as a distraction.

Fauci, director of the National Institute of Allergy and Infectious Diseases since 1984, has been a ubiquitous presence during the coronavirus outbreak, appearing on political talk shows, sports podcasts and Instagram live chats.

He has emerged as something of a beacon for liberals in particular for his willingness to gently correct Trump on matters like a timetable for a vaccine and the efficacy of hydroxychloroquine, an anti-malaria drug the president has touted as a potential treatment for the coronavirus.

But his prominence has made him a target of criticism, so much so that he was given added security at the end of March.

One feature of Trump’s presidency has been his distrust of long-time government officials, particularly those who have served in previous administrations. Another has been Trump’s tendency to tire of aides and advisers who garner more of a spotlight than he does, putting Fauci in a precarious position even at a time when his expertise is most relevant.

Trump would have difficulty firing Fauci, who is not a political appointee, without cause. Attempting to do so would cause a firestorm among even some Republicans who have urged the president to listen to his health experts.

But one former administration official suggested Fauci could see his influence reduced. The official likened it to the way Health and Human Services (HHS) Secretary Alex Azar has been diminished after he warned Trump in January and February about the threat of a pandemic but was dismissed as too alarmist.

“What happens when somebody repeatedly tells the president something he doesn’t want to hear?” said the former administration official, who requested anonymity to speak candidly. “He won’t fire [Fauci], but he’ll just sideline him.”

But doing so could risk damaging public confidence in the administration’s response to the virus. 

A Monmouth University poll released last week found that 35 percent of Americans named Fauci when asked who they trust the most among public officials who discuss the outbreak on television, whereas 20 percent named Trump. 

“Regardless of the issue, [Trump is] not always his most disciplined messenger,” said GOP strategist Doug Heye. “The more that he’s able to rely on the expertise of scientists, the more credibility that it gives him in this entire process.”