You could find Beatriz Diaz at this spring’s Winter Party Festival in Miami Beach, giving out hand sanitizer.
It was early March. She knew the coronavirus was beginning to make its way around the world, but she figured if she kept her hands clean and avoided sweaty people, she would be safe.
“I was thinking, ‘OK, well, hold on, the government did not cancel it, so it should be fine,’” she said.
Within days, reports started popping up on Facebook about a DJ and several partygoers who were suddenly terribly ill. By the end of the month, two people who attended the festival had died.
As of last week, 38 people had reported that they were symptomatic or had tested positive for the coronavirus in the weeks following the event, according to the organizer, the National LGBTQ Task Force. Diaz was among them.
Weeks before Florida ordered people to stay at home, the coronavirus was well into its insidious spread in the state, infecting residents and visitors who days earlier had danced at beach parties and reveled in theme parks. Only now, as people have gotten sick and recovered from — or succumbed to — COVID-19, the disease caused by the coronavirus, has the costly toll of keeping Florida open during the spring break season started to become apparent.
Gov. Ron DeSantis, a Republican, has blamed travelers from New York, Europe and other places for seeding the virus in the state. But the reverse was also true: People got sick in Florida and took the infection back home.
The exact number of people who returned from leisure trips to Florida with the coronavirus may never be known. Cases as far away as California and Massachusetts have been linked to the Winter Party Festival, a beachside dance party and fundraiser for the LGBTQ community held March 4-10. Another California man died after going to Orlando for a conference and then to a packed Disney World. Two people went to Disney and later got relatives sick in Florida and Georgia.
Slow action by Florida’s governor left local leaders scrambling to make their own closure decisions during one of the busiest and most profitable times of the year for a state with an $86 billion tourism economy. The result was that rules were often in conflict, with one city canceling a major event while a neighboring city allowed another event to continue.
The governor, who did not order people to stay home until April 1, has said the state supported local governments that ordered event cancellations and beach closures but that it was not his role to step in first.
“Let’s have tailored approaches, surgical approaches, that are going to work best for those regions,” DeSantis said at a news conference March 24. “These blunt measures — you wouldn’t want to do them on a community where the virus hasn’t spread.”
With little testing available, local officials made decisions blindly. Data that suggested looming trouble, such as rising fever readings from internet-connected thermometers, were ignored, a spokeswoman for Kinsa Health, the company that produces the thermometers, has said.
Only later did the effects become apparent.
Florida has confirmed more than 17,500 coronavirus cases and nearly 400 deaths, with the epidemic still expanding in the state.
A video by data analytics and visualization company Tectonix showed how cellphones that were on one Fort Lauderdale beach at the beginning of March spread across the country — up the Eastern Seaboard and further West — over the next two weeks.
“At the time, there was still this debate: Should we close public beaches? Should we shut down these big public events?” said Mike DiMarco, the company’s chief marketing officer. “When you actually see it visually on a map like that, it brings a ton of awareness to what that really looks like.”
The first festivalgoer to die was Israel Carrera, a 40-year-old Lyft and Uber driver who spent several days in the hospital in Miami Beach before his death March 26. His boyfriend, who also attended, got mildly sick and is now making plans to deliver Carrera’s ashes to his surviving family in Cuba.
Ron Rich, a 65-year-old festival volunteer, died over the weekend of March 28.
The decision to hold the festival five weeks ago came at a different point in the crisis, before a single person had tested positive in Miami-Dade County, said Rea Carey, executive director of the National LGBTQ Task Force. The event ended the day before the World Health Organization declared the virus a pandemic.
“It points to what we didn’t know at the time,” she said. “If we had had the information that is available now, the information that has become available after Winter Party as this pandemic has played out, we would have made a different decision.”
Photos of the festival show hundreds of people crammed in front of a stage under neon lights, dancing, hugging and practicing little social distancing.
Diaz, 42, got a fever March 15. The next day her girlfriend was also sick. By the time Diaz was confirmed positive for COVID-19, she had been grocery shopping, gone to the pharmacy and spent time with her employer’s 80-year-old father and 14-year-old daughter.
“I understand that was my choice to be there; I take full responsibility for that,” Diaz, who lives in Wilton Manors, Florida, said of the Winter Party Festival, which drew about 5,500 people and has been a fixture in the LGBTQ community for more than 25 years.
“I am really upset for the way it was handled,” she said.
Loc Nguyen, a software developer, felt exhausted from the time he returned home to Los Angeles from the festival March 9. He went to work the next day but had to call in sick after that, feeling shortness of breath and such terrible shivers that he wrapped himself in three winter jackets to go to the doctor.
“You’re coughing and gasping for air,” Nguyen said. “You are scared. You can’t breathe.”
His friend who went to the festival with him also tested positive. A third friend got sick but was unable to get a test.
Nguyen knew the risk of attending but said he did not want to lose the money he had spent on tickets. He did not blame organizers for holding the festival and pointed to mixed messages from local officials.
“If one city closes and one city is open, it’s not consistent,” he said. “And therefore you can’t stop this pandemic.”
On March 6, the city of Miami, which is separate from Miami Beach, canceled the Ultra Music Festival, a marquee electronic dance music event that draws tens of thousands of people. Other local leaders criticized the action as too drastic: The Centers for Disease Control and Prevention was not yet recommending mass closures. Florida announced its first confirmed coronavirus case March 1, but it was in the Tampa area.
“We should live our lives normally,” with public health safeguards in place, Mayor Carlos Gimenez of Miami-Dade County said March 5.
By March 12, he had reversed course and canceled the Miami Open tennis tournament and the county youth fair. The fairgrounds now house a field hospital.
“We did what we thought — and I’m sure all cities did what they thought — was the right thing to do at the right time,” Gimenez said last week. “It’s called novel coronavirus for a reason. We don’t really know how it acts.”
Mayor Francis Suarez of Miami, one of the first elected officials in the country to test positive for the coronavirus, said other jurisdictions’ decisions to keep events going proved costly.
“That ended up as a national embarrassment, when you saw what happened with the spring breakers and what happened unfortunately, tragically, with the music festival,” he said, referring to the Winter Party.
Further north, near Orlando, people streamed into the six Disney World theme parks before they closed March 15. Courtney Sheard recalled that the weather was beautiful and that a new ride at Hollywood Studios, Mickey & Minnie’s Runaway Railway, was especially crowded.
After she got back home to Naples, Florida, on March 12, she awoke with a terrible headache and a sore throat. Her 3-year-old daughter, Journey, ran a fever and vomited.
By the time she received a positive test result, Sheard, 30, had been around her sister, her sister’s children, a friend, her parents, beachgoers and diners at a Bonefish Grill.
When Sheard learned that Jeffrey Ghazarian, 34, had died March 19 in California after visiting the theme park, she figured that the coronavirus had been circulating in Disney while he, and then she, were there.
“Think of all the people from around the world, from around the country, that were in Disney and then went home,” she said.
Officials at Walt Disney World did not respond to a request for comment.
Mayor Jerry Demings of Orange County, home to Orlando, said local officials had insufficient guidance to act consistently to slow the spread.
“We were left to our own devices to come up with strategies ourselves because of the lack of direction from the federal government and governor’s office,” he said.
Nicholas Hickman started feeling ill three or four days after returning home to Ringgold, Georgia, on March 11. He had spent five days at Disney with friends who were on spring break. They were also celebrating Hickman’s 20th birthday.
Back home, Hickman came down with a fever, chills and chest pains but struggled to get tested because no one else in his county had received a coronavirus diagnosis.
Hickman has since recovered, but only after getting his mother, and likely his father, sick. He does not blame Disney for his infection.
“If we would have been told not to go to Disney and just avoid going, we would not have gone,” he said. “There’s no way we would have gone.”
A projection from the Department of Homeland Security, published by the New York Times, shows coronavirus cases spiking again at the end of summer.
It’s a stark reminder that American life after lockdown will still be one of limited human interaction. And that means we’ll have to live with a smaller economy too.
The economy will be packed with uncertainty given the possibility of another shelter-in-place order.
Until we can all hang out again with confidence, the US economy is going to be a shell of its former self.
When the US emerges from its various shades of shelter-in-place orders, it will emerge to a shrunken global economy. One that will not easily be inflated living within parameters the coronavirus demands.
Financial transactions are a form of human interaction, and even after strict orders to stay at home are lifted, Americans will need to limit human interaction to mitigate the spread of coronavirus. One projection from the Department of Homeland Security, first reported by the New York Times, imagines a world where schools remain closed, 25% of Americans work from home, and social distancing remains in place through the summer.
And people will still be scared. They will know that there is an deadly virus infecting people who interact with other people.
In this scenario, back to work doesn’t mean back to growth because people won’t be spending money the way they did before. Back to work simply means finding a more sane, stable way to maintain society until we get a vaccine. There will be no V-shaped recovery. This is a marathon, and if we’re lucky, we will limp across the finish line.
As incomplete as it is, China is the best picture we have for understanding what a life after lockdown looks like, and it doesn’t look like a booming economy. 460,000 businesses closed permanently in China during the first quarter.
One Chinese county has gone back into lockdown already. In Beijing — where state media says epidemic prevention and control will “probably” become“long-term normal” — restaurants have been ordered to maintain social distance by cutting seating in half and limiting tables to three people. Customers have been slow to come back anyway.
All of this is to say that even if we’re out of lockdown, this saga isn’t remotely over.
Deflation strikes back
What China’s economy is telling us is that once this weird supply funk brought on by everyone staying home is over, and some people are able to go back to work, we’ll still have a demand crisis. Even though the virus has been contained analysts at Oxford Economics told clients it expects to see “basically no growth” in China this year. With other global economies weakened it will sell fewer exports.
Zhu Jun, director of the international department of the People’s Bank of China, said that there’s a small chance the world risks another Great Depression. Cheery, I know, but until there’s a vaccine, optimism will be in short supply.
Here in the US, just as in China, people will be broke and businesses will be broken. Money will be scarce. Demand will be depressed not just because of a lack of funds, but because people will have changed their behavior to avoid getting sick.
Wall Street it seems, hasn’t processed this bad news yet. It’s taking this pandemic day-by-day, not looking at life after lockdown. This week the market rallied on news that all over the US, even New York City, the curve is flattening. It was a silly rally.
It’s silly for the market to declare victory before we’ve even seen how much damage has been done (that will take months at least). It’s silly to expect any kind of stability until we know what kind of demand a post-shelter-in-place, pre-vaccine American economy will have.
Finally, we don’t know how long Washington will be in a giving mood. So far the Federal Reserve has pulled out all the stops, and Congress has approved trillions in aid. But will Washington keep sending checks to unemployed Americans until we have a vaccine?
We thought we knew uncertainty
I think back to all the times I’ve heard CEOs and Wall Street types talk about uncertainty around regulations, or elections, or literally anything else that has happened in my life time, and I have to laugh. All of it seems silly compared to the uncertainty before us right now.
It is quite possible that sometime this summer scientists will develop a treatment for COVID-19 that makes the symptoms much more mild — something more like a standard, week-long flu. That discovery could make things a lot easier, and really bolster confidence enough to bring the economy back until we have a vaccine. But government officials obviously can’t plan with that in mind. Neither can businesses.
And so, those charged with imagining the worst case scenario must imagine a world where Americans are again forced to shelter-in-place to flatten the curve. Homeland Security’s projections put a resurgence of the virus somewhere around the end of summer to the beginning of fall. It’s not unreasonable to think certain populations may have to go back into shelter-in-place then.
Singapore has a robust system of testing for and tracking the coronavirus and its citizens went back into shelter-in-place this week. Here in the US we don’t have such a system. Last week the White House ended federal funding for its drive-thru testing site program.
On Friday New York Governor Andrew Cuomo urged the President to invoke the Defense Production Act to ramp up production of antibody tests that can show who has been infected with the coronavirus and built up immunity. That would allow people to go back to work, but the federal government will only be able to produce 2,000 a day in the next two weeks.
As a nation, we need to be doing everything we can to ensure that when this lockdown is over, those who can go out can do so with as much confidence as possible. We need to inject as much certainty into this situation as possible Without testing, that’s not happening.
In an interview with CNBC, Bill Gates — the Microsoft founder and billionaire philanthropist who has dedicated a significant chunk of his charitable efforts to studying pandemics — said the federal government simply doesn’t seem interested in a unified testing system. This is one of the few variables in this pandemic the government can control, and it’s blowing it.
Testing is one of the only things that will make our beleaguered, shrunken coronavirus economy a little bit bigger. It’s one of the only ways we can impact the ugly twist of this economic downturn, behavior.
Even then, though, the possibility of an outbreak in a workplace, city, or state will change the way our economy works in ways that will make money scarce. We need to be ready for that.
The decades-old drug that President Donald Trump has persistently promoted as a potential weapon against COVID-19 has within a matter of weeks become a standard of care in areas of the United States hit hard by the pandemic — though doctors prescribing it have no idea whether it works.
Doctors and pharmacists from more than half a dozen large healthcare systems in New York, Louisiana, Massachusetts, Ohio, Washington and California told Reuters they are routinely using hydroxychloroquine on patients hospitalized with COVID-19. At the same time, several said they have seen no evidence that the drug, used for years to treat malaria and autoimmune disorders, has any effect on the virus.
Use of hydroxychloroquine has soared as the United States has quickly become the epicenter of the pandemic. More than 355,000 people in the United States have tested positive for the novel coronavirus, and more than 10,000 have died. The federal government estimates that as many as 240,000 people in the country may die from the disease before the outbreak is over.
Facing those numbers, and in the absence of any known effective treatments, doctors on the frontlines said they began using hydroxychloroquine and the related chloroquine on patients who are deteriorating based on a few small studies suggesting a possible benefit. Some said they had come under pressure from patients to use the therapies widely touted by Trump and other supporters.
“I may take it,” Trump said on Saturday, referring to hydroxychloroquine, though he has twice tested negative for coronavirus, according to the White House. “We’re just hearing really positive stories, and we’re continuing to collect the data.”
Potential side effects of hydroxychloroquine include vision loss and heart problems. But doctors interviewed by Reuters say they are comfortable prescribing the drug for a short course of several days for coronavirus patients because the risks are relatively low and the therapies are inexpensive and generally available.
However, protocols directing how these drugs should be used vary from one hospital to another, including when to introduce them and whether to combine them with other drugs. In addition, some studies showing promise involve patients who took the therapies for mild or early-stage illness. Many of those people are likely to recover from the virus on their own.
Patients admitted to the hospital in the United States are generally much sicker than the mildly ill cases cited in such studies when they receive therapy. These factors, doctors said, have made it difficult for them to determine whether the drugs are making a difference. “I have seen hundreds of patients with severe COVID and most of these people are on hydroxychloroquine,” Dr Mangala Narasimhan, regional director of critical care at Northwell Health, a 23-hospital system in New York, said in an email. “In my opinion, although it is very early, I do not see a dramatic improvement from the hydroxychloroquine in these patients.” Dr Daniel McQuillen, an infectious disease specialist at Lahey Hospital & Medical Center in Burlington, Massachusetts, said he has prescribed a course of hydroxychloroquine for about 30 COVID-19 patients so far because the drug has shown “a little bit of antiviral activity.” But he has not seen “marked improvement for patients.”
“Anecdotally, it may have had limited effect in patients with milder disease,” McQuillen said. The therapy “has had no effect in limiting or slowing progression of our patients that have been at or near ICU level when they arrived.”
‘SEE WHAT STICKS’
The experience of David Lat, a legal recruiter and commentator who founded the blog Above the Law, reflects the mixture of hope and uncertainty surrounding the drugs now being pursued as possible coronavirus treatments.
Since early March, the 44-year-old New Yorker has chronicled his near-fatal infection with coronavirus in social media posts followed by thousands of people. Lat’s case has resonated with a U.S. audience that has begun to recognize the risk that coronavirus poses not only to elderly patients with serious medical conditions, but also to generally healthy younger adults.
After more than a week of worsening symptoms, Lat was admitted to NYU Langone Medical Center on March 16 and later placed on a ventilator. On March 28, he shared on Facebook that his doctors had taken him off of the ventilator and had moved him out of intensive care after his condition improved dramatically.
In an exchange of text messages with Reuters, Lat said he was treated with hydroxychloroquine and the antibiotic azithromycin. He also received the experimental therapy clazakizumab, which aims to regulate an overreaction by the body’s immune system thought to trigger the respiratory distress seen in severe COVID-19. After the story was published, Lat clarified that he received a fourth therapy, the antiviral Kaletra, not Kevzara, as he had initially recalled.
“The doctors haven’t concluded what caused my recovery,” Lat said. “The state of coronavirus research is very much ‘throw stuff against a wall and see what sticks’ – but when something does stick, in terms of a good patient outcome, you’re not sure what stuck.” Lat’s doctors were not immediately available to comment on his treatment.
Some doctors have been vocal in advocating the drug. Dr Vladimir Zelenko, a general practitioner in upstate New York, has claimed that a three-drug cocktail of hydroxychloroquine, azithromycin and zinc sulfate has helped mitigate the infection in nearly 200 hundred of his patients before they became sick enough to require hospitalization. His recommendations have attracted the attention of Trump’s supporters. Zelenko wasn’t immediately available for comment.
Despite such encouraging reports, hard evidence that any of the therapies now under study will work is weeks and possibly months way.
Early, but mixed, data has emerged from COVID-19 trials of the malaria drugs in China. A research team in Marseilles, France, has published data showing that out of 80 mild COVID-19 patients treated with hydroxychloroquine and azithromycin, 93 percent had no detectable levels of the virus after eight days.
Doctors have questioned the value of the Marseille study and several papers from China as being too small or poorly designed to offer hard evidence of benefit. Most do not compare outcomes of patients who received the malaria therapies with people who did not, considered the most reliable measure of a drug’s effectiveness. Last week, doctors in Paris reported that they tried to replicate the results of the Marseille study and failed. Results from a trial conducted in Wuhan, China, were released that included a control group of patients who did not receive the anti-malarial therapy for comparison. But critics questioned why information on the trial’s main goal — detecting viral load — was not disclosed, and said data was missing for some patients. More rigorous U.S.-led trials are now underway. But most focus on whether the drugs can help prevent illness in people exposed to the coronavirus, such as healthcare workers or relatives of confirmed patients, and not people who are already sick. Randomized, controlled trials of the drugs are being conducted in other countries, including China, Brazil and Norway.
Until the evidence is in, “each institution is setting their own treatment guidelines,” said Dr Otto Yang, an infectious disease specialist at the University of California, Los Angeles Medical Center. “There is simply no data,” he said. “It is a matter of opinion, and opinions differ.”
GAME-CHANGER?
Trump is deeply invested in the idea that the malaria drugs will show a benefit, and personally pressured federal health officials to make them available, Reuters reported on Saturday. The president announced on Twitter last month that hydroxychloroquine, when combined with azithromycin, has the potential to become “one of the biggest game changers in the history of medicine.”
The White House coronavirus task force had its biggest fight yet on Saturday, pitting economic adviser Peter Navarro against infectious disease expert Anthony Fauci. At issue: How enthusiastically should the White House tout the prospects of an antimalarial drug to fight COVID-19?
Behind the scenes: This drama erupted into an epic Situation Room showdown. Trump’s coronavirus task force gathered in the White House Situation Room on Saturday at about 1:30pm, according to four sources familiar with the conversation. Vice President Mike Pence sat at the head of the table.
Numerous government officials were at the table, including Fauci, coronavirus response coordinator Deborah Birx, Jared Kushner, acting Homeland Security Secretary Chad Wolf, and Commissioner of Food and Drugs Stephen Hahn.
Behind them sat staff, including Peter Navarro, tapped by Trump to compel private companies to meet the government’s coronavirus needs under the Defense Production Act.
Toward the end of the meeting, Hahn began a discussion of the malaria drug hydroxychloroquine, which Trump believes could be a “game-changer” against the coronavirus.
Hahn gave an update about the drug and what he was seeing in different trials and real-world results.
Then Navarro got up. He brought over a stack of folders and dropped them on the table. People started passing them around.
“And the first words out of his mouth are that the studies that he’s seen, I believe they’re mostly overseas, show ‘clear therapeutic efficacy,'” said a source familiar with the conversation. “Those are the exact words out of his mouth.”
Navarro’s comments set off a heated exchange about how the Trump administration and the president ought to talk about the malaria drug, which Fauci and other public health officials stress is unproven to combat COVID-19.
Fauci pushed back against Navarro, saying that there was only anecdotal evidence that hydroxychloroquine works against the coronavirus.
Researchers have said studies out of France and China are inadequate because they did not include control groups.
Fauci and others have said much more data is needed to prove that hydroxychloroquine is effective against the coronavirus.
As part of his role, Navarro has been trying to source hydroxychloroquine from around the world. He’s also been trying to ensure that there are enough domestic production capabilities inside the U.S.
Fauci’s mention of anecdotal evidence “just set Peter off,” said one of the sources. Navarro pointed to the pile of folders on the desk, which included printouts of studies on hydroxychloroquine from around the world.
Navarro said to Fauci, “That’s science, not anecdote,” said another of the sources.
Navarro started raising his voice, and at one point accused Fauci of objecting to Trump’s travel restrictions, saying, “You were the one who early on objected to the travel restrictions with China,” saying that travel restrictions don’t work. (Navarro was one of the earliest to push the China travel ban.)
Fauci looked confused, according to a source in the room. After Trump imposed the travel restrictions, Fauci has publicly praised the president’s restriction on travel from China.
Pence was trying to moderate the heated discussion. “It was pretty clear that everyone was just trying to get Peter to sit down and stop being so confrontational,” said one of the sources.
Eventually, Kushner turned to Navarro and said, “Peter, take yes for an answer,” because most everyone agreed, by that time, it was important to surge the supply of the drug to hot zones.
The principals agreed that the administration’s public stance should be that the decision to use the drug is between doctors and patients.
Trump ended up announcing at his press conference that he had 29 million doses of hydroxychloroquine in the Strategic National Stockpile.
Between the lines: “There has never been a confrontation in the task force meetings like the one yesterday,” said a source familiar with the argument. “People speak up and there’s robust debate, but there’s never been a confrontation. Yesterday was the first confrontation.”
In response to a request for comment on Axios’ reporting, Katie Miller, a spokesperson for the vice president, said: “We don’t comment on meetings in the Situation Room.”
The bottom line: The way to discuss the drug’s potential has become a fraught issue within the Trump administration.
Most members of the task force support a cautious approach to discussing the drug until it’s proven.
Navarro, on the other hand, is convinced based on his reading that the drug works against the coronavirus and speaks about it enthusiastically.
Some of Trump’s favorite TV hosts, including Fox’s Sean Hannity, and friends including Rudy Giuliani, have also been touting the malaria drug for the coronavirus. Trump has made no secret who he sides with.
“What do you have to lose? Take it,” the president said in a White House briefing on Saturday. “I really think they should take it. But it’s their choice. And it’s their doctor’s choice or the doctors in the hospital. But hydroxychloroquine. Try it, if you’d like.”
As hospitals across the country brace for an onslaught of coronavirus patients, doctors, nurses and other health care workers — even in emerging hot spots — are being furloughed, reassigned or told they must take pay cuts.
The job cuts, which stretch from Massachusetts to Nevada, are a new and possibly urgent problem for a business-oriented health care system whose hospitals must earn revenue even in a national crisis. Hospitals large and small have canceled many elective services — often under state government orders — as they prepare for the virus, sending revenues plummeting.
That has left trained health care workers sidelined, even in areas around Detroit and Washington, where infection rates are climbing, and even as hard-hit hospitals are pleading for help.
“I’m 46. I’ve never been on unemployment in my life,” said Casey Cox, who three weeks ago worked two jobs, one conducting sleep research at the University of Michigan and another as a technician at the St. Joseph Mercy Chelsea Hospital near Ann Arbor, Michigan. Within a week, he had lost both.
Mayor Bill de Blasio of New York has begged doctors and other medical workers from around the country to come to the city to help in areas where the coronavirus is overwhelming hospitals.
“Unless there is a national effort to enlist doctors, nurses, hospital workers of all kinds and get them where they are needed most in the country in time, I don’t see, honestly, how we’re going to have the professionals we need to get through this crisis,” de Blasio said Friday morning on MSNBC.
And the Department of Veterans Affairs is scrambling to hire health care workers for its government-run hospitals, especially in hard-hit New Orleans and Detroit, where many staff members have fallen ill. The department moved to get a federal waiver to hire retired medical workers to beef up staff levels.
But even as some hospitals are straining to handle the influx of coronavirus patients, empty hospital beds elsewhere carry their own burden.
“We’re in trouble,” said Gene Morreale, the chief executive of Oneida Health Hospital in upstate New York, which has not yet seen a surge in coronavirus patients.
Governors in dozens of states have delivered executive orders or guidelines directing hospitals to stop nonurgent procedures and surgeries to various degrees. Last month, the U.S. surgeon general, Dr. Jerome M. Adams, also implored hospitals to halt elective procedures.
That has left many health systems struggling to survive.
Next week, Morreale said, Oneida will announce that it is putting 25% to 30% of its employees on involuntary furlough. They will have access to their health insurance through June. Physicians and senior staff at the hospital have taken a 20% pay cut.
“We’ve been here 121 years, and I’m hoping we’re still there on the other side of this,” Morreale said.
Appalachian Regional Healthcare, a 13-hospital system in eastern Kentucky and southern West Virginia, has seen a 30% decrease in its overall business because of a decline in patient volume and services related to the pandemic. Last week, the hospital system announced it would furlough about 8% of its workforce — around 500 employees.
Hospital executives across the country are cutting pay while also trying to repurpose employees for other jobs.
At Intermountain Healthcare, which operates 215 clinics and 24 hospitals in Utah, Idaho and Nevada, about 600 of the 2,600 physicians, physicians assistants and registered nurses who are compensated based on volume will see their pay dip by about 15%, said Daron Cowley, a company spokesman.
Those reductions are tied to the drop in procedures, which has fallen significantly for some specialties, he said. The organization is working to preserve employment as much as possible, in part by trying to deploy 3,000 staff members into new roles.
“You have an endoscopy tech right now that may be deployed to be at hospital entrances” where they would take the temperatures of people coming in, Cowley explained.
In Boston, a spokesman for Partners HealthCare, with 12 hospitals, including Massachusetts General and Brigham and Women’s, said staff members whose work has decreased are being deployed to other areas or will be paid for up to eight weeks if no work is available.
But redeployment is not always an option. Janet Conway, a spokeswoman for Cape Fear Valley Health System in Fayetteville, North Carolina, said many of the company’s operating room nurses trained in specialized procedures have been furloughed because their training did not translate to other roles.
“Those OR nurses, many have never worked as a floor nurse,” she said.
Conway said nearly 300 furloughed staff members have the option to use their paid time off, but beyond that, the furlough would be unpaid. Most employees are afforded 25 days per year.
Some furloughed hospital workers are likely to be asked to return as the number of coronavirus cases rise in their communities. But the unpredictable virus has offered little clarity and left hospitals, like much of the economy, in a free fall.
Many health systems are making direct cuts to their payrolls, eliminating or shrinking performance bonuses and prorating paychecks to mirror reduced workload until operations stabilize.
Scott Weavil, a lawyer in California who counsels physicians and other health care workers on employment contracts, said he was hearing from doctors across the country who were being asked to take pay cuts of 20% to 70%.
The requests are coming from hospital administrators or private physician groups hired by the hospitals, he said, and are essentially new contracts that doctors are being asked to sign.
Many of the contracts do not say when the cuts might end, and are mostly affecting doctors who are not treating coronavirus patients on the front lines, such as urologists, rheumatologists, bariatric surgeons, obstetricians and gynecologists.
Such doctors are still being asked to work — often in a decreased capacity — yet may be risking their health going into hospitals and clinics.
“It’s just not sitting well,” Weavil said, noting that he tells doctors they unfortunately have few options if they want to work for their institution long term.
“If you fight this pay cut, administration could write your name down and remember that forever,” he said he tells them.
In other cases, physicians are continuing to find opportunities to practice in a more limited capacity, like telemedicine appointments. But that has not eliminated steep pay cuts.
“Physicians are only paid in our clinic based on their productivity in the work they do,” said Dr. Pam Cutler, the president of Western Montana Clinic in Missoula. “So they’re automatically taking a very significant — usually greater than 50% or 25% — pay cut just because they don’t have any work.”
In some areas, layoffs have left behind health care workers who worry that they will not be able to find new roles or redeploy their skills.
Cox in Michigan said he was briefly reassigned at his hospital, helping screen and process patients coming in with coronavirus symptoms, but eventually the people seeking reassignments outgrew the number of roles.
He also expressed concern that inevitable changes in the health care industry after the pandemic — paired with the possibility of a lengthy period of unemployment — could make it difficult to get his job back.
“I’m just concerned that the job I got laid off from may not be there when this is over,” Cox said. “The longer you’re away, the more you worry, ‘Am I going to be able to come back?’ So there’s a lot of anxiety about it.”
Even as many of the largest hospital networks grapple with sudden financial uncertainty, much smaller practices and clinics face a more immediate threat.
According to a statistical model produced by HealthLandscape and the American Academy of Family Physicians, by the end of April, nearly 20,000 family physicians could be fully out of work, underemployed or reassigned elsewhere, particularly as cities like New York consider large-scale, emergency reassignments of physicians.
“Many of these smaller practices were living on a financial edge to start with, so they’re not entering into this in a good position at all,” said Dr. Gary Price, the president of the Physicians Foundation. “Their margins are narrower, their patients don’t want to come in, and many of them shouldn’t anyway, so their cash flow has been severely impacted and their overhead really hasn’t.”
The State Department issued a global level 3 health advisory late Wednesday advising Americans to “reconsider travel abroad due to the global impact” of the novel coronavirus pandemic.
The big picture: President Trump announced hours earlier European travel to the U.S. will be restricted for 30 days, with some exemptions, and the NBA suspended its season. There are more than 126,000 cases in over 100 countries and territories and more than 4,600 deaths. There are over 1,300 cases in the U.S.
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Travel restrictions: The Trump administration’s new rules affect European member states of the Schengen Area, which includes most but not all of the EU. The United Kingdom and Ireland are not in the zone and are not affected by the restrictions.
In Israel, all travelers entering from any country — including Israeli citizens — are required to self-quarantine for 14 days.
Travel advisory: “Many areas throughout the world are now experiencing COVID-19 outbreaks and taking action that may limit traveler mobility, including quarantines and border restrictions,” the State Department advisory reads. “Even countries, jurisdictions, or areas where cases have not been reported may restrict travel without notice.”
U.S. cases: Nearly 40 states reported at least 1,220 cases as of Wednesday, and roughly two dozen have declared a state of emergency. The novel coronavirus has now killed at least 30 Americans in five states.
Washington, D.C., Mayor Muriel Bowser announced a state of emergency Wednesday, as well as six new COVID-19 cases. There are now 10 presumptive cases in D.C. — including person-to-person transmission and at least two individuals who contracted the virus from unknown causes.
A staffer in the D.C. office of Sen. Maria Cantwell (D-Wash.) has tested positive to the virus — the first known case of a congressional staffer becoming infected with the virus.
California’s Los Angeles County announced six additional cases on Wednesday — including one that health officials presume is the county’s second case of community spread transmission.
There are now four deaths in California after Los Angeles County announced Wednesday the death of an “older adult” who “traveled extensively over the past month,” including to South Korea.
Virginia announced that a teenager in the Chickahominy Health District, who recently traveled internationally, has tested positive for COVID-19 on Wednesday, marking 9 current cases in the state. The affected teen did not attend school.
The states with the most cases as of Wednesday are: Washington, New York and California — where three TSA officers at Mineta San Jose International Airport were confirmed to have tested positive for the virus Tuesday night.
Maryland now has 9 confirmed cases after a 70-year-old Montana resident who was visiting Anne Arundel County came in close contact with someone who had contracted the virus, Maryland Gov. Larry Hogan said Wednesday.
New York Gov. Andrew Cuomo said he planned to deploy the National Guard to the New York City suburb New Rochelle on Tuesday to establish a one-mile “containment zone” and help contain the spread of the novel coronavirus.
Global impact: Cases continue to surge in Spain, Germany, France and Italy, which is on complete lockdown with more than 12,000 cases — second-highest to China.
Google recommended Tuesday that all its employees in North America work from home until at least April 10 amid the novel coronavirus outbreak, one of the most sweeping cautionary edicts.
The Securities and Exchange Commission is the first federal agency to direct its staff at its D.C. office to work remotely after an employee with respiratory problems was told they may have the virus.
IBM is encouraging its employees who live or work in New York City and Westchester County to work from home. Amazon, Facebook, Microsoft and Salesforce have similar practices in place.
Deloitte has recommended its staff return from areas impacted by COVID-19 to work from home for 14 days from their return date. The consulting firm has asked workers to defer nonessential international and domestic travel.
Australia: Actor Tom Hanks confirmed Wednesday he and his wife, Rita Wilson, tested positive for the virus while in Australia, which now has 128 cases.
Federal aid: The Department of Health and Human Services announced Wednesday it is allocating over $560 million to states and local areas to assist with COVID-19 response.
Cruise ship: Nearly 300 people left the docked Grand Princess ship in Oakland, Calif. on Tuesday, with more than half sent to Travis Air Force base and 98 to Lackland Air Force base in Texas, Gov. Gavin Newsom said Tuesday.
Community spread warning: Some areas in the U.S. have passed the point of containment and communities should focus on mitigation plans, such as canceling events, CDC director Robert Redfield said Tuesday.
TheCenters for Medicare & Medicaid Services asked nursing homes to limit visitation due to the high amount of deaths and greater risk for people over 60 and/or with underlying health conditions have.
Conferences and events: Music festival Coachellahas been postponed until October. Many international and domestic conferences affecting all businesses, trades and entertainment are being either postponed or canceled.
Financial impact: U.S. stocks have taken a toll with various dips and corrections all week. Worries are growing that the outbreak could shrink global GDP and perhaps sink the U.S. dollar.
Oil: Already struggling with mounting debt and falling market valuations, energy companies are at serious risk for mass bond defaults.
Diagnostics: Health insurers and regulators are working to ensure coronavirus diagnostic tests are covered — but that doesn’t necessarily mean COVID-19 treatment will be affordable. Concerns linger as to how the health care system can meet the demands of high-volume testing.
Universities: As colleges cancel classes and boot students off campus because of the coronavirus, they’re creating logistical and financial nightmares that could leave many students in a bind.
Tourism: White House advisers are looking at policy changes to help relieve the travel and hospitality industry. Tourism and travel operators have had to reprice globally, as airlines, hotels and travel operators see major declines in bookings and revenue.
Social media: A large part of the problem is the “infodemic,” as stories get shared that are designed to drive fear rather than build understanding about the illness, according to NewsWhip data provided to Axios.
An epidemiological threat such as the new coronavirus, which causes the disease COVID-19, can have disruptive effects on the economy. It can disrupt the global supply of goods, making it harder for U.S. firms to fill orders. It can also waylay workers in affected areas, reducing labor supply on one end and on the other slow the demand for U.S. products and services.
International Monetary Fund Managing Director Kristalina Georgieva says the outbreak is the world’s “most pressing uncertainty.” The economic disruptions caused by the virus and the increased uncertainty are being reflected in lower valuations and increased volatility in the financial markets. While the exact effect of the coronavirus on the U.S. economy is unknown and unknowable, it is clear that it poses tremendous risks.
Policymakers should therefore immediately undertake a number of steps to address any economic fallout from the virus. The burden of meeting this challenge falls squarely on Congress and the Trump administration. To its credit, the Federal Reserve has aggressively cut interest rates, but monetary policy will likely have a very limited effect since interest rates are already low and have been so for some time. To put the U.S. economy on steady footing, CAP recommends that Congress and the Trump administration engage in fiscal stimulus and embrace five key principles for economic policy action in response to the coronavirus:
Do no harm
Put more, not fewer, resources in public health efforts
Assure businesses that things will be fine if the virus hits their sector and remediate harm when necessary
Calm financial markets
Ease the risks for households and vulnerable populations
The risks to the economy from the spread of the virus can be contained—even if the virus cannot. Congress and the Trump administration, however, will need to act quickly and communicate their actions clearly to ensure that the U.S. economy faces a more certain future.
Assessing the economic impact of COVID-19
In order to assess the possible impact of the coronavirus on the economy, it is important not only to focus on the epidemiological profile of the virus but also on the ways that consumers, businesses, and governments may respond to it. COVID-19 will most directly shape economic losses through supply chains, demand, and financial markets, affecting business investment, household consumption, and international trade. And it will do so both in traditional, textbook supply-and-demand ways and through the introduction of potentially large levels of uncertainty.
Economists have been using the SARS epidemic to put the coronavirus outbreak in context. The 2003 SARS epidemic is estimated to have shaved 0.5 percent to 1 percent off of China’s growth that year and cost the global economy about $40 billion (or 0.1 percent of global GDP).The coronavirus epidemic, which like SARS originated in China, differs in a few key ways. China’s economy accounted for roughly 4 percent of the world’s GDP in 2003; it now commands 16.3 percent. If the coronavirus has a similar effect on China as SARS, the impact on global growth will be worse. Moreover, China’s growth is weaker than it was in 2003—after years of rapid economic development, China’s growth stands at 6 percent, the lowest it’s been since 1990. Its confidence had been shaken by the dual effects of general economic deceleration and the U.S.-China trade war escalation. Even before the epidemic, China’s Purchasing Managers’ Index was already showing signs of contraction. The February reading slowed from 50 to 35.7, a level in line with that of November 2008 during the global financial crisis. The economic fallout from the coronavirus could rattle China’s economy further and dampen global growth.
The coronavirus spreads more quickly than SARS, but, so far, seems to have a lower mortality rate. For its part, China responded more quickly to the coronavirus outbreak than it did with SARS, employing unprecedented confinement measures in areas such as Wuhan. These measures, while prudent, have created short-term economic pain on the supply-and-demand side.
Outside China, the outbreak has also affected global supply chains, as other governments have also taken immediate steps to slow the spread of the virus. The Harvard Business Reviewpredicts that the peak of the impact will occur in mid-March, “forcing thousands of companies to throttle down or temporarily shut assembly and manufacturing plants in the U.S. and Europe.” This again will disrupt global supply chains as well as demand for goods and services in the affected economies. These disruptions make it more difficult for companies in the U.S. and elsewhere to bring their goods to customers, and these companies will reduce exports from the U.S. to the rest of the world in the coming months.
Furthermore, households, companies, and governments alike are deeper in debt now than they were when SARS hit. For example, the U.S. nonfinancial corporate debt of large companies is currently around $10 trillion, up from around $4.8 trillion in 2003. Deutsche Bank released analysis showing the world’s major economies harboring the highest debt levels of the past 150 years, with World War II as an exception. They all still need to continue repaying that debt, even if jobs, customers, and tax revenues decline in a weakening economy. These fixed costs then will leave less money to spend on other things. Large amounts of debt often exacerbate an economic slowdown, especially if central banks can do little to ease that burden by cutting interest rates.
The world looks different from the last global virus outbreak in 2003. Global growth is already slow, and financial markets already have very low interest rates, which means that central banks in almost every major country have little ammunition with which to mitigate any potential economic fallout. This puts greater pressure on governments to use the power of their purse to counter the economic fallout from the coronavirus. While the fallout from the coronavirus will disrupt supply chains and global demand that could also affect the U.S. economy, the current situation also creates a lot of uncertainty over the longer term. Congress and the Trump administration can do a lot to counter the risks associated with the spread of the virus by engaging in fiscal policies (deficit spending) that will provide relief to affected populations and mitigate disruptions to U.S firms.
Supply chain disruptions make it difficult for U.S. firms to finish their products
Disruptions to global supply chains are one of the clearest effects of the coronavirus. Looking more closely at global supply chains, there have already been significant disruptions, with the list of manufacturers outside of China forced to decrease production in their plants growing longer every day.
As noted earlier, China has shut down factories in areas affected by the virus as a preventive measure, causing supply chain disruptions and affecting the mobility and near-term employment prospects of migrant workers.
These disruptions could further spread. As the virus has moved outside of China along with the efforts to contain it, it is possible that many workers around the world may not be able or willing to show up at work, further reducing economic activity. The viral outbreak in northern Italy, for instance, has shut down a firm that is the supplier of electronic parts to automakers across the European Union, meaning auto plants in several countries may need to close. This kind of widening of supply chain disruptions to suppliers of intermediate goods outside of China will make it increasingly difficult for U.S. firms to substitute products from other countries for the missing inputs from China.
How much this affects U.S. firms will depend on how tightly they manage their supply chains. Many firms manage the time between needing new supplies from China and putting them into their own production with very short lead times—often weeks and not months. These companies will feel the effect of factory shutdowns in China relatively quickly. These challenges affect not just traditional industries such as car manufacturing but also increasingly high-tech industries such as smart phones and computers. As a consequence of these supply chain disruptions, U.S. firms cannot finish their own production and thus cannot bring their products to customers. The result is reduced economic activity and growth.
Consumers are buying fewer things as they worry about the virus and its spread
The virus will not only affect supply, but some sectors of the U.S. economy may also experience declines in demand—and big reductions in revenue—because of the overall effects on the economy. There are two separate effects to consider. First, people will buy less of some goods and services because they are afraid of potential exposure to the virus. For example, they may be less willing to travel or go out to eat. The result is that air travel and hotels could feel a real pinch. Already lessened demand on food and beverage industries seems to be occurring. As Americans feel increasingly uneasy about the spread of the virus in the country, it is foreseeable that they will further cut back on some goods and increase their emergency savings instead.
Second, when firms are forced to close, workers likely will receive less money than they otherwise would have expected and, in some instances, will receive no pay. As a result, these workers will have less to spend, again cutting overall demand. A fall in demand that follows a supply shock constitutes a one-two punch that will further contract economic activity, although the size of these effects is largely unknown.
Mass flight cancellations to and from China—which has been designated as a “do not travel” destination in the United States—means almost no one is traveling to China and, more importantly for U.S. firms, Chinese tourists are not traveling overseas. A consulting firm estimates that the United States will lose 1.6 million visitors from mainland China, with an associated decrease in spending of $10.3 billion dollars. Multinational companies and luxury goods makers who rely on Chinese consumers have already suffered and had to close stores. As such effects proliferate around the world, U.S. exporters will find it harder to sell their wares around their globe, which will have negative repercussions for U.S. growth and jobs.
Meanwhile, the U.S. anticipates lower imports from China. The last quarter of 2019 saw low imports, exports, and international trade. There is a risk of a sizeable negative demand shock if the public overreacts to the coronavirus outbreak.
Uncertainty over the virus and its economic effects can damage the economy
As much as economists think about risk-taking as a key driver of the economy, an economy only works if risks are largely known. But unknown risks, or uncertainties, can have a larger, more paralyzing effect.
The current U.S. domestic economy—with its strong labor market and consumption levels but concerningly low inflation and investment—already exhibits a heightened sense of uncertainty. Political polarization and conflicting policies on regulation have led to firms thinking twice before investing or expanding. Both a global and U.S. economic uncertainty index, developed by economists from Northwestern, Stanford, and the University of Chicago note an all-time high in August 2019.
In addition to the already high level of policy uncertainty, the effects of the coronavirus outbreak have a commonality with the 2008 financial crisis, specifically, its unknown magnitude. There are uncertainties about the scale of the virus, contagion rate, mortality rates, risk of incidence, and more. On top of the usual online disinformation and swirl of conspiracy theories, there are questions about the accuracy of the health statistics coming from China, in part because of China’s history of providing less-than-credible numbers related to its economy. Federal Reserve Chairman Jerome Powell remarked that it’s “very hard” to understand China’s economy. That issue of credibility has only become more challenging during this crisis and it makes assessing the impact of the virus on the global economy that much more difficult.
How may a heightened sense of uncertainty affect the economy? It could affect businesses, households, and financial market participants. Businesses may hold off on investments because they don’t know what happens to supply chains as well as their domestic and international customers. Internationally, it is not known where and how far the virus will spread. This makes it hard or even impossible to assess the effects on supply chain and demand disruptions discussed above. But if these effects are difficult to evaluate, businesses will not know whether they should continue with planned or even new investments. Yet, any slowdown of business investment in the United States would come after investment spending by U.S. firms has already fallen from March to December 2019.
Businesses are not the only ones that could pull back amid uncertainty. Households, worried about contracting the virus, could cut spending on some items such as traveling and going out. Moreover, this health risk poses a real economic risk, as many households have inadequate health insurance, which could leave them with large doctors’ bills when they get sick. And, most Americans do not have paid sick leave, meaning if they get sick from the virus and need to stay home, they will not get paid. In light of the risks, many people will view it as good economic precaution to avoid activities that increase exposure to others. On an economywide scale, though, this means less spending and thus less growth.
Banks and other financial institutions may restrict and reprice credit because they cannot properly assess short-term risks to particular borrowers, sectors, or countries. Less credit availability could make it harder for businesses, especially smaller ones, to invest and grow. And, some potential home buyers could find it harder to get a mortgage. Credit market uncertainty could then exacerbate the demand fallout from the coronavirus.
There is also an international wrinkle to growing uncertainty. International financial investors could become worried about the unknown risks to the global economy from the coronavirus. They could look for the comfort of a safe investment. Traditionally, U.S. treasuries are seen as very safe investment. However, more money coming into the United States from abroad typically strengthens the U.S. dollar, and a stronger U.S. dollar will eventually make U.S. exports costlier, making it more difficult for U.S. firms to compete globally.
Supply chain disruptions, demand contractions, and global economic uncertainty happen against the backdrop of many firms and households straining under large amounts of debt. This debt has to be repaid even if the economy slows. This continued debt service then leaves less money for businesses and households to spend when their incomes drop. High debt levels will exacerbate the economic fallout from the virus.
Interest rates and stock price decline as economic uncertainty takes hold
U.S. interest rates have recently fallen to historic lows in a sign of increasing economic uncertainty. The 10-year Treasury yield fell from 1.69 percent to 1.50 percent in the last week of January after remaining steadily around 1.7 percent to 1.8 percent throughout 2019 and early 2020. The decline continued through February, and for the first time in 150 years, the yield rate dipped below 1 percent on March 3.
The abnormal decline has increased calls for action from Wall Street, demanding that the White House and Congress to do something. The 10-year yield rate—often looked to as a fear index of the economy—clearly reflects the uncertainty and instability caused by the coronavirus and lack of appropriate response.
Prices on bonds with a range of maturities reflect an increasing possibility of a recession. In technical parlance, the yield curve has become inverted. Shorter-term interest rates are now higher than longer-term interest rates—the opposite of what happens in normal economic times. Such inversions are typically taken as a sign that financial markets worry about the longer-term outlook for the economy. Financial markets now see a growing risk of a recession. In the same vein, lower long-term interest rates mean that financial markets expect the Fed to cut interest rates, which are already low, to reduce the risk of a recession.
Financial markets, however, clearly worry that Federal Reserve action on interest rates may not be enough. The federal funds rate—the main interest rate that the Federal Reserve seeks to influence—has already been low. Moreover, longer-term interest rates—such as mortgage rates that matter for economic activity, including people buying houses—have fallen even without the Fed cutting rates. In addition, households hold a lot of consumer debt—student debt, car loans, and credit cards—where interest rates do not appear to react much to what the Fed is doing. That said, the effect of Federal Reserve bank interest rate cuts will be limited.
All these factors worry the stock market as the future outlook for the economy—and thus the outlook for profits—becomes murkier. The Dow Jones Industrial Average, S&P 500, and the Nasdaq composite all fell into correction territory at the end of February, representing their worst weekly skids since 2008. Stock market conditions are expected to remain volatile as measured by the Volatility Index (VIX).
Data from the Federal Reserve Bank of St. Louis shows volatility spiking abnormally in mid-February, as global panic surrounding the outbreak starts to set in. The index jumped from around 15 to almost 40 within a month. Such volatility has led corporate borrowers, who were looking to take advantage of favorable credit conditions to refinance loans, to withdraw their loans from the market and wait for stabilization. According to the Harvard Business Review, volatility “has signaled the greatest strain” on the valuation of risk assets, setting up volatility levels on par with the most major economic disruptions of the last three decades—barring the 2008 financial crisis.
5 core economic principles to inform policy in response to the coronavirus
The coronavirus puts the spotlight on policymakers to counter the risks of the virus in a quick, constructive, and effective way. It is imperative for policymakers to keep cool heads and take steps to ensure that the disruptions to workers, individual businesses, and sectors—which will cascade through the economy because of interconnectedness—are minimized while not interfering with efforts to deal with the epidemic. To that end CAP recommends five principles for economic policy action.
Do no harm
The Trump administration must find one voice and stop adding to the confusion. Moreover, the administration must to stop attacking the very programs Americans need right now: paid leave, public health insurance, SNAP, and other social programs. In its early 2020 budget proposal, the Trump administration sought to cut Centers for Disease Control and Prevention (CDC) funding by 16 percent; cut $85 million from the Emerging and Zoonotic Infectious Diseases program; and had the U.S. Department of Health and Human Services (HHS) cut $25 million from the Office of Public Health Preparedness and Response along with another $18 million from the department’s Hospital Preparedness Program. The latest budget proposal, modified to address the coronavirus outbreak, asks for $1.25 billion in new emergency funds for preparation and response efforts and to divert another $1.25 billion from other federal programs. It is imperative to change the message from cutting funding for public health, planning, and preparedness and instead articulate clear and decisive support of public efforts to contain the outbreak, minimize harms, and ensure investments in public health and emergency preparedness.
Put more, not fewer, resources in public health efforts
Potentially massive externalities related to epidemics alter conventional economic thinking. For example, many medical services that providers would normally charge for should be highly subsidized and delivered free (or close to free) and at a minimum of inconvenience to users. The Trump administration should consider immediate efforts to subsidize detection, treatment, and eventually immunization. Reimbursements could be a way of accomplishing this. Specifically, in terms of lowering barriers to testing, the government should make it clear that testing will be free (or at least not too expensive) and that people should not fear hospitalization (as undocumented people sometimes do).
The federal government needs to identify crucial medical supplies to deal with the outbreak and make sure that production will meet demand. Production and stockpiling of facemasks and protective gear for medical workers, and saline bags to treat patients, must be organized with government financial support. In addition, since many of the active ingredients in generic pharmaceuticals are made throughout the world—in places such as India, China, and the Czech Republic—the federal government needs to coordinate with domestic drug manufacturers to make sure the supply of many lifesaving drugs is not disrupted.
Policymakers should consider providing relief to hospitals and health care providers. It is unrealistic to think that health care providers won’t face financial strain in the event of a major outbreak or pandemic. Moreover, pandemics affect everyone, and many of the patients in need of acute care may be uninsured. Failure to treat these patients would produce large, negative health and economic externalities. Thus, pandemic preparedness cannot be approached by relying on standard health care business models. The spending necessary to expand capacity during such a public health crisis should come from the federal government, principally through the U.S. Department of Homeland Security, and, ideally, informed by a robust interagency working group with HHS, CDC, and other relevant executive agencies.
Assure businesses that they will be fine if their sector is hit by the virus and remediate harm when necessary.
Beyond the health sector, other industries necessary for the well-being of U.S. citizens may also need direct federal support. For example, a common response to natural disasters is panic buying in food stores, reflecting fear that supplies may not last. If the effects of the outbreak on food processors and retailers are severe, that sort of heightened anxiety will reappear—and perhaps for good reason. The government needs to consult with major food retailers and their suppliers to plan for possible disruptions in deliveries all along the food supply network and provide direct financial support to ensure that food supply does not become a serious problem.
Congress and the administration should consider measures that would provide immediate and direct relief where it is needed most. For example, in areas where the local, state, or federal government has mandated quarantines, the federal government could provide low-interest loans to small businesses for their associated costs and loss of profits. This will ensure that small businesses stay in business and that they do not have to let employees go or cut their pay. If the Trump administration can do three rounds of farm bailouts due to the trade wars, the government can certainly offer some better-designed insurance program to sectors and firms affected by the fallout from the virus.
Targeted relief to sectors heavily affected in a direct way serves both to ensure minimum service levels, minimize supply chain disruptions, and avoid credit events that could spread across the economy.
Calm financial markets
The spread of COVID-19 has begun to affect financial markets, but it is uncertain how severely the coronavirus will strain the broader financial system moving forward. As financial markets become more volatile, and more economically vulnerable actors suffer increased difficulties to meet financial contracts, it will be important to act swiftly in order to avoid any disruptions in the chain of payments and too much risk-averse behavior.
The Federal Reserve cut its benchmark interest rate by half (.5) a percentage point on March 3 in a move that was widely seen as a reaction to the coronavirus. Other central banks have already lowered interest rates or are considering doing so. The Federal Reserve should adopt an accommodative monetary policy stance and should consider using all tools at its disposal, including its emergency lending authorities. But as interest rates are close to zero in many large markets, there is limited scope for further decreases, so more creative instruments such as quantitative easing may be warranted. Inflating financial asset prices (such as the stock market) should not be a main goal in this context.
The federal government and regulators should monitor financial markets closely and prepare for possible market stress; credit events; or sudden drops in credit supply or in liquidity in markets such as overnight repurchase agreements (repos) and intervene where it is sensible to do so.
Moreover, financial regulators should carefully monitor the ongoing impact of COVID-19 on broader financial stability. If, for example, community banks in hard hit areas are unable to meet commercially viable business loans because they are capital constrained, a program to temporarily purchase preferred stock in these banks would allow them to meet local needs and keep good businesses operating.
The Financial Stability Oversight Council (FSOC)—a postcrisis body of financial regulators—should immediately convene a meeting to discuss the risks COVID-19 may pose to the financial system. The FSOC should task its research arm—the Office of Financial Research (OFR)—to assist with this monitoring and analysis. If the COVID-19 outbreak leads to severe stress at financial institutions and markets, financial regulators should stand ready to use the emergency authorities under their respective jurisdictions. It is important to note that the officials currently leading the financial regulatory agencies were not in office during the 2007-2008 financial crisis and may not be intimately familiar with the mechanics and protocols associated with their respective emergency authorities. To that end, the FSOC could organize a wargaming exercise to ensure financial regulators are not caught off guard if the health of the financial system does deteriorate.
It is important to emphasize that financial regulators should refrain from relaxing critical regulatory and supervisory safeguards during this period. Weakening financial stability rules for large banking institutions would undermine the core resiliency of the financial system and increase risk to the real economy.
Finally, as the coronavirus advances, it will be optimal to aim for international cooperation on economic policy matters, including financial policy. Coordinated responses will lower the likelihood of beggar-thy-neighbor policies and accusations of currency manipulation. International cooperation and coordination should also help address supply chain issues, especially in crucial supplies such as medicines.
Ease the risks for households and vulnerable populations
It will be important to reduce the impact that this outbreak with have on the financial stability and prosperity of households, particularly those who are already vulnerable. Many workers do not have health insurance, and roughly 27 percent of private-sector workers did not have access to paid sick days in 2019. Given that this is unlikely to be the last health crisis Americans will experience, the United States should adopt a guaranteed paid sick leave policy as soon as possible, just as virtually every other developed country has done. In the event of a major health crisis that involves extended sick leave, the federal government could support employers with the cost of providing paid sick time or help workers by expanding benefits through the unemployment insurance system. This would ensure that employees can recover from COVID-19 or care for a sick family member without losing their job or pay while also benefitting the businesses where they are employed.
Being uninsured or underinsured, combined with limited or no paid sick time, makes people particularly financially vulnerable. For instance, lower-wage frontline workers who work in jobs where they interact with other people—such as health aides, personal care workers, cooks and servers, and retail sales people—were less likely to have health insurance and more likely to incur medical debt due to an unexpected health event than other workers in 2018. Almost one-fourth of these workers, 23.4 percent, did not have health insurance then, compared to 10.5 percent of other workers and 4.7 percent of health care workers, such as doctors, nurses, and technicians. (see Table 1) Even though the share of lower-wage frontline workers that had unexpected health expenses in 2018 was less than that of other groups of workers (see Table 1), more than half of those frontline workers with unexpected health expenses ended up with medical debt compared to only 23.1 percent for other health care workers and 38.7 percent of all other workers. (see Table 2) Health care emergencies can quickly translate into financial burdens when people lack health insurance and the ability to take time off. The 14 states that have yet to adopt the Affordable Care Act’s Medicaid expansion should do so immediately, which would result in more than 2 million low-income people gaining comprehensive health care coverage.
Congress and the administration should also mitigate the economic harm to households. This will also have the important effect of supporting consumption—the most important pillar of the economy.
Congress could take several steps to help vulnerable households. These would include ensuring free—or affordable to the patient—access to testing and treatment for the coronavirus and protecting patients from surprise bills. Other ideas for temporary assistance could include getting cash into the hands of average people. This could be done through a payroll tax holiday or through direct cash payments. Providing financial assistance to vulnerable individuals in times of hardship ensures that they can afford the basic everyday necessities; retain a measure of control over their own lives; and avoid the dire consequences of financial disaster. Putting cash in the pockets of households increases consumption and can motivate businesses to invest more. Increased consumption and business investment have a direct positive effect on economic activity and can ignite a virtuous circle of economic growth. Consumption and investment are the cornerstone of a full economic recovery.
Conclusion
With the spread of the coronavirus, the United States is facing a potential “black swan event”—an extremely rare and unpredictable incident that has potentially severe consequences. Therefore, it is important to act swiftly and in meaningful ways to minimize the fallout from this shock. Now is precisely the time for deficit spending: Low interest rates make it cheap and easy for the government to finance itself while limiting the potency of further monetary stimuli from the Federal Reserve. Therefore, it is incumbent upon the federal government to provide fiscal stimulus to ignite economic activity. In other words, the government needs to engage in sizeable spending and investment in key areas of the economy in order to increase economic activity; minimize disruption to the health and prosperity of the population; and to limit the effects on supply chains and the business sector. The five principles for economic policy action outlined in this report provide a roadmap for meaningful and decisive fiscal action that will help the economy regain its footing.
It is important to note a policy prescription that is clearly not included in the list of recommended actions outlined above: a broad-based tax cut that favors corporations and the wealthy. There is evidence that the Tax Cuts and Jobs Act (TCJA) constituted a large corporate-tax windfall that went mostly to already wealthy individuals with little evidence that it well to middle- and working-class families. It did not spur large levels of investment or growth and ballooned the fiscal deficit. The tax cuts recently proposed by the Trump administration will be very costly and will not directly or efficiently address the economic fallouts from a potential widespread coronavirus outbreak in the United States. Such proposals, including further cuts to the corporate income tax, would provide a windfall to many large and profitable corporations and other businesses—regardless of whether or not they have been meaningfully impacted. Most of these firms are already benefitting from enormous tax cuts enacted in the 2017 tax law. Redoubling this mistake will distract from other efforts and waste resources that are urgently needed for the purposes outlined in this report.
A potential sudden stop in activity, coupled with heightened uncertainty, may expose structural vulnerabilities in certain households and markets. A decisive and rational response along the lines of the five principles outlined here will minimize economic risks and contribute to a speedy recovery.
The Supreme Court on Tuesday rejected an effort by Democrats to expedite a challenge to a lower court’s ruling striking down a key tenet of ObamaCare, narrowing the possibility that the court takes up the contentious case this year.
The House of Representatives and a group of blue states had asked the court to fast-track their appeal after the 5th Circuit Court of Appeals ruled that the Affordable Care Act’s individual mandate is unconstitutional.
“Under the current state of affairs, there is considerable doubt over whether millions of individuals will continue to be able to afford vitally important care,” the House wrote in a court filing earlier this month.
“Millions of individuals will live with the insecurity of not knowing that they have access to affordable health care, and will be forced to make important life decisions without knowing how those decisions will affect their continued access to such care.”
“If the Court does not hear the case this Term, that uncertainty will likely persist through next year’s open enrollment period,” the House wrote.
Tuesday’s order makes it unlikely that the high court will rule on the health care law before the November presidential election, where health insurance policy is sure to play a prominent role.
The 5th Circuit’s ruling delivered a victory for the coalition of conservative state attorneys general challenging the Obama administration’s signature achievement.
The Trump administration has declined to defend the Affordable Care Act in court, and the president has cheered on legal efforts to dismantle it.
“This decision will not alter the current healthcare system,” President Trump said in a statement last month. “My Administration continues to work to provide access to high-quality healthcare at a price you can afford, while strongly protecting those with pre-existing conditions. The radical healthcare changes being proposed by the far left would strip Americans of their current coverage. I will not let this happen.”
It’s still unclear whether the Supreme Court will decide to hear the challenge to the 5th Circuit ruling. Now that the justices have chosen to adhere to a normal briefing schedule, that decision will likely not come until March at the earliest.