HEALTH CARE BRIEFING: Death Toll, Economy Fail to Unite Congress

Congress‘s near unanimity on last month’s $2.2 trillion coronavirus rescue bill has given way to partisan finger-pointing that threatens to poison the debate when lawmakers try to construct another emergency boost to the struggling economy.

The crisis has only worsened since President Donald Trump signed the law on March 27. But there is little consensus on next steps as patients flood hospitals in some U.S. cities and leaders extend the economic shutdown.

Trump and Senate Minority Leader Chuck Schumer (D-N.Y.) late last week exchanged biting letters accusing each other of fumbling the initial response. Senate Majority Leader Mitch McConnell (R-Ky.) blamed Democrats for distracting the nation from an emerging threat with an impeachment trial. Speaker Nancy Pelosi (D-Calif.) said Trump’s slow response has cost lives.

The rancor was growing as the number of Covid-19 cases in the U.S. pushed past 325,000, deaths exceeded 9,200 and government data began showing the pandemic’s rapid and widespread impact on the world’s biggest economy. Meanwhile, the current rescue plan got off to a rocky start, as small businesses struggled to submit documents and lenders ran into trouble with the government’s portal for loans.

The increasingly alarming numbers prompted Pelosi to scale back her earlier ambitions for Congress‘s next coronavirus stimulus package. She said Congress should “update” the current legislation to provide more money for small businesses and individuals. Pelosi said over the weekend she wants the legislation to get a vote this month.

Yet there isn’t consensus on what the next stimulus should look like. McConnell told the Associated Press in an interview that there will be a fourth virus-related bill, but said he and Pelosi have “a little different point of view” about the timing of the next package and what should be included.

Even after last week’s jobless claims shattered all records, House Minority Leader Kevin McCarthy (R-Calif.) said he didn’t think a fourth tranche of aid “is appropriate at this time,” adding that a “tweak” to the most recent legislation might be in order. He also took the opportunity to accuse Pelosi of delaying earlier stimulus packages. Read more from Billy House.

Urgent Funds for Health Centers: House Democrats want to inject an emergency $10 billion into the country’s community health-center program, but clinics and hospitals say they need seven times more. Their costs are mounting as health centers, like hospitals, forgo more lucrative services like dental care or cosmetic operations to prioritize coronavirus patients. The National Association for Community Health Centers had originally asked Congress for $3.2 billion but received $1.3 billion as part of the stimulus. The group now wants $77.3 billion, which would include a five-year extension of the program. Alex Ruoff has more.

Research, Treatment & Coordination

One in 1,000 Americans Infected: The U.S. has more than 330,000 coronavirus cases confirmed as of yesterday, meaning one in every 1,000 Americans are infected, according to data from Johns Hopkins University and Medicine, Derek Wallbank reports.

Trump Warns of Deadly Weeks: Trump warned that deaths from the virus in the U.S. will escalate over the next one to two weeks, and could be on par with the number of fatalities seen in world wars. “There’s going to be a very, very deadly period, unfortunately,” Trump told reporters at the White House on Saturday. Trump said that as the number of deaths peak, “I really believe we probably have never seen anything like these kind of numbers, maybe during the war—a world war. A World War I or II or something.”

“The next week is going to be our Pearl Harbor moment, it’s going to be our 9/11 moment, it’s going to be the hardest moment for many Americans in their entire lives,” U.S. Surgeon General Jerome Adams said yesterday on NBC’s “Meet the Press.” Separately, on “Fox News Sunday,” Adams said the difference between the pandemic and those historic events were “it’s not going to be localized. It’s going to be happening all over the country. And I want America to understand that.” Read more from Jordan Fabian and Justin Sink.

Trump struck a more upbeat tone yesterday, as he and Vice President Mike Pence said they see signs the U.S. outbreak is beginning to level off or stabilize, citing a day-to-day reduction in deaths in New York, the epicenter in the country. “We are beginning to see the glimmers of progress,” Pence said at a White House news conference on Sunday. “The experts will tell me not to jump to any conclusions, and I’m not, but like your president I’m an optimistic person and I’m hopeful.” Pence said the government is starting to see “cases, and most importantly losses and hospitalizations, begin to stabilize.”

New York state reported 594 new coronavirus deaths yesterday, a reduction of 36 from Saturday. Governor Andrew Cuomo said in a daily briefing that the data may show the state is reaching a “plateau” — or could be “just a blip.”

But Trump was more optimistic. “Maybe that’s a good sign,” he said. “We hope we’re seeing a leveling off.” Justin Sink and Mario Parker have more.

  • Governors from across the country whose states are at various points in the pandemic response spoke out yesterday, with some critical of the absence of sweeping federal guidance and many in the process of setting up field hospitals for an anticipated rush of patients. Hailey Waller has more.

Hospitals Said Can’t Charge Uninsured: Hospitals and health-care providers that accept federal funding provided through the $2 trillion stimulus measure (Public Law 116-136) aren’t allowed to bill uninsured people treated for Covid-19, HHS Secretary Alex Azar said Friday. The providers will be reimbursed at Medicare rates, Azar said, which will be carved out of a $100 billion slice of the law. When probed about re-opening enrollment for Affordable Care Act plans or potentially expanding Medicaid, Azar demurred. People who’ve recently lost their employer-provided insurance can enroll through Obamacare’s exchanges under the law’s special enrollment rules, said Azar, Jacquie Lee reports.

  • Reopening Obamacare exchanges is the most efficient way to let uninsured Americans buy coverage amid the pandemic, health-care advocates say. But so far that seems to be a quixotic hope for many. The Trump administration has signaled that it won’t reopen the HealthCare.gov exchange to allow more people to sign up for health coverage. Read more from Sara Hansard.
  • Separately, Reps. Pramila Jayapal (D-Wash.) and Debbie Dingell (D-Mich.) urged Trump in a letter “requesting a virtual meeting to discuss proposals for immediately expanding health insurance coverage to uninsured Americans,” such as through Medicare and Medicaid, according to a statement. Jayapal and Dingell are lead sponsors of H.R. 1384, the Medicare for All Act of 2019. Read their letter here.

Special Covid-19 Commission: Reps. Stephanie Murphy (D-Fla.) and John Katko (R-N.Y.) introduced a measure last week that would create a bipartisan commission to assess the country’s “preparation for and response to pandemics” that would be modeled on the Sept. 11 commission, according to a statement. The bill calls for 10 members for the “COVID-19 Commission,” split equally between Democrats and Republicans. Read text of their bill here. Speaker Pelosi said last week that her chamber would create a special committee to oversee the government’s response to the outbreak. Billy House and Erik Wasson have more on that agenda item.

Patient Privacy Amid Pandemic: Data sharing by big technology companies is helping government officials combat the dizzying spread of the coronavirus by monitoring compliance with social distancing and stay-at-home orders. It’s also putting privacy experts on edge. Companies including Google and Facebook had already been collecting, for advertising purposes, massive volumes of data. And some of them are now stripping data of personal ID markers, aggregating it, and providing it to researchers, public-health authorities and government agencies.

Consumer advocates fear an emphasis on health over privacy could undermine the protection of civil liberties, similar to what happened after 9/11, when the U.S. secretly began collecting mass amounts of information on its own citizens in an effort to track down terrorists. Read more from Ben Brody and Naomi Nix.

  • Separately on Friday, Senate Democrats asked Apple CEO Tim Cook about how his company is ensuring the privacy of consumers’ health data that’s submitted to Apple’s coronavirus app. Sens. Bob Menendez (D-N.J.), Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), and Kamala Harris (D-Calif.) asked Cook for more details on the terms of agreement between Apple and federal and state governments, and whether the screening site and app must be HIPAA compliant, Rebecca Kern and Mark Gurman have more.

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Combating Shortages at Hospitals

Virus Spurs Global Free-for-All Over $597 Billion Medical Trade: Germany’s Vice Chancellor Olaf Scholz has said the shared experience of battling the coronavirus could lead to a “new age of solidarity.” There’s little sign of the crisis bringing nations closer together, though: From India to Europe and the U.S., governments are rushing to get hold of masks, ventilators, gloves and medicines in a free-for-all that’s stoking tensions in a world already stung by globalization. Countries are rushing to introduce export restrictions, contributing to what the World Trade Organization calls a “severe shortage” of goods needed to fight the virus. Read more from Alan Crawford.

Defense Act to Retaliate on Supplies: Trump said he would use the Defense Production Act to retaliate in cases where companies ship medical equipment elsewhere that’s needed in the U.S. to cope with the pandemic. “You could call it retaliation because that’s what it is. It’s a retaliation. If people don’t give us what we need for our people, we’re going to be very tough,” Trump told reporters on Saturday. The president has said he invoked the act to ban exports of supplies needed around the world to fight the virus, escalating a spat with allies including Canada and 3M. Read more from Justin Sink and Ben Bain.

  • Related: Germany and France Blame Americans for Playing Dirty Over Masks
  • Trade experts have warned that any decision to block exports of masks and other equipment would risk retaliatory measures by countries that would undermine international efforts to fight the Covid-19 outbreak. The shortage of supplies in the U.S. has been blamed on inadequate federal stockpiles as well as a shortfall in domestic production.The U.S. has until now been relying on emergency air shipments from China and other countries to help fill the gap. Yet it is unclear whether other countries would allow such flights to continue if the U.S. is refusing to allow its own exports. Read more from Mario Parker, Justin Sink and Shawn Donnan.
  • Meanwhile, India banned all exports of hydroxychloroquine, a malaria drug that Trump has repeatedly touted as a “game changer” in the fight against Covid-19. Exports of the drug and its formulations are prohibited “without any exceptions” and with immediate effect, India’s Directorate General of Foreign Trade said in an April 4 order on its website. At a press conference on Saturday, Trump said he spoke to Indian Prime Minister Narendra Modi and appealed for the release of shipments U.S. has already ordered. India is giving his request “serious consideration,” he said. Read more from Rajesh Kumar Singh.

Hahn Says China Not Creating Shortages: FDA Commissioner Stephen Hahn said there’s no evidence that any drug is in short supply because China or any another country is blocking key ingredients from flowing into the U.S. market. “We are monitoring that very closely,” Hahn told Fox News yesterday. Some of those shortages may be evident due to spikes in demand for some medications, he said. The FDA maintains a public database of shortages, which can occur for many reasons including manufacturing problems, delays and discontinuations. Read more from Naomi Nix.

DOD Cautious Over Virus Patients on Ship: The Defense Department remains cautious about allowing Covid-19 patients on the Navy hospital ship anchored in Manhattan but is reassessing that policy daily, Pentagon spokesman Jonathan Hoffman said Friday. The USNS Comfort is “not an environment built for treating infectious diseases en masse,” Hoffman said. The Comfort, which docked in New York last Monday, was assigned to add 1,000 beds to the city’s capacity with the intention to take virus-free patients, such as trauma victims, in order to free up space in hospitals. Only a handful of New Yorkers are being treated on the Comfort so far, however. Read more from Tony Capaccio, Glen Carey, and Travis Tritten.

Apple Designing Face Shields for Medical Workers: Apple is designing face shields for medical workers and separately has sourced over 20 million masks through its global supply chain, CEO Tim Cook said in a tweet yesterday. Cook said the company’s design, engineering, packaging and operations teams are working with suppliers to get the shield made and shipped. The first shipment was delivered to a Santa Clara, California, hospital last week and there are plans to ship over a million this week and another million weekly after that. Read more from Mark Gurman.

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Distancing, Politics & Wider Impacts

Trump Says CDC Suggests Masks: Trump said that public health officials are recommending the use of non-surgical grade cloth masks as a voluntary way to prevent the spread of the virus, but that he did not plan to wear one himself. “It’s only a recommendation,” Trump told reporters at the White House. “You don’t have to do it.” The announcement marks a reversal for health officials, who had previously said those without symptoms didn’t need to don a mask. Trump said the advice on masks from the CDC doesn’t change guidelines calling for social distancing. He emphasized that the CDC isn’t suggesting the use of commercial medical-grade masks, which are in short supply at hospitals. Read more from Mario Parker and Jordan Fabian.

WHO Warns of Cycle of Lockdowns: The World Health Organization warned nations against abruptly dropping their restrictions aimed at slowing the virus’ march around the world, saying that careful planning is needed to prevent an economically destructive cycle of repeated lockdowns. A transition strategy is vital to avoid repeated quarantines, Mike Ryan, head of the WHO’s emergencies program, said at a press briefing in Geneva. “If we lurch from lockdown to poor control back to lockdown and back to poor control, that is not what anybody needs right now,” Ryan said.

Countries around the world have frozen public life to try to stop the pandemic, but those efforts have challenged economies, with nearly 100 countries already seeking financial help related to the coronavirus, according to the International Monetary Fund. Still, public health officials have warned that simply quelling the current wave of infections won’t be enough to stop the pandemic. As long as the virus lingers and there’s a large number of people who haven’t been exposed, there’s a risk of resurgence. Read more from Naomi Kresge and Corinne Gretler.

Abortion Limits in Pandemic: The U.S. Constitution doesn’t require Oklahoma to allow access to abortion during the pandemic, the state told a federal district court that is considering whether to block it from enforcing an emergency order that shuttered abortion providers. Providers, saying the state’s interpretation of the emergency order amounts to an illegal ban on abortions, want a temporary restraining order to halt it. Read more from Mary Anne Pazanowski.

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What Else to Know Today

FTC Says Altria Made Secret Deal: Altria Group withdrew from the e-cigarette market in the fall of 2018 because of a secret deal with rival Juul Labs, not over public-health reasons that it had cited publicly at the time, according to federal antitrust officials. The Federal Trade Commission published Altria’s clandestine arrangement with Juul in an antitrust complaint Friday. The FTC complaint cites new evidence about the negotiations between the two companies that resulted in Altria’s $12.8 billion investment in Juul in 2018. David McLaughlin and Tiffany Kary have more.

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To contact the reporter on this story: Brandon Lee in Washington at blee@bgov.com

To contact the editors responsible for this story: Giuseppe Macri at gmacri@bgov.com; Zachary Sherwood at zsherwood@bgov.com; Michaela Ross at mross@bgov.com

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