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May 5, 2020

Analysis | The Health 202: Social distancing hasn't been as effective in stemming U.S. coronavirus deaths as policymakers had hoped.


By Paige Winfield Cunningham


with Paulina Firozi
Social distancing isn’t having the effects many had hoped for.
Despite encouraging signs on the nation’s East and West coasts, daily diagnosed cases of the novel coronavirus appear to still be on the rise in about 20 states. A number of rural counties have become unexpected hot spots in recent weeks, including in the Black Belt region of Mississippi and Alabama and in communities throughout Iowa and northern Texas around the Oklahoma panhandle. The country's overall daily figures of diagnoses and deaths have plateaued, worrying health policymakers as many states move to reopen parts of their economy.

A sign at St. Pete Beach, Fla. (Steve Nesius/Reuters)
That steep curve of covid-19 cases in March and April isn't receding the way it rose.
Hot spots are shifting geographically from New York City to areas around the country. For the past month, the figures have hovered around 30,000 diagnosed cases and around 2,000 deaths every day, former Food and Drug Administration commissioner Scott Gottlieb noted in a Wall Street Journal op-ed.
“Everyone thought we’d be in a better place after weeks of sheltering in place and bringing the economy to a near standstill,” he wrote. “Mitigation hasn’t failed; social distancing and other measures have slowed the spread. But the halt hasn’t brought the number of new cases and deaths down as much as expected or stopped the epidemic from expanding.”

President Trump, who last week suggested the novel coronavirus would disappear even without a vaccine, has now upgraded his prediction of fatalities to as many as 100,000 people. Nonetheless, he said in a New York Post interview yesterday that Americans are “starting to to feel good now. The country’s opening again. We saved millions of lives, I think."
A leaked government report, still in draft version, predicts a spike in cases and deaths beginning on May 14.
The report, which the Centers for Disease Control quickly disavowed as an unfinished projection, suggests new cases could surge to 200,000 per day and daily American deaths could number more than 3,000 by June 1. That’s far more than what other models predict, but the Johns Hopkins epidemiologist who prepared it told my colleagues William Wan, Lenny Bernstein, Laurie McGinley and Josh Dawsey that 100,000 new cases per day by the end of the month isn’t out of the realm of possibility.
Former FDA commissioner Scott Gottlieb:
From the full CDC deck on projected deaths per day. 2/3 pic.twitter.com/2UnZNN1B2z
— Scott Gottlieb, MD (@ScottGottliebMD) May 4, 2020
From the full CDC deck on projected cases per day. 3/3 pic.twitter.com/7kJoLjlOH3
— Scott Gottlieb, MD (@ScottGottliebMD) May 4, 2020
University of Michigan professor Justin Wolfers:
Here's some simple and grim math for our covid future: At the moment, the number of new cases each day has been roughly flat for the past 3-4 weeks. pic.twitter.com/5xvyPfgsl4
— Justin Wolfers (@JustinWolfers) May 4, 2020
That’s not the only model showing discouraging figures for the month of May. A model out of the University of Washington, relied upon heavily by the administration, yesterday upgraded its U.S. fatality predictions for the virus’s first wave from 72,433 deaths to 134,475 deaths by Aug. 4.
These aren’t the trends many policymakers had hoped to see, after most Americans spent seven weeks at home under an unprecedented lockdown that has torched the once-booming economy and thrust millions into economic uncertainty. Protests against extended lockdowns are starting to mount around the country, and many governors have assembled and even embarked upon gradual plans to reopen businesses, schools and other public areas.
Nonetheless, a new Washington Post-University of Maryland poll out this morning shows sizable majority of Americans oppose the reopening of restaurants, retail stores and businesses.
Executive producer of 7News WHDH in Boston:
#BREAKING Protesters taking to the streets outside of the Massachusetts State House calling for the Governor to reopen the state, protesting the stay at home advisory. Some also appear to be protesting the mask mandate that takes effect on Wednesday #7News pic.twitter.com/hRHMopJlcB
— Mike Fahey (@michaelefahey) May 4, 2020
Social distancing did accomplish some important objectives. It undoubtedly saved the health-care system from being crushed by an overwhelming caseload of sick patients all at once.
And the United States is still outranked by half a dozen European countries when it comes to deaths per capita. The U.S. death rate is about 206 deaths per million people. That figure is 538 in Spain, 372 in France, 481 in Italy, 432 in the United Kingdom and 207 in Switzerland, according to a tally by Mother Jones.

But distancing clearly hasn’t been enough — at least the way it’s been carried out — to halt the spread of the highly contagious virus in some places.
New cases and deaths across the whole U.S. are about where they were 20 days ago, my colleague Philip Bump reports. He created a graphic where you can view the three-day averages of cases, deaths and tests performed by state (check it out here).
“The back of the mountain doesn’t look the way the front did,” Philip writes. “We saw a steady, exponential rise in confirmed cases and deaths each day for several weeks. But particularly with daily case totals, the period after the peak nationally has looked more like a plateau than a downward slide.”
Daily cases appear to be rising significantly in Delaware, Illinois, Indiana, Minnesota and Virginia. They're also trending upward in Arizona, Colorado, D.C., Iowa, Kansas, Maryland, Mississippi, Nebraska, New Hampshire, New Mexico, North Carolina, Tennessee, Texas, Utah and Wisconsin.
Even as more economic activity is restarted, covid is expanding in many states and we face a persistent plateau of 30,000 daily cases and 2,000 deaths. A lot of the spread is clustered in disadvantaged communities and in at risk environments. We must focus intense resources there pic.twitter.com/QDYXL43iHm
— Scott Gottlieb, MD (@ScottGottliebMD) May 3, 2020
Andy Slavitt, former head of the Centers for Medicare and Medicaid Services:
When you take out NY, pay attention to your trends. Below are cases, hospitalizations, and death rates in NY and the rest of the country is not flattening out. 15/ pic.twitter.com/Mfo7so7Dh5
— Andy Slavitt @ 🏡 (@ASlavitt) May 3, 2020
“There are so many emerging areas still throughout the country that our group has been trying to wave our hands about,” Marynia Kolak, a health and spatial data science researcher at the University of Chicago, told me.
Kolak and her colleagues are tracking covid-19 cases and deaths at the county level. They’ve been increasingly spotting clusters of the disease in rural areas. Kaiser Family Foundation researchers have also found that rural areas are experiencing a faster growth in cases, even as their total numbers remain far below those seen in urban settings.
One example: Five counties in Minnesota with significant meat-processing plants. State officials said about a quarter of cases reported over the weekend came from those counties.
One is Nobles County, home to a JBS USA pork processing plant in Worthington, with a population of around 22,000. It is scheduled to partially reopen this week, under an order by Trump to keep meat plants open.
The outbreaks in counties with meat-processing plants “illustrates how powerfully situations can change at the community level,” said Jan Malcolm, commissioner of Minnesota’s Department of Health.
Malcolm stressed how hard it is to stem the spread of the virus in these types of facilities.
“These are particularly challenging investigations,” Malcolm said. “Many of the workers involved don’t have phones, don’t provide phone numbers, aren’t answering calls. It’s been a very labor-intensive, shoe-leather kind of an approach.”
Ahh, oof and ouch
AHH: The isolation, fear and job loss from the coronavirus and resulting lockdowns may lead to a wave of depression, substance abuse, post-traumatic stress disorder and suicide.

A man walks on Pier 45 at Hudson River Park in New York. (Mark Lennihan/AP)
“Just as the initial coronavirus outbreak caught hospitals unprepared, the country’s mental health system — vastly underfunded, fragmented and difficult to access before the pandemic — is even less prepared to handle this coming surge,” William Wan writes. As The Health 202 reported this week, a federal emergency hotline registered a more than 1,000 percent increase last month compared with the same period last year.
“Researchers have created models — based on data collected after natural disasters, terrorist attacks and economic downturns — that show a likely increase in suicides, overdose deaths and substance use disorders,” he writes.
“When diseases strike, experts say, they cast a shadow pandemic of psychological and societal injuries. The shadow often trails the disease by weeks, months, even years. And it receives scant attention compared with the disease, even though it, too, wreaks carnage, devastates families, harms and kills.”
We want to hear from you: The Post wants to hear from anyone who has faced obstacles in accessing mental health care during the pandemic. You can share your story here.
OOF: As vice president, Joe Biden urged a more aggressive approach to H1N1 than President Obama.
Eleven years ago, the now-presumptive Democratic presidential nominee was informed about H1N1, the swine flu virus, that was spreading rapidly in Mexico and popping up in some places in the United States.

Former vice president Joe Biden. (Matt Rourke/AP)
Then-vice president Biden told homeland security adviser John Brennan in April 2009 that “we need to be aggressive early on this,” as Politico’s Natasha Korecki reports. 
“Airlines angrily accused Biden of fearmongering. Media reports noted that Biden’s pessimism contrasted sharply with the reassurances President Barack Obama had given a day earlier, when he said there was no need to panic even as he declared a national health emergency,” Natasha writes. “Now, as Biden prepares to take on President Donald Trump in a presidential election marked by a far more lethal pandemic…Biden intimates have seized on the idea that the former vice president is the man for this moment,”
Yet the Obama administration's response was far from smooth. Former officials describe vaccine shortfalls, fights over funding and sometimes contradictory messaging.
“An extensive review of the handling of H1N1, including the examination of public records and congressional testimony, suggests the response was not the panacea portrayed by the Biden camp and its defenders: Biden’s role, while significant, was not equivalent to leading the response,” Natasha writes.
OUCH: The economic slump is particularly devastating for America's baby boomers heading into retirement.

Nancy and Terry Koch outside of their apartment complex in West Allis, Wis. Nancy, a retired psychiatric nurse, and Terry, a technical writer, are struggling to make ends meet in their retirement. (Darren Hauck for The Washington Post)
Will Englund spoke with six Americans in this very situation.
“The coronavirus pandemic has scrambled the lives of these six boomers just as it has everyone else’s, though with no savings to worry about at least it hasn’t directly hurt them financially,” he writes. “Some have hunkered down, as best they can in sometimes tight spaces. For others, the pandemic has brought a surprising twist to their lives. … Thirty million Americans have applied for unemployment benefits since the pandemic struck. But for laid-off workers in their 50s and 60s — and 70s — finding employment again will be tough.”
One boomer, Nancy Koch, told The Post she’s tried to return to work. “I’m looking, but nobody wants a 70-year-old,” she said. “I’ve applied for a zillion jobs. It’s completely impersonal.”

The Trump administration’s response

The FDA is ramping up its oversight of antibody tests. 
The agency was criticized for allowing more than 100 commercial coronavirus antibody tests to enter the market without review. But now it says tests will have to meet standards for quality and accuracy, Laurie McGinley reports.
“The action was the latest about-face in the administration’s coronavirus effort as it seeks to fix a flawed testing response that has been criticized as either too restrictive or too lenient,” she writes.
After products of questionable quality flooded the market, sparking scrutiny of the agency’s leniency, the stricter requirements “will make it harder to buy questionable tests, but officials say there should still be enough reliable options for hospitals, doctors and consumers. The agency already has authorized 12 antibody tests for emergency use, including one by Roche. And it is working with companies on authorizations for an additional 200 serology tests.”
U.S. leaders were missing from a virtual vaccine summit. 
The Trump administration declined to participate in an online conference led by European Commission President Ursula von der Leyen and a half-dozen countries. The world leaders are pledging billions of dollars toward the rapid development of coronavirus treatments and vaccines, William Booth, Carolyn Y. Johnson and Carol Morello report.

German Chancellor Angela Merkel. (Kay Nietfeld/AP)
Germany’s Angela Merkel, France’s Emmanuel Macron, Britain’s Boris Johnson, Japan’s Shinzo Abe, Israel’s Benjamin Netanyahu and Turkey’s Recep Tayyip Erdogan participated in the summit.
“A senior Trump administration official said Monday the United States ‘welcomes’ the efforts of the conference participants. He did not explain why the United States did not join them,” they write.
Meanwhile, public health experts and researchers were surprised at the absence.
“It’s the first time that I can think of where you have had a major international pledging conference for a global crisis of this kind of importance, and the U.S. is just absent,” Jeremy Konyndyk, who worked on the Ebola response in the Obama administration, told The Post.
The summit was expected to raise $8.2 billion from government, philanthropies and private firms.

Coronavirus latest

Here are a few more stories to catch up on this morning:
Congress on coronavirus: 
  • The Senate returned yesterday, arriving in Washington to convene for the first time in five weeks. “Most staff members kept masks on as they worked on the Senate dais and ringed the ornate chamber. Meanwhile, senators did not always follow health experts’ guidance to reduce the risk of spreading the deadly disease,” Mike DeBonis reports.
  • House Democratic leaders are hoping to up the pressure on Republican leaders to move forward on the next round of coronavirus relief. House Speaker Nancy Pelosi (D-Calif.) called on lawmakers to “think big” on a call and detailed hopes for a package providing more than a trillion dollars in relief for state and local governments and support for the most vulnerable, Politico’s Heather Caygle and Sarah Ferris report.
On the front lines: 
  • A trio of workers at Elmhurst Hospital Center in the Queens borough of New York had the critical task of managing an inventory of masks, gloves and other protective gear, handing out supplies and keeping the stockroom replenished. By April 12, Wayne Edwards, Derik Braswell and Priscilla Carrow had died, the New York Times’s Nicole Hong reports.
  • The health-care industry is suffering from a historic drop in business, Todd C. Frankel and Tony Romm report. It’s in part because of postponed elective surgeries and individuals avoiding medial services, overall adjustments that led to an 18 percent decline in health-care spending in the first quarter of the year, they write.
The fallout: 
  • The Treasury Department is set to borrow nearly $3 trillion from April through June to cover the response to the pandemic, Rachel Siegel reports.
  • Tyson Foods said the nation’s pork production is down 50 percent, even after Trump announced an executive order last week to keep meat processing plants open, Laura Reiley reports.
  • What will the post-pandemic restaurant culture look like? Sneeze guards, disposable menus, single-serve condiments, and questions about whether customers will come at all, Laura reports.
  • The pandemic has shuttered scientific research labs, a consequence fueling fears that the disruptions to research will be too much to overcome, Stat News’s Justin Chen reports.

Sugar rush


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