April 20, 2020

Is it time to loosen social distancing? Governors are sharply divided.

Daily Briefing

    While some states have quickly taken steps to reopen businesses and ease social distancing measures as soon as this week, governors from other states warned they still don't have the testing capacity needed to safely ease restrictions aimed at combating the new coronavirus epidemic.

    Covid-19 weekly webinar: What you need to know in 45 minutes

    US Covid-19 cases surpass 750K, death toll tops 36K


    As of Monday morning, U.S. officials had reported 753,317 cases of Covid-19, the disease caused by the new coronavirus, in the country—up from 667,945 cases as of Friday morning.

    Officials as of Monday morning also had reported 36,109 U.S. deaths linked to the new coronavirus—up from 30,665 deaths reported as of Friday morning.

    Some states move to ease social distancing measures

    As the numbers of Covid-19 cases and deaths continue to rise across the United States, President Trump on Thursday announced guidelines for states to relax so-called "stay-at-home" orders aimed at curbing the new coronavirus' spread and begin reopening nonessential businesses that had been closed if the states meet certain metrics. The guidelines recommend that state officials should consider easing social distancing measures only if:

    • Officials have seen a downward trajectory in influenza-like illnesses in their state for 14 days;
    • Officials have seen a downward trajectory in Covid-19 cases in their state for 14 days;
    • Officials have testing programs, including antibody testing, set up for at-risk health care workers; and
    • Providers have the capacity to treat all Covid-19 patients in the state without operating under a crisis care plan.

    Trump on Saturday said some states already are taking steps to ease social distancing measures to reopen certain businesses. Following the White House's release of the guidelines, officials in Florida, Montana, Texas, and Vermont announced plans to ease social distancing measures.

    For example, Florida Gov. Ron DeSantis (R) on Friday gave municipalities permission to reopen beaches, but said beachgoers must follow physical distancing guidelines. Officials in Montana also began lifting some of the state's coronavirus-related restrictions on Friday. Meanwhile, officials in Texas and Vermont announced that certain businesses in the states can reopen on Monday, though the businesses are required to maintain certain precautions intended to prevent the new coronavirus' spread.

    But officials in other states said they are not ready to lift social distancing measures and reopen nonessential businesses because they still do not have the testing capacity needed to safely ease the restrictions. The governors of Maryland, New Jersey, New York, Michigan, and Virginia all have raised concerns over testing capacity. Virginia Gov. Ralph Northam (D) during an interview on CNN's "State of the Union" on Sunday said, "We are fighting a biological war," and, "We have been asked as governors to fight that war without the supplies we need."

    However, Trump administration officials have claimed the United States does have the testing capacity needed to safely ease social distancing measures and reopen shuttered businesses. For example, Vice President Pence during an interview on NBC's "Meet the Press" on Sunday said, "[T]here is a sufficient capacity of testing across the country today for any state in America" to begin to easing coronavirus-related restrictions.

    Trump also said his administration plans to take additional steps to boost the country's coronavirus testing capacity. For instance, Trump said his administration is preparing to use the Defense Production Act to compel U.S. facility to increase test swab production by more than 20 million per month. Trump did not name the manufacturer.

    CMS, CDC seek to improve Covid-19 reporting

    The administration also is taking steps to improve reporting of Covid-19 cases.

    On Sunday, CMS announced new regulations requiring nursing homes to directly notify CDC, residents, and residents' families of confirmed or suspected cases of Covid-19 in their facilities. Under the new regulations, nursing homes must report Covid-19 cases to CDC in accordance with existing privacy regulations and statues. CMS said CDC will provide nursing homes with a reporting tool to collect the data and assist with Covid-19 surveillance, and CMS plans to make the data available to the public.

    According to CMS, the move builds on recent recommendations from two large nursing home associations, the American Health Care Association and Leading Age, which have called on nursing homes to quickly report cases of Covid-19.

    In addition, CDC has said it plans to unveil an app based on Fast Healthcare Interoperability Resources (FHIR) standards that health care providers can use to automate Covid-19 case reporting. Laura Conn—a health scientist and electronic case reporting (eCR) lead at CDC's Center for Surveillance, Epidemiology, and Laboratory Services—said, "The FHIR app can be rapidly implemented to automate Covid-19 [eCR] in otherwise non-enabled EHRs. The app will connect Covid-19 eCR to existing infrastructure to confirm cases and route to appropriate public health surveillance systems. We are making sure that can be easily used without requiring a software release by the vendors."

    Conn said an initial version of the app, called eCR Now, will be available May 1.

    CMS releases recommendations for reopening health care facilities for non-Covid-19 care

    Separately, CMS on Sunday also released recommendations on how health care systems in regions of the United States with low numbers of Covid-19 cases or stable rates of new Covid-19 cases can begin to provide essential non-Covid-19 care to patients who are not showing symptoms of Covid-19. CMS said the recommendations fall under phase one of the Trump administration's guidelines for reopening the United States.

    CMS in the recommendations said health care facilities must consider a number of factors before resuming essential care not related to Covid-19. For example, CMS said facilities should review their availability of personal protective equipment, workforce availability, sanitation protocols, and testing capacity.

    CMS in the recommendations also said health care systems should coordinate with local and state officials before restarting or increasing in-person care. However, CMS encouraged providers to continue maximizing "use of all telehealth" services for care that can be offered virtually.

    CMS Administrator Seema Verma said, "Every state and local official will need to assess the situation on the ground to determine the best course forward, but these guidelines provide a gradual process for restarting non-Covid-19 essential care while keeping patients safe" (Mason et al., Reuters, 4/18; Hines, USA Today, 4/19; Rojas, New York Times, 4/19; Perano, Axios, 4/19; Harris et al., Washington Post, 4/19; Higgins-Dunn, CNBC, 4/19; Landi, FierceHealthcare, 4/17; Perez, Politico, 4/19; Falconer, Axios, 4/19; CMS release, 4/19 [1]; CMS release, 4/19 [2]; CMS recommendations, accessed 4/19; New York Times, 4/20).

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