The Health 202: More than a dozen governors haven’t issued stay-at-home orders

Are you a medical provider caring for or preparing to care for coronavirus patients? If so, we’d love to hear your story. Please send me a note at paige.cunningham@washpost.com. 

Thanks for reading Health 202, especially now. Sign up here and forward our daily health policy tipsheet to your friends, family and colleagues.

THE PROGNOSIS

The governors of more than a dozen U.S. states still haven’t ordered their residents to stay at home, even as coronavirus infections begin to spike in large, inland cities.

These states are mainly in the South and West — places where infections haven’t reached the levels seen in New York or Washington state, but where officials increasingly warn that similar scenarios could unfold if people don’t start taking social distancing more seriously.

In Alabama, where cases quintupled over the past week, Gov. Kay Ivey (R) declined to issue a stay-at-home order. 

“Y’all, we are not Louisiana, we are not New York state, we are not California,” she said on Thursday. “Right now is not the time to order people to shelter in place.”

Neither has Wyoming Gov. Mark Gordon (R), even as cases in his state have tripled in the past week and the Wyoming Medical Society has urged him to institute a stay-at-home order.

Texas Gov. Greg Abbott (R) has banned gatherings of more than 10 people but has resisted calls from state Democratic lawmakers to go further.

Florida Gov. Ron DeSantis (R), whose state has recorded more than 5,000 coronavirus cases, has issued a stay-at-home order through mid-April for only the southern part of the state, an area encompassing Broward, Miami-Dade, Palm Beach and Monroe counties.

“The ‘Safer-At-Home’ [order] is the right move for southeast Florida,” DeSantis said at a news conference yesterday.

Former FDA commissioner Scott Gottlieb:

And while Mississippi Gov. Tate Reeves (R) issued an executive order last week to restrict large gatherings, it carves out major exemptions for organizations like churches and restaurants as long as they serve fewer than 10 people at any given time, and some retailers.

These governors belong to a shrinking group of officials still resisting a dramatic crackdown on residents not voluntarily following social distancing guidelines. Around 75 percent of Americans are now living under stay-at-home orders that could result in fines or even jail time for violating them.

That population now includes residents of Virginia, Maryland, Pennsylvania, Arizona and the District of Columbia, whose leaders all announced yesterday they’re directing people to stay at home for varying periods. Virginia Gov. Ralph Northam (D) has set the longest time frame for his order, extending it until June 10.

“You are being very, very selfish because you are putting all of us, especially our health-care providers, at risk,” Northam, who is also a doctor, said at a news conference. “To date, this has been a suggestion to Virginians. Today, it’s an order.”

(Check out this great explainer from my colleague Rebecca Tan on what these orders mean for the day-to-day life of Virginia, Maryland and D.C. residents).

People quickly started analyzing the orders. CQ Roll Call reporter Niels Lesniewski:

Politico’s Dan Diamond:

City officials across California’s Bay Area issued the first shelter-in-place orders two weeks ago (although, yes, it feels more like two months ago). Every day since then, more governors and mayors have followed suit.

Now the Trump administration is urging every state and local leader to seriously consider how to ensure people are following its guidance through April 30 that Americans avoid any gatherings with more than 10 people although it’s increasingly apparent the United States acted far too late to avoid perhaps the largest coronavirus outbreak of any country in the world.

“We really do recommend every governor, every mayor looks very carefully and ensures their communities are utilizing this guidance,” Deborah Birx, coordinator of the White House coronavirus task force, said at the task force’s daily briefing.

The New York Times’s Ross Douthat:

The administration has been hesitant to issue an enforceable national directive, resulting in the patchwork of orders and guidance from governors and mayors. President Trump said “it’s pretty unlikely at this time” there will be a federal stay-at-home order.

Instead of taking shots at Northam — a governor he has often criticized — Trump backed him on Virginia’s long-lasting stay-at-home order.

“People are questioning that, but look, staying at home with respect to what we are talking about doesn’t bother me,” Trump said. “People should be staying at home.”

AHH, OOF and OUCH

AHH: Federal officials are weighing whether the general population should be wearing face masks out in public. 

The federal government has yet made no such a recommendation, but officials at the Centers for Disease Control and Prevention are considering an update to guidance, our Post colleagues Joel Achenbach, Lena H. Sun and Laurie McGinley report. 

“But there’s still no consensus on whether widespread use of facial coverings would make a significant difference, and some infectious disease experts worry that masks could lull people into a false sense of security and make them less disciplined about social distancing,” they write. 

If the CDC issues such guidance, it would likely call on people to use DIY cloth coverings and make clear they shouldn’t be using medical masks that health-care workers desperately need.

At a briefing yesterday, Trump said having the public wear nonmedical fabric masks is “certainly something we could discuss.” 

— Trump also said more than a million Americans can be saved by following safety guidelines, debuting new rhetoric emphasizing the lives that can be saved rather than lost, our colleague Felicia Sonmez writes

“The statement marked a shift from Sunday, when Trump emphasized National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci’s estimate that the United States could record as many as 100,000 to 200,000 deaths and noted that one model has predicted the U.S. death toll could rise to as high as 2.2 million people,” she adds. 

“The more we dedicate ourselves today, the more quickly we will emerge on the other side of the crisis,” Trump said.

— Rep. Nydia M. Velázquez (D-N.Y.) said she has been diagnosed with a “presumed coronavirus infection” days after speaking on the House floor. 

“I developed the abrupt onset of muscle aches, fevers, nasal congestion and stomach upset. I noticed that I could no longer smell my perfume or taste my food,” the 67-year-old said in a statement. “After speaking with The Attending Physician by phone, I was diagnosed with presumed coronavirus infection.” 

Photos from the signing ceremony show her standing behind Pelosi, D-Calif., at the bill signing and later chatting in close quarters with Pelosi and Rep. Maxine Waters, D-Calif.,” NBC News’s Dareh Gregorian reports. “A spokesman for Pelosi, Drew Hammill, said she’s ‘consulted with the Attending Physician who found her contact to be of low risk and recommended the Speaker take no particular action.’ ”

House Majority Leader Steny H. Hoyer (D-Md.) said the House is not expecting to convene again before April 20, following the Senate announcement last week the chamber had no plans to take up votes until the same date. 

OOF: The Food and Drug Administration has authorized the widespread use of millions of doses of anti-malarial drugs at hospitals nationwide. There’s some evidence they help coronavirus patients but they also carry well-known risks.

“There have been only a few, small anecdotal studies showing a possible benefit of the drugs, hydroxychloroquine and chloroquine, to relieve the acute respiratory symptoms of covid-19 and clear the virus from infected patients,” our colleague Christopher Rowland reports

But there are risks and side effects, including possible death for patients with existing heart problems or who take certain medications. 

“With no established treatments available, the FDA said in an approval letter Saturday that, essentially, trying the anti-malarial drugs was worth a shot,” Christopher adds. “It cited the actions of other countries that adopted the drugs as a coronavirus treatment and the limited laboratory tests and clinical experience that may show benefit.”

— Mike Ryan, executive director of the World Health Organization’s health emergencies program, said preliminary research suggests some drugs “may have an impact” on fighting the coronavirus but noted there’s “no proven effective therapeutic or drug against covid-19. 

He called for more research on potential treatments. 

“Some of those drugs may impact the length of disease, some may impact the severity of disease, and the dosages of those drugs when they’re given to what patient at what stage of the disease has not been standardized,” Ryan said. “We have never had a comparison group where we’ve had a randomized approach to treatment with the drug or not treatment with the drug.”

— Meanwhile, companies are still working on a vaccine to prevent future spread.  

Johnson & Johnson said it is working on a product that could be ready for widespread use by early next year. 

“The New Brunswick, N.J., company selected a lead candidate for the vaccine from the constructs it had been working on, and said human trials would begin by September at the latest,” the Wall Street Journal’s Matt Grossman reports. “The company had said in February it expected trials to begin in eight to 12 months.”

Other companies, including Moderna Inc. and Sanofi, are also working on vaccines, Matt writes. 

OUCH: Hospitals are reconfiguring as health workers attempt to address this unprecedented crisis.

It looks like this. Cabins and trailers in state parks used to isolate people who are sick. A 200-bed facility constructed on a soccer field in the Seattle area. A medical center inside the Jacob K. Javits Convention Center in New York. 

Soon, “hospitals appear likely to look and operate very differently than today,” our colleagues Ariana Eunjung Cha, Brittney Martin and Steven Mufson report. “With the need for social distancing even among the sick, securing and configuring physical spaces large enough to handle the load has become one of the biggest challenges facing state officials and hospital administrators.”

“Part of the reason for the need for auxiliary, emergency measures is that many hospitals have closed in recent years because of financial trouble,” they explain. “The United States has fewer beds per capita — just 2.7 per 1,000 people — than many other countries. That compares with 6.5 per 1,000 for South Korea and France, for example, and 4.3 for China.”

“The U.S. has 924,100 hospital beds, most of which are occupied on a typical day, according to a 2018 survey from the American Hospital Association. But in a severe pandemic situation, such as the one the country faced during the 1918 flu pandemic, experts have estimated that 38 million people would need medical care, resulting in 9.6 million hospitalizations and 2.9 million intensive care stays.”

— Other news to know:

The Democratic primary carries on: 

  • Sen. Bernie Sanders (I-Vt.) says he’s staying in the presidential race for now, leaving some party leaders worried about a repeat of the divisions some blame for Hillary Clinton’s 2016 defeat, our colleagues Sean Sullivan, Michael Scherer and David Weigel report.
  • Democratic groups are changing their messages and strategies amid the pandemic as they continue to spend top dollar to try to beat Trump in the fall, the Wall Street Journal’s Tarini Parti and Chad Day report.
  • Trump said New York Gov. Andrew M. Cuomo (D) — whose efforts in response to the state’s outbreak have boosted his profile — would be a “better candidate than Sleepy Joe.”

The hardest hit:           

  • After being discharged from hospital visits, some seniors are having a hard time returning to nursing homes or rehabilitation centers afraid of spreading the coronavirus, our colleagues Katie Mettler and Jennifer Oldham report.
  • The 70 million displaced people in the world, including refugees and asylum seekers, are among the most vulnerable to the spread of the coronavirus, our colleague Karen DeYoung writes.

In states: 

  • A group of abortion rights advocates filed legal challenges against Alabama, Iowa, Ohio and Oklahoma for orders there to temporarily ban abortion procedures during the pandemic, CBS News’s Kate Smith reports. Meanwhile, a federal district judge in Texas blocked a temporary ban on the procedure after the governor’s emergency executive order halted all medically unnecessary surgeries to preserve resources, our colleague Arelis R. Hernández writes.
  • California Gov. Gavin Newsom (D) called on recently retired health-care workers to join a new “California Health Corps” to  help with the surge in coronavirus patients, the Los Angeles Times reports. Newsom also called on people working on getting a medical license in the state and students in medical or nursing schools to apply to the corps.

Good to know: 

  • Signs of life are returning to Wuhan, China, the city that was at the center of the country’s coronavirus outbreak. Yesterday, numerous shops opened their doors after tens of millions of people were asked to stay home for two months, the Associated Press reports.
  • The Tokyo Olympics have been rescheduled for July 23, 2021, our colleague Simon Denyer reports.

SUGAR RUSH

Leave a Reply