The Health 202: Nearly 100 million Americans are living under stay-at-home orders as coronavirus spreads

THE PROGNOSIS

President Trump insists he won’t issue a nationwide lockdown to halt the coronavirus. But it may be just a matter of time before virtually every American is living in an area with a shelter-in-place or stay-at-home order.

By the day by the hour, even more state and local officials are ordering people to stay at home except for activities deemed essential, such as buying food and medicine. The governors of Ohio and Louisiana issued stay-at-home orders yesterday, joining New York, California, Illinois, Connecticut and Oregon in trying to more strictly limit the movement of people around their communities. The mayors of St. Louis and Kansas City both announced stay-at-home orders over the weekend.  

All told, nearly 100 million Americans now live in an area where they could be fined for gathering with large groups of people or keeping open a business such as a hair salon or dine-in restaurant. 

Ohio Gov. Mike DeWine (R):

And there are calls for other states to join in:

Shelter-in-place orders are not an easy decision to make, considering the certain, crippling economic effects from telling people they can’t go to work or patronize businesses for weeks on end. Government-mandated lockdowns will undoubtedly result in enormous job losses and bankruptcies that could sink the United States into a severe economic recession.

But it’s a decision that is being left up to state and local authorities to make individually. “I don’t think we’ll ever find [a national lockdown order] necessary,” the president said on Friday, pointing to states that have already made the call on their own. 

Trump’s posture is frustrating to some public-health experts, who say it’s time to issue a national directive given the speed at which the novel virus is spreading in the United States and the lackadaisical attitude some people are taking about social distancing. There are now more than 32,000 confirmed cases in the U.S. and more than 400 deaths – numbers that multiply by the day.

“Bureaucratic missteps have led to a shortfall in tests needed to determine the true scope of the virus,” my colleagues Toluse Olorunnipa, Griff Witte and Seung Min Kim write. “Hospitals are pleading for more medical equipment as doctors resort to using homemade masks. Financial markets have lost a third of their value in less than a month. Reveling spring breakers have hit the beaches in defiance of a nationwide social distancing campaign.”

Many Americans do appear to be voluntarily observing the federal government’s recommendation for people to avoid gatherings of more than 10 people and to generally stay at home. But a good portion aren’t. Just one in four respondents to a Kaiser Family Foundation poll said they had stayed home instead of going to regular activities and 40 percent had canceled plans to attend large gatherings — although the poll was conducted from March 11-15, just as officials started taking widespread actions.

Irwin Redlener, director of the National Center for Disease Preparedness at Columbia University, told me he wouldn’t have necessarily supported a federal lockdown 10 days ago. Now, he has changed his mind.

“I’d like to hear it announced this afternoon,” Redlener said on Sunday morning.

State and local officials looking to take more aggressive action have a range of responses. They must decide: Is simply encouraging people to stay at home enough? Or should they kick it up a notch by turning that suggestion into an order that is enforceable by police officers and other law enforcement?

“We get this kind of freelancing by very well-meaning governors and mayors who are struggling to come up with their own solutions and strategies,” Redlener said. 

And it took some governors a while to decide on something as drastic as a lockdown. DeWine, for instance, was one of the most aggressive governors in taking early action to shut down public gatherings, banning spectators at the Arnold Classic in early March and shuttering schools, restaurants and bars shortly thereafter. But a half-dozen other governors had already issued stay-at-home orders before DeWine went that far yesterday. 

In California, Gov. Gavin Newsom (D) at first responded to the virus’s spread by directing that people shouldn’t meet in groups larger than 250. Then he said schools and bars should close and restaurants should offer only takeout. It was only after San Francisco and Los Angles issued shelter-in-place orders that Newsom expanded it to the whole state on Thursday.

“If we’re to be criticized at this moment, let us be criticized for taking this moment seriously, Newsom said as he announced his order. Let us be criticized for going full force and meeting the virus head-on.”

Newsom’s order means that all businesses not providing “essential” services must close. Grocery stores, health-care facilities, pharmacies, gas stations, convenience stores, banks and laundromats may continue operating

House Minority Leader Kevin McCarthy (R-Calif.) criticized Newsom’s decision, saying he wasn’t consulted on it and suggesting it’s unnecessarily drastic.

We do think there was an ability to do this without shutting down the entire state, McCarthy told Fox News on Thursday. I hope he consulted with a lot of experts before he just made this decision.” 

The mayors of St. Louis and Kansas City said the stay-at-home orders they announced over the weekend were the “next step” in trying to slow the spread of covid-19, said Dan Robeson, emergency management coordinator for Johnson County, the Kansas county that contains much of Kansas City.

Starting 12:01 a.m. on Tuesday, violators in Kansas City could be charged with a misdemeanor that carries a fine of $500 and up to six months in jail. But Robeson told me it’s not his intent for people to be cited by law enforcement as they move around — he hopes they’ll follow the order regardless. He said officials will reevaluate in 30 days how effective the order has been and whether it should be extended.

“We want everyone not only to follow the letter of this order, but the spirit of it,” Robeson said.

Kansas City Mayor Quinton Lucas told residents in a Facebook Live video he realizes “there is great pain in connection with what’s going on.”

“I recognize there is an amazing challenge. I know this as well as anyone,” Lucas said. “I’m a mayor of a city who likes tax revenues and there is a lot of stuff that is not happening. But we are all shouldering the burden now to try to make our community safer.” 

Rather than relying on the administration for guidance on how to handle the pandemic, many governors and mayors are alarmed by Trump’s response. His top advisers continue to make confusing statements about the federal government’s scramble to confront the crisis, including whether he will force private industry to mass produce needed medical items, The Post’s Bob Costa and Aaron Gregg report.

“Trump — who has sought to cast himself as a wartime leader — reacted to criticism that his administration has blundered with a torrent of soaring boasts and searing grievances,” they write.

Trump tweeted this yesterday:

Trump quickly changed his tone at an evening news conference, where he pledged support from the National Guard and federal agencies. He touted an “amazing” relationship with New York Gov. Andrew M. Cuomo (D) and said governors he spoke with on Sunday will be “very happy” with the upcoming federal response.

“The governors, locally, are going to be in command,” Trump said. “We will be following them, and we hope they can do the job. And I think they will.”

“But the growing gulf between the White House and officials on the front lines of the pandemic underscored concerns in cities, states and Congress that Trump does not have a coherent or ready plan to mobilize private and public entities to confront a crisis that could soon push the nation’s health-care system to the brink of collapse,” my colleagues write.

Trump tweeted this at 11:50 p.m.:

If there’s anyone who understands the pain of extreme stay-home orders, it’s residents of European countries that have enacted stringent lockdowns in response to surging coronavirus cases.

France has deployed 100,000 police officers to enforce its lockdown and fine people up to 135 euros if they violate it. Italy has pressed charges against more than 40,000 people for leaving their homes for reasons considered unnecessary. Officials in Spain announced yesterday they’re expanding the country’s lockdown for an additional 15 days, until April 11.

— And British officials have warned of stricter measures. At a news conference yesterday, Prime Minister Boris Johnson said the health service will send letters, texts and emails to 1.5 million people of all ages who are especially vulnerable to the coronavirus, telling them not to leave their homes for the next 12 weeks, my Post colleagues report.

“I don’t underestimate what we’re asking for people. It will be tough,” said Robert Jenrick, secretary for housing, communities and local government.

Yet thousands of people appeared to ignore the advice over the weekend, flocking to their local parks for bike rides, picnics, drinks and ice cream as the sun came out. Photos of congested car parks, children playing and groups strolling through London’s famous Columbia Road flower market sparked concern on social media, causing Richmond Park — one of the city’s eight royal parks — to trend on social media in Britain.

Labour lawmaker David Lammy:

Johnson said he doesn’t want to cut off people’s freedom to walk in a park or stroll in the countryside, begging them to keep two meters apart — about six feet — saying, “It’s not that hard.”

But he gave this warning: “If people won’t do it, we’ll bring in tougher measures.” 

Actor Kevin Bacon started an #IStayHomeFor challenge:

AHH, OOF and OUCH

AHH: There was no deal last night on a massive coronavirus stimulus package that is meant to stop the economy’s plummet. Senate Democrats opposed a procedural vote to allow the bill to advance. 

“Lawmakers had hoped to pass a massive $1.8 trillion bill by Monday but Sunday night they were scrambling to revive talks, with the stock market poised for another sharp drop and households and businesses fretting about an uncertain future,” our Post colleagues Erica Werner, Seung Min Kim, Rachael Bade and Jeff Stein report. 

But both Republican and Democratic senators said they are prepared to continue negotiations around the clock and another vote is expected today. 

Democrats say the bill overly favors corporations and doesn’t “include much oversight for $500 billion in loans and guarantees that could go to firms selected by the Treasury Department.” Meanwhile, Senate Majority Leader Mitch McConnell (R-Ky.) chided his colleagues for blocking the measure, accusing Democrats of “obstruction.”

“Right now, they’re not there,” Trump said as the vote was ongoing. “But I think that the Democrats want to get there. And I can tell you for a fact, the Republicans want to get there. And I don’t think anybody actually has a choice.”

— Underlining the growing crisis lawmakers seek to address, Sen. Rand Paul (R-Ky.) became the first senator to announce he tested positive for covid-19. 

The development “raises questions about the threat the virus poses to senators’ health as they defy warnings about public gatherings,” our colleagues Felicia Sonmez, Paul Kane and Seung Min report. The announcement “prompted two of his fellow senators, Republicans Mike Lee and Mitt Romney, both of Utah, to announce that they were self-quarantining because of their recent contact with him.” 

Some more details about Paul: 

And on Romney, from The Post’s Paul Kane: 

Trump’s response:

OOF: Anthony Fauci was remarkably candid about Trump, in an interview with Science magazine’s Jon Cohen.

When Fauci, head of the National Institute of Allergy and Infectious Diseases, was asked about having to stand in front of the nation as “the representative of truth and facts” when “things are being said that aren’t true and aren’t factual,” the 79-year-old said there is only so much he can do.

“I can’t jump in front of the microphone and push him down,” Fauci said, referencing Trump. “OK, he said it. Let’s try and get it corrected for the next time.”

“The frank comment was just one part of a remarkable Q&A published Sunday night in which Fauci shed light on his relationship with Trump, how the pair handles their differences and what happens before each coronavirus task force news conference,” my colleague Allyson Chiu writes.

OUCH: Many across the country have dismissed the warnings about the spreading pandemic. In West Virginia, for example, some churches were still recently packed, and one hospital head is worried about the members of his community who are not taking warnings seriously. 

“His hospital sits at the heart of a politically conservative community, even by West Virginia standards, in a county where President Trump won nearly 90 percent of the 2016 vote. For weeks, people here listened as Trump and conservative media dismissed the virus as a hoax,” our Post colleague Todd C. Frankel reports “…West Virginia was the last state to report a confirmed coronavirus case, allowing the fear that gripped other parts of the nation to feel far away.”

Local health officials are hoping they can convince some residents to take action, not to see the dire predictions as partisan. 

— Those dismissing the escalating demands to isolate are gathering on beaches, in casinos and national parks. 

“They were the defiers and the disbelievers. They were those eager to flout authority or those afflicted with cabin fever, if not Covid-19. They were the officials crowded on the podium of the White House briefing room, doing not as they say,” the New York Times’s John Branch reports. “They were all people who dismissed the calls for isolation, seeing more reward than risk in gathering. They conflated confidence with immunity. As in other times of national crisis, they exposed the relationship between individuals and society and our responsibility to others.”

The number of people dismissing and denying is shrinking, however, as pressure rises from peers and officials. But the impact they’ve already had on the spread, John writes, “may never be known.” 

For some who have been sickened with covid-19, the experiences and symptoms have ranged from severe to no big deal. 

The illness can induce intense fatigue and trigger a recurring cough and intermittent fever. There is a psychological toll, some patients report, an unfamiliarity that leads to anxiety, as our Post colleagues Joel Achenbach, Ben Guarino and Ariana Eunjung Cha report.

One 34-year-old man said he had “mild symptoms for several days and then abruptly developed shortness of breath, fever and chest pains.” 

Jerri Jorgensen, a 65-year-old former high school volleyball and track coach, said she never felt symptoms — “never had a sore throat or headache or anything.” “I would do planks, push-ups and put my headphones on, and I’d have really good ’80s rock ’n roll and just dance in the room,” she told The Post. 

Alison McGrath Howard, a Washington clinical psychologist, described taking her dog outside and feeling like “I’m going to fall down…And my fever is gone, and then it comes back. And while I have been sicker with other things like bronchitis or stomach viruses or really bad colds, this feels like a constant fatigue. It’s the weirdest thing.”

Mike Saag, an infectious-disease doctor, said he developed a cough, like a smoker’s cough, and his mind was foggy. “This is not something anybody wants to go through,” Saag said. But still he implored others to “stay calm. Monitor yourself. The number one thing to keep an eye on is breathing. If it becomes difficult to breathe, you should really get to a facility.” 

— Sen. Elizabeth Warren (D-Mass.) and Sen. Bernie Sanders (I-Vt.) – the Democratic Party’s liberal leaders whose 2020 prospects have respectively collapsed and faded – are now seizing on the coronavirus response to influence the national agenda, our Post colleagues Annie Linskey and Sean Sullivan report. 

Sanders has called for a renewed focus on overhauling the health-care system. Warren has pressed Senate Minority Leader Charles E. Schumer (D-N.Y.) on details of the coronavirus relief package. Both have been in touch with former vice president Joe Biden’s presidential campaign. 

“Many liberals see the response to the virus as a way to enact quicker versions of the broad social changes at the heart of the Warren and Sanders campaigns. The talks could enable Sanders to win policy concessions in a way that eases his own departure from the presidential race,” our colleagues write. “…The apparent political opening for liberal, big-government initiatives has come up suddenly, the result of a shocking pandemic and accompanying economic crisis. Even many Republicans are joining calls for free health treatments, cash handouts to poorer Americans, and significant aid to businesses — a head-spinning twist in a political season that for months saw relentless attacks on ‘socialism’ and ‘socialized medicine.’ ” 

In case you missed them, here are a few key headlines and developments from over the weekend: 

What the Trump administration has and hasn’t done: 

  • U.S. intelligence reports in January and February issued “ominous, classified warnings … about the global danger posed by the coronavirus while President Trump and lawmakers played down the threat and failed to take action that might have slowed the spread of the pathogen,” our colleagues Shane Harris, Greg Miller, Josh Dawsey and Ellen Nakashima report.
  • What should hospitals do if they run out of critical supplies? The White House is seeking advice from emergency physicians about that prospect, asking experts about strategies for coping with the lack of masks, eye-shields or ventilators, our colleagues Lenny Bernstein, Yasmeen Abutaleb, Ariana Eunjung Cha, Lena H. Sun and Josh Dawsey report.
  • While other countries were pushing for and conducting widespread testing, the Centers for Disease Control and Prevention provided restrictive guidance on who should get tested and had a faulty initial test batch, the Wall Street Journal’s Jessica Wang, Lindsay Huth and Taylor Umlauf report.
  • The administration is considering whether to reopen enrollment for Affordable Care Act coverage amid the pandemic, while a number of Democratic-led states have already done so for their own marketplaces, Politico’s Mohana Ravindranath reports.

The hardest hit: 

  • At least a quarter of all U.S. coronavirus deaths have occurred in elder-care facilities, according to a review by The Washington Post of reports from states, local media and nursing homes.
  • The coronavirus has begun spreading among the homeless. The more than half a million in the United States in this population are largely sick or elderly, many with mental illness that makes reasoning difficult. They’re “seen as crucial links in the spread of a pathogen that has the potential to overwhelm the country’s hospital capacity,” The Post’s Hannah Dreier reports.

Movement on Capitol Hill:

  • Industry groups, from health insurers, restaurant groups and aviation businesses, are lobbying Congress to add measures to aid them into the Trump administration’s sprawling stimulus package, the Wall Street Journal’s Brody Mullins and Ted Mann report.
  • Congress is not allowed to vote remotely. A bipartisan group of young lawmakers want to change that, writes our colleague Amber Phillips.

Concerns mount over resources for health workers: 

  • In some of the hardest-hit areas, officials are restricting testing to health-care workers and the severely ill, “saying the battle to contain the virus is lost and the country is moving into a new phase of the pandemic response,” our colleagues Lena, Carolyn Y. Johnson and Laurie McGinley report.
  • Ohio’s attorney general ordered clinics to stop providing abortions to preserve resources, even as officials in other states have said the need to pause elective procedures does not apply to abortions, our colleague Hannah Knowles reports.

The big picture:

  • The coronavirus crisis feels undoubtedly like it will reshape American society in a lasting way, and Politico Magazine surveyed dozens of thinkers who assessed what that change may look like.
  • Can Americans rise to the occasion to defeat this crisis, a moment that like others in U.S. history — from war to depression to natural disasters — will test the nation’s ability to overcome monumental challenges? From The Post’s Toluse Olorunnipa, Griff Witte and Seung Min Kim.

SUGAR RUSH

— Neil Diamond has a new version of his “Sweet Caroline” to get us through this moment: 

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