HEALTH CARE BRIEFING: Trump Plans to Rank Counties by Virus Risk

President Donald Trump told governors in a letter that the federal government will rank counties according to their risk of a coronavirus outbreak, as he seeks to return Americans to work by his aspirational Easter deadline.

Trump said the White House “is working to publish new guidelines for state and local policymakers to use in making decisions about maintaining, increasing, or relaxing social distancing and other mitigation measures they have put in place.” His letter followed a video conference from the White House with the governors yesterday.

“This is what we envision: Our expanded testing capabilities will quickly enable us to publish criteria, developed in close coordination with the nation’s public health officials and scientists, to help classify counties with respect to continued risks posed by the virus,” he wrote.

Parts of the U.S. might be able to relent on social distancing practices that have crippled the economy as the country battles the coronavirus outbreak, Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, said in an interview conducted by NBA star Steph Curry on Instagram.

“There are places in the country now where you want to look at carefully and say you know maybe you want to pull back a little bit on the restrictions so long as you don’t just say let it rip and say I don’t care what happens,” Fauci said. “So you treat New York City a little different than you treat Nebraska.”

But the principal deputy director of the U.S. Centers for Disease Control and Prevention, Anne Schuchat, warned in an interview that relenting on social distancing risks outbreaks in new parts of the country.

“It would be surprising to me, based on what I’ve seen about how this virus spreads, if it were not going to increase in many other parts of the country,” she told The Hill. “I would be very reluctant to let up on measures in the nation as a whole. There are probably geographies where the virus hasn’t yet arrived in great force but where the health-care system needs to be prepared for it.” Read more from Justin Sink and Angelica LaVito.

Ambitious Plans for Covid-19 Vaccine: Fauci also said yesterday a Covid-19 vaccine will go into production while researchers are still studying if it works, under an ambitious plan to get a vaccine across the finish line in record time.

The proposal to start ramping up production while the candidate is still in a clinical trial is a risky step for a manufacturer, which would have to start assembling raw materials to make a vaccine without knowing whether it would work.

But the plan would make sure a vaccine is ready for patients if Covid-19, the disease caused by the new coronavirus, comes back next year, Fauci said at a White House press conference. Read more from Jeannie Baumann.

Fourth Package: Meanwhile, on Capitol Hill,lawmakers haven’t yet cleared the Senate-passed $2 trillion stimulus package, but leaders are already considering a fourth coronavirus relief measure that may include more money for frontline health-care workers, congressional leaders and advocates said. House Speaker Nancy Pelosi (D-Calif.) on Bloomberg TV yesterday said the next coronavirus bill would “lean toward recovery” and look at covering health-care services beyond testing for people who have contracted the illness.

  • Read the BGOV Bill Summary on the Senate-passed emergency funding measure (H.R. 748) here.

“It’s not just the tests, it’s the doctor’s visits,” Pelosi said. Within her caucus there is a demand for expanding federal enforcement of safety rules for health-care providers and building on Obamacare to lower what Americans pay for health care. For Republicans, a fourth stimulus bill could mean aid for rural health-care providers. Some hospital and health-care provider groups are already signaling they’re going to need more than the $100 billion included in the bill set to pass the House today. Both the House and Senate are expected to go on recess until late April after this week.

“With all the uncertainty surrounding this, it’s hard to put a firm figure on what more we need,” according to Carlos Jackson, vice president of legislative affairs for American’s Essential Hospitals. “But it’s clear that we’ll need more, given the projections we see,” Jackson said. “A better understanding of how this will flow to our hospitals.”

Vice President Mike Pence said the administration was open to a fourth bill to support states.

“Already we’re hearing from some governors about the need for additional resources, and we will evaluate those very carefully,” Pence said at the White House’s press conference yesterday. “I think the Secretary of the Treasury’s already indicated and congressional leadership has already indicated a willingness to remain open to that.”

Research, Testing & Treatment

U.S. Surpasses China: The U.S. surpassed China as having the most confirmed cases in the world, Johns Hopkins data show. Infections in America yesterday afternoon topped 82,400, compared with 81,782 in China where the outbreak began three months ago. The American tally was bolstered by a major jump in New York, which had 6,448 new cases yesterday, bringing the state’s total to 37,258. That accounts for almost half the outbreak nationwide, according to data collected by Bloomberg. Read developments here.

Trump, Xi Vow Cooperation and EU Leaders Bicker: Trump and China’s Xi Jinping pledged to cooperate in the fight against the pandemic after weeks of rising tensions, while European leaders struggled to agree on a strategy, leaving key details to be negotiated in the weeks ahead.

The leader of the World Health Organization, who himself didn’t call the coronavirus a pandemic until mid-March, told G-20 leaders to fight the virus “like your lives depended on it.” Read more in Bloomberg News’ virus update.

Labs Take Hit on No-Cost Tests: The American Clinical Laboratory Association said in a statement commercial labs had completed approximately 405,000 coronavirus tests as of March 25, but that Congress’ latest legislation didn’t fund the costs they’re incurring, as earlier bills made testing free for patients, Jeannie Bauman reports. “If Congress fails to designate essential emergency funding for clinical laboratories to support our efforts, labs will be soon be forced to make difficult decisions about whether they can keep building the capacity our nation needs.”

Worst-Case Scenario Not Materializing: Worst-case projections for the spread of coronavirus aren’t supported by evidence emerging from outbreaks in China, South Korea, and Italy, said Deborah Birx, the immunologist advising Vice President Mike Pence.“There’s enough data now of the real experience with the coronavirus on the ground to really make these predictions much more sound,” Birx said at a White House press conference yesterday. Read more from Jordan Fabian, Josh Wingrove and Mario Parker.

Trump Shuns War Authority: As hospitals, health-care workers and governors clamor for ventilators, intensive-care beds and protective equipment, Trump and the U.S. Chamber of Commerce are opposing the single thing many say would do the most good in the fight against the runaway pandemic: activate the Defense Production Act to coordinate a war-like campaign to ramp up both the manufacture and distribution of critical supplies.

Over 100 former national security officials urged Trump in a letter yesterday to use the act’s authority, saying it was necessary that government coordinate the effort and assign priorities to confront the pandemic. Trade groups, governors, attorneys general and Democratic senators are lodging similar calls.

Trump on March 18 issued an executive order essentially declaring he’s ready to use the law, but so far, he’s repeatedly declined to act on it. He’s suggested that the government is coordinating with companies that have voluntarily offered to manufacture medical gear and has compared using the act to “nationalizing our business” like Venezuela. The White House argued in a statement today that the response “has been overwhelming, fulfilling government-identified needs faster than anyone thought possible.” Read more from Ben Brody.

Blood Donation Rule Repeal Urged: Sens. Tammy Baldwin (D-Wis.), Elizabeth Warren (D-Mass.) and Cory Booker (D-N.J.) wrote in a letter to FDA Commissioner Stephen Hahn yesterday that the coronavirus outbreak is creating a “shortage of donated blood” and that the agency should lift a rule barring men from donating blood if they have had sex with other men in the past year. “The FDA continues to enforce a discriminatory donor deferral policy that effectively prohibits many healthy gay and bisexual men from doing so,” the senators wrote in the letter.

How to Ration Scarce Ventilators: New Jersey will ask medical experts on a bioethics panel to set guidelines for which Covid-19 patients will get ventilators, wrenching decisions that could determine who lives and who dies. New Jersey’s medical society and the state’s former epidemiologist will consider the question, State Health Commissioner Judith Persichilli told reporters in Trenton yesterday, calling it “one of the more difficult issues that we will be discussing.” Confirmed infections are rising rapidly in New Jersey. Officials reported a 56% jump in new cases, to almost 7,000, yesterday. Elise Young and David Voreacos have more.

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Wider Actions & Societal Impacts

Abortion Providers Sue Over ‘Non-Essential’ Label: Planned Parenthood and other health-care clinics sued Texas over an executive order classifying abortion as “non-essential” and thus barred as part of the state’s emergency response to the pandemic. The lawsuit, filed in federal court, alleges that the order will force women to carry pregnancies to term and violate their rights to equal protection guaranteed by the 14th Amendment. Gov. Greg Abbott(R) issued the order last Sunday banning all non-essential procedures in an effort to combat the surge in Covid-19 cases. Read more from Ayanna Alexander and Mary Anne Pazanowski.

Cost of Health Benefits Could Rise: The cost of providing health care benefits could increase as much as 7% this year due to the outbreak of the coronavirus in the U.S., according to an actuarial analysis of self-funded employers by Willis Towers Watson. Even as Americans are canceling some health procedures amid the outbreak, the analysis found medical and prescription drug spending is set to soar this year. Willis Towers Watson estimated that costs per infected person are estimated at about $250 for mild cases, $2,500 for moderate cases, $30,000 for severe cases requiring an inpatient stay, and near $100,000 for catastrophic cases requiring intensive care, Alex Ruoff reports.

Older Convicts May Get Home Arrest: The Justice Department will allow more older, nonviolent federal inmates to be placed in home confinement in order to cope with rising Covid-19 cases affecting the federal prison population, Attorney General William Barr said. Barr told reporters today he has directed the Bureau of Prisons to increase the use of home confinement for older convicts, following infections that have caused some federal prisons to be closed down such as the Metropolitan Correctional Center in New York. Chris Strohm has more.

Lawmakers Ask for Tariff Deferral: House Minority Leader Kevin McCarthy (R-Calif.) and Sen. Dianne Feinstein (D-Calif.) are among lawmakers who signed letter yesterday to the Trump administration seeking deferral of at least 90 days on all tariffs amid the coronavirus outbreak.

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What Else to Know

More Time for Rural Telehealth: The Federal Communications Commission is giving rural hospitals and other health-care providers two extra months to apply for discounts on telecom services in response to the outbreak. The Rural Health Care Program application deadline will be June 30 instead of at the end of April, the FCC said in an order adopted yesterday. The order also lets some providers keep existing telecom service contracts for another year, and offers them more time to file invoices and meet other program rules.

The changes “will allow health care providers to focus their attention on their immediate task at hand—addressing the influx of patients associated with the COVID-19 outbreak,” FCC Chairman AJit Pai said in a statement. The program helps subsidize rural telehealth costs and provides a separate 65% discount for providers on some broadband expenses, Jon Reid reports.

E-Cigarette Rule Delay Requested: Altria sent a letter to the FDA yesterday asking that a crucial regulatory deadline for some tobacco products be pushed back by eight weeks due to complications caused by the coronavirus pandemic. Currently, companies must apply to the FDA by May 12 for authorization to keep selling certain tobacco products. Regulators, public-health groups and companies fought over the timing for years before settling on that date last year in federal court. The deadline applies to products such as e-cigarettes and nicotine pouches. Read more from Angelica LaVito.

Anthem Sued for Medicaid Fraud: Anthem overcharged the U.S. government by millions of dollars for services provided to Medicare patients, according to a fraud lawsuit filed by prosecutors. The U.S. Attorney’s office in Manhattan alleges that the medical insurance giant jacked up its Medicare reimbursement by submitting inaccurate diagnostic data for hundreds of thousands of patients covered by Medicare Plan C. Read more from Robert Burnson.

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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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