COVID Update April 8: Most of the day with the US Senate on what’s in the next bill— negotiations beginning, the testing mess, what’s happening in hospitals right now that I didn’t know. And @PhilMurphyNJ.

About an hour after I dig through some reports I got sent. 1/

Data on Singapore and Hong Kong are showing that a relaxing of social distancing has created a new run of cases.

In the US, given the relatively lax social distancing, we are past Italy, Spain & other countries on how long it’s taking to flatten. People are impatient. 2/

Lots of people eager to push back to normal— and it’s understandable.

Trump Administration apparently readying a plan to open rural areas first. Keep hot spots closed. 3/

I’m not sure if that strategy divides us, but with herd immunity still low, much better testing is obviously required. We live in a voluntary contact tracing environment. That means whack-a-mole, not a wholesale solution. 4/

Will talk about testing but first the Senate bill. 4 is under way and 5 is already being assembled from a number of my conversations. 5/

Trump and McConnell want another $250 billion for small businesses. I think they will get it but that means the bill won’t stop at $250 billion, but the laws of Congress mean that it’s likely to be $500 billion. 6/

When pay-go rules are off, everybody who wants something puts it on the table. And bills get passed easily if there’s no need to make tradeoffs— just say “yes, I’ll give you that, but I want this other thing too.” 7/

Hospitals will get more money too. Maybe another $100 billion. With word that 1 out of 4 rural hospitals could close, this seems likely. A rural hospital CEO that texted me today sound . . . Urgent is the word I would use. 8/

But it is our primary care doctors we need to worry about more. Volumes are down 30-40%. And while telemedicine is taking some of the sting out, it really doesn’t work for everything. 9/

Here’s my worry. Many will shutter. Insurance companies, flush with cash, will end up buying the primary care practices. And our health care system will be reshaped forever.

I will be reviewing a proposal tomorrow I hope for what to do about it.

10/

Other things on the table. Democrats will put more SNAP benefits in and likely more measures aimed at helping people pay for health care costs.

There’s a longer laundry list, but most of it won’t make it in. 11/

Laundry list:

-Automatic enrollment into Medicaid (tough push)
-100% Medicaid expansion match (also tough)
-Combat pay for health care providers
-Money to expand voting

The HELP Committee appears to be driving details. 12/

Got a chance to talk to @ashishkjha along with Zeke Emanuel as we talked with the Senate.

Very impressed with Ashish’s grasp and focal areas if you don’t follow him.

He spent a fair amount of time talking about the testing challenge. 13/

We are currently conducting about 1 million tests/week. This is up from 10,000 tests/week when the outbreak began. Ashish believes we need to get to 3.5 million/week.

Lab tests were designed to be done one by one, not at the kind of massive scale we need now. 14/

The concerning data about the testing is that even as we significantly grow the num of tests we do, the positive rate isn’t declining. And we are still only testing health care workers & people with symptoms.

The implication is that we are still working thru backlog.15/

What do we need 3.5 million weekly tests for?
1. Continuing to test caregivers & at risk populations
2. Sampling healthy people in cities
3. Significant testing regionally as we open 16/

He Abbott 5 minute test is now available at CVS in Rhode Island and Georgia. If this test proves effective and scales up quickly, it will be a big deal. 17/

At hospitals I connected with in NY and talking to other doctors, they are concerned about shortages of morphine & many of the other drugs used in the ER.

One doc described serious anxiety among the health care workforce. 18/

Hopefully NY/NJ rally levels off and resources can get to Texas, Georgia, and Florida which are emerging as hot spots.

This means more #StayHome until testing and tracking capabilities are in place. 19/

Attention is finally catching up with the sad reality of the disparities in who this disease effects. People of color are at high risk. I fear we are going to see continued spread at many nursing homes.20/

A or B?

As we come to Passover, the holiday of the 10 plagues, may all of your houses and families be safe. /end

Post Script:

Listen to the first 30 seconds of the new podcast for what I think is the most stirring recording in history. So relevant to today.

(And the rest of course)

https://twitter.com/aslavitt/status/1247956185896095745?s=21 https://twitter.com/aslavitt/status/1247956185896095745