Tens of thousands of Health and Human Services employees are heading into the office — the morning after President Trump urged Americans to limit social interactions to a maximum of 10 people to slow the novel coronavirus’s rapid spread.
Only two departments within HHS have instructed their employees to telework if they’re able: The National Institutes of Health sent out such guidance on Friday; a much smaller department, the Agency for Healthcare Research and Quality, did so on Sunday.
“By taking these social-distancing measures, we reduce the risk for everyone,” said a note sent to AHRQ employees Sunday, directing them to telework through April 3.
Most other HHS workers — the vast majority at the agency — are still expected to be at their desks working alongside dozens of other people, even as they can no longer visit restaurants or bars in their neighborhoods, send their children to school or rely on a regularly running Metro service to get to work.
They’re feeling mounting frustration, as the rest of the world seems to shut down around them — and as they hear state, city and county officials set unprecedented and drastic social-distancing measures that limit the number of people who can interact at one time.
“The department’s job is to keep the American public safe, so staff are feeling like why do they not count as members of the American public?” an HHS official told me on the condition of anonymity in order to speak freely.
The White House Personnel Office issued two sets of guidance over the weekend saying the elderly, pregnant or those with health risks should be allowed to telework and urging agencies to “offer maximum telework flexibilities” to employees eligible for remote work — yet left it up to agency and department heads to make a final determination.
“Every agency is scared to death to do anything without getting approval, and they don’t want to be first,” one senior manager told my colleague Lisa Rein.
But as federal employees come in to work, it means major government agencies are out of step with guidance being issued around the country.
Virginia Gov. Ralph Northam (D) has banned public events with more than 100 people. New York, New Jersey and Connecticut officials have banned gatherings with 50 people or more. Massachusetts Gov. Charlie Baker (R) has set the ban at 25 people or more. San Francisco and five Bay Area counties have taken the drastic step of banning people from leaving their homes except for visiting the doctor and buying groceries.
San Francisco mayor London Breed:
Effective at midnight, San Francisco will require people to stay home except for essential needs.
Necessary government functions & essential stores will remain open.
These steps are based on the advice of public health experts to slow the spread of #COVID19.
— London Breed (@LondonBreed) March 16, 2020
On Sunday, the Centers for Disease Control and Prevention recommended limiting all gatherings to fewer than 50 people. But yesterday, President Trump went further, saying Americans shouldn’t gather with more than 10 people.
The president and his coronavirus task force also recommended that states where the virus is spreading — virtually everywhere, at this point — should close gathering spots such as schools and restaurants.
“It isn’t an overreaction,” said Anthony S. Fauci, director of infectious diseases at the National Institutes of Health.
A projection given to the White House over the weekend prompted the more dramatic guidelines, said Deborah Birx, one of the task force leaders. Developed by an epidemic modeling group at Imperial College London, the forecast says that simply halting mass gatherings won’t be enough to stop the virus. Social distancing is a necessary step to slow transmission enough that each patient is on average infecting fewer than one person – the point at which an epidemic will eventually grind to a halt.
“Our projections show that to be able to reduce R to close to 1 or below, a combination of case isolation, social distancing of the entire population and either household quarantine or school and university closure are required,” the researchers wrote.
Lead author Neil Ferguson compared the potential health impacts of the coronavirus to the devastating 1918 influenza outbreak, in an interview with the New York Times. It would “kind of overwhelm health system capacity in any developed country, including the United States,” unless measures to reduce the spread of the virus were taken, he said.
Power Up writer Jackie Alemany:
Amb. Birx says decision to limit group gatherings from 50 to 10 people overnight is a result of new information from a model: “What had biggest impact was social distancing and small groups,’ she says of mitigating the virus.
— Jacqueline Alemany (@JaxAlemany) March 16, 2020
Some reporters noted an irony in the announcement. Reuters writer Timothy Aeppel:
There are 16 people in this picture. https://t.co/XWXseOaKZy
— Timothy Aeppel (@TimAeppel) March 16, 2020
The mixed guidance could leave some Americans confused about what social interactions are still acceptable amid the outbreak. It seems clear that visiting the gym or going to a church service is a bad idea. But are playdates between kids still okay, for example? What about grabbing coffee with a friend? Or having another family over for dinner?
But the precise size of a gathering — whether it’s five people, 20 people or 250 people — isn’t the point anymore, given the virus’s rapid transmission. The point now is to avoid all social interaction that isn’t essential — so, anyone beyond those within your household and the clerks who sell you food and medicine.
That’s according to former Baltimore health commissioner Leana Wen, who told me Americans should take away this message: It’s no longer okay to go about your regular social routine with friends and family. People haven’t always realized that in areas where the officials set the threshold at 25 or 50 people.
“What was happening is, people were still going out, they were still getting together with their friends,” Wen said. “That is not okay.”
Trump seems to finally be grasping the gravity of the situation, my colleague Philip Rucker writes. “We have an invisible enemy,” the president said yesterday, with a notably changed demeanor and tone from his previous coronavirus briefings.
“Nearly eight weeks after the first coronavirus case was reported in the United States, Trump conveyed that he at last recognizes the magnitude of the crisis that is threatening lives across the nation, disrupting the economy and fundamentally upending the daily rhythms of American life,” Philip writes.
HEALTH ON THE HILL
— Congressional leaders and Trump administration officials have started working on a third coronavirus relief bill, although the Senate has yet to act on legislation passed by the House authorizing tens of billions of dollars in new paid sick leave benefits, unemployment insurance, free coronavirus testing and food safety programs.
Senate Majority Leader Mitch McConnell (R-Ky.) said the measure – a massive measure expected to carry a price tag in the hundreds of billions of dollars – “should include further steps to assist individual Americans and families; actions to secure the economy and small businesses; and additional steps to shore up the health care system and support medical professionals who are expected to be overwhelmed in coming weeks,” our colleagues Erica Werner, Paul Kane, Jeff Stein and Seung Min Kim report.
The sweeping measure is also expected to address broader anxiety about an economic slowdown. “Democrats and a handful of Republicans have backed disbursing direct cash payments to tens of millions of poor and middle class Americans to help them weather the downturn. Among these is Sen. Mitt Romney (R-Utah) who released a proposal Monday stating: ‘Every American adult should immediately receive $1,000 to help ensure families and workers can meet their short-term obligations and increase spending in the economy.’”
— Casinos have joined the airline industry in asking lawmakers for emergency financial support as the coronavirus fallout roils the industry – and support for specific industries is expected in the third congressional package, per Jeff, Rachel Siegel and Jonathan O’Connell.
Details from Jeff:
Other key items on list:
— Anti-price-gouging measures
— Assistance for Amtrak/transit authorities
— Expanded Medicaid spending
— Expanded unemployment insurnace
Described to me as “monster” of a bill coming, much bigger than packages 1 or 2https://t.co/Q5e4paXs48
— Jeffrey Stein (@JStein_WaPo) March 16, 2020
BuzzFeed news reporter Paul McLeod:
Reporters here are Senate-distancing. pic.twitter.com/0vo1RH7Fpo
— Paul McLeod (@pdmcleod) March 16, 2020
CNN’s Manu Raju:
GOP senators practicing social distancing. They moved their leadership meeting tonight from McConnell’s office to the more spacious Strom Thurmond room – and are moving lunch tomorow from the Mansfield Room to the grand Kennedy Caucus Room
— Manu Raju (@mkraju) March 16, 2020
AHH, OOF and OUCH
AHH: Ohio’s primary election will be postponed today, in a last-minute move by Republican Gov. Mike DeWine. DeWine late last night announced the polls for the state’s primary will not open today after a back-and-forth legal battle, citing a “health emergency” after a judge ruled voting should go on.
During this time when we face an unprecedented public health crisis, to conduct an election tomorrow would force poll workers and voters to place themselves at an unacceptable health risk of contracting coronavirus.
— Governor Mike DeWine (@GovMikeDeWine) March 17, 2020
“The announcement was sure to create more uncertainty as voters, poll workers and county election officials received yet another reversal regarding the fate of Tuesday’s presidential primary, with voting set to begin at 6:30 a.m,” our colleagues Amy Gardner, Elise Viebeck and Isaac Stanley-Becker report.
Franklin County Court of Common Pleas Judge Richard A. Frye ruled earlier that postponing voting “set a terrible precedent.” But DeWine and Secretary of State Frank LaRose defended the effort to delay: “Logistically, under these extraordinary circumstances, it simply isn’t possible to hold an election tomorrow that will be considered legitimate by Ohioans. They mustn’t be forced to choose between their health and exercising their constitutional rights.”
Trump said yesterday he would leave the decision up to the states, but personally believes it’s “unnecessary” to delay elections.
“I think postponing elections, it’s not a very good thing,” Trump told reporters. “They have lots of room in the electoral places. … But I think postponing is unnecessary.”
(Read about how the coronavirus response from DeWine, the 73-year-old Republican governor of America’s seventh-most-populous state, has become a national guide, from our colleagues Griff Witte and Katie Zezima.)
— Democrats are weighing calendar changes. “The coronavirus pandemic is forcing the Democratic Party to adjust its planning for the remainder of the primary calendar, scrambling state plans to select convention delegates, delaying preparations for a 12th debate in April and increasing pressure for a change in party rules,” our colleagues write.
A Democratic official said: “We are taking everything day by day at the moment.”
— Louisiana rescheduled its primary for June 20. Georgia delayed its primary to May 19.
The key problem: There’s essentially no precedent for the current dilemma of how to move ahead with contests as Americans are warned to stay home and “hunker down” to minimize spread.
— Listen to more on this: Our colleagues discuss these challenges on yesterday’s episode of Post Reports.
OOF: Trump told governors they will need to be responsible for acquiring critical medical equipment, like respirators and ventilators, for their states — and not to wait for the federal government for help.
“Respirators, ventilators, all of the equipment — try getting it yourselves,” the president told governors on a call, the New York Times’s Jonathan Martin reports, according to an obtained recording. “We will be backing you, but try getting it yourselves. Point of sales, much better, much more direct if you can get it yourself.”
Some governors were surprised — others angry — at the suggestion, especially as they look to the federal government to support containing the outbreak.
“If one state doesn’t get the resources and materials they need, the entire nation continues to be at risk,” said New Mexico Gov. Michelle Lujan Grisham (D).
The Post reported “Virginia Gov. Ralph Northam (D) compared the comment to being at war and ‘we just heard our leader say you all need to get your own weapons at the state level to defeat this. But that’s the way it’s been’ …
Maryland Gov. Larry Hogan (R), who chairs the National Governors Association, said in an interview that ‘some of my colleagues were pretty upset,’ although he allowed for the possibility that the president may have misspoken.”
.@JayInslee, whose state has been the domestic epicenter of the outbreak, also said feds need to do more.
— Jonathan Martin (@jmartNYT) March 16, 2020
— The crush of cases and the need for this equipment underlines the type of coronavirus math experts are truly worried about, as our colleagues William Wan, Ariana Eunjung Cha and Lena H. Sun write: “How many ventilators do we have in this country? How many hospital beds? How many doctors and nurses? And most importantly, how many sick people can they all treat at the same time?”
OUCH: For days before two of its patients were diagnosed with covid-19, the illness caused by the coronavirus, officials at the Life Care Center in Kirkland, Wash., thought they were dealing with a surge in influenza cases.
Those were two of the earliest cases in the country. And what followed was a series of missed opportunities to curb the spread.
The flu assumption held even after a senior state health official “urged all nursing homes to prepare for the coronavirus by checking hygiene and infection controls,” our Post colleagues Jon Swaine and Maria Sacchetti report.
On Feb. 27, more than two weeks after the facility began discouraging visits, it notified the county of an “increase in respiratory illness.” It was required legally to report to county authorities a flu outbreak within 24 hours. The facility still admitted new patients. It continued to hold communal events — including a Mardi Gras party where residents sat “wheelchair to wheelchair.”
“Some who visited now say that Life Care Centers of America, the Cleveland, Tenn.-based company that owns the home, should have been quicker to suspect the coronavirus was inside — and to properly lock down the home once the virus was confirmed,” Jon and Maria write.
— The Seattle-area nursing home could signal what’s to come, and underlines the need to address prevention in long-term-care facilities.
“The federal government has dispatched teams of personnel to Kirkland, both to provide caregiving staff and to investigate why the infection spread as quickly as it did,” HuffPost’s Jonathan Cohn writes. “Meanwhile, the Trump administration, working with the U.S. Centers for Disease Control and Prevention, has issued nationwide guidelines for nursing homes and other long-term care facilities.”
There are several reasons nursing homes and similar facilities are ripe for such outbreaks.
“They are chronically understaffed, even though they generate significant profits for some private-equity firms. Government oversight has always been lax ― although, notably, the Trump administration has for the last few years been taking steps to weaken it even more,” Jonathan writes. “Truly fixing these problems will take time, because they were literally decades in the making.”
Nicholas Bagley, a professor of law at the University of Michigan Law School:
We’re all talking about hospitals. But we need to be talking more about nursing homes.
— Nicholas Bagley (@nicholas_bagley) March 16, 2020
— States and local governments are updating their guidance daily.
- D.C. Mayor Muriel E. Bowser (D) said all restaurants and bars must close for on-site service as of 10 p.m. last night. Maryland Gov. Hogan announced the closure of bars, restaurants, movie theaters and gyms.
- The states of New York, Connecticut and New Jersey issued a joint action to close gyms, movie theaters and casinos; close bars and restaurants except for takeout and delivery; and to reduce crowd capacity to 50. Louisiana followed suit with similar restrictions.
- In California, six counties in the San Francisco Bay area have been placed under a remain-in-place order “for all but the most essential outings” until at least April 7.
- Michigan’s Gov. Gretchen Whitmer (D) signed an order to temporarily close theaters, casinos and gyms as well as dine-in services for bars, restaurants and cafes.
- Rhode Island Gov. Gina Raimondo (D) announced the same for all restaurants, bars and coffee shops, adding officials would “revisit this direction in two weeks.”
Follow our colleague Fenit Nirappil for updates from D.C.:
D.C. Mayor Bowser also said she is submitting emergency legislation that would allow restaurants to deliver closed containers of alcohol. Think a bottle of wine, but not a Moscow mule. This is big for mitigating revenue loss. Live updates here: https://t.co/mr3zMNnlbg
— Fenit Nirappil (@FenitN) March 16, 2020
Scott Gottlieb, a resident fellow at the American Enterprise Institute and ex-FDA commissioner:
We’ve updated out tracker of state actions. In some states, local government’s have taken actions that go further. We’ll begin to highlight local actions that supersede those taken by the states in which they reside. Follow @COVID2019Action for updates on state mitigation. https://t.co/sF4ZvaEnVF
— Scott Gottlieb, MD (@ScottGottliebMD) March 17, 2020
— Some other headlines and developments to read while you’re hunkered down at home:
By the numbers:
- The United States reported the largest number of coronavirus-related deaths on any one day since the outbreak began. Monday was the 17th straight day a death has been reported somewhere in the nation.
On social distancing:
- One question we’re all asking: How long are we going to live like this? It depends on a number of factors, including when U.S. cases reach their peak. Our colleague William Wan breaks it down, adding: “It’s not going to be over anytime soon — a matter of months rather than weeks.”
- As people around the world lock themselves away, there’s at least a dozen members of Congress, per our colleague Amber Phillips, who have also decided to self-quarantine after coming in contact with a person infected with the coronavirus.
- A group of 16 health-care leaders penned an op-ed in USA Today imploring people to “stay at home as much as possible.”
The response from agencies:
- The Food and Drug Administration announced states can approve and roll out coronavirus tests developed by private labs in their states without getting FDA authorization.
- The Department of Veterans Affairs is meant to serve as a backup health system for non-veteran civilians in times of crisis, but a mission statement about this role vanished from its website, our colleague Alex Horton reports.
Those hardest hit:
- Fears are rising about the impact on the homeless, who are largely unable to self-quarantine, receive medical attention or access cleaning facilities, as our colleagues Jeff Stein and Tracy Jan report.
- The logistics of feeding the hungry have become more complicated. Volunteers at food banks and soup kitchens are staying away, and donations from stores and corporations have decreased, our colleague Laura Reiley report.
- Here’s who will (and won’t) be covered by the bill granting paid sick leave during the ongoing outbreak, via our colleague Heather Long.