The Health 202: Why South Korea, not Iran, is a model for U.S. coronavirus response

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THE PROGNOSIS

A stark contrast in the coronavirus mortality rates in South Korea and Iran show how critical a government’s response can be in determining whether the disease is stymied or spread. 

Public health experts say they want to ensure the U.S. outcome turns out more like the former. 

“Will we take the tough actions to mitigate spread or will we let this spread like the flu?” Scott Gottlieb, former head of the Food and Drug Administration, wrote me. “I think we will end up somewhere in between. Not helpless like Iran but not as aggressive and swift as South Korea.”

South Korea has managed to dramatically arrest the spread. It’s conducting more tests per person than any other country in the world, with about 15,000 people getting tested every day. Four companies are providing test kits to 118 facilities where people can get tested free. The government has set up dozens of drive-through centers, where medical workers dressed in face masks and protective clothing swab people’s mouth and throat.

“South Korea’s most effective weapon against the virus has been to rapidly expand testing…210,000 South Koreans have been tested since Jan. 3,” The Washington Post’s Josh Rogin writes

South Korean officials have done two other things: They’ve particularly targeted the northern city of Daegu, where spreading infections within a large church congregation made it the center of the outbreak.

And, they’ve undergone aggressive efforts to inform the public about how to respond and where the infection is spreading. South Koreans regularly get cell phone alerts notifying them of new cases near them. The government has shuttered schools and urged the cancellation of all mass gatherings. Government websites are regularly updated with information about testing.

By the numbers: The country has reported 7,800 cases but just 66 deaths – a relatively low mortality rate under 1 percent. And now its daily growth in new cases appears to be slowing, with fewer than 200 new cases reported daily over the past few days.

But it’s a different story in Iran, a country with 80 million people where cases are surging and several top officials — including two dozen members of parliament and a vice president — have been infected.

As neighboring countries canceled flights and alerted medical personnel, Iranian officials said little in public about the virus. The government didn’t even mention the disease’s arrival in the country until Feb. 19, when officials said two people had already died. The following week it became evident that a disproportionate number of officials were infected, my Post colleagues Erin Cunningham and Dalton Bennett reported.

The country’s Health Ministry claims that about 10,000 have been infected and 429 have died. But mass graves — confirmed by videos, satellite images and other open-source data from the cemetery — could mean Iran has suffered more deaths than its government has let on. 

Satellite images show the excavation of a new section of a graveyard in the city of Qom began as early as Feb. 21 — two days after Iran declared its first coronavirus cases. By the end of the month, two long trenches were visible at the site from space, Erin and Dalton report.

“A senior imagery analyst at Maxar Technologies in Colorado said the size of the trenches and the speed with which they were excavated together mark a clear departure from past burial practices involving individual and family plots at the site,” my colleagues write. “In addition to satellite imagery, videos posted on social media from the cemetery show the extended rows of graves at Behesht-e Masoumeh and say they are meant for coronavirus victims.”

Meanwhile, the U.S. continues to lag far behind other countries in testing for the virus. Only about 11,000 people have been tested so far, according to figures shared with members of Congress. And nationwide capacity to process the test kits being distributed is at 20,000 people per day, per statistics compiled by the American Enterprise Institute.

The delay in testing has exploded into a major political issue, with lawmakers of both parties angrily demanding more tests for Americans even as Trump has insisted problems that have hindered capacity are being addressed, The Post’s Mike DeBonis, Erica Werner and Seung Min Kim report.

“The system is not geared toward what we need right now, what you are asking for,” Anthony S. Fauci, an immunologist and the head of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, told lawmakers. “That is a failing. Let’s admit it.”

Yet Trump is downplaying the situation. He said from the White House that “over the next few days, they’re going to have four million tests out.”

“Frankly, the testing has been going very smooth,” he said. “If you go to the right agency, if you go to the right area, you get the test.”

East Asia historian Nick Kapur:

The Twitterverse is using the hashtag #flattenthecurve to describe how people can stop the virus’s spread quickly:

— Trump has left open the possibility that travel restrictions could be enacted within the United States if necessary. When asked whether travel restrictions in states such as Washington and California had been discussed, the president said they had not been but left open the possibility that such actions could be taken.

“Is it a possibility?” he said. “Yes. If somebody gets a little bit out of control, if an area gets too hot. You see what they are doing in New Rochelle, which is good, frankly. It’s the right thing.”

– The president may have been exposed to the coronavirus while meeting with Fabio Wajngarten, the press secretary for Brazilian President Jair Bolsonaro. Wajngarten posted an image of himself standing with Trump and Vice President Pence at Mar-a-Lago over the weekend.

Trump told the press he’s “not concerned at all.” “We did nothing very unusual; we sat next to each other for a period of time,” Trump said, referring to Bolsonaro.

— The Trump administration isn’t loosening Medicaid rules so they can more freely respond to the crisis by expanding medical services, LA Times’s Noam Levey reports.

“In previous emergencies, including the 9/11 terrorist attacks, Hurricane Katrina and the H1N1 flu outbreak, both Republican and Democratic administrations loosened Medicaid rules to empower states to meet surging needs,” Noam writes. “But months into the current global disease outbreak, the White House and senior federal health officials haven’t taken the necessary steps to give states simple pathways to fully leverage the mammoth safety net program to prevent a wider epidemic.”

It’s partly because of the president’s reluctance to declare a national emergency, something Democrats and health provider groups are urging him to do. 

The major health provider associations have asked him to declare the outbreak a disaster or emergency under the National Emergencies Act, a step beyond the public health emergency the administration declared in January.

“This step is necessary to provide … Azar the authority to take critical actions, such as providing Section 1135 waivers, to ensure that health care services and sufficient health care items are available to respond to the COVID-19 outbreak,” the American Medical Association, the American Hospital Association and the American Nurses Association wrote in a letter to Vice President Pence.

Sen. Jeanne Shaheen (D-N.H.):

America is shutting down, folks. At this point, it’s nearly impossible to keep pace with everything being cancelled or postponed. Some of the more notable developments, some via The Post’s live blog:

  • The White House, U.S. Capitol and Pentagon are closed to tours. The Supreme Court is closed to the public. House and Senate office buildings will now be closed to tourists until April 1. Only staff, media and individuals conducting official business will be allowed in, The Post reports.
  • Major League Soccer suspended matches for 30 days, following the National Basketball Association’s lead. Major League Baseball canceled the rest of spring training and announced it would delay Opening Day by at least two weeks. The NHL suspended its season indefinitely.
  • The NCAA canceled its men’s and women’s basketball tournaments and all other winter and spring championships.
  • Disneyland and Disney California Adventure will soon close through the end of the month after California barred mass gatherings.
  • New York will indefinitely ban all events greater than 500 people across the state, per an announcement by Gov. Andrew Cuomo (D). Broadway was ordered to shut its 41 theaters.
  • Ohio, Maryland and Kentucky announced statewide school closures to slow the rate of infections.
  • The Smithsonian announced all museums and the National Zoo would close on Saturday.
  • The Metropolitan Museum of Art said it will temporarily close all three of its locations, including the flagship Fifth Avenue location, starting on Friday, the New York Times reports.

The Hill’s Peter Sullivan:

— The health insurers association clarified yesterday that its members haven’t agreed to waive out-of-pocket costs for coronavirus treatment — despite the misleading promise Trump made In his prime-time speech.

“A broad swath of the nation’s private health insurers has agreed to waive the charges for a coronavirus test for their members,” The Post’s Amy Goldstein explains. “But they have not committed to cover the cost of care for those sickened by the virus. … And while there is no specific treatment for the rapidly spreading infections, insurers have not expanded coverage for anyone, including the more seriously ill who need hospitalization.”

— Speaking of Trump’s Oval Office address, it did the opposite of reassuring many Americans, The Post’s Dan Balz writes.

“From the misstatements to the omissions to his labored demeanor, the president sent a message that shook financial markets, disrupted relations with European allies, confused his many viewers and undermined the most precious commodity of any president, his credibility,” Dan writes. 

“With the stock markets plunging into bear territory, the health-care system struggling to keep pace with the spreading virus and Americans wondering what’s next, Trump is dealing unsteadily with the greatest crisis of his presidency.”

(Here’s a fact-check on Trump’s address, from Glenn Kessler and Salvador Rizzo.)

Some more coronavirus reads:

  • The administration’s whipsawing posture on cruise ships with infected passengers has led to an intensive behind-the-scenes lobbying effort by cruise executives to mitigate the financial fallout from the virus, Josh Dawsey, Jonathan O’Connell, Ashley Parker and Beth Reinhard write.
  • The largely preventive mission of public health programs aimed at protecting the entire community has been consistently overlooked in a country that puts a premium — and spends more money per capita than any other — on treating individual sick people, Francis Stead Sellers writes.
  • A wave of cancellations are hitting the president’s family business, which owns and operates hotels and golf courses, The Post’s Joshua Partlow, David A. Fahrenthold and Jonathan O’Connell report.

AHH, OOF and OUCH

AHH: Trump administration officials and congressional Democrats have neared an agreement on an initial economic relief package in the wake of coronavirus. House Speaker Nancy Pelosi (D-Calif.) and Treasury Secretary Steven Mnuchin exchanged multiple intense communications, and Pelosi told reporters she expected a Friday vote “one way or another” to approve a package set to amount to several tens of billions of dollars. 

“We’ve resolved most of our differences, and those we haven’t we’ll continue to have a conversation because there will obviously be other bills,” Pelosi said. 

Lawmakers on both sides of the aisle wanted to deliver the measure before the congressional recess set for next week – although now the Senate will be coming in after Majority Leader Mitch McConnell cancelled recess for his chamber. The White House’s approval of the package is expected today. 

“The legislation will include measures to boost paid family leave and unemployment insurance, ensure free coronavirus testing, and strengthen nutritional aid such as food stamps. The emerging agreement builds upon a bill House Democrats released late Wednesday that included a number of provisions Republicans opposed, setting off hours of frenzied negotiations on Capitol Hill to reach bipartisan consensus,” Mike, Erica and Jeff Stein report

“A final hang-up was over a paid family and medical leave provision, with Republicans pushing to structure it in a way that it could be implemented quickly and avoid undue burdens on employers.”

— “The near-deal Thursday evening represented a dramatic turnaround from the state of play in the morning, when the White House and congressional Republicans panned House Democrats’ bill and suggested that chances for a quick deal were remote,” our colleagues write. “But as the hours progressed and the scale of the crisis mounted, it became clear there was no appetite among lawmakers to leave Washington for a week or more without acting.” 

OOF: Joe Biden and Bernie Sanders forcefully criticized Trump, in their own remarks about the coronavirus crisis. 

“Typically, an incumbent president running for reelection might step into a moment of crisis to harness the power and megaphone of the office to demonstrate strong leadership,” our colleagues Matt Viser and Jenna Johnson report. “But Trump’s response gave Biden, Sanders and other Democrats a chance Thursday to turn those conventions upside down, asking voters to envision them steering the country through troubled waters.”

Biden chided the administration for a “failure on testing … it’s a failure of planning, leadership and execution,” releasing his own proposal that calls for free and widely available testing and emergency paid leave for sick Americans.

Biden also slammed the president’s description of the coronavirus as a “foreign” virus. 

“Downplaying it, being overly dismissive, or spreading misinformation is only going to hurt us and further advantage the spread of the disease,” Biden said. “But neither should we panic or fall back on xenophobia. Labeling COVID-19 a foreign virus does not displace accountability for the misjudgments that have been taken thus far by the Trump administration.” 

Trump shot back in a tweet late last night:

— Sanders also offered a list of policy proposals for addressing the outbreak, including emergency funding for paid family and medical leave. He urged lawmakers to convene an “emergency bipartisan authority of experts” to help lead the government response.

“Unfortunately, in this time of international crisis, the current administration is largely incompetent, and its incompetence and recklessness has threatened the lives of many people.” Sanders said at his Burlington, Vt., news conference. 

He reiterated his push for universal health care, warning about the risks of not covering all Americans.

“While we work to pass a Medicare-for-all single-payer system, the United States government today must it make it clear that in the midst of this emergency, everyone in our country, regardless of income or where they live, must be able to get all of the health care they need without cost,” Sanders said.

OUCH: The outbreak has already had an effect on the 2020 Democratic presidential primary. Biden campaign staffers will work remotely as of Saturday, according to a memo obtained by our Post colleagues. He also announced he would replace campaign rallies with virtual town halls. Sanders joined Biden in telling staff to work from home and said the campaign will move to “digital formats and outreach wherever possible.” 

— Democratic National Committee chairman Tom Perez said in an interview with Axios that he’s not planning to cancel the party’s July nominating convention in Milwaukee or replace it with an online event.

— The Democratic debate scheduled for this Sunday has been moved to the District of Columbia from Arizona. “Out of an abundance of caution and in order to reduce cross-country travel, all parties have decided that the best path forward is to hold Sunday’s debate at CNN’s studio in Washington, D.C., with no live audience,” DNC communications director Xochitl Hinojosa said in a statement.

— And here are a few more good reads:

MEDICAL MISSIVES

HEALTH ON THE HILL

The legislation reauthorizes the Older Americans Act, which provides for home-delivered and group meals for anyone 60 and older while supporting an array of other services, such as transportation and in-home care. The bill cleared the House on Wednesday after a Senate vote in early March — more than five months after the previous authorization expired Sept. 30.

Kaiser Health News

INDUSTRY RX

REPRODUCTIVE WARS

SUGAR RUSH

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