“We would like to warn everyone not to drop their guard even for a second in epidemic prevention control; we must be prepared for a prolonged fight with the virus,” Xu Hejian, a spokesman for the Beijing municipal government, said at a news conference Saturday.
“We have to stay alert to the risks of imported cases and to the fact that epidemic control in our city is complicated and serious and will be here for a long time,” he said.
https://www.insider.com/expert-us-is-in-an-unsure-moment-with-coronavirus-2020-6
Dr. Michael Osterholm, the director of the Center for Infectious Disease Research and Prevention, said Sunday that the US is in an “unsure moment” as states reopen and new cases emerge.
“We have to be humble and say we’re in an unsure moment,” Osterholm said on “Fox News Sunday,” adding that states across the country are in varied stages of the pandemic as 22 have recorded an increase in coronavirus cases, eight in plateaus, and 21 with decreasing cases.
Osterholm was speaking as states have been reopening businesses for weeks, Americans flocked to warm weather, and widespread protests drew people to the streets in cities across the country. The first few weeks of June have seen sharp rises in new cases and hospitalizations.
The US hit a grim milestone two weeks into June as it marked more than 2 million infected and 115,000 dead from the virus. Centers for Disease Control and Prevention predicted on June 12 that the US coronavirus death toll could increase to 130,000 by July 4.
“About 5% of the US population has been infected to date with the virus, this virus is not going to rest until it gets to about 60% or 70%,” Osterholm said. “When I say rest, I mean just slow down, so one way or another we’re going to see a lot of additional cases.”
The expert told host Chris Wallace that the increase cannot only be attributed to increasingly available testing, and it’s too early to tell if protests have been a source of widespread infections, but early data suggests not.
“These next weeks, the two weeks are going to be the telling time, we just don’t know,” he said. “We’re not driving this tiger, we’re riding it.”
“My biggest concern is if cases start to disappear across the country, suggesting we are in a trough” that would lead to a second wave of the virus, Osterholm said.
Dr. Anthony Fauci has recently downplayed concerns that the recent rise in cases of the novel coronavirus in the US doesn’t a “second spike” of infections, and a seasonal resurgence was “not inevitable.”
Though Fauci told CNN on June 12 that indicators like hospitalizations could still spell concern for officials, increased testing and CDC capabilities could counter a possible resurgence in cases.
As the industry braces for the next phase of COVID-19, experts at Kaiser Permanente are sharing several key capabilities that will be critical to prepare for another potential surge.
In an article for NEJM Catalyst, leaders at the healthcare giant highlight eight focus areas health systems must consider as the country reopens and offer a look at how Kaiser Permanente tackled those challenges.
A critical starting point, they write, is a robust testing program that feeds into essential contact tracing and monitoring of any spikes in cases. As of May 18, Kaiser Permanente has performed more than 233,706 diagnostic tests and is also tracking the spread telephonically through its call centers as well as secure emails between patients and doctors.
The Oakland, California-based system is also mulling greater use of patient symptom surveying and harnessing data within electronic health records to further enhance the testing effort, according to the article.
Stephen Parodi, M.D., executive vice president at The Permanente Federation and Kaiser Permanente’s national infectious disease leader, told Fierce Healthcare that the goal of the paper is to spotlight how crucial it is to consider all fronts in preventing the spread of COVID-19.
“I think one of the biggest takeaways here is that we need a complete and comprehensive approach to suppress the virus,” Parodi, one of the report’s lead authors, said.
Bechara Choucair, M.D., senior vice president and chief health officer at Kaiser Permanente, is also one of the paper’s lead authors.
The other capabilities included in the report are:
Parodi said two of the biggest challenges Kaiser Permanente faced in working through this checklist of capabilities were a lack of supplies and the need to work alongside other organizations.
He said that didn’t only mean strengthening and reinforcing existing relationships with community groups but also reaching out to other health systems and providers to coordinate plans and work together.
It also required coordination between officials and policymakers at all levels of government, he said.
“Having the leaders at individual medical centers working with the county level folks is really key to making sure that we’re aware of each other’s work and response, then actually syncing them together,” Parodi said.
Parodi also said that Kaiser Permanente went “wholesale” into using telehealth during the initial surge of COVID-19 cases, and now the system and its physicians will be working together to determine where virtual care is most appropriate and effective, as the interest in and growth of those services isn’t going away anytime soon.
He added that moving into the reopening phase poses its own set of challenges, because it’s an “unprecedented” situation to navigate.
Kaiser Permanente is aiming to center shared decision-making and patient education in the response to reopening, he said, while also providing guidance to support providers. That way, decisions are ultimately made by the doctor and patient, but they’re informed and guided decisions, he said.
“There is no set playbook for how to do it right,” Parodi said.
In Rhode Island, officials have proactively tested all of the state’s 7,500 nursing home residents, including those with no symptoms, and are developing plans to test more people in high-risk workplaces, such as restaurants and grocery stores.
The wide range of approaches across the country comes as the federal government has offered little guidance on the best way to test a broad swath of the population, leaving state public health officials to wrestle on their own with difficult questions about how to measure the spread of the virus and make decisions about reopening their economies.
Faced with conflicting advice from experts in the field, states are using different tests that vary in reliability and have adopted a variety of policies about who else should get tested and when — particularly when it comes to asymptomatic people who are considered low-risk for the illness.
“The states are on their own,” said Kelly Wroblewski, director of infectious diseases at the Association of Public Health Laboratories, noting that the kind of guidance the federal government routinely gives in screening for flu and other outbreaks “has been absent” in the covid-19 pandemic. “There has been no coordination.”
That means that while tests are available to anyone who wants them in states such as Kentucky and Georgia and some large cities such as Detroit and Los Angeles, state officials in Idaho and Louisiana continue to recommend that only sick people get tested.
The lack of a unified national strategy has left Americans uncertain about whether and how to be tested and is hampering reopening plans, experts warn.
Many officials now worry that protests in more than 100 U.S. cities in recent days after the death of George Floyd in police custody, which have drawn thousands of people packed closely together, could spark new infections.
So far, about 460,000 Americans are being tested a day — 0.15 percent of the population, and still shy of the 900,000 to 30 million that experts say need to be tested daily to capture the extent of the virus’s spread.
“The case numbers we’re seeing are probably massively undercounted,” said Divya Siddarth, a researcher who helped devise a testing strategy for Harvard University’s Safra Center that emphasizes finding and suppressing the disease in areas with fewer cases. “These [lower prevalence] regions are likely to reopen, and they’ve barely done any tests.”
The lack of clear information is forcing businesses large and small, schools, universities and professional sports organizations to make their own decisions about how much testing they need to be safe.
Some institutions have announced their own plans for universal testing. The National Hockey League, for example, has said it plans to test all players daily as part of a plan to resume play in June. The University of Arizona has developed its own antibody test that’s available to all students and local health-care workers.
Under a law passed earlier this year, the Trump administration is required to develop a national testing strategy. But an 81-page document submitted to Congress by the Department of Health and Human Services late last month was not released publicly and offered few detailed recommendations.
The Washington Post obtained a copy of the plan, which set a goal for states of testing at least 2 percent of their residents in May and June. But how to meet that benchmark and whether to go further was left up to state leaders who were required to submit plans this month to HHS for review.
The Centers for Disease Control and Prevention has recommended universal testing for residents of nursing homes, which have been especially hit hard by the coronavirus. But the HHS document said the CDC was still working on guidelines for other large populations of mostly asymptomatic people — including at universities, prisons and “critical infrastructure worksites” — as well as those for integrating testing into reopening work places.
Mia Palmieri Heck, a spokeswoman for HHS, said the federal government “has provided prescriptive criteria about testing asymptomatic individuals when they affect highly vulnerable populations such as individuals who live in nursing homes, working in or visiting health-care clinics or communal dining spaces.” She added that federal experts have also been advising states on developing plans to more broadly test people without symptoms to determine community spread.
The question of asymptomatic testing is particularly tricky given that the CDC late last month said that its researchers now believe as many as 35 percent of people infected with the coronavirus never show symptoms of disease.
Typifying the kind of conflicting information facing states, a World Health Organization official sparked global confusion on Monday when she said it is “very rare” for people with no symptoms to transmit the disease. After significant pushback from researchers, the official said Tuesday that scientists continue to believe that people without symptoms do in fact spread the virus — but more research is needed to understand by how much.
She noted that some modeling shows as much as 41 percent of transmission may be due to asymptomatic people.
“In some ways, this may be the Achilles’ heel of the entire testing challenge for this virus,” said Ashish Jha, director of the Harvard Global Health Institute, who has advocated for increasing the number of people getting tested.
Local and state health officials worry that the lack of coherent strategy could result in tests becoming widely available for the affluent, while remaining limited for those with fewer resources, including minority communities that have already been disproportionately affected by the virus.
At the University of Arizona, officials plan to reserve molecular swab tests, which determine if a person is currently infected, for symptomatic students and their contacts. Each test is about $50 to $75 dollars; there are 60,000 students, staff and faculty and each would have to be tested repeatedly.
“Maybe the NFL can afford that; we can’t, and I don’t know any university that can,” said Robert C. Robbins, the university’s president.
When coronavirus cases began to mount in March, a severe shortage of test kits and supplies meant tests were sharply rationed. Even after it was clear that the virus was spreading in the United States, the CDC at first recommend only testing people who had visited China or been in contact with someone who had.
Later, federal officials suggested that younger, healthy people did not necessarily need testing even if they were experiencing coronavirus symptoms, reasoning that the tests should be reserved for hospitalized patients for whom a positive result might make a difference in treatment plan.
As tests have become more available, officials have begun to recommend that anyone who is experiencing signs of illness, even a mild cough or sore throat, get one.
The goal is to identify and quarantine people with the disease, and then use contact tracers to track down people who have interacted with that person and quarantine them as well.
“Testing is just part of a comprehensive strategy,” former CDC director Tom Frieden said. “As you emerge from that sheltering situation, you box the virus in.”
But when it comes to testing people without symptoms, state recommendations vary.
About at least half of states aim to test people identified as contacts of known positive cases, according to a Post tally, as was recommended in new guidance from the CDC this week. But many others tell those people to self-isolate for 14 days.
“Every state is figuring this out on its own, little bit by little bit,” said Philip Chan, medical director for the Rhode Island Department of Health.
Nearly all states have set aside thousands of tests for people in congregate settings — residential settings where large numbers of people live in proximity, especially nursing homes and prisons.
But only a handful of states have so far satisfied the CDC goal to test everyone living in a nursing home, where the age and underlying medical conditions of residents make them especially vulnerable to covid-19 outbreaks.
Some states have also prioritized testing front-line health-care workers and other people working elbow-to-elbow in manufacturing facilities, particularly meatpacking plants, which have been hit hard by the virus.
Even states that have conducted widespread testing in such facilities face difficult questions about whether a single round of testing is sufficient, given that people could easily contract the virus at any time, including after testing negative.
“There’s not a lot of communication between the states and there’s not a lot of specifics, so everybody’s kind of going on their own,” Wroblewski said.
A number of states and large cities, such as Detroit and Los Angeles, have opened drive-through testing sites like those offered in Maryland, a mode of mass testing used effectively overseas in South Korea and elsewhere.
Experts have warned that drive-through sites often fail to collect enough information from those tested to follow up effectively. They also prioritize people who choose to show up, tending to mean tests go to better educated and informed residents and not necessarily those most likely to have been exposed to the virus.
In Macon, Ga., the Moonhanger Group set up drive-through testing for employees returning to work at their four restaurants. But they did not wait for the results, or for all employees to get tested, before reopening on May 26.
“We were confident, based on the low number of positive results reported in Bibb county, that none of our employees would test positive and we hoped to share that news with the public,” owner Wes Griffith wrote on Facebook. “Unfortunately and surprisingly, we have employees who have tested positive. All of them were a-symptomatic.” Griffith did not respond to a request for comment.
Three of the four restaurants had to quickly close again, pending further testing.
In Georgia, public officials are advertising on radio and social media to encourage anyone to get tested at drive-through sites.
Those tested have included political leaders, who got tested largely to encourage others to do so too, only to find themselves “shocked” when their results came back positive, said Phillip Coule, chief medical officer of the Augusta University Health System, which is partnering with the state on testing.
“It’s a great demonstration of how tricky this disease is,” he said.
Other states have downplayed asymptomatic testing as unreliable or a poor use of resources.
Coule noted that the message, “If you want a test, you can get a test,” puts the onus for deciding who should get tested on individuals, rather than prioritizing the highest-risk or the most vulnerable. One of his patients, he noted, sought a test because he wanted to honeymoon in St. Lucia and needed a negative result to enter the country.
Oregon only opened testing to front-line workers and long-term care residents without symptoms in April and continues not to recommend asymptomatic testing, saying on the state website that it is “not useful” because the false negative rate is high. Viral tests have been estimated to have up to a 20 percent false negative rate.
At a recent news conference, Oregon Health Authority Chief Medical Officer Dana Hargunani said people without symptoms are “unlikely or certainly less likely to cause transmission of the virus.”
For states looking to figure out who to test and when, advice from national experts has been abundant — but not always consistent.
Proposals from academics and other experts vary widely in their recommendations of the numbers of tests that should be performed each day, and many do not offer guidance about who should be tested.
Some researchers have recommended focusing on parts of the country that have few cases in hopes of stamping out the disease.
“We should quickly get resources to places where the disease can be suppressed, then backfill tests in the places currently overwhelmed,” said Glen Weyl, an economist at Microsoft, who worked on the Harvard University proposal. “It’s like a war — you have to more troops than the enemy in order to win a battle.”
Other researchers have proposed blanketing the country with tests, with a focus on places experiencing clear outbreaks.
Paul Romer, an economist at New York University, said there should be mass testing in hot spots that is quickly expanded to near-universal, constant testing for everyone — 23 million tests a day, noting that the cost of tests have dropped.
“It would be feasible if we just invested and made it happen,” he said.
Other countries have used aggressive and organized testing to help stop the spread of the virus. South Korea — where the first case of the coronavirus was diagnosed on the same day as in the United States — quickly started mass testing at drive-through sites to spot and isolate cases.
The government has also instituted a sophisticated and aggressive effort to trace contacts of any known case, to squelch outbreaks. After several people who visited nightclubs in Seoul tested positive in early May, the government within two weeks tracked down 46,000 people who might have been exposed and tested them all.
In Wuhan, China, the site of the world’s first major coronavirus outbreak, government officials said they tested nearly 10 million of the city’s 11 million residents since mid-May, part of an effort to test universally and ensure the city doesn’t experience a new wave of infections.
Still, many experts agree that completely random asymptomatic testing is not an effective strategy.
A report issued late last month by the Center for Infectious Disease Research and Policy at the University of Minnesota called for ramping up testing nationwide, including in some congregate settings and as part of public health research. But the report found that widespread testing of people without symptoms was not advisable in most workplaces, in schools or in the broader community.
Researchers at the center found such testing could waste precious resources and could cause problems for communities, given that the tests are not fully reliable.
“There’s been far too much of this group think around, ‘test, test, test,’ without understanding what it’s accomplishing,” said Michael Osterholm, the director of the center. “You need the right test, at the right time, for the right reasons.”
The report’s central recommendation: that HHS form a blue-ribbon commission with national experts to formulate advice for states.
When protests broke out against the coronavirus lockdown, many public health experts were quick to warn about spreading the virus. When protests broke out after George Floyd’s death, some of the same experts embraced the protests. That’s led to charges of double standards among scientists.
Why it matters: Scientists who are seen as changing recommendations based on political and social priorities, however important, risk losing public trust. That could cause people to disregard their advice should the pandemic require stricter lockdown policies.
What’s happening: Many public health experts came out against public gatherings of almost any sort this spring — including protests over lockdown policies and large religious gatherings.
Yes, but: Spending time in a large group, even outdoors and wearing masks — as many of the protesters are — does raise the risk of coronavirus transmission, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
The difference in tone between how some public health experts are viewing the current protests and earlier ones focused on the lockdowns themselves was seized upon by a number of critics, as well as the Trump campaign.
The current debate underscores a larger question: What role should scientists play in policymaking?
The big picture: The debate risks exacerbating a partisan divide among Americans in their reported trust in scientists.
What to watch: If there is a rise in new cases in the coming weeks, there will be pressure to trace them — to protests, rallies and the reopening of states. How experts weigh in could affect how their recommendations will be viewed in the future — and whether the public, whatever their political leanings, will follow them again.
When throngs of tourists and revelers left their homes over Memorial Day weekend, public health experts braced for a surge in coronavirus infections that could force a second round of painful shutdowns.
Two weeks later, that surge has hit places like Houston, Phoenix, South Carolina and Missouri. Week-over-week case counts are on the rise in half of all states. Only 16 states and the District of Columbia have seen their total case counts decline for two consecutive weeks.
But instead of new lockdowns to stop a second spike in cases, states are moving ahead with plans to allow most businesses to reopen, lifting stay-at-home orders and returning to something that resembles normal life.
“There is no — zero — discussion of re-tightening any measures to combat this trend. Instead, states are treating this as a one-way trip. That sets us up for a very dangerous fall, but potentially even for a dangerous summer,” said Jeremy Konyndyk, a senior fellow at the Center for Global Development who oversaw the U.S. Agency for International Development’s Office of Foreign Disaster Assistance during the Obama administration.
The moves suggest that many Americans — anxious to end two-plus months of lockdowns, smarting from the devastating economic toll they have already suffered and focused on the social justice protests that have roiled the nation — are ready to put the coronavirus behind them.
Even as case curves bend upward again, little action has been taken to counter the reversal.
“There are places that I suspect a lot of people are shrugging their shoulders and just rushing forward,” said David Rubin, who runs the PolicyLab at Children’s Hospital of Philadelphia. “I just worry that they might lose control of their epidemic, and that’s what you have to worry about these days.”
The statistics are startling. The average number of confirmed cases over a two-week period has doubled or more in Arizona, Arkansas, Oregon and Utah. Fewer than a quarter of intensive care unit beds in Alabama, Georgia and Rhode Island are available.
In Texas, the number of people admitted to the hospital has grown 42 percent since Memorial Day. Arizona’s top health official has urged hospitals to activate their emergency plans.
North Carolina, California, Mississippi and Arkansas are all reporting record levels of hospitalizations.
Some experts worry Americans have begun to accept the drumbeat of death, numbed by the nearly 2 million cases already confirmed across the country and the 112,000 who have died.
A virus once dismissed as not a serious threat to the nation and later acknowledged as a public health emergency is now becoming just another daily worry to be absorbed.
“One fear is that the U.S. will accept tens of thousands of deaths, as from gun violence, unlike other countries,” said Tom Frieden, director of the Centers for Disease Control and Prevention during the Obama administration.
“It’s not just lives. Unless we protect lives, we won’t get livelihoods back,” said Frieden, who now runs Resolve to Save Lives, a global health nonprofit.
The race to reopen comes even as new research shows the lockdowns were working. The dramatic steps Americans took to stop the virus saved an estimated 5 million infections through April 6, according to research by the Global Policy Lab at the University of California-Berkeley.
President Trump has been perhaps the loudest proponent of reopening, at times putting pressure on states to lift coronavirus restrictions even if the data is flashing warning signs.
World Health Organization (WHO) officials have practically begged nations to be slow and considerate as they move to reopen their economies.
“We need to focus on the now. This is far from over,” Maria Van Kerkhove, the WHO’s technical lead on the coronavirus, told reporters at a virtual press conference Monday. “I know many of us would like this to be over and I know many situations are seeing positive signs. But it is far from over.”
On Wednesday, WHO’s director of emergency programs acknowledged the challenges of lockdown life.
“We fully understand that governments are very reticent to go back into lockdowns that can be damaging to social and economic life,” said Mike Ryan.
“There has to be a balance between lives and livelihoods and the public health control of COVID-19,” Ryan added.
There are few signs that Americans are heeding the warnings.
“We’re just at the beginning of the Memorial Day story, not at the end,” Rubin said. “We are seeing the sea levels rise.”
https://www.cbsnews.com/news/coronavirus-united-states-cases-2-million/
The number of confirmed coronavirus cases in the United States topped 2 million late Wednesday night, according to Johns Hopkins University. The mark was passed with all 50 states in various stages of re-opening and with numerous states experiencing surges in cases and severe strain on their hospitals.
It’s been just five months since the coronavirus caused its first known U.S. fatality, in California, broke out in Washington state and quickly spread around the country.
The next closest nation to the U.S. in terms of number of cases is Brazil, with some 772,000.
The virus has killed almost 113,000 people in the U.S., Johns Hopkins said, and there were more than 7.3 million cases worldwide and 416,000 deaths.
And according to the Reuters News Service, the head of Harvard’s Global Health Institute, Ashish Jha, told CNN Wednesday that, “Even if we don’t have increasing cases, even if we keep things flat, it’s reasonable to expect that we’re going to hit 200,000 deaths sometime during the month of September. And that’s just through September. The pandemic won’t be over in September.”
Seventeen states have reported an increase in average daily new COVID-19 cases compared with two weeks ago, including Florida, California and Texas.
The ongoing pandemic has wreaked havoc on the U.S. economy. Tens of millions of people have filed for unemployment since states shut down to try to limit the virus’ spread. Several major companies, including J.C. Penney, J. Crew, Gold’s Gym and Hertz have filed for bankruptcy.
The Congressional Budget Office predicts the coronavirus could impact the nation until 2029 and cost the economy almost $16 trillion.
On Monday, White House Coronavirus Task Force officials said the police brutality protests around the country may spur a spike in virus cases. Many demonstrators haven’t been heeding public health guidelines for containing the virus, such as wearing masks and social distancing.
The coronavirus is still killing as many as 1,000 Americans per day — but the Trump administration isn’t saying much about it.
It’s been more than a month since the White House halted its daily coronavirus task force briefings. Top officials like infectious disease expert Anthony Fauci have largely disappeared from national television — with Fauci making just four cable TV appearances in May after being a near fixture on Sunday shows across March and April — and are frequently restricted from testifying before Congress. Meanwhile, President Donald Trump is preparing to resume his campaign rallies after a three-month hiatus, an attempted signal to voters that normalcy is returning ahead of November’s election, and that he’s all but put the pandemic behind him.
“We’ve made every decision correctly,” Trump claimed in remarks in the Rose Garden Friday morning. “We may have some embers or some ashes or we may have some flames coming, but we’ll put them out. We’ll stomp them out.”
Inside the White House, top advisers like Jared Kushner privately assured colleagues last month that the outbreak was well in hand — citing data on declines in community spread — and that the long-feared “second wave” may have even been averted, according to three current and former officials.
However, new data from states like Florida and mass protests across the country are renewing concerns about the virus’s spread. Texas, for instance, has reported two straight days of record-breaking coronavirus hospitalizations — highs that come shortly after the state kicked off the third stage of its reopening plan.
Those officials also acknowledge that the Covid-19 task force has scaled back its once-daily internal meetings — the task force now meets twice per week — but insist that the pandemic response remains a priority. One official with direct knowledge of the administration’s strategy cited efforts to scale up testing, accelerate the development of treatments and vaccines and perform other behind-the-scenes work to get ready for a potential fall surge.
“We’re delivering the supplies and resources that states asked for,” said the official. “This doesn’t need to be the public ‘coronavirus show’ every day anymore.”
“You can’t win,” said a senior administration official. “Some people complained for weeks that ‘we don’t want so much White House involvement,’ and that ‘the President should stop doing daily briefings,’ and then they turn around and complain that there aren’t enough or as many briefings.”
But the White House’s apparent eagerness to change the subject comes as new coronavirus clusters — centered around meatpacking plants, prisons and other facilities — drive spikes in disparate states like Utah and Arkansas. Meanwhile, states and major cities are lifting lockdowns and reopening their economies, prompting public health experts to fret that additional outbreaks are imminent. And several Democratic governors also have defied their own states’ social distancing restrictions to join mass protests over police brutality, where hundreds of thousands of Americans have spilled into the streets, further raising public health risks.
The fear is that all the mixed signals will only confuse people, stoke public skepticism over the health threat and promote the belief the worst is over just as the outbreak enters a dangerous new phase.
“Cases are rising, including from cases in congregate settings,” said Luciana Borio, who led pandemic preparedness for the National Security Council between 2017 and 2019. “We still have a pandemic.”
Nine current and former administration officials, as well as outside experts, further detailed how the White House is steadily ramping down the urgency to fight a threat that continues to sicken more than 100,000 Americans per week and is spiking in more than 20 states.
For instance, the administration in recent days told state health officials that it planned to reorganize its pandemic response, with HHS and its agencies taking over the bulk of the day-to-day responsibilities from the Federal Emergency Management Agency.
“The acuity of the response is not what it was, so they’re trying to go back to a little more of a normal ongoing presence,” said Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials.
The coronavirus task force, which used to send daily updates to state officials, has done so with less regularity over the last several weeks, Plescia said. And the CDC has restructured its daily conference calls with states, moving away from the practice of giving top-down briefings to encouraging state officials to offer updates on what they’re seeing in their parts of the country.
One current and one former FEMA official also said they’re keen to have HHS resume its leadership role in containing the coronavirus so FEMA can make contingencies for a summer of hurricanes, floods and other natural disasters.
“Given the likelihood that we will soon see both hurricanes and coronavirus, HHS should manage the ongoing pandemic response so FEMA can prepare for coming ‘coronacanes,’” Daniel Kaniewski, who served as the top deputy at FEMA through January, wrote last week. “But they need to act soon. Coronacanes are in the forecast.”
Meanwhile, officials in at least 19 states have recorded two-week trends of increasing coronavirus cases, including spikes of more than 200 percent in Arizona and more than 180 percent in Kentucky. Two months after the White House issued so-called gating criteria that it recommended states hit before resuming business and social activities, only a handful of states — like Connecticut, New Jersey, New York and South Dakota — currently meet all of those benchmarks, according to CovidExitStrategy.org.
Officials within Trump’s health department are strategizing over how to convey the current level of risk, given data that Americans have put off emergency care and other potential medical needs, fearful of contracting Covid-19. “Our message now is that people should start returning to their health care providers to get the screenings, vaccines, care, or emergency services that they need,” Laura Trueman, the HHS official in charge of external affairs, wrote in an office-wide email to colleagues and shared with external groups on June 3, which was obtained by POLITICO.
Dan Abel, a longtime Coast Guard vice admiral, also has been installed at HHS with a small team, where he’s coordinating daily Covid-19 calls with HHS Secretary Alex Azar and the department’s division leaders, according to four officials with knowledge of the calls — an arrangement that’s raised some questions.
“Why is a Coast Guard admiral leading meetings between the HHS secretary and his senior staff?” asked one senior official, suggesting it created an unnecessary layer of management.
Meanwhile, the department is steadily turning back to its many pre-Covid-19 priorities. At the Food and Drug Administration, officials are returning to hot-button issues like tobacco and CBD regulations. Some staff in the health department’s emergency response arm are pivoting away from Covid-19 and back toward natural disasters as hurricane season begins.
At the same time, the Centers for Disease Control — traditionally the beating heart of the nation’s infectious disease response — remains largely demoralized and often sidelined in fighting what CDC director Robert Redfield last week acknowledged as the nation’s biggest health challenge in more than a century, and one he said is “moving through our social consciousness, our outward expression, and our grief.” That grim message has conflicted with Trump’s frequent vows of victory over the coronavirus.
“We were able to close our country, save millions of lives, open,” Trump said in Friday’s Rose Garden remarks. “And now the trajectory is great.”
“I fully recognize the anguish our Nation is experiencing & am deeply saddened by the many lives lost to COVID19,” Redfield tweeted just minutes later. “I call upon the American people to remain vigilant in protecting the vulnerable – protect your community, grandparents and loved ones from COVID-19.”
Redfield and other top officials also have spent the past week reckoning with the implications of widespread protests over police brutality, from meeting with staff to discuss longstanding concerns about systemic racism in health care to acknowledging the probability that those protests will spark new outbreaks.
HHS also on Monday sent members of Congress a fact sheet on its response to racial disparities in Covid-19 care — a much scrutinized issue in public health, with African Americans contracting and dying from the virus at much higher rates.
But on Capitol Hill, watchdogs say that fact sheets don’t cut it, and they’re frustrated by the lack of access to experts and insight into how the administration is handling a historic pandemic.
“Some are acting like the battle has been won when in reality it’s just beginning,” said a senior Democratic staffer. “The White House still won’t let task force members testify at hearings in June even though they have disappeared from TV and it’s not clear how often they are meeting.”
Fauci, meanwhile, has continued to issue a string of dire warnings in his lower-profile media appearances and at an industry conference on Tuesday.
“We have something that turned out to be my worst nightmare,” Fauci said in virtual remarks aired at a conference of the biotech industry’s Washington trade group, recounting how quickly the virus spread around the globe, outpacing Ebola and HIV. “And it isn’t over yet.”
The White House has maintained that chief of staff Mark Meadows has needed to clear officials like Fauci to testify, so they can stay focused on other priorities, and a spokesperson insisted that Trump has still prioritized the coronavirus fight even as the White House shifts toward focusing on revitalizing the economy.
Several officials have suggested that the task force’s lower profile has been helpful for the response, especially because the daily Covid-19 press briefings were often hijacked by Trump’s meandering remarks or the day’s other political news.
“In some ways, it actually has been easier to get Covid-related work done,” said one HHS staffer who’s helped support the Covid-19 response. “The task force briefings and the prep sessions for them took up a lot of principals’ time, and staff would sometimes have to crash on putting together materials for them.”
But the white-hot spotlight on the coronavirus also brought urgency and intensity, and the increasingly scattered nature of the current response could present new challenges if there’s an uptick in cases.
“This is when a one-government approach is needed more now than ever,” said Howard Koh, who served as President Barack Obama’s HHS assistant secretary for health. “Get all those people together in one room every day at the highest level and track outcomes and address all the questions and try to maximize coordination as much as possible.”
https://mailchi.mp/9f24c0f1da9a/the-weekly-gist-june-5-2020?e=d1e747d2d8
If, like us, you’ve been wondering exactly why the CDC always seems to be a step behind in responding to the pandemic, a new, in-depth New York Times piece helps elucidate the myriad challenges—structural, cultural and political—that led to the agency’s flawed response.
Given the CDC’s history, it should have been the world’s “undisputed leader” in the pandemic response. But its early reticence to absorb lessons from other countries, combined with flawed testing, slowed down responses across the nation. While much has been made of political machinations within the Trump administration, a deep-rooted bureaucratic and exacting culture left the CDC ill-suited to respond to a crisis of this scale, requiring improvisation and rapid adaptation.
Career scientists and epidemiologists clashed with CDC leader Dr. Robert Redfield, who was eclipsed by Drs. Tony Fauci and Deborah Birx in public communication. But even if it were firing on all cylinders, the CDC is only one of the many parts of government at the table for what should have been a coordinated, all-government response.
Whether led by the CDC or another entity, the pandemic response has highlighted the need for a massive overhaul of the nation’s public health system, so that future challenges—both COVID-related and beyond—are met with a rapid and coordinated response.
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Most states still need to reduce coronavirus cases and build up their testing capacity.
All 50 states are moving to reopen their economies, at least partially, after shutting down businesses and gatherings in response to the coronavirus pandemic.
But a Vox analysis suggests that most states haven’t made the preparations needed to contain future waves of the pandemic — putting themselves at risk for a rise in Covid-19 cases and deaths should they continue to reopen.
Experts told me states need three things to be ready to reopen. State leaders, from the governor to the legislature to health departments, need to ensure the SARS-CoV-2 virus is no longer spreading unabated. They need the testing capacity to track and isolate the sick and their contacts. And they need the hospital capacity to handle a potential surge in Covid-19 cases.
More specifically, states should meet at least five basic criteria. They should see a two-week drop in coronavirus cases, indicating that the virus is actually abating. They should have fewer than four daily new cases per 100,000 people per day — to show that cases aren’t just dropping, but also below dangerous levels. They need at least 150 new tests per 100,000 people per day, letting them quickly track and contain outbreaks. They need an overall positive rate for tests below 5 percent — another critical indicator for testing capacity. And states should have more than 40 percent of their ICU beds free to actually treat an influx of people stricken with Covid-19 should it be necessary.
These metrics line up with experts’ recommendations, as well as the various policy plans put out by both independent groups and government officials to deal with the coronavirus.
Meeting these metrics doesn’t mean that a state is ready to reopen its economy — a process that describes a wide range of local and state actions. And failing them doesn’t mean a state is in immediate danger of a coronavirus outbreak if it starts to reopen; with Covid-19, there’s always an element of luck and other factors.
But with these metrics, states can gauge if they have repressed the coronavirus while building the capacity to contain future outbreaks should they come. In other words, the benchmarks show how ready states are for the next phase of the fight.
So far, most states are not there. As of May 27, just three states — Alaska, Kentucky, and New York — met four or five of the goals, which demonstrates strong progress. Thirty states hit two or three of the benchmarks. The other 17, along with Washington, DC, achieved zero or one.
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Even the states that have made the most progress aren’t necessarily ready to safely reopen. There’s a big difference between Alaska — which has not suffered from a high number of coronavirus cases — and New York, and no expert would say that all of New York is ready to get back to normal.
Nor do the metrics cover everything that states should do before they can reopen. They don’t show, for example, if states have the capacity to do contact tracing, in which people who came into contact with someone who’s sick with Covid-19 are tracked down by “disease detectives” and quarantined. Contact tracing is key to containing an epidemic, but states don’t track how many contact tracers they’ve hired in a standardized, readily available way.
They also don’t have ready data for health care workers’ access to personal protective equipment, such as masks and gloves — a critical measure of the health care system’s readiness that is difficult to track.
But the map gives an idea of how much progress states have made toward containing the coronavirus and keeping it contained.
States will have to follow these kinds of metrics as they reopen. If the numbers — especially coronavirus cases — go in the wrong direction again, experts said governments should be ready to bring back restrictions. If states move too quickly to reopen or respond too slowly to a turn for the worse, they could see a renewed surge in Covid-19 cases.
“Planning for reclosing is part of planning for reopening,” Mark McClellan, a health policy expert at Duke, told me. “There will be outbreaks, and there will be needs for pauses and going back — hopefully not too much if we do this carefully.”
So this will be a work in progress, at least until we get a Covid-19 vaccine or the pandemic otherwise ends, whether by natural or human means. But the metrics can at least help give states an idea of how far along they are in finally starting to open back up.
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What’s the goal? A 10 percent drop in daily new coronavirus cases compared to two weeks ago and a 5 percent drop in cases compared to one week ago, based on data from the New York Times.
Which states meet the goal? Colorado, Connecticut, Delaware, Hawaii, Indiana, Kansas, Kentucky, Massachusetts, Michigan, Missouri, Nebraska, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, and Texas — 17 states in all. Washington, DC, did as well.
Why is this important? Guidance from the White House and several independent groups emphasize that states need to see coronavirus cases drop consistently over two weeks before they can say they’re ready to begin reopening. After all, nothing shows you’re out of an outbreak like a sustained reduction in infections.
“The first and foremost [metric] is you want to have a continued decrease in cases,” Saskia Popescu, an infectious disease epidemiologist, told me. “It’s a huge piece.”
A simple reduction in cases compared to two weeks prior isn’t enough; it has to be a significant drop, and it has to be sustained over the two weeks. So for Vox’s map, states need at least a 10 percent drop in daily new cases compared to two weeks prior and at least a 5 percent drop compared to one week prior.
Reported cases can be a reflection of testing capacity: More testing will pick up more cases, and less testing will pick up fewer. So it’s important that the decrease occur while testing is either growing or already sufficient. And since states have recently boosted their testing abilities, increases in Covid-19 cases can also reflect improvements in testing.
Even after meeting this benchmark, continued caution is warranted. If a state meets the goal of a reduction in cases compared to one and two weeks ago but cases seemed to go up in recent days, then perhaps it’s not time to reopen just yet. “You have to use common sense,” Cyrus Shahpar, a director at the public health policy group Resolve to Save Lives, told me.
For states with small outbreaks, this goal is infeasible. Montana has seen around one to two new Covid-19 cases a day for several weeks. Getting that down to zero would be nice, but the current level of daily new cases isn’t a big threat to the whole state. That’s one reason Vox’s map lets states meet four or five of the five goals — in case they miss one goal that doesn’t make sense for them but hit others.
Still, the two-week reduction in cases is the most cited by experts and proposals to ease social distancing.
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What’s the goal? Fewer than four daily new coronavirus cases per 100,000 people per day, based on data from the New York Times and Census Bureau.
Which states meet the goal? Alaska, Florida, Hawaii, Idaho, Kentucky, Maine, Michigan, Missouri, Montana, Oklahoma, Oregon, South Carolina, Texas, Vermont, Washington, West Virginia, and Wyoming — 17 states.
Why is this important? One of the best ways to know you’re getting away from a disease outbreak is to no longer see a high number of daily new infections. While there’s no universally accepted number, experts said that four daily new coronavirus cases per 100,000 people is a decent ceiling.
“If I go from one to two to three [coronavirus cases a day], it’s different than going from 1,000 to 2,000 to 3,000, even though the percent difference is the same,” Shahpar said. “That’s why you have to take into account the overall level, too.”
This number can balance out the shortcomings in other metrics on this list. For example, New York — which has suffered the worst coronavirus outbreak in the country — has seen its reported daily new coronavirus cases drop for weeks, meeting the goal of a sustained drop in cases. But since that’s coming down from a huge high, even a month of sustained decreases may not be enough. New York has to make sure it falls below a threshold of new cases, too.
At the same time, if your state is now below four daily new cases per 100,000 but it’s seen a recent uptick in cases, that’s a reason for caution. New York, after all, saw just a handful of confirmed coronavirus cases before an exponential explosion of the disease took the state to thousands of new cases a day.
But if your state is below the threshold, it’s in a pretty solid place relative to most other states.
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What’s the goal? At least 150 tests per 100,000 people per day, based on data from the Covid Tracking Project and Census Bureau.
Which states meet the goal? Alaska, Connecticut, Delaware, Georgia, Illinois, Louisiana, Nevada, New Jersey, New Mexico, New York, North Dakota, and Rhode Island — for a total of 12 states.
Why is this important? Since the beginning of the coronavirus pandemic, experts have argued that the US needs the capacity for about 500,000 Covid-19 tests a day. Controlling for population, that adds up to about 150 new tests per 100,000 people per day.
Testing is crucial to getting the coronavirus outbreak under control. When paired with contact tracing, testing lets officials track the scale of the outbreak, isolate the sick, quarantine those the sick came into contact with, and deploy community-wide efforts as necessary. Testing and tracing are how other countries, like South Korea and Germany, have managed to control their outbreaks and started to reopen their economies.
The idea, experts said, is to have enough surveillance to detect embers before they turn into full wildfires.
“States should be shoring up their testing capacity not just for what it looks like right now while everyone’s in their homes, but as people start to move more,” Jen Kates, the director of global health and HIV policy at the Kaiser Family Foundation, told me. “As people start doing more movement, you’ll have to test more, because people are going to come into contact with each other more.”
The 500,000-a-day goal is the minimum. Some experts have recommended as many as millions of tests nationwide each day. But 500,000 is the most often-cited goal, and it’s, at the very least, a good start.
This goal is supposed to be for diagnostic tests, not antibody tests. Diagnostic tests gauge whether a person has the virus in their system and is, therefore, sick right at the moment of the test. Antibody tests check if someone ever developed antibodies to the virus to see if they had ever been sick in the past. Since diagnostic tests give a more recent gauge of the level of infection, they’re seen as much more reliable for evaluating the current state of the Covid-19 outbreak in a state.
But some states have included antibody tests in their overall counts. Experts said states shouldn’t do this. But since the data they report and the Covid Tracking Project collects is the best testing data we have, it’s hard to tease out how much antibody tests are skewing the total.
In particular, Georgia’s data suggested it met the goal of 150 daily tests per 100,000 people, but the state only started separating antibody tests from its total after the data was collected. Without the antibody tests, Georgia very likely wouldn’t meet the goal.
Some states’ numbers, like Missouri’s, also may appear significantly worse than they should due to recent efforts to decouple diagnostic testing data from antibody testing data, which can temporarily warp the overall test count.
“The virus isn’t going to care whether they were manipulating the numbers or not in order to look more favorable; it’s going to continue to spread,” Crystal Watson, a senior scholar at the Johns Hopkins Center for Health Security, told me. “It’s better to really understand what’s going on and report that accurately.”
For states honestly reporting these numbers, though, they’re a critical measure of their ability to detect, control, and contain coronavirus outbreaks.
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What’s the goal? Below 5 percent of coronavirus tests coming back positive over the past week, based on data from the Covid Tracking Project.
Which states meet the goal? Alaska, California, Florida, Georgia, Hawaii, Kentucky, Louisiana, Maine, Michigan, Montana, Nevada, New Hampshire, New Mexico, New York, North Dakota, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington, West Virginia, and Wyoming — for a total of 23 states.
Why is this important? The positive or positivity rate, which tracks how many tests come back positive for Covid-19, is another way to measure testing capacity.
Generally, a higher positive rate suggests there’s not enough testing happening. An area with adequate testing should be testing lots and lots of people, many of whom don’t have the disease or don’t show severe symptoms. The positive testing rate in South Korea, for example, is below 2 percent. High positive rates indicate only people with obvious symptoms are getting tested, so there’s not quite enough testing to match the scope of an outbreak.
Previously, the World Health Organization (WHO) recommended a maximum positive rate of 10 percent. But the WHO more recently recommended 5 percent, which is in line with the rate for countries that have better managed to better control their outbreaks, like Germany, New Zealand, and South Korea. “Even lower is better,” Shahpar said.
The positive rate data is subject to the same limitations as the overall testing data from the Covid Tracking Project. So if a state includes antibody tests in its test count, it could skew the positive rate to look better than it is. States only risk hurting themselves if they do this.
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What’s the goal? Below 60 percent occupancy of ICU beds in hospitals, based on data from the Centers for Disease Control and Prevention.
Which states meet the goal? Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, Utah, Vermont, Virginia, Washington, Wisconsin, and Wyoming — for a total of 30 states.
Why is this important? If a pandemic hits, the health care system needs to be ready to treat the most severe cases and potentially save lives. That’s the key goal of “flattening the curve” and “raising the line,” in which social distancing helps reduce the spread of the disease so the health care system can maintain and grow its capacity to treat an influx of Covid-19 patients.
“There’s this idea that in six weeks we can open more things,” Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told me. “But the virus is still there. It’s all about making sure that the case count isn’t too immense for our hospital system to deal with.”
The aim is to avoid the nightmare scenario that Italy went through when it had more Covid-19 cases than its health care system could handle, leading to hospitals turning away even dangerously ill patients.
To gauge this, experts recommended looking at ICU capacity, with states aiming to have less than 60 percent occupancy in their ICUs.
A big limitation in the metric: It’s based on data collected by the Centers for Disease Control and Prevention of only some hospitals in each state. So it might not be fully representative of hospital capacity throughout an entire state. But it’s the best current data available, and it suggests that the majority of states meet that standard.
That’s extremely good news. It shows that America really has flattened the curve, at least for now. But it’s done that so far through extreme social distancing. If the next step is to keep the curve flattened while easing restrictions, that will require meeting the other metrics on this list.
Vox’s map is just one way of tracking success against the coronavirus. Other groups have come up with their own measures, including Covid Act Now, Covid Exit Strategy, and Test and Trace. Vox’s model uses more up-to-date data than some of these other examples, while focusing not just on the state of the pandemic but states’ readiness to contain Covid-19 outbreaks in the future.
Very few states hit all the marks recommended by experts. But even those that do shouldn’t consider the pandemic over. They should continue to improve — for example, getting the positive rate below even 1 percent, as in New Zealand — and look at even more granular metrics, such as at the city or county level.
Meeting the benchmarks, however, indicates a state is better equipped to contain future coronavirus outbreaks as it eases previous restrictions.
Experts emphasized that states have to keep hitting all these goals week after week and day after day — Covid-19 cases must remain low, testing ability needs to stay high, and hospital capacity should be good enough for an influx of patients — until the pandemic is truly over, whether thanks to a vaccine or other means. Otherwise, a future wave of coronavirus cases, as seen in past pandemics, could kill many more people.
“You need to have all the metrics met,” Popescu said. “This needs to be a very incremental, slow process to ensure success.”
And if the numbers do start trending in the wrong direction, states should be ready to shut down at least some parts of the economy again. Maybe not as much as before, as we learn which places are truly at risk of increasing spread. But experts caution that future shutdowns will likely be necessary to some extent.
“I do worry we’re going to see surges of cases and hot spots,” Watson said. “We do need to keep pushing on building those capacities. … Otherwise, we’re just rolling the dice on the spread of the virus. It’s better if we have more control of the spread.”
That’s another reason these metrics, along with broader coronavirus surveillance, are so important: They not only help show how far along states are in dealing with their current Covid-19 outbreaks, but will help track progress to stop and prevent future crises as well.
HENRY KOTULA 