���ϳԹ���

Five weeks ago, when there were 60 confirmed cases of the coronavirus in the United States, President Trump expressed little alarm. “This is a flu,” he said. “This is like a flu.” He was still likening it to an ordinary flu as late as Friday. By Tuesday, however, with more than 187,000 recorded cases in the United States and more Americans having been killed by the virus than by the Sept. 11, 2001, attacks, the president’s assessment had rather drastically changed. “It’s not the flu,” he said. “It’s vicious.” The grim-faced president who appeared in the White House briefing room for more than two hours on Tuesday evening beside charts showing death projections of hellacious proportions was coming to grips with a reality he had long refused to accept. (Baker, 4/1)

President Donald Trump warned Americans to brace for a “hell of a bad two weeks” ahead as the White House projected there could be 100,000 to 240,000 deaths in the U.S. from the coronavirus pandemic even if current social distancing guidelines are maintained. Public health officials stressed Tuesday that the number could be less if people across the country bear down on keeping their distance from one another. (Madhani, Freking and Alonso-Zaldivar, 4/1)

“I want every American to be prepared for the hard days that lie ahead,” said Mr. Trump, who answered questions for more than two hours and predicted that there would be “light at the end of the tunnel,” but warned that “we’re going to go through a very tough two weeks.” Dr. Fauci and Dr. Birx showed charts indicating that coronavirus cases in New York and New Jersey had risen far higher than in other parts of the country, a fact that they said gave them hope that the overall number of deaths might be lower if people in the rest of the states followed the guidelines for at least the next month. (Shear, Crowley and Glanz, 3/31)

“Each of us has the power — through our own choices and actions — to save American lives and rescue the most vulnerable among us,” Trump said. “Every citizen is being called on to make sacrifices. Every business is being asked to fulfill its patriotic duty. Every community is making fundamental changes to how we live, work and interact each and every single day.” (Megerian and Wire, 3/31)

“We’ve got to brace ourselves,” said Dr. Anthony Fauci, a member of the White House coronavirus task force. But Dr. Fauci said that continued protective social-distancing measures could help prevent the worst-case scenario. “In the next several days to a week or so, we’re going to continue to see things go up,” Dr. Fauci said. “We cannot be discouraged by that. Because the mitigation is actually working, and will work.” (Leary, Calfas and Ping, 4/1)

Fauci warned that Americans needed to brace themselves for grim numbers, explaining that deaths and hospitalizations lagged behind diagnoses and arguing they were all the more reason to keep up the push to “flatten the curve” through social distancing. “Now is the time, whenever you‘re having an effect, not to take your foot off the accelerator and on the brake, but to just press it down on the accelerator,” Fauci said. (Oprysko, 3/31)

“It’s absolutely critical for the American people to follow the guidelines for the next 30 days. It’s a matter of life and death,” Trump said.White House coronavirus coordinator Deborah Birx displayed charts demonstrating data and modeling that showed an enormous jump in deaths to a range of 100,000 to 240,000 people from the virus in the coming months. That figure was predicated on Americans following mitigation efforts. One of Birx’s charts showed as many as 2.2 million people were projected to die without such measures, a statistic that prompted Trump to ditch a plan he articulated last week to get the U.S. economy moving again by Easter on April 12. (Holland and Mason, 3/31)

Birx noted the Detroit, Chicago and New Orleans areas, as well as the state of Massachusetts, as places with a troubling rise in cases. She said spikes there and in other cities can be prevented only with mitigation in every community coast to coast. “There’s no magic bullet,” Birx said. “There’s no magic vaccine or therapy. It’s just behaviors — each of our behaviors translating into something that changes the course of this viral pandemic over the next 30 days.” (Rucker and Wan, 3/31)

Designed by the University of Washington's Institute for Health Metrics and Evaluation, the model relies on information from state and national governments, hospital groups and the World Health Organization. Birx, the White House health official, also mentioned the model to Chuck Todd on "Meet the Press" this weekend. "No state, no metro area will be spared," she said during the interview. State and local officials should quickly react to the coronavirus threat and enact social distancing measures, she said, so that "we'll be able to move forward together and protect the most Americans." (Azad, 3/31)

Epidemiologists, who study the spread of infectious diseases, rely on data collected about diseases combined with statistical analysis to create predictive models of different outcomes to figure out how best to deal with outbreaks. A model developed by researchers at Imperial College London and published March 17 suggested that without any mitigation measures in place, the coronavirus could kill 2.2 million people in the U.S. That's an entirely hypothetical scenario, because it assumes that all government agencies would ignore the virus and would take no steps, such as social isolation, to reduce its spread. Nonetheless, the stark findings were reported to have been among the first to prompt U.S. authorities to take drastic action. (Chow, 3/31)

The U.S. recorded a big daily jump of 26,000 new cases, bringing the total to more than 189,000. The death toll leaped to over 4,000, including more than 1,000 in New York City. ... Some people have chosen to ignore social distancing guidelines. In Louisiana, buses and cars filled a church parking lot on Tuesday evening as worshippers flocked to hear a pastor who is facing misdemeanor charges for holding services despite a ban on gatherings. (Perry and Matthews, 4/1)

The United States passed a grim milestone on Tuesday as it surpassed China in the official death count from the coronavirus. The United States now has 3,415 deaths from the virus, surpassing China’s figure of 3,309, according to a tracker from Johns Hopkins University. It's important to note that there are significant doubts about the accuracy of China’s figures. (Sullivan, 3/31)

Facing a grim reality of surging coronavirus cases, President Donald Trump is making premature assertions about relatively low death rates in the U.S. and revising history about how seriously he viewed the threat, including the need for ventilators. A look at his claims. (Yen, Neergaard and Woodward, 4/1)

As TV cameras tracked him, President Trump walked from the Rose Garden podium to a nearby table for the dramatic unveiling of a new and improved product, one supposedly able to deliver faster, better results. As the head of the Food and Drug Administration extolled the coronavirus testing kit, Trump opened a box, carefully pulled out the device and held it up for viewers to see on Monday, like a scene from a Home Shopping Network show. (Megerian, 3/31)

A new survey finds widespread public support for aggressive measures like government cellphone tracking and mandatory health screenings in public places to curb the spread of coronavirus, which has infected more than 180,000 Americans. The new results from Harris Poll show that support for such policies—even when they might affect privacy and civil liberties—crosses a spectrum of demographic and ideological lines, suggesting that policy makers have significant latitude from the public in crafting emergency responses to combat the virus. (Tau, 3/31)

President Trump’s aspirational plan to restart the U.S. economy by mid-April ran into a major obstacle: Anthony Fauci. After Mr. Trump envisioned packed churches on Easter, Dr. Fauci went to the Oval Office. He and Deborah Birx, members of the White House coronavirus task force, outlined data projecting a surge in cases without continued social distancing. The president agreed. Aides say Mr. Trump’s decision Sunday to extend social distancing through April reflects the influence of some political advisers, public health experts, and Dr. Fauci, a 79-year-old scientist who has so far retained his leverage with Mr. Trump in an administration where critics of the president rarely last long. (Armour and Leary, 3/31)

Global stocks fell Wednesday after President Trump issued a stark new warning on the spread of the novel coronavirus in the U.S., reviving concerns about the potential damage to the world’s largest economy. Futures tied to the Dow Jones Industrial Average dropped 3%, suggesting that blue-chip stocks will decline a day after U.S. equities closed out their worst quarter since the financial crisis. European stocks also declined, with the pan-continental Stoxx Europe 600 index retreating 3%. (Yoon and Chilkoti, 4/1)

White House economists published a study last September that warned a pandemic disease could kill a half million Americans and devastate the economy.It went unheeded inside the administration. In late February and early March, as the coronavirus pandemic began to spread from China to the rest of the world, President Trump’s top economic advisers played down the threat the virus posed to the U.S. economy and public health. (Tankersley, 3/31)

Should healthy people be wearing masks when they’re outside to protect themselves and others? Both the World Health Organization and the Centers for Disease Control and Prevention have repeatedly said that ordinary citizens do not need to wear masks unless they are sick and coughing. And as health care workers around the world face shortages of N95 masks and protective gear, public health officials have warned people not to hoard masks. (Goodnough and Sheikh, 3/31)

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, revealed on Tuesday that the White House coronavirus task force is seriously considering guidance that Americans wear masks to help thwart the rapid spread of COVID-19. But the country’s top infectious disease expert also acknowledged that such a directive has been complicated by the nationwide dearth of personal protective equipment. (Forgey, 3/31)

Federal officials debating whether to recommend that face coverings be routinely worn in public are responding to increasing evidence that infected people without symptoms can spread the coronavirus, according to internal memos provided to the White House by the Centers for Disease Control and Prevention. Simple cloth masks that cover the mouth and nose can prevent virus transmission from such individuals when they are out buying groceries or seeking medical care, according to the memos obtained by The Washington Post. (Sun and McGinley, 3/31)

And Tuesday, President Trump weighed in suggesting people may want to wear scarves. "I would say do it," he said, noting that masks are needed for health care works. "You can use scarves, you can use something else," he said. On Tuesday Dr. Deborah Birx, who serves as the White House's coronavirus response coordinator, said the task force is still discussing whether to change to the recommendation on masks. Other prominent public health experts have been raising this issue in recent days. Wearing a mask is "an additional layer of protection for those who have to go out," former FDA Commissioner Scott Gottlieb told NPR in an interview. It's a step you can take — on top of washing your hands and avoiding gatherings. (Jingnan, Aubrey and Wroth, 3/31)

some experts say a mask may give the user a false sense of security. And the eyes — an important pathway for the virus to infect a person — remain exposed even though the mouth and nose are covered. Surgeon General Jerome Adams has been outspoken against healthy people wearing masks or other coverings in public. (Edwards, 3/31)

Much of Central Europe is now following the example set by China, Taiwan and South Korea. On Monday, Austria mandated its citizens wear masks when outside the home, after the Czech, Slovak and Bosnian governments issued similar orders. CDC Director Dr. Robert Redfield said his agency was reviewing its mask recommendations, especially on growing evidence that people experiencing no symptoms can spread the disease more widely than previously thought. (Hinshaw and Lucey, 3/31)

Brian Kolfage, a Florida military veteran, recently convinced Americans to donate millions of dollars for a privately built wall on the U.S. southern border. Now he has jumped into a new venture: hawking millions of protective face masks that are in critically short supply during the coronavirus pandemic. About a month ago, Kolfage formed a business called America First Medical, which offers on its website and in social media pitches to broker large-volume sales of high-grade masks known as N95s. He said he charges about $4 each - several times the pre-pandemic prices but a few dollars less than some hospitals, nursing homes and first responders are now paying. (Tanfani and Horwitz, 3/31)

The federal Bureau of Prisons said Tuesday that it would keep thousands of inmates at facilities nationwide locked in their cells with limited exceptions for the next 14 days as officials try to stem the spread of the coronavirus after one prisoner died and more prisoners and staff tested positive for the disease. Prison officials stopped short of calling the rare move a lockdown but said inmates would only be allowed out in small groups for things such as showers, commissary and phone calls. (Gurman and Paul, 3/31)

One man was accused of stealing whiskey from a drugstore. A homeless man had allegedly refused to leave a hotel lobby. A woman had walked out of a grocery store without paying for a cart full of food worth $375, according to the police. These are among the people the New Orleans Police Department arrested and booked into the city jail during the past 10 days, as it became clear that the city was at the center of one of the nation’s fastest-growing covid-19 hotspots. (Webster, Brown and Kindy, 3/31)

Two men allegedly involved in a robbery where a New York City police detective was killed in friendly fire were among the violent offenders on the list of inmates slated to be released from the infamous Rikers Island jail complex due to the coronavirus pendemic, until prosecutors intervened, multiple sources told ABC News. ... The only thing that kept alleged violent offenders from being released was the intervention of the city’s five district attorneys, who said in a joint letter issued Monday that “we want to make clear that the categories of those proposed for release have, in some instances, included individuals who pose a high risk to public safety.” (Carrega and Katersky, 3/31)

California is granting early release to 3,500 inmates in an effort to reduce crowding as coronavirus infections begin spreading through the state prison system. Lawyers for Gov. Gavin Newsom on Tuesday told a panel of federal judges the state is taking “extraordinary and unprecedented protective measures” to slow the spread of the virus and protect those who live and work within California’s 35 prisons. The accelerated prison discharges — affecting inmates due to be released over the next 60 days — come in the face of pressure to do much more. (St. John, 3/31)

The captain of the U.S. aircraft carrier Theodore Roosevelt, in a blunt letter, has called on Navy leadership for stronger measures to save the lives of his sailors and stop the spread of the coronavirus aboard the huge ship. The four-page letter, the contents of which were confirmed by U.S. officials to Reuters on Tuesday, described a bleak situation on board the nuclear-powered carrier as more and more sailors test positive for the virus. The Navy puts the ship’s complement at 5,000, the equivalent of a small American town. (Ali and Stewart, 3/31)

At least 70 sailors now have tested positive for the new coronavirus, which first appeared on the ship last week, Navy officials said. The Navy had said it was flying testing supplies to the ship. But in his memo, Capt. Crozier described the limitations of testing, saying that of the first 33 sailors tested for the coronavirus, seven who tested negative displayed symptoms of infection one to three days later. (Youssef, 3/31)

"The problem is that Guam doesn't have enough beds right now, so we're having to talk to the government there to see if we can get some hotel space, create some tent-type facilities there," he said. Modly added that Navy leaders "don’t disagree with the CO on that ship and we’re [handling the situation] in a very methodical way because it's not the same as a cruise ship. I mean that ship has armaments on it, it has aircraft on it. We have to be able to fight fires if there are fires onboard the ship. We have to run a nuclear power plant." (Feldscher and Seligman, 3/31)

The mayor of Holyoke, Mass., got an unsigned letter over the weekend that deeply disturbed him. “Are you aware of the horrific circumstances at the Soldiers’ Home?” the letter read, and went on to describe serious breaches, like a resident suspected of having the coronavirus, awaiting the results of a test, being sent back to a dementia ward with 20 other veterans. “Where is the state in addressing what is truly happening in this building?” the letter concluded. (Barry, 3/31)

The Trump administration has decided against reopening Obamacare enrollment to uninsured Americans during the coronavirus pandemic, defying calls from health insurers and Democrats to create a special sign-up window amid the health crisis. President Donald Trump and administration officials recently said they were considering relaunching HealthCare.gov, the federal enrollment site, and insurers said they privately received assurances from health officials overseeing the law's marketplace. However, a White House official on Tuesday evening told POLITICO the administration will not reopen the site for a special enrollment period, and that the administration is "exploring other options." (Luthi, 3/31)

Democratic lawmakers asked administration officials to temporarily reopen the exchanges several weeks ago. Also, two leading health insurance industry groups wrote congressional leaders in mid-March asking for such a move. "Given the risk posed by Covid-19, it is more important than ever for people to have health coverage," the CEOs of America's Health Insurance Plans and Blue Cross Blue Shield Association wrote, referring to the disease caused by coronavirus. (Luhby, 3/31)

A chorus of governors from across the political spectrum is publicly challenging the Trump administration’s assertion that the United States is well-stocked and well-prepared to test people for the coronavirus and care for the sickest patients. In New York State — the center of the nation’s outbreak, with at least 1,550 deaths — Gov. Andrew M. Cuomo said on Tuesday that the country’s patchwork approach to the pandemic had made it harder to get desperately needed ventilators. (Mervosh and Rogers, 3/31)

As states across the country have pleaded for critical medical equipment from a key national stockpile, Florida has promptly received 100 percent of its first two requests — with President Trump and Republican Gov. Ron DeSantis both touting their close relationship. States including Oklahoma and Kentucky have received more of some equipment than they requested, while others such as Illinois, Massachusetts and Maine have secured only a fraction of their requests. It’s a disparity that has caused frustration and confusion in governors’ offices across the country, with some officials wondering whether politics is playing a role in the response. (Olorunnipa, Dawsey, Janes and Stanley-Becker, 3/31)

Illinois Gov. J.B. Pritzker (D) on Tuesday urged President Trump to make greater use of the Defense Production Act to help states experiencing a rapid surge in hospitalizations due the novel coronavirus outbreak. During an appearance on CNN's "Cuomo Prime Time," Pritzker said that his state had received just 10 percent of the medical equipment it has asked for, warning that it could cause severe shortages by as early as next week. (Wise, 3/31)

The Ohio Department of Health has received its requested supplies of personal protective equipment from the Strategic National Stockpile, but officials claim it is not enough. The Strategic National Stockpile sent over 670,000 surgical masks, more than 490,000 gloves and a number of other items, outlined below. (Mitchell, 3/31)

President Donald Trump’s allies are trying to contain a politically risky election-year fight with Michigan Gov. Gretchen Whitmer as he struggles to balance presidential politics with a global pandemic in one of the nation’s most important swing states. Both sides have tried to de-escalate the feud this week, although Trump’s supporters in particular sought to downplay tensions that ratcheted up over the weekend when the Republican president unleashed a social media broadside against Whitmer, a Democrat who had been critical of the federal government’s response to the coronavirus outbreak. (Peoples and Eggert, 4/1)

Chemicals used to construct military missiles. Materials needed to build drones. Body armor for agents patrolling the southwest border. Equipment for natural disaster response. A Korean War-era law called the Defense Production Act has been invoked hundreds of thousands of times by President Trump and his administration to ensure the procurement of vital equipment, according to reports submitted to Congress and interviews with former government officials. (Kanno-Youngs and Swanson, 3/31)

Despite having committed to transferring 2,000 ventilators in military stocks to the Federal Emergency Management Agency and the Department of Health and Human Services to fight the coronavirus outbreak, the Pentagon has not shipped any of them because the agencies have not asked for them or provided a shipping location, the Pentagon's top logistics official said Tuesday. In order to ship the badly needed equipment, the Defense Department has to be given a location to send them by civilian authorities who have to decide where the items are most needed. (Starr and Cohen, 3/31)

The Trump administration is telling hospitals they can split ventilators between two patients and is escalating calls to scrap elective surgeries, as federal officials try to limit care rationing in facilities lacking the critical breathing machines. New federal guidelines on so-called ventilator splitting — an idea that's been used extremely rarely in emergency situations — emphasizes it should "only be considered as an absolute last resort" for hospitals swamped by coronavirus patients. But it underscores concerns that hospitals could soon be faced with challenging ethical decisions about how to prioritize which patients receive life-saving equipment. (Roubein, 3/31)

In the chaos of New York City, where coronavirus deaths are mounting so quickly that freezer trucks have been set up as makeshift morgues, several hospitals have taken the unprecedented step of allowing doctors not to resuscitate people with covid-19 to avoid exposing health-care workers to the highly contagious virus. The shift is part of a flurry of changes besieged hospitals are making almost daily, including canceling all but the most urgent surgeries, forgoing the use of isolation rooms, and requiring infected health workers who no longer have a fever to show up to work before the end of the previously recommended 14-day self-isolation period. (Cha, Bernstein, Sellers and Harris, 3/31)

As states sound the alarm over a lack of ventilators to help hospitalized novel coronavirus patients -- including a plea for 30,000 machines for New York state alone -- experts warned that even if the equipment arrives, facilities could face a shortage of health care workers trained to use them. "If you have a thousand more ventilators magically appear, do you have the 20 ICU [Intensive Care Unit] doctors, 300 ICU nurses, 150 respiratory therapists and all of the [personal protective equipment] needed to support those 1,000 new ventilators?" Dr. Doug White, an intensive care physician with the University of Pittsburgh School of Medicine, told ABC News. "Simply put, ventilators don’t run themselves." (Folmer, Siegel and Abdelmalek, 4/1)

Tesla CEO Elon Musk said Tuesday the company would deliver FDA-approved ventilators to hospitals within the company’s delivery area. “We have extra FDA-approved ventilators. Will ship to hospitals worldwide within Tesla delivery regions. Device & shipping cost are free. Only requirement is that the vents are needed immediately for patients, not stored in a warehouse," Musk tweeted, requesting that inquiries be directed to himself and Tesla. (Budryk, 3/31)

The U.S. government raced on Tuesday to build hundreds of makeshift hospitals near major cities as healthcare systems were pushed to capacity, and sometimes beyond, by the coronavirus pandemic. Even as millions of Americans hunkered down in their homes under strict “stay-at-home” orders, the death toll, as tallied by Reuters, shot up by more than 850 on Tuesday, by far the most for a single day. (Brown and Whitcomb, 3/31)

The University of Michigan announced Tuesday it plans to convert its indoor track into hospital space, redeploy staff, and convert other areas within its health system, including dormitories, to handle a surge of coronavirus patients as demand for hospital beds grows. Michigan Medicine, the Ann Arbor-based hospital system, is licensed for 1,000 beds, but its projections for the rising number of coronavirus patients suggest that number won't be enough. (Shamus, Jesse and Gray, 3/31)

The tennis complex that hosts the U.S. Open will by next week become a field hospital to treat coronavirus patients — part of a race to build more beds and relieve New York City's health care facilities, where a top official said all indicators are “flashing red.” The USTA Billie Jean King National Tennis Center in Queens will host a 350-bed hospital, Mayor Bill de Blasio said in a visit to the site Tuesday — and unlike other emergency hospitals opened in the city so far, it will be able to treat patients suffering from Covid-19. (Durkin, 3/31)

A foundation run by the billionaire owner of the Los Angeles Times is looking to buy the closed St. Vincent Medical Center in Los Angeles out of bankruptcy for $135 million and reopen it to treat coronavirus patients. The Chan Soon-Shiong Family Foundation, a nonprofit founded about a decade ago by Patrick Soon-Shiong and his wife, Michele B. Chan, has agreed to serve as the lead bidder to acquire St. Vincent from the hospital’s bankrupt owner, Verity Health System of California Inc., according to court papers. (Al-Muslim, 3/31)

Pennsylvania is coming to the rescue of a roughly 200-bed hospital whose private equity-owned operator announced plans to shutter the facility amid the deadly COVID-19 pandemic.Gov. Tom Wolf's office has agreed to hand over $8 million in emergency funding to Easton Hospital in Easton, roughly 70 miles north of Philadelphia. The hospital's operator, Steward Health Care, has in exchange agreed to keep the hospital open until the end of April. Steward is owned by the private equity firm Cerberus Capital Management, which has more than $42 billion in assets under management. (Bannow, 3/31)

The coronavirus careening through New York City has brought one of the world’s premier medical capitals to its knees. The city’s cash-strapped public hospitals were predictably overwhelmed by the breadth of the virus: Despite relocating certain patients and rearranging wards to open up space for the influx, the system was consumed by the crisis. So too was New York City’s network of private hospitals, most of which operate on much more comfortable margins and have boards that count New York’s civic elite as members. (Goldenberg, Eisenberg and Muoio, 3/31)

In hospitals across New York City and elsewhere in the country, nurses and doctors are complaining about a lack of safety equipment, insufficient staffing, murky policies and other challenges. New York City accounts for the largest number of Covid-19 cases in the U.S. On Tuesday morning, the city reported 40,900 cases and 932 deaths. In the last few weeks, the 57-year-old Ms. Norstein and other nurses say they have seen freezer trucks out back for dead bodies; four to five patients dying every emergency-room shift; the loudspeaker frequently booming out “codes” for patients whose hearts or breathing stopped. Colleagues who were healthy one day fell critically ill the next. (Ramachandran and Safdar, 3/31)

An influx of coronavirus patients has overwhelmed the American health care infrastructure, leaving front-line medical providers to improvise creative solutions to the day-to-day pitfalls of treating those afflicted with the highly contagious disease. The latest innovative solution found in hard-hit hospitals? Baby monitors. (Bruggeman, 4/1)

An elected official in the San Francisco Bay Area pleaded for help Tuesday, appalled by the shortage of personal protective equipment at a hospital leased by the state of California to care for coronavirus patients. “Here’s what I see: I see a disaster on the brink of happening,” San Mateo County Supervisor David Canepa said at a meeting of the Board of Supervisors on Tuesday, of the shortage of personal protective equipment, a category that includes masks, gowns and gloves, at Seton Medical Center in Daly City. (Lin, 3/31)

When a woman who didn’t speak English arrived at the overrun emergency room of a Brooklyn hospital last week, she was initially placed in a unit for patients who didn’t have the coronavirus. But on Thursday, a doctor realized she had a cough and fever and should be treated for COVID-19. The doctor brought her over to the coronavirus unit with a warning: “Good luck. She speaks Hungarian.” She died the following night. (Kaplan, 3/31)

Doctors in hospitals in coronavirus epicenters such as New York City are reporting "apocalyptic" scenes of death, disease, and lack of equipment to protect healthcare workers from infection. But less-affected hospitals anticipating local outbreaks should be thinking creatively and acting urgently to care for COVID-19 patients before, during, and after the pandemic, hospital preparedness experts say. (Van Beusekom, 3/31)

When Fasika Getahun, 48, finishes her shift as a custodian at Harborview Medical Center in Seattle each day, she goes home exhausted but excited to see her seven kids. She's a single mom who immigrated from East Africa, and it's gratifying to come home to see them healthy and happy. But since the coronavirus outbreak has pummeled Washington and her adopted city, the anxiety of working on the front lines in a hospital — where she thoroughly disinfects bathrooms and infected patient areas without personal protective equipment — has begun to wear on her. Returning home now doesn't bring the same comfort it once did. (McCausland, 3/31)

As the coronavirus marches from America’s coastal cities to its heartland, testing gaps in the South and Midwest are crippling efforts to contain emerging hot spots in smaller cities and rural areas. Georgia, Michigan and Oklahoma are among the states where coronavirus outbreaks are intensifying — and where per capita testing rates are some of the lowest in the nation. While hard-hit New York was testing more than 950 for every 100,000 people as of Monday, Georgia was testing only 127 and Oklahoma 43. That raises the likelihood that these states are severely underestimating the size of their outbreaks. (Lim, 3/31)

On March 15, the governor of Washington called the Seattle area the “hotbed of this outbreak.” “Code Red,” blared the tabloid cover of the New York Post eight days later. And this weekend, the Tampa Bay Times forecast that Florida, where the governor has not imposed statewide stay-at-home measures, would “see tens of thousands of infections in the coming weeks” from the coronavirus pandemic. (Joseph, 1/1)

As many as 25 percent of people infected with the new coronavirus may not show symptoms, the director of the Centers for Disease Control and Prevention warns — a startlingly high number that complicates efforts to predict the pandemic’s course and strategies to mitigate its spread. In particular, the high level of symptom-free cases is leading the C.D.C. to consider broadening its guidelines on who should wear masks. “This helps explain how rapidly this virus continues to spread across the country,” the director, Dr. Robert Redfield, told National Public Radio in an interview broadcast on Tuesday. (Mandavilli, 3/31)

With tests scarce, epidemiologists are looking at hospitalizations as an indicator of how the novel coronavirus is spreading. But in some of the areas of the country worst-hit by COVID-19, states and counties aren't releasing that data. The result is an incomplete picture of where the pandemic is surging, even in hotspots such as Washington and California. (Sommer, 3/31)

Kaiser Health News: Temperature Check: Tips For Tracking A Key Symptom Of Coronavirus Contagion
After I was told I’d been exposed to the novel coronavirus, I tried to follow the best medical advice. I started working from home. I socially isolated. And I “self-monitored” for signs I’d been infected. Or, at least, I tried to. COVID-19 symptoms seem pretty clear. The dry cough and difficulty breathing. Fatigue. And the fever. (Luthra, 4/1)

The two top infectious disease experts on the White House coronavirus task force think social distancing measures appear to be helping but reminded Americans they are going to have a significant effect on how many people in the Unites States die. "It's communities that will do this. There's no magic bullet (for Covid-19), there's no magic vaccine or therapy, it's just behaviors," said Dr. Deborah Birx, coordinator of the task force. "Each of our behaviors translating into something that changes the course of this viral pandemic over the next 30 days." (Almasy, Hanna and Maxouris, 4/1)

Ohio Gov. Mike DeWine signaled that the state's "stay at home" order and other restrictions aimed at reducing the spread of the novel coronavirus won't end in the near future. "We’re not to the point where we can let up," DeWine said Tuesday. Ohio Department of Health Director Dr. Amy Acton asked Ohioans to consider each trip to the grocery or another outing critically. (Borchardt and Balmert, 3/31)

Right around the time the World Health Organization was declaring the novel coronavirus a full-blown pandemic, Cody Lee Pfister walked into a Walmart in Missouri and delivered his own public service announcement — of the twisted variety. Mr. Pfister, 26, looked directly into a camera and asked, “Who’s scared of coronavirus?” As if to answer his own question, he proceeded to lick a row of deodorants on a store shelf. For six seconds, he awkwardly slid backward, his tongue running from one brand of deodorant to the next. (Burch, 4/1)

Across the nation, people are under strict orders to follow social distancing guidelines in order to lower the risk of coronavirus spreading. To comply with new stay-at-home orders, many people have postponed their planned celebrations, everything from birthdays to weddings. Others have canceled big trips. Theaters have closed their doors, concerts and festivals have been delayed, and restaurants have moved to delivery or takeout only. But, some people have ignored the Trump administration and Centers for Disease Control and Prevention's recommendation to avoid mass gatherings and maintain distance from others. As a result, some local officials are cracking down. (Jackson, 3/31)

It’s an order without much teeth. In Atlanta and across the state, some residents maintain a cavalier attitude about the risks of social interaction, openly flouting shelter-in-place edicts meant to curb the spread of the coronavirus.But with infections rising, will police be called upon to enforce what, up to now, have amounted to little more than strongly worded suggestions? (Boone, 3/31)

Defense Secretary Mark Esper said Tuesday that states have the option of using the National Guard to enforce stay-at-home orders amid the coronavirus pandemic. “[T]hat would be an option for the governors,” Esper said on CBS News. “Again, the guard is active in all 50 states and territories. I'm very proud of what our guardsmen are doing, but we have a whole lot more capacity out there in the guard right now to do more.” (Axelrod, 3/31)

Caitlin Wright was working as a welder apprentice at the ExxonMobil complex in Beaumont, Texas, when she was given orders from the Louisiana National Guard to help support the state's coronavirus response. A combat medic with the rank of sergeant, Wright has been putting her medical training to use at one of the two drive-thru testing sites in New Orleans. (Sneath, 3/31)

Microsoft founder and billionaire philanthropist Bill Gates called for a nationwide shutdown on Tuesday, arguing it would be the most effective way to combat the spread of the coronavirus. Gates wrote in a Washington Post op-ed that he has spoken with experts through his work with his charity who said a national policy would be more effective over having a hodgepodge of states issue stay-at-home orders while others remain more open. He argued that the country needs a "consistent nationwide approach to shutting down." (Axelrod, 3/31)

Just after 6:30 on a recent morning, Dr. Henry Nikicicz, an anesthesiologist in Texas, finished an emergency intubation of a man in his 70s who was suffering severe respiratory distress. Then the doctor’s own trouble began. Stepping out of an elevator after finishing the procedure, Dr. Nikicicz put his respirator face mask back on when he saw a group of people walking down the hallway toward him — reflexively trying to protect himself, and them, should anyone have been infected by the coronavirus. In the days that followed, Dr. Nikicicz said, he was told that his job was at risk because policy at the hospital where he works, University Medical Center in El Paso, prohibited the use of protective masks in the hallways. (Richtel, 3/31)

Million-dollar wire transfers to strangers. Rumors of hidden supplies in forgotten warehouses. Wheeler-dealers trying to talk regulators and customs officials into letting that one precious shipment through. Global desperation to protect front-line medical workers battling the coronavirus epidemic has spurred a mad international scramble for masks and other protective gear. Governments, hospital chains, clinics and entrepreneurs are scouring the world for personal protection equipment they can buy or sell — and a new type of trader has sprung up to make that happen. (Bradsher, 4/1)

In response to the growing strain brought on by the pandemic, providers are coming up with new workarounds when the normal protocols, like seeing patients in person, have become fraught with risk. Meanwhile, how health care institutions approach potential cases of COVID-19 is entirely dependent on what resources they have at their disposal — a dilemma that may spur innovation, born of tough choices. (Isaacs-Thomas, 3/31)

Across the Bay Area and beyond, crafty people have mobilized to make face masks for health care workers, who are reporting dire protective equipment shortages. There’s a whole lot of heart in the effort, but are these homemade jobs truly suited to front line health care workers confronting COVID-19? That depends on how desperate they are. (Myrow, 3/31)

The medical supplier's emission control system meets state approval. So now it is looking for a federal OK to re-sterilize used face masks for hospitals.Medline Industries is pursuing U.S. Food and Drug Administration approval of a plan to resterilize hundreds of thousands of healthcare workers' face masks now that sterilization services are back online at its Waukegan, Il. facility. (Asplund, 3/31)

As Speaker Nancy Pelosi draws up plans for the next coronavirus rescue package, lawmakers on the ground say they’re faced with a more urgent task: finding basic supplies for doctors and nurses. Democrats and Republicans across the country say they’re desperately trying to acquire masks, gloves and ventilators for the most at-risk health care workers in their districts — a crisis that, for now, can’t be solved with simply more cash. (Ferris and Caygle, 4/1)

The California Department of Public Health drastically curtailed the kind of coronavirus data it is sharing with the public this week — including the number of health care workers who test positive for COVID-19 each day — at a time when the public is hungry for the information. To the consternation of health care workers who say infection details are crucial to tracking and halting the pandemic, the state health department announced Monday that it will report only the running total number of statewide infections every day, rather than breaking down where they came from. (Moench, 4/1)

The scarcity of supplies to protect against the coronavirus has prompted one sheriff to tap prisoners for help. Hampden County Sheriff Nick Cocchi said 20 prisoners are making masks and gowns at the jail in Ludlow. He said so far, they've made about 1,000 items to be used mostly at the jail, but also for some first responders. (Becker, 3/31)

Emergency medical service workers in Queens, New York, described living and working in what amounts to a "war zone" as they seek to help residents during the COVID-19 pandemic. "We have thousands of people that are sick. Thousands that are dying," Oren Barzilay, president of FDNY-EMS Local 2507, told ABC News on Tuesday. "It's all over our city. It's not just an isolated case. It's all around us." (Pilgrim, O'Brien, Margolin and Francis, 3/31)

The United States health care system is mobilizing to triage a public health emergency that is rapidly taking members of its workforce out of the ranks... Amid an alarming rise in cases in California where hospitalizations have doubled and ICU admissions have tripled in recent days, Gov. Gavin Newsom launched an initiative Monday aimed at increasing the ranks of the state's health care workforce in advance of an expected surge in coronavirus patients. "If you're a nursing school student, a medical school student, we need you," Gov. Newsom said at a press conference Monday. (Cannon, 4/1)

As the number of Rhode Islanders becoming infected with the coronavirus shot up overnight, Governor Gina M. Raimondo called on all retired and part-time medical professionals to sign up to help the state handle the pandemic. Rhode Island is in “desperate need” of trained medical and behavioral health professionals, Raimondo said during a news conference Tuesday at the State House. (Milkovits, 3/31)

Boston Medical Center is putting 700 employees on furlough — about 10 percent of its workforce — as it braces for major financial losses from the coronavirus pandemic.Like other hospitals, it cut elective surgeries and nonurgent medical appointments to slow the spread of the virus and to make space for patients sick with the virus. The top official at the hospital, which serves much of the city’s indigent population, said that a sudden and drastic drop in revenue is the reason behind the painful move. (Dayal McCluskey, 3/31)

Emergency room doctors and nurses many of whom are dealing with an onslaught of coronavirus patients and shortages of protective equipment — are now finding out that their compensation is getting cut. Most ER providers in the U.S. work for staffing companies that have contracts with hospitals. Those staffing companies are losing revenue as hospitals postpone elective procedures and non-coronavirus patients avoid emergency rooms. Health insurers are processing claims more slowly as they adapt to a remote workforce. (Arnsdorg, 3/31)

A private equity-backed health care company is slashing its doctors’ benefits in response to the coronavirus pandemic, even as many of those same doctors work to treat patients infected with the virus. Alteon Health, which employs about 1,700 emergency medicine doctors and other physicians who staff hospital emergency rooms across the country, announced it would suspend paid time off, matching contributions to employees’ 401(K) retirement accounts, and discretionary bonuses in response to the pandemic, according to an email obtained by STAT. (Facher, 1/1)

The coronavirus outbreak has changed the nation’s dialogue by more than adding “social distancing” and “flattening the curve” to the lexicon. Just a few weeks ago, many people would have been hard-pressed to talk about the nation’s supply chain. But with shortages of protective gear for medical workers and basics like toilet paper and hand sanitizer, the inner workings of transporting goods from manufacturers to consumers, medical professionals and other businesses suddenly has taken on new importance. (Rosen, 4/1)

Dozens of workers at Whole Foods Market stores across the U.S. skipped their shifts to call attention to demands for better pay and more safety measures to protect them during the coronavirus pandemic, according to a group that organized the action. Business continued as usual at the chain, which employs more than 95,000 people. The group, called Whole Worker, is asking Whole Foods for expanded sick pay, hazard pay and health care coverage for part-time and temporary workers. (Kang, 3/31)

New York City’s human-rights watchdog is investigating Amazon.com Inc. over allegations an employee at a Staten Island warehouse was fired for helping to organize a walkout over work conditions in the midst of the new coronavirus pandemic, city officials said Tuesday. The company fired Chris Smalls, a stock worker at the warehouse, on Monday. The company said in a statement that Mr. Smalls violated social-distancing guidelines, including ignoring orders to stay home for two weeks after coming into contact with a co-worker who had a confirmed case of Covid-19. (Honan, 3/31)

Walmart added to its worker safety policies Tuesday as protections for retail and grocery store workers come under greater public scrutiny. Walmart will begin taking workers' temperatures at stores and warehouses before they begin their shifts. Any employee with a temperature above 100 degrees will be sent home to seek medical treatment, if necessary, but will be paid for showing up. The retailer will also make medical masks and gloves available for employees who want to wear them. "They will be high-quality masks, but not N95 respirators — which should be reserved for at-risk healthcare workers," the company said. (Meyersohn, 3/31)

Farmers who sell boxes of meat, dairy, fruits and vegetables directly to consumers are seeing a huge spike in orders as the coronavirus outbreak changes how people buy food. Food delivery businesses run by local farmers across the country are flourishing as people grow wary of making frequent trips to the grocery store and choosing to cook at home instead of eating out. (Crampton, 3/31)

Kaiser Health News: ‘Essential’ Or Not, These Workers Report For Duty
Pauline Lawrence is 63, an age that puts her at increased risk if she contracts COVID-19. Yet, three days a week, she spends 16 hours with someone at even greater risk: a 97-year-old man who depends on her and two other home health aides to survive. “Somebody has to take care of him,” said Lawrence, an immigrant from Jamaica who lives with her 30-year-old son in a South Los Angeles apartment. “I will stand up to do what I have to do to help.” (De Marco, 4/1)

Nearly every boss in the state must have expected Governor Charlie Baker to extend his shutdown of nonessential businesses. But that won’t make it any easier, now that it is here: Baker on Tuesday pushed the closure of nonessential workplaces out to May 4, from the earlier date of April 7 that he established last week, to slow the spread of COVID-19 cases. (Chesto, 3/31)

Are construction workers essential? It depends.The standards for what constitutes essential work under COVID-19 pandemic rules vary state to state, city to city, and, in some cases, hour to hour. Some orders change because of industry pressure; some change as the pandemic worsens; and some governors clarify earlier orders when confusion ensues. (Povich, 4/1)

New York City’s death toll from the coronavirus topped 1,000 on Tuesday, a grim milestone as the city grapples with a rising number of COVID-19 cases. The New York City Department of Health announced in an update Tuesday that 1,096 people have died from the highly infectious virus. There are more than 41,000 people infected with the illness, and more than 8,500 people are hospitalized. (Axelrod, 3/31)

New York City has launched an online portal that provides residents with information and updates if they or someone they know has contracted the coronavirus. The website, which launched Friday at nyc.gov/cv19engagementportal, allows New Yorkers to self-report confidential information if they or someone they know has contracted the disease, shows symptoms, came into contact with someone who tested positive, or are in quarantine. (Pereira, 3/31)

Some New York City hospitals are still unable to perform reliable on-site coronavirus testing for patients and staff who show symptoms of COVID-19 and must instead wait days for results from outside laboratories, even as the city's hospital beds fill up with seriously ill people. For weeks, pathology departments and laboratory facilities associated with hospitals in New York City have been focused on getting on-site testing with a quick turnaround set up so they don't have to rely on outside laboratories. The goal is to get coronavirus test results within 24 hours for doctors, nurses and patients who show symptoms of COVID-19. (Hersher, /31)

The nation’s largest state utility has initiated talks with New York’s private generators to enter into a pact to keep critical power plants staffed and fueled as the coronavirus pandemic worsens. The New York Power Authority began isolating critical control room and security staff on-site at its major power plants and transmission control stations last week, as did the independent operator of the state’s power grid. (French and Maldonado, 3/30)

Just outside of Albany, New York, 37 electrical grid operators and support staffers are currently cut off from outside human contact, living two to a trailer, to make sure the state’s power stays on. “We’ve had it in our plans as a hypothetical drill that we walk through every year to practice,” said Rich Dewey, the president of the New York Independent Systems Operator, which oversees the state’s energy grid and deployed those sequestered workers. “But we’ve never actually had to put it into practice.” (Collier, 3/31)

Days before New York City ground to a halt from the coronavirus pandemic, Mayor Bill de Blasio said in an interview on Comedy Central’s “The Daily Show” that New Yorkers could go about their lives, save for a few inconveniences to contain the spread. During the March 11 episode, he quipped about elbow bumps and warned of the “cascading effect” of closing businesses and schools. “What I worry about is, they become no longer about health and facts, and they become sort of a rush to the exits,” he said. (Honan, 3/31)

CNN’s Chris Cuomo made his first television appearance Tuesday night since testing positive for the novel coronavirus, describing the social distancing precautions he is taking and urging viewers to remain resolute even though “it’s going to get worse” as testing becomes more commonplace. “I feel fine. I’m able to do the show. You do not want this, and I am not able to be there for my family right now in the way that I want to be,” Cuomo said in a broadcast from his basement, where he also broadcast Monday ahead of the test results, adding that he was not yet sure whether he had transmitted the virus to any members of his family. (Budryk, 3/31)

Grieving for the 239 Louisiana residents who have died as a result of the COVID-19 pandemic, Gov. John Bel Edwards Tuesday afternoon continued to urge constituents to honor his stay-at-home order, which is expected to be extended through April later this week.“We have a long way to go,” he said. “This is still going to get worse before it gets better. We don’t know how much worse. But we do know we can control it to some degree. We know that the stay-at-home order works. Social distancing works. But these measures only work to the degree that people comply with them.” (Ravits, 3/31)

Louisiana reported by far its largest number of new coronavirus cases in a 24-hour period Tuesday afternoon, with reported infections and deaths each jumping about 30 percent, as state leaders renewed calls for residents to comply with social distancing rules, and crackdowns on violators continued. The "very sobering numbers" brought the state's total number of cases to 5,237, and 239 covid-19 patients have died, Gov. John Bel Edwards (D) said at a news conference. (Montgomery and Webster, 3/31)

The rise in Washington-area coronavirus cases continued to accelerate Tuesday as leaders scrambled to prepare for an even greater surge, cobbling together bed space and supplies while calling for more help and coordination from the federal government. A day after leaders in the District, Maryland and Virginia ordered residents to stay home to limit the spread of the virus, the greater capital region added 477 known coronavirus cases, bringing the regional tally to 3,411. (Schneider, Tan, Chason and Cox, 3/31)

Kaiser Health News: With Coronavirus Rare In Rural Florida, Experts Dispute Way Forward
Florida Gov. Ron DeSantis has refused to issue a statewide “stay-at-home” order to stem the spread of the novel coronavirus because the disease has not hit many areas of the state, he said. At least 30 states have issued statewide stay-at-home orders so far. Florida, among eight states with the most COVID-19 cases, is the only one without such an order. DeSantis’ approach in trying to manage the disease without doing undue harm to the economy mirrors comments from President Donald Trump, who Monday reiterated his belief that a nationwide stay-at-home order is not needed. (Galewitz, 4/1)

Yesterday, judges overturned temporary coronavirus-related abortion prohibitions in Alabama, Ohio and Texas. The decisions may have implications for similar bans in Iowa, Mississippi and Oklahoma, where governors designated abortions nonessential. At least 32 states ordered hospitals and other medical facilities to postpone nonessential surgeries to ease demand for personal protective equipment and other medical supplies during the coronavirus crisis, according to the Ambulatory Surgery Center Association. (Vestal, 3/31)

The Fifth Circuit Court of Appeals is allowing a controversial Texas executive order that blocks elective abortions during the coronavirus pandemic to remain in effect for now. The case tees up a battle between supporters of abortion rights and a handful of conservative states arguing that bans on elective abortions and other medical procedures are necessary to help preserve medical supplies. (Kelly and de Vogue, 3/31)

In late February, doctors around Los Angeles County began seeing an unexpected rise in the number of patients with mild, flu-like illnesses. The timing was definitely odd. Hospital emergency departments had already dealt with two “spikes” in flu cases. The number of patients with flu symptoms had been falling, from a little more than 100 cases per 1,000 patients at the beginning of the month to around 65 cases per 1,000 a few weeks later. The number of lab tests that came back positive for influenza was dropping too. (Kaplan, 3/31)

A Southern California nursing home has been hit hard by the coronavirus, with more than 50 residents infected — a troubling development amid cautious optimism that cases in the state may peak more slowly than expected. Cedar Mountain Post Acute Rehabilitation in Yucaipa has been told to assume that all of its patients have the COVID-19 virus, San Bernardino County Department of Public Health Director Trudy Raymundo said. (Jablon, 4/1)

Bay Area health officials issued a sweeping new order on Tuesday banning a range of commercial and residential construction that had previously been exempt from stay-at-home mandates. The move could swell the record number of Californians seeking unemployment by putting some construction workers out of jobs. (Dineen, 3/31)

At any other time, in a predominantly Christian nation that enshrines freedom of worship in the Constitution, the news would sound absurd or terrifying: “Pastor arrested after holding church services.” But that’s what happened this week when sheriff’s deputies handcuffed a Tampa, Fla., minister for violating municipal stay-at-home orders by gathering hundreds to worship. (Kaleem, 3/31)

It is clear that healthcare workers across our state are committed to stopping the spread of COVID-19. This is especially true for long-term care staff who are fighting every day to protect a vulnerable population with a staggeringly high mortality rate from the virus.For good reason, federal and state guidelines have restricted visitation into nursing home and assisted living facilities to essential staff only. In the absence of visits from family, friends and community groups, facilities now lack the usual hum of social interaction, while residents’ needs are truly greater than ever. (Kevin Warren, 3/31)

Despite pleas from leaders in the cannabis industry to reopen adult-use marijuana stores, Governor Charlie Baker defended his choice Tuesday to keep them closed, even while deeming medical dispensaries “essential" and allowing them to remain open. Baker has repeatedly said his biggest concern about reopening adult-use stores is attracting hoards of out-of-state customers, which could further spread the coronavirus virus throughout Massachusetts. (Gans, 3/31)

Three major health insurers based in the state, Harvard Pilgrim Health Care, Blue Cross Blue Shield of Massachusetts and Tufts Health Plan, have begun waiving all patient-related payments for treatment of the coronavirus, joining several national health insurers that have announced similar breaks for policyholders. The moves expand upon a directive from the state Division of Insurance earlier in March that insurers waive copays for any treatment related to COVID-19. (Caffrey, 3/31)

The state will deploy more than 100 Georgia National Guardsmen to assisted-living facilities and nursing homes with coronavirus cases to help limit exposure to the disease among the most vulnerable residents. Gov. Brian Kemp announced the deployment Tuesday as the state’s long-term care system is starting to feel strains from the pandemic. (Schrade, 3/31)

Insurance scams are nothing new, but Canton police are looking into a group trying to take advantage and profit off the thing affecting everyone’s lives right now: the coronavirus pandemic. About 6:45 p.m. Monday, police were alerted that three people were going around Canton neighborhoods attempting to sell supplemental COVID-19 insurance, police spokesman Pacer Cordry told AJC.com. The targeted areas were near East Main and Crisler streets. (Hansen, 3/31)

For many Detroiters, home remedies have long been the first resort for cures and treatments, particularly among those who have had less access to doctors, less money to pay for health care and less trust of the whole system. For years, many of them relied on folk medicine passed down through families for generations. And as this pandemic sweeps through the state, many of them are flocking to the few stores in town that specialize in the remedies they swear by. (Carlisle, 3/31)

Lawmakers are already running into a litany of obstacles — from the logistical limitations of working remotely to President Donald Trump’s early resistance — that could undermine oversight of the biggest economic rescue package in U.S. history. And with the administration moving to get money out as fast as possible, it means lawmakers have even less time than usual to ramp up one of the most far-reaching oversight regimes they've ever undertaken, even as the public remains deeply skeptical. “In the wake of the financial crisis 10 years ago, there are going to be a lot of suspicions,” Rep. Katie Porter (D-Calif.) said in an interview. “Can we trust the Fed and the Treasury? We need, in Congress, to give them that reassurance.” (Cheney and Zanona, 4/1)

Days after President Trump signed a roughly $2 trillion economic rescue package, the White House and congressional Democrats are at odds over a key provision of the bill. The administration says it has the right to review reports by a newly created internal watchdog before they are sent to Congress. But Democratic senators, in a letter on Tuesday, said that isn’t what Treasury Secretary Steven Mnuchin agreed to when the bill was being negotiated. (Davidson, 3/31)

Mitch McConnell and Nancy Pelosi are on another coronavirus collision course. As Speaker Pelosi prepares the House to pass sweeping “Phase 4” economic legislation this spring, Senate Majority Leader McConnell is throwing cold water on Democrats’ hopes to address the crisis by boosting infrastructure spending and social programs. (Everett, 3/31)

The bipartisan partnership that propelled a $2.2 trillion economic rescue package through Congress just days ago is already showing signs of strain, raising questions about how quickly calls for massive followup legislation may bear fruit. House Speaker Nancy Pelosi, D-Calif., and fellow Democrats are collecting ideas for the next stab at stabilizing an economy knocked into free fall by the coronavirus outbreak. Their proposals include money for extended unemployment benefits, state and local governments, hospitals and a job-creating infrastructure program, plus expanded job protections and benefits for workers. (Fram, 4/1)

President Trump on Tuesday said a significant investment in infrastructure should be part of a fourth congressional coronavirus relief package, citing an opportunity in low interest rates. “With interest rates for the United States being at ZERO, this is the time to do our decades long awaited Infrastructure Bill,” Mr. Trump wrote on Twitter. “It should be VERY BIG & BOLD, Two Trillion Dollars, and be focused solely on jobs and rebuilding the once great infrastructure of our Country!” (Lucey and Duehren, 3/31)

The first three coronavirus relief bills passed Congress with relative ease — three massive bills in three weeks with overwhelming support.But the early jockeying over the focus of a potential fourth aid package is already beginning to show deep partisan fault lines, with House Speaker Nancy Pelosi outlining Democratic priorities and Senate Republicans pushing back. In an attempt to draw a stark contrast with House Democrats, Senate Republicans are focusing their criticism on proposed spending provisions similar to ideas like the Green New Deal that might end up in a new bill. (Caldwell, 3/31)

The IRS and the Treasury Department say Americans will start receiving their economic impact checks in the next three weeks. The payments are part of the $2.2 trillion rescue package signed into law last week by President Donald Trump aimed at combating the economic ravages of the coronavirus outbreak. (Sell, 3/31)

Large hospitals and health systems may be eligible for a $500 billion corporate COVID-19 relief fund, but the money comes with strings attached including limits on compensation for highly paid employees.Congress' more than $2 trillion economic stimulus package included several funding streams explicitly for healthcare providers including a $100 billion provider emergency fund, boosts to Medicare payments and expanding accelerated Medicare payments. But there's a chance that if those funding streams aren't enough, hospitals could qualify for a much larger corporate relief fund that has more strings attached. (Cohrs, 3/31)

The Small Business Administration and Treasury Department Tuesday released guidelines for how small businesses, including some hospitals and physicians, can access $349 billion in loans to compensate for losses due to COVID-19. Hospitals and independent physicians have been squeezed by delaying elective procedures and non-urgent doctors' visits, struggling to obtain personal protective equipment, and preparing for a potential surge in seriously ill patients. (Cohrs, 3/31)

In other news from Capitol Hill —

Sen. Kelly Loeffler and her husband purchased and sold about $1.4 million in stocks in the past month amid the coronavirus market panic. They suffered losses but limited the investment damage through some timely trades, according to a summary provided by the Georgia Republican’s re-election campaign. Ms. Loeffler and her husband, Jeffrey Sprecher, who is chairman of the New York Stock Exchange, ended up with more paper losses on their stock purchases than they saved in dumping shares, according to a Wall Street Journal review of the senator’s financial disclosure. (Grimaldi, Wise and McGinty, 3/31)

The cars arrived at the food bank in southern Dallas in a stream — a minivan, a Chevrolet Tahoe, a sedan with a busted window, a Jaguar of unclear vintage. Inside the vehicles sat people who scarcely could believe they needed to be there. There was a landscaper, a high school administrator, a college student, and Dalen Lacy, a warehouse worker and 7-Eleven clerk. Like 70 percent of the people who showed up at Crossroads Community Services one day last week, Mr. Lacy had never been there before. (Buckley, 3/31)

President Trump and congressional Republicans spent the last three years fighting to cut anti-poverty programs and expand work rules, so their support for emergency relief — especially in the form of directly sending people checks, usually a nonstarter in American politics — is a significant reversal of their effort to shrink the safety net. It has also intensified a long-running debate about whether that safety net adequately protects the needy in ordinary times as well. (DeParle, 3/31)

With many Californians losing income and jobs, the economic toll of the coronavirus pandemic has spurred a record surge in the number of applications for CalFresh, the state’s food stamp program, forcing operational changes to expedite help for those unable to put meals on the table. The number of people applying for food assistance jumped to 55,624 in the third week of March, up from 34,882 during the same period last year, said Jason Montiel, a spokesman for the state Department of Social Services. (McGreevy, 3/31)

New York hair stylist Vanessa Karim has not worked since March 21, when the state closed all salons to slow the spread of the coronavirus. She only has enough cash on hand to cover half of her $1,400 April rent. “It all feels like a bad dream,” said Karim, 36, who planned to ask her landlord if he would be willing to accept a partial payment. “Every day I’m like, ‘Is this really happening?’ I’m trying not to stress out.” (Ax and Trotta, 3/31)

Wednesday marks the first of a new month, a day when rent comes due for millions of Americans for the first time since the coronavirus outbreak shuttered much of the country and caused widespread job losses. Federal, state and local governments have scrambled to enact policies to keep renters whose sources of income have disappeared from getting evicted in the immediate future while treading carefully around measures that could adversely affect landlords and the real estate market at large. But experts say the initial steps are nowhere near enough to protect low- and middle-income renters and handle what they say is the next biggest issue on legislators' plates after ensuring the stability of the health care system. (Smith, 3/31)

The true economic toll of all but shutting down New York City to stem the spread of the coronavirus is likely to become clearer on Wednesday when April rent is due. In just a month’s time, the lives of millions of New Yorkers have been turned upside down, many of them losing their jobs and now worrying about paying their bills. (Haag, 3/31)

A legal aid nonprofit has created a new “toolkit” for those affected by COVID-19 after seeing a significant increase in demand for such services in the Las Vegas Valley. The Legal Aid Center of Southern Nevada has received a high volume of calls from area residents seeking help on evictions, family law issues, health care, unemployment and debt collection. The agency said calls to the Legal Aid Center have nearly doubled in a week. (Puit, 3/31)

U.S. consumer confidence tumbled this month to its lowest level in nearly three years as the impact of the coronavirus on the economy began to be felt. The Conference Board reported Tuesday that its confidence index dropped to a reading of 120 in March from February’s 132.6. It was the lowest reading since the index was at 117.3 in June 2017. (3/31)

A closely watched survey of consumer sentiment published monthly showed Tuesday that Americans across the board are getting more worried about the state of the economy and how their own personal finances will fare. The index published by The Conference Board dropped to 120 in March from 132.6 in February — its lowest level since June 2017. (The index is compared to a 1985 benchmark, set at 100). Steep dents in consumer optimism are to be expected with such severe and widespread economic pain, but it’s a hugely important measure to keep track of because consumers’ short-term outlook is a telling indicator of what will happen in the economy. (Guida, 3/31)

The world is almost certainly ensnared in a devastating recession delivered by the coronavirus pandemic. Now, fears are growing that the downturn could be far more punishing and long lasting than initially feared — potentially enduring into next year, and even beyond — as governments intensify restrictions on business to halt the spread of the pandemic, and as fear of the virus reconfigures the very concept of public space, impeding consumer-led economic growth. (Goodman, 4/1)

The Trump administration is encouraging regulators to allow a decades-old flu drug to be administered as a possible coronavirus treatment, despite career officials’ concerns about the risks and limited evidence that the drug would work as a coronavirus treatment, according to three officials with knowledge of the deliberations and internal documents reviewed by POLITICO. Japanese Prime Minister Shinzo Abe has championed the drug, Avigan, as a possible treatment, and clinical trials are now getting underway in Japan. Chinese scientists also have touted the drug, produced by Japan-based Fujifilm, as a potential coronavirus treatment, but global regulators and U.S. researchers have long expressed concern about the drug’s risks, such as birth defects, and have warned that the Chinese data is insufficient. (Diamond and Toosi, 3/31)

A nationwide trial is underway to see if the drug hydroxychloroquine can prevent disease in people exposed to the novel coronavirus. A second trial will test to see if the drug can prevent severe disease in people who are already showing COVID-19 symptoms.The trials are being run by David Boulware, an infectious disease scientist at the University of Minnesota. (Palca, 3/31)

Using flag-draped memes and military terminology, the Trump administration and its Chinese counterparts have cast coronavirus research as national imperatives, sparking talk of a biotech arms race. The world’s scientists, for the most part, have responded with a collective eye roll. “Absolutely ridiculous,” said Jonathan Heeney, a Cambridge University researcher working on a coronavirus vaccine. “That isn’t how things happen,” said Adrian Hill, the head of the Jenner Institute at Oxford, one of the largest vaccine research centers at an academic institution. (Apuzzo and Kirkpatrick, 4/1)

The CDC said Americans don’t need masks — but now they might. The agency said the virus spread through “droplets” from coughs and sneezes — but then warned about catching it from people with no symptoms, or even from surfaces, like subway turnstiles or metal shopping carts. It said young people are at low risk — but the hospital beds and morgues of New York called that into question. America’s best scientists and its vaunted public health agency are still learning on the job about the coronavirus. For a terrified American public, the kaleidoscope of changing messages has created more fear, confusion and distrust. Scientists are used to gaining knowledge one step at a time — and they’ve learned a lot in a hurry about a virus none of them had ever seen before, allowing the search for treatments and vaccines to begin. But the virus always seems one step ahead of them. (Kenen and Roubein, 3/31)

New York-based hospital system Northwell Health said it has started to make its own nasal swabs using 3D printing, enabling it to produce thousands of swabs a day that can be used in testing for the coronavirus. Northwell said its focus on swabs was part of an effort to avoid supply shortages related to the components for kits used in testing for COVID-19, the highly contagious, sometimes deadly respiratory disease caused by the coronavirus. Carroll, 3/31)

How many times have you seen the image? It looms behind newscasters during evening updates, gets handed out on printed fliers and scrolls by in tweet after tweet. It might even show up in your dreams. But for Alissa Eckert — a medical illustrator at the Centers for Disease Control and Prevention who helped to create what has become the iconic representation of the novel coronavirus — it started out as just another assignment. (Giaimo, 4/1)

Dozens of scientists across the globe are expeditiously developing and testing a variety of therapeutic treatments for COVID-19, the respiratory illness caused by a novel coronavirus. Meanwhile, dozens more are working to protect those who have not yet been affected by creating a vaccine. The Department of Health and Human Services just announced that the government is working with major pharmaceutical and biotech companies to speed up the development of COVID-19 vaccine trials and, ultimately, the manufacturing of said vaccines. (Nunneley, 4/1)

People who have chronic medical conditions, such as diabetes, lung disease and heart disease, face an increased chance of being hospitalized with covid-19 and put into intensive care, according to data released Tuesday by the Centers for Disease Control and Prevention that is consistent with reports from China and Italy. The new data gives the most sweeping look at the way covid-19 is causing serious illnesses among people in the United States who already face medical challenges. (Achenbach and Wan, 3/31)

Roughly 28.5% of adult patients with at least one underlying health condition were hospitalized in a non-ICU setting, compared with 7.5% of patients without other conditions. The percentages of adults with and without underlying conditions admitted to the ICU were about 14% and 2.3%, respectively. Of the 184 deaths among Covid-19 patients with complete information on risk factors, 173 occurred among patients with at least one underlying condition, according to the report. The CDC considered a range of factors and conditions, including heart and lung ailments, chronic renal disease, neurological disorders, chronic liver disease, pregnancy and smoking history. Some underlying ailments were grouped together in the analysis, and for risk factors such as pregnancy and smoking status, the number of severe cases was too small to draw any conclusions, the agency said. (Abbott, 3/31)

More than a third of American adults — or 105 million people — are at higher risk of serious illness if they get infected with the coronavirus, according to a Kaiser Family Foundation analysis of CDC data. For most of them, their age puts them in danger: More than 76 million Americans are 60 or older. The remaining 29 million people are younger but have underlying health issues. Age and underlying health issues go hand in hand: COVID-19 has so far been most menacing to older people with underlying illnesses. (Whyte and Zubak-Skees, 4/1)

The fatality rate for people infected with the novel coronavirus is estimated to be less than 1%, according to a new study. Among the those whose infections cause them to become sickened by the disease known as COVID-19, the fatality rate is 1.38%, the study authors estimate. Both fatality rates vary greatly with age, according to the report in the medical journal Lancet. (Kaplan, 3/31)

Nearly one in three licensed doctors in the United States is older than 60 years, an age-group particularly vulnerable to adverse outcomes from COVID-19, according to a study published today on the preprint server medRxiv. And New York and California, two hard-hit states, have the most older physicians. "The physician workforce is not only at risk of losing time spent in clinical care due to these exposures, but at a personal risk from severe disease that requires hospitalization and is associated with high morbidity and mortality," the authors said, noting that 80% of deaths in China were in people 60 and older and that, in the United States, nearly half of hospitalizations and intensive care admissions and up to 80% of deaths have been in that age-group. (Van Beusekom, 3/31)

Public health officials in Illinois on Saturday announced the death of an infant in Chicago who tested positive for the novel coronavirus. Dr. Ngozi Ezike, the director of the Illinois Department of Public Health, said a full investigation was underway to determine the cause of death of the infant, adding, "There has never before been a death associated with COVID-19 in an infant. "No other details were released about the baby's health condition, but the news, along with several other reports of infants testing positive for COVID-19, the illness caused by the virus, has given the parents of newborns and infants another worry -- that their baby could contract the virus, which has to date resulted in more than 3,000 deaths in the U.S. (Kindelan, 3/31)

At the root of almost every plan to restart society is a new kind of coronavirus test that searches not for the virus itself, but the remnants floating in people’s blood of the battle between their immune systems and the infection. These “serology tests” aren’t aimed primarily at people who currently have the disease caused by the coronavirus, but anyone who has ever had it — those who were very sick and got better, those who had mild symptoms they mistook for something else and those who never felt sick at all. (Johnson, 3/31)

Andrew Sherman, a Covid-19 survivor, is finally starting to feel better. One of the first things he did during his recovery: volunteer to donate blood plasma to help seriously ill patients fight the disease. Mr. Sherman, age 52, spent three days on oxygen in a New York City hospital in mid-March before being released to complete his recovery at home in the Williamsburg section of Brooklyn, where he lives with his wife, Jodi Sheeler, and their two children: Maisy, 8, and Milo, 11. “I feel obligated to help now that I am on the other side of it,” Mr. Sherman said. (Marcus, 4/1)

Kaiser Health News: Blood Centers Will Collect Plasma From COVID-19 Survivors In Bid For Treatment
Blood donation centers across the U.S. are ramping up efforts to collect plasma from people who have recovered from COVID-19 in hopes it could be used to save the lives of others infected with the pandemic disease. Under guidelines released Tuesday by the AABB, an international nonprofit agency focused on transfusion medicine and cellular therapies, dozens of community blood centers nationwide could become a key source for the century-old treatment known as convalescent plasma therapy. (Aleccia, 4/1)

In other news on blood donations —

Two weeks ago, the message from blood banks and hospitals was dire: Mass closures and disintegrating blood drives were creating a potential death spiral for perishable supplies nationwide as the coronavirus pandemic surged. Amid a respiratory-infection outbreak that has little to do with blood, doctors pondered the horror of treating patients who need transfusions with no blood to replenish their bodies. (Horton, 3/31)

Time is running out to allow millions of Americans to vote this fall without fear of contracting the novel coronavirus. Mail voting — the voting method that best preserves social distancing — is infrequently used in many states, and those that don’t have extensive mail voting might be unable to implement systems before November. And while 33 states, including most 2020 presidential battlegrounds, already allow any voter to cast a ballot by mail who wants to, a number of those states aren’t prepared to handle the crush of mailed-in ballots that could be coming their way in November. (Montellaro, 3/31)

House Speaker Nancy Pelosi on Tuesday suggested vote-by-mail capabilities should be scaled up ahead of 2020’s remaining elections, shielding Americans from the threats in-person voting could pose amid the coronavirus pandemic. “In terms of the elections, I think that we’ll probably be moving to vote by mail,” Pelosi told MSNBC’s “Morning Joe,” adding that congressional Democrats had pushed to allocate increased funding in the recent $2 trillion relief package “to get those resources to the states to facilitate the reality of life: that we are going to have to have more vote by mail.” (Forgey, 3/31)

Americans are coming to grips with the fact that there will be no quick end to the coronavirus crisis — a realization that will shake up the 2020 presidential race in profound ways. President Trump has sought to shift expectations in recent days, acknowledging that the de facto shutdown of the nation’s economy will last longer than he had originally hoped and that the death toll will likely climb far higher. (Stanage, 3/31)

Joe Biden raised significant doubts about whether the Democratic National Convention will be held as planned in July, with the likely nominee suggesting that the party’s major gathering slated for Milwaukee may need to be altered or postponed. When asked whether he could envision holding the convention in July, given the coronovirus outbreak and concerns about large gatherings, Biden said, “It’s hard to envision that.” (Viser, 4/1)

Democratic presidential front-runner Joe Biden has quietly expanded his lead over President Donald Trump among registered voters, even as the rapidly spreading coronavirus has all but sidelined the former vice president’s campaign, according to a Reuters/Ipsos opinion poll released on Tuesday. The poll conducted on Monday and Tuesday of more than 1,100 American adults found that 46% of registered voters said they would support Biden if he were running against Trump in the Nov. 3 election, while 40% said they would vote for Trump. That advantage of 6 percentage points was up from a 1-point lead for Biden recorded in a similar poll that ran from March 6 to 9. (Kahn, 3/31)

Justin Penn, a Pittsburgh voter who calls himself politically independent, favored Joseph R. Biden Jr. in a matchup with President Trump until recently. But the president’s performance during the coronavirus outbreak has Mr. Penn reconsidering. “I think he’s handled it pretty well,” he said of the president, whose daily White House appearances Mr. Penn catches on Facebook after returning from his job as a bank security guard. “I think he’s tried to keep people calm,” he said. “I know some people don’t think he’s taking it seriously, but I think he’s doing the best with the information he had.” (Gabriel and Lerer, 3/31)

More voters say the Trump administration isn’t doing enough to combat the coronavirus outbreak, according to a new POLITICO/Morning Consult poll. The survey, conducted immediately before President Donald Trump announced a 30-day extension of his physical and social distancing guidelines “to slow the spread” of Covid-19, shows 47 percent of voters feel the administration isn’t doing enough in response to the outbreak, greater than the 40 percent who feel the administration is doing the right amount. (Shepard, 4/1)

If he had done nothing at all, President Donald Trump said Tuesday, the American death toll from the coronavirus would be geometrically higher than the low six-figure count he now expects. In other words, it could have been worse. Looking like he'd been visited by the ghosts of hometown past and election future, Trump deviated from his typically ebullient, brash and optimistic style to deliver a somber message much more in line with that of his leading scientists. (Allen, 3/31)

The coronavirus pandemic is wreaking havoc on Wisconsin’s upcoming statewide election, one of the only presidential primaries still scheduled in April. The state is facing a huge shortage in poll workers ahead of Tuesday’s vote. Local elections officials may have to close and consolidate precincts to manage the situation, and some are warning of steep drops in turnout. State officials are urging voters to request absentee ballots so they don’t have to vote in person, but there isn’t the time or resources, or the appetite among state legislators, to just send ballots or even ballot request forms to all voters, the plan adopted by some states postponing their elections. (Montellaro, 3/31)

From the Canadian Arctic to the Brazilian Amazon to the Australian coast, indigenous groups are racing to protect themselves from a familiar foe that has historically threatened their very existence: the rapid spread of foreign infectious disease. Fifteenth-century Europeans introduced smallpox and other diseases to the New World, decimating upward of 80 percent of the indigenous population. The 1918 flu pandemic wiped out entire villages. Now, as the novel coronavirus advances, indigenous groups are locking down and imploring outsiders to stay away. (Coletta and Traiano, 3/31)

The CARES Act, signed on Friday by President Donald Trump, lays out $10 billion of relief that will go to tribes and tribal organizations.Of that money $8 billion in emergency funds will be disturbed to help tribal governments, enterprises and businesses recover from the fallout of COVID-19 as many tribes across Montana have had to close non-essential businesses, and ask tribal members to stay home. (Sukut, 3/31)

You had some exposures that may put you at risk for coronavirus. A few days later you come down with a bad cough yourself and feel a little short of breath and really tired. You take your temperature: 101 degrees. A fever. You suspect you might have Covid-19, the disease caused by the novel coronavirus. The days roll into each other, and your doctor urges you to stay home unless your condition worsens. You feel pretty bad, though, and finally get an appointment. (Krumholz, 4/1)

Thousands of Louisiana residents are isolating themselves at home after testing positive for the novel coronavirus or after they have experienced symptoms that suggest they may be infected. And doctors say the steps Ealem is taking, however difficult, are critical to protecting loved ones and slowing the spread of the disease. The people in home care often struggle with anxiety because of their condition and loneliness that comes with isolation. Their condition can also worsen, and there's always the fear that they could infect loved ones. (Williams, 3/31)

It’s not unusual for people to turn to alcohol to ease anxiety, but doctors warn that overusing it can weaken your immune system and lead to dangerous behavior. “It is a depressant,” said Dr. Elspeth Cameron Ritchie, the psychiatry chairwoman at MedStar Washington Hospital Center. ... During previous SARS and MERS pandemics, when people became unemployed and confined at home, Ritchie said the rate of suicide and domestic violence went up over time. (King, 3/30)

[Diana] Fernandes is among the millions of elderly Californians who live alone amid a strange new reality imposed by the coronavirus. Confined indoors, they are safer from the threat of the virus, but increasingly vulnerable to isolation, fear and anxiety as their connections to the outside world shut down. Friends and volunteers can’t visit, and most senior centers are closed. (Hellerstein, 3/31)

The Trump administration is turning back immigrant children caught crossing the border illegally with their relatives, in a break from past practice, under emergency powers being invoked during the new coronavirus pandemic, three administration officials familiar with the matter said. Previously, border agents would have separated many of these children from family members if they weren’t parents or guardians. The children then would have been placed in the custody of the Department of Health and Human Services and treated as unaccompanied minors. (Hackman and Caldwell, 3/31)

Covid-19 is impacting lives across the U.S., and health officials are racing to provide communities with important information about the illness. But language divides are likely to put non-English speakers at greater risk. While some health information is being translated into commonly spoken languages including Spanish and Chinese, the U.S. is home to non-English speakers who speak any of more than 350 other languages. (Zia, 1/1)

Every morning and evening for five days, Angie, 36, injected the flesh around her belly button with in vitro fertilization drugs to stimulate her ovaries to produce eggs. Her fertility doctor planned to harvest the eggs in a 15-minute surgical procedure about a week later. On the morning of the sixth day, March 20, Angie, who asked that her last name not be used out of concern that her employer would retaliate if it found out she was trying to conceive, was working at her home in Vancouver, British Columbia, when she got a call from a nurse at her fertility clinic. Because of the coronavirus pandemic, the clinic was suspending all treatments and closing down. (Solon, 4/1)

In recent weeks, as the coronavirus has tightened restrictions on public and private life, Americans have been hoarding toilet paper, their shopping carts piled high, as supplies were quickly depleted: the shelves, and sometimes whole aisles, bare. What we buy in times of crisis says a lot about who we are. “The pasta shelves are empty!” cried an older man stepping out of an Italian grocery store in a video from February. (Oldershausen, 4/1)

Taking an extra 4,000 steps a day might reduce our risk of dying prematurely, even if those steps are not swift, according to a large-scale new study of moving and mortality. At a time when so many of us are confined to home and worried about whether we are being active enough, the study is especially inspiring in that the added steps do not have to come from running or other vigorous exercise. It finds that for every additional 4,000 steps someone takes in a day, even if it’s just ambling around the block or across the room, his or her risk of dying early from heart disease, cancer or any other cause drops by 50 percent or more. (Reynolds, 4/1)

Health scams are popping up as the coronavirus health crisis grows around the country, according to the U.S. Food and Drug Administration and the Federal Trade Commission. The agencies warn about the proliferation of fraudulent products that claim to test for coronavirus and prevent or cure COVID-19. The FDA has sent warning letters to seven manufacturers of therapy products including essential oils, nasal sprays and herbal concoctions. (Peñaloza ,3/31)

The coronavirus pandemic is pushing the once-niche telemedicine industry into the mainstream, testing its ability to keep up with soaring demand and forcing innovation on the fly. Before the outbreak, telemedicine struggled to take hold, in part because of government regulation and a lack of interest from patients and big companies. Now, companies like Teladoc Health Inc. TDOC -5.23% and Doctor on Demand Inc. are racing to add doctors and bandwidth, while big tech firms like Microsoft Corp. add services. (Olson, 4/1)

On Monday, President Donald Trump’s administration took the unprecedented step to temporarily waive rules for the nation's largest insurer -- Centers for Medicare & Medicaid Services (CMS) -- giving some healthcare providers the ability to have phone-only visits with their patients as the coronavirus crisis rages on. CMS covers at least 140 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program, and Federal Exchanges – typically covering a constituency of people with disabilities, the elderly, and those with low incomes, many of whom may be unable to access the advanced technologies required for telehealth -- seen as an important emerging tool in maintaining people's health amid the fight against the virus. (Lantry, 4/1)

As the Bay Area shelters in place, health care providers are urging everyone to stay home and away from hospitals except for emergencies. Telemedicine is a way to meet patients’ medical needs while keeping them distant — care conducted virtually by messaging apps, phone or video chat. Here’s what you should know about telehealth in the Bay Area. (Moench, 3/31)

Meanwhile, in other technology news —

In the heart of Silicon Valley, Stanford clinicians and researchers are exploring whether artificial intelligence could help manage a potential surge of Covid-19 patients — and identify patients who will need intensive care before their condition rapidly deteriorates. The challenge is not to build the algorithm — the Stanford team simply picked an off-the-shelf tool already on the market — but rather to determine how to carefully integrate it into already-frenzied clinical operations. (Robbins, 4/1)

Last week, a Trump administration official working to secure much-needed protective gear for doctors and nurses in the United States had a startling encounter with counterparts in Thailand. The official asked the Thais for help—only to be informed by the puzzled voices on the other side of the line that a U.S. shipment of the same supplies, the second of two so far, was already on its way to Bangkok. (Bertrand, Orr, Lippman and Toosi, 3/31)

The U.S. and Chinese governments have increasingly turned the novel coronavirus pandemic into a contest over their primacy as the world's leading humanitarian force, with Secretary of State Mike Pompeo highlighting U.S. contributions to global aid agencies Tuesday and pushing back on Chinese propaganda about its overseas assistance. But as the pandemic spreads to the developing world and kills more people in nearly every region, experts say a lack of global coordination has cost the world time, money, and lives, with some saying U.S. leadership has been missing. (Finnegan, 3/31)

In China, international flights have been cut back so severely that Chinese students abroad wonder when they will be able to get home. In Singapore, recently returned citizens must share their phones’ location data with the authorities each day to prove they are sticking to government-ordered quarantines. In Taiwan, a man who had traveled to Southeast Asia was fined $33,000 for sneaking out to a club when he was supposed to be on lockdown in his home. In Hong Kong, a 13-year-old girl, who was spotted out at a restaurant wearing a tracking bracelet to monitor those in quarantine, was followed, filmed and subsequently shamed online. (Rich, 3/31)

Mainland China, where the global coronavirus pandemic began in December, reported dwindling new infections on Wednesday, but it also published the daily change in asymptomatic cases for the first time, creating a murkier picture of the trends. (4/1)

Sen. Rick Scott on Tuesday called for a congressional investigation into the World Health Organization, suggesting the U.S. should cut off its funding for “helping Communist China cover up” the full extent of the coronavirus pandemic. The Florida Republican, a noted China hawk, has long raised concerns about the WHO’s relationship with Beijing, which has undercounted the number of coronavirus cases in the country. (Desiderio, 3/31)

Japan remains on the brink of a state of emergency as the rate of new coronavirus cases accelerates across the country, its top government spokesman said on Wednesday, amid reports the capital may order public schools to stay closed for a second month. (3/31)

Late last year — long before most people had heard of the new coronavirus now sweeping the globe — scientists in Germany sprang into action to develop a test for the virus causing an unusual respiratory disease in central China. They had one by mid-January — and labs around the country were ready to start using it just weeks later, around the same time that Europe’s most populous country registered its first case. (Jordans, 4/1)

Two weeks ago, an opposition-leaning radio station in Russia interviewed political analyst Valery Solovei, who alleged the government was lying when it said no one had died in the country from the coronavirus. Solovei told radio station Echo Moskvy at least 1,600 people might have died since mid-January. Russia’s media and internet watchdog, Roscomnadzor, quickly pressured the station to delete the interview from its website. (Litvinova, 4/1)

Italian authorities believe the country’s coronavirus epidemic, the world’s deadliest, is slowing down appreciably after three weeks of national lockdown, a hopeful sign for other Western countries that are following approaches similar to Italy’s with a time lag. But Italian officials and health experts said it will take until after Easter to cut new infections enough to begin loosening the lockdown and reopen parts of Italy’s economy. (Walker, 3/31)

One in 10 babies in the U.S. is born premature, with elevated rates of disability and death. For almost a decade, a drug called Makena has been used to reduce the risk of further instances of early delivery for women who’ve previously given birth prematurely. The medicine, approved in 2011 under the Food and Drug Administration’s accelerated process, contributed more than $300 million of annual sales for its manufacturer, Amag Pharmaceuticals Inc. New research calling into question how well the drug works is now prompting the FDA to consider delisting Makena—a rare step for an approved treatment. (Court, 3/27)

With the sense of urgency rightly focused on slowing or stopping the spread of Covid-19, it seems like everything else in the news, and in health care, has come to a grinding halt. Yet important decision-making continues in the background, including some that could have long-lasting effects on health care today and in the future. One of these is the decision by the U.S. Supreme Court to hear California v. Texas, a case that will decide whether most or all of the Affordable Care Act should be overturned. (Lynch, 1/1)

Before the coronavirus pandemic became Congress’ sole focus, late May was widely viewed as a final 2020 deadline for lawmakers to take action on key health policy issues, including legislation to lower the price of prescription drugs. But with the Covid-19 crisis dominating every aspect of American politics, such legislation will have to wait. A recent $2 trillion relief package that lawmakers passed on Friday could mean drug pricing advocates might be waiting a long while — likely until November, weeks after Election Day. (Facher, 3/30)

The EpiPen and EpiPen Jr. devices, which are commonly used to treat emergency allergic reactions, may have delayed injections or fail to inject properly due to design issues or improper administration by users, the U.S. Food and Drug Administration alert said. The agency was made aware of the issues through a letter Mylan recently sent to healthcare workers warning of the problems. Mylan was recently acquired by drug maker Pfizer but continues to use its name. (Castellucci, 3/24)

Eli Lilly wants diabetes patients who use its drugs to know that help is available, and to get the word out, it bought full-page ads in more than a dozen newspapers in the U.S. The simple print ads, which ran Monday, spoke directly to people who recently lost jobs or health insurance and told them to contact the Lilly Diabetes Solution Center for help. Driven by COVID-19 shutdowns and job losses in the millions, Lilly had already seen a 32% increase in call volumes to the diabetes help call center. After the ads ran Monday, call volume jumped by 91% over the previous Monday, March 23. The 340 incoming calls marked the highest single-day call volume since the program began in August 2018. (Bulik, 3/31)

Sickle cell disease and cystic fibrosis are both rare, genetic diseases. While there are three times as many people (predominantly of African ancestry) in the U.S. with sickle cell disease compared to people (predominantly of European ancestry) with cystic fibrosis, research dollars are the same, after tallying federal funding from the National Institutes of Health and disease-specific foundations. That per-patient funding gap has been known for decades. (Cooney, 3/31)

The Patent Trial and Appeal Board (PTAB) upheld the validity of three Teva patents on its migraine treatment Ajovy, rejecting arguments by Eli Lilly that they were invalid. Teva Pharmaceutical Industries Ltd on Tuesday won a ruling from a U.S. administrative court that could help it fend off competition from Eli Lilly and Co in the market for migraine drugs. (Wolfe, 3/31)

An embarrassing scandal that Novartis (NVS) endured over data integrity has quietly come to a close, with the Food and Drug Administration instructing the drug maker to correct the problem at its AveXis unit, but without imposing any penalties. At issue was a delay in the disclosing to the agency that manipulated data existed for its Zolgensma gene therapy. Novartis became aware of the problem in March 2019, but did not inform the FDA until after the drug was approved last May. Zolgensma, which costs $2.1 million, is used to treat a type of spinal muscular atrophy and was developed by AveXis, which Novartis bought in April 2018. (Silverman, 3/31)

When Novartis’ Zolgensma data manipulation problem first went public last August, an angry FDA said it would consider civil or criminal penalties. But it looks like neither of those is going to happen. In a statement shared with FiercePharma, an FDA spokesperson said the agency has decided it will not punish Novartis’ gene therapy unit AveXis for doctoring Zolgensma mice testing data in its drug application package. The news was first reported by Biopharma Dive. (Liu, 3/31)

Amid operations concerns over the novel coronavirus pandemic, Mylan and Pfizer's Upjohn unit have already postponed the close of their pending generics megamerger. Now, in order to clear antitrust hurdles in Europe, the drugmakers have agreed to meet regulators in the middle. Mylan and Upjohn have agreed to concessions as part of the European Commission's antitrust review of their pending merger, according to a commission filing. While the EU did not disclose just what those concessions are, the sale of competing assets in merging drugmakers' portfolios is often a sticking point for antitrust legislators. (Blankenship, 3/31)

The shoe is on the other foot, so to speak.For the past few years, the Food and Drug Administration has tried harder to scrutinize Chinese pharmaceutical suppliers over widespread quality control concerns. Now, though, a Chinese government agency has found problems with a U.S. company that does contract manufacturing work for Bristol Myers Squibb (BMY) and, as a result, shipment of a key product to China has been suspended. (Silverman, 3/25)

If we want a vaccine or drug treatment to stop coronavirus, the government should ignore those complaining about drug-company profits and commit to a huge reward that encourages more businesses to develop one. It wouldn’t just save lives; it could save the global economy. The coronavirus could cost the U.S. $1.5 trillion in annual economic output, or $125 billion every month — and that’s a conservative estimate. The losses for the entire world economy will be four to five times larger. And these economic costs will be dwarfed by the human costs of illness and death. (Hanno Lustig and Jeffrey Zwiebel, 3/31)

The need for any kind of  treatment to help stem the coronavirus outbreak is acute as cases and hospitalizations continue to mount. But there's a strong need to balance urgency and evidence. President Donald Trump's cheerleading of chloroquine and its derivative hydroxychloroquine — older malaria drugs with limited evidence of efficacy in Covid-19 — is arguably dangerous. As he touts the drugs in press conferences, people are reportedly poisoning themselves via self-administration and hoarding it to create hazardous shortages, making the prudent use and evaluation of it as a treatment more difficult. (Max Nisen, 3/25)

n late February, as it became increasingly clear that the coronavirus was going to spread widely in the U.S., Health and Human Services Secretary Alex Azar told Congress, “We would want to ensure that we work to make [COVID-19 drugs] affordable, but we can’t control that price because we need the private sector to invest.” We do need the private sector to invest. But the U.S. government is investing too, and it deserves a say here, on behalf of taxpayers. Since the outbreak of SARS in 2002, the National Institutes of Health has invested nearly $700 million in coronavirus research, and the first COVID-19 package passed by Congress included another $826 million for the development of coronavirus treatments, vaccines, and tests. (Matthew Lane, 3/26,)

As the pandemic deepens, physicians face an agonizing decision — to medicate or not to medicate? Here’s the dilemma: Over the past few weeks, some small studies suggested a decades-old malaria drug called hydroxychloroquine may have the potential to combat the novel coronavirus known as Covid-19. And as the results trickled out, the tablet has become more valuable than gold. (Ed Silverman, 3/31)

High out of pocket costs likely won’t be an issue when a treatment for the coronavirus becomes available. Based on past epidemics, it’s probable the government will direct patients to receive a vaccine without having to hand over a copay to an insurance company. Before the current pandemic, rumor had it that the Trump administration was quietly considering reviving a drug pricing reform it abandoned last year. (Drew Johnson, 3/27)

Before this novel coronavirus ever reached American shores, I heard dark tones of reassurance. Don’t worry, people said. It kills only the old and the sick. The thought, a temporary (and misleading) escape from rising panic, crossed my mind, and surfaced in conversation. When I spoke last week to Jessica Smietana, a 30-year-old doctoral student in French literature at New York University, she admitted the thought had occurred to her, too. “I remember saying, ‘Well, you know, when it’s reaching people that aren’t in vulnerable populations, that’s when I’ll worry about it.’” (Elizabeth Bruenig, 4/1)

During a time when we’re afraid to go out, fearful of others as possible Covid-19 carriers, how do we ensure we continue acting in ways consistent with our common human dignity? Holland America Line is working tirelessly to find medical help and safe passage home for the 1,243 guests and 1,247 crew stranded at sea, cruising north near Mexico’s Yucatán Peninsula, on two of our ships, Zaandam and Rotterdam. (Orlando Ashford, president of Holland America Line, 3/31)

My pager goes off again: The police are en route to my hospital. They’re bringing a gunshot victim. E.T.A.? Right now. I get these pages almost every night at the trauma center where I work. I rush to put on my protective equipment to guard against blood and other bodily fluids. But for the first time, I’m saving clean masks to reuse them. Because of coronavirus, the parents of my patients need a special escort because visitors are not allowed in the waiting room. I can’t bring a family to a gunshot victim’s bedside in the intensive care unit. I can’t tell a frightened mother that she can stay as long as she wants. (Elinore Kaufman, 4/1)

Early in the coronavirus crisis, many public health officials insisted that masks could not protect the public from covid-19. But that thinking is increasingly in question. People should be encouraged to cover their faces — responsibly.To be clear: No one should hoard equipment that health-care workers need, particularly N95 masks that protect them from fine aerosol particles their patients exhale. Doctors and nurses who must interact closely with sick people need that gear. (3/31)

Kaiser Health News: He Got Tested For Coronavirus. Then Came The Flood Of Medical Bills.
By March 5, Andrew Cencini, a computer science professor at Vermont’s Bennington College, had been having bouts of fever, malaise and a bit of difficulty breathing for a couple of weeks. Just before falling ill, he had traveled to New York City, helped with computers at a local prison and gone out on multiple calls as a volunteer firefighter. So with COVID-19 cases rising across the country, he called his doctor for direction. He was advised to come to the doctor’s group practice, where staff took swabs for flu and other viruses as he sat in his truck. The results came back negative. (Elisabeth Rosenthal and Emmarie Huetteman, 4/1)

I am sitting at my desk in a furious rage. Recently I read an article in ProPublica in which pharmacists described "unusual and fraudulent" prescribing activity for the drug hydroxychloroquine, suggesting that doctors may be hoarding it in a "just in case" manner. Not long after that, another article popped up in my Facebook feed, describing a 45-year-old woman with lupus who said she was denied a refill on her hydroxychloroquine at Kaiser because all supplies had been diverted for the "critically ill with Covid-19" who might fill their system. As for her? According to Buzzfeed, the woman was told she could manage for 40 days without the drug and thanked her for her "sacrifice" and "understanding." (Cory Martin, 3/31)

There’s no question the United States missed the opportunity to get ahead of the novel coronavirus. But the window for making important decisions hasn’t closed. The choices we and our leaders make now will have an enormous impact on how soon case numbers start to go down, how long the economy remains shut down and how many Americans will have to bury a loved one because of covid-19. Through my work with the Gates Foundation, I’ve spoken with experts and leaders in Washington and across the country. It’s become clear to me that we must take three steps. First, we need a consistent nationwide approach to shutting down. (Bill Gates, 3/31)

Like President Trump, Florida’s governor worried too much about the economy and not enough about public health. Gov. DeSantis rode into Palm Beach County on Monday, boasting, “We’re going guns blazing, doing all that we can to slow the spread of COVID-19.” In fact, DeSantis has brought only a knife to this gunfight. He’s listening to the wrong people and doesn’t understand the problem. (Randy Schultz, 3/31)

Let’s face it, there are voters who will believe whatever President Trump says, no matter how illogical, patently false or self-contradictory his pronouncements may be. Creating a parallel reality, of course, is how he got elected. Many elected Republicans will pretend to believe Trump for fear of incurring his wrath. And politically disengaged voters may be happy to get unemployment checks and other benefits without holding the president responsible for making the virus deadlier with his ignorance and sloth in January and February. That does not mean Trump will escape blame for the pandemic unfolding before our eyes, a pandemic that has now killed more Americans than terrorists did on 9/11 and is projected to kill more Americans than have died in multiple U.S. wars. There are powerful forces diminishing Trump’s spin: Republican governors who are doing valiant work. (Jennifer Rubin, 3/31)

On Saturday, Tulsa, Okla., and Oklahoma City joined 43 of the nation’s 50 largest cities in America that had ordered residents to “shelter in place.” The public response was swift and intense. Many people thanked me for taking action to save lives in our community. Others compared me to Hitler. That is what it is like to be a mayor in red-state America during this crisis. (G.T. Bynum, 4/1)

Donald Trump isn’t the first U.S. president to face a deadly new pathogen that wreaks havoc on American life and the wider world. But he may be the least suited for the challenge, a judgment based on how a handful of his predecessors confronted these invisible and terrifying foes. (J.M. Opal and Steven M. Opal, 4/1)

Weeks into the COVID-19 crisis, the U.S. population needs accurate information on the virus, but we are still struggling to get it right. The way that officials, leaders, and experts talk with the public during this crisis matters because it could mean the difference between life and death. (Dr. Jonathan Fielding, 3/31)

At the daily coronavirus press conference on Monday night, CNN's Jim Acosta asked President Donald Trump about his past comments that downplayed the threat posed by the coronavirus. "If you look at those individual statements, they're all true," Trump responded. "Stay calm, it will go away. You know it -- you know it is going away, and it will go away, and we're going to have a great victory." (Chris Cillizza, 3/31)

One week after President George W. Bush declared war in Iraq in 2003, I was deployed there as an Army nurse. During my year in the war, I kept a daily journal of the fear I experienced and the injuries and deaths I witnessed. But on the last day of my deployment, I ripped it up and threw it away. Now that I’m in the fight against a different and invisible enemy, the SARS-CoV-2 virus, in a major medical center in the Northeast, I wish I still had that journal. (Rachel E. Smith, 4/1)

There is only a small window of time in which we can prevent widespread transmission of Covid-19 among people who are living on the streets or in shelters. Once the disease begins to spread in these groups, it will likely accelerate rapidly and be uncontainable, creating a crisis for the homeless and the entire community. This will undermine all efforts to slow the pace of the epidemic and will increase the disastrous consequences of Covid-19.We offer a radical solution: Use suddenly empty and available living spaces — empty dorm and hotel rooms, abandoned offices — to provide safe, private housing for individuals and families who are living on the street or in shelters. (Miriam Komaromy and Michael Botticelli, 3/31)

The Covid-19 epidemic is a fight with an invisible enemy. What’s also worrying is that we just don’t know how bad the disease really is. Many people wonder whether we’re overestimating its deadliness, since countries find it impossible to test those with few or no symptoms. The case fatality rate is the ratio of coronavirus deaths to the number of infected patients. If we underestimate the latter, the detected fatality rate will look much higher than the real one. That’s why there’s such huge interest in scientific models that suggest the overall infection rate is far in excess of the official numbers. If that were true, the mortality rate across the population would fall to less worrying levels. (Ferdinando Giugliano, 4/1)

On Sunday, President Trump heeded the warnings of public-health officials and walked back his plan to lift social distancing guidelines by Easter. Instead, all Americans have been instructed to continue to avoid nonessential travel, going to work, drinking and eating at bars and restaurants, or gathering in groups of more than 10 for another month, and perhaps even longer.But how much longer? Here are a few timelines that public-health experts and journalists have proposed for when and how life might start to regain at least a semblance of normalcy. (Spencer Bokat-Lindell, 3/31)