HEALTH CARE BRIEFING: Pence to Talk Testing Shortage With States

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Vice President Mike Pence will discuss today shortcomings in U.S. testing for coronavirus infections with governors, President Donald Trump said yesterday.

Trump said his administration will share information with the governors ahead of the call, about testing capacity in their states that might not yet be utilized. Pence will “review what more they could do, and do together, to develop locally tailored testing strategies,” Trump said at a White House press conference.

Governors of both parties have complained they can’t begin the White House’s three-phase plan to reopen the U.S. economy without far more widespread testing for the virus. Several governors criticized Trump earlier Sunday for trying to cast the shortfall in testing as a problem for states to resolve. Read more from Mario Parker.

Negotiating the Next Stimulus

Talks advanced between the Trump administration and Congress over the weekend on more funding to aid fight the coronavirus and its impact on the economy.

Democratic leaders and Treasury Secretary Steven Mnuchin said they’re close an an agreement to top up funds for a loan program aimed at helping small businesses stay afloat during the coronavirus pandemic, and to provide funds for hospitals.

Mnuchin said on CNN’s “State of the Union” that he’s hopeful the deal can be passed in the Senate today and the House tomorrow. House Speaker Nancy Pelosi (D-Calif.) offered no specific timetable but said the sides are “close.”

While the Senate has a pro forma session scheduled for today, passage of any measure then is unlikely. Leaders of both parties must check with all senators to ensure they would agree to approve something by unanimous consent, and text of legislation is usually provided first. The Senate’s next scheduled session is currently set for Thursday.

House Majority Leader Steny Hoyer (D-Md.) in a statement yesterday told lawmakers the chamber could meet as as soon as 10 a.m. Wednesday to consider legislation to expand a small business loan program.

Apart from adding an additional $300 billion to the Paycheck Protection Program, or PPP, designed to help small businesses keep workers on their payrolls, Mnuchin said he also proposed $50 billion more for a separate Economic Injury Disaster Loan program, or EIDL, that provides financing and advances as grants of as much as $10,000.

Senate Majority Leader Mitch McConnell (R-Ky.) and Mnuchin reiterated that state and local government funding and food-stamp demands from Democrats would not be part of the package now under review. The deal will include $75 billion of the $100 billion Democrats have demanded for hospitals, and $25 billion for virus testing, Mnuchin said.

Senators Propose $500 Billion State Aid: Separately, a Republican and a Democrat in the Senate are proposing a $500 billion fund for state and local governments in the next comprehensive rescue package from Congress, to aid parts of the country reeling from the coronavirus pandemic. As Democratic leaders and the Trump administration negotiate an interim injection of aid for small businesses, Sens. Bill Cassidy (R-La.) and Bob Menendez (D-N.J.) are looking to establish the fund to help the states hardest hit by the Covid-19 pandemic. The money would be split into three tranches and distributed according to formulas that reflect population, infection rates and revenue loss.

Governors and mayors nationwide have been pleading for the federal government to provide additional aid as tax revenues plummet and demands for resources skyrocket. Over 22 million people have been thrown out of work and businesses have closed or curtailed operations, with many losing their employer-sponsored health insurance. At the same time, health infrastructure has been stretched in many areas. Read more from Daniel Flatley.

Letters & Legislation:

E-cigarettes will stay on the market amid the pandemic over Democratic concerns that vaping can exacerbate the illness. The House Oversight Economic and Consumer Policy Subcommittee said on Friday that the FDA told committee leaders it’s still considering the evidence to decide whether vaping is a risk factor for Covid-19. Earlier this month, the director of the National Institute on Drug Abuse warned that people with lung damage due to vaping have a higher risk of severe Covid-19 symptoms and death. Read more from Jacquie Lee.
Reps. Tom Malinowski (D-N.J.) and Rosa DeLauro (D-Conn.) introduced a bill Friday they say would make sure that the U.S. has “a properly stocked and maintained Strategic National Stockpile” to combat future health crises. The pandemic “has shed light on the life threatening inadequacies of our current strategic national stockpile,” they said Friday in a statement. The bill would require HHS Secretary Alex Azar to submit to lawmakers information on “the minimum level of supplies, such as personal protective equipment, in the SNS to adequately respond to a pandemic,” among other requirements, the statement says.
House Energy and Commerce Chairman Frank Pallone (D-N.J.), Oversight Chairwoman Carolyn Maloney (D-N.Y.) and Senate Health, Education, Labor, and Pensions Committee ranking member Patty Murray (D-Wash.) in a letter Friday to HHS Secretary Azar urged the administration “to immediately reverse its fetal tissue restrictions for any current or future federally supported COVID-19-related research,” according to a statement. “Scientific research involving fetal tissue has previously helped lead to major medical breakthroughs,” they said. Read the letter here.

Response, Research & Treatment

Gap in Testing for Re-Opening: A gap is widening over how much testing is enough—and many public health experts fear the current level could cost lives and set back efforts to re-open after weeks of social distancing efforts to stop the virus. The Trump administration says the U.S. is conducting 150,000 tests per day, the bulk of which are performed by commercial labs and some by state health labs. Trump has argued that is enough for a phased re-opening, and on Saturday, he praised states that have begun to do so.

But experts say that number is low, obscuring the extent of the virus’s spread and leaving newly reopened states vulnerable to a new wave of infections. One estimate by Howard Forman, director of the Yale School of Public Health’s health-care management program, claims the U.S. would need the capacity of a million tests a day to be confident the outbreak is contained—which is roughly what the country now does in a week.

“The question is, can you stay open?” asked Harvard Global Health Institute Director Ashish Jha. He said the U.S. must be able to do at least 500,000 tests a day by May 1. At current levels of testing, he said, “it’s nearly impossible for me to see how we do this.” Read more from Emma Court.

Cuomo Sees New York on ‘Other Side’: Gov. Andrew Cuomo (D) said yesterday that New York appears to be “on the other side” of the coronavirus crisis as he announced another drop in daily deaths and highlighted other positive trends. “If this trend holds, we are past the high point,” Cuomo told reporters. “Whether or not the descent continues depends on what we do. But right now we are on a descent.” The daily death count of 507—in the nation’s epicenter of the Covid-19 epidemic—was the lowest since April 6, after New York weathered almost two weeks of fatalities numbering between 606 and 799, the peak from April 9. On Saturday, Cuomo reported 540 new fatalities.

In a notably upbeat briefing, Cuomo showed the curve of total hospitalizations on a steady downward trend. He said that intubations onto ventilators also continue to drop. Total new hospitalizations from Covid-19 fell dramatically, to 1,384 on Sunday from 1,915 on Saturday. Read more from Ian Fisher.

Antibody Treatments May Be Best Hope Against Virus Until Vaccine: The novel coronavirus is devious, persistent, and, according to some scientists, not even alive. But, as the world has had to learn, this tiny bundle of genetic material is a highly efficient invader. Each particle is armored with roughly 100 protrusions, or spikes, perfectly evolved to latch onto an enzyme on the surfaces of throat and lung cells, then slip into them and replicate millions and millions of times. Neutralizing those spikes may be the best way to prevent the virus from harming its host. And among the most promising approaches to doing that is finding the right antibodies. Read more from Robert Langreth and Susan Berfield.

Related Headlines:

Nursing Homes Must Report Cases, Hospitals Can Ease Services Back: Nursing homes will be required to report confirmed cases of Covid-19 to families, residents, and the CDC, according to a new directive issued yesterday by the CMS. These data aren’t currently collected by the CDC, the CMS, or the Federal Emergency Management Agency. “Nursing homes have been ground zero for COVID-19,” said CMS Administrator Seema Verma in a release. Read more from Fawn Johnson.

Also at a White House press conference yesterday, Verma announced new guidelines outlining how hospitals can gradually resume elective surgeries and other in-person services as social distancing measures ease. In a statement, CMS said this transition should be done in coordination with local and state public health officials and while ensuring there is enough personal protective equipment and staff available.

NIH Launches Public-Private Vaccine Force: More than a dozen drugmakers including Pfizer, Johnson & Johnson, and Sanofi are coordinating their Covid-19 response with the National Institutes of Health to push out new treatments and vaccines. The public-private partnership plans to develop a global framework for prioritizing vaccine and drug candidates, streamlining clinical trials, coordinating regulatory processes across different nations, and using assets available among all collaborators to respond rapidly to both the current and future pandemics. The NIH announced the “Accelerating COVID-19 Therapeutic Interventions and Vaccines” partnership on Friday. Jeannie Baumann and Jacquie Lee have more.

Gilead Virus Treatment Has Early Results: A report on drug company Gilead Sciences’ coronavirus treatment showed that a group of patients being treated in Chicago were “seeing rapid recoveries in fever and respiratory symptoms.” The report posted last week, from medical news publication Stat, cited a video made by a researcher at the University of Chicago who’s helping conduct a trial of Gilead’s remdesivir. The researcher, infectious disease professor Kathleen Mullane, said that most patients had been discharged from the hospital and only two had died, according to Stat. Gilead’s drug is one of the most-watched therapies being studied for treatment of Covid-19 patients. Read more from Drew Armstrong.

More Headlines:

What Else to Know Today

ACA Insurers to Owe $2.7 Billion: Health insurers will refund at estimated $2.7 billion to 7.9 million Obamacare consumers this fall to pay back overcharges in recent years, nearly double the 2019 record of $1.3 billion in refunds. Refunds, or rebates, to people who purchased health coverage through the Affordable Care Act individual marketplaces will average $420 per customer, according to a report released Friday by the Kaiser Family Foundation. More than 4.7 million people in that market are expected to receive the refunds, it said.

The refunds result from the Affordable Care Act’s medical loss ratio provision, which requires insurers to spend at least 80% of their premium income (85% for large group plans) on claims and quality improvements over the previous three years. Insurers that do not meet that requirement must refund the difference as rebates. Read more from Sara Hansard.

More Headlines:

To contact the reporters on this story: Alex Ruoff in Washington at aruoff@bgov.com; 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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