— Health officials are increasingly alarmed by the recent surge of Covid cases, warning that behaviors need to change and face-coverings should be more regularly worn in hot zones.
— Not enough contact tracers and a shortage of testing supplies could cause serious problems as the case counts tick up.
— A senior HHS official is set to take on a simultaneous role in the White House as a key policy aide on health care.
Driving the Day
WHERE WE ARE ON COVID AS JULY LOOMS — It’s been nearly six months since the CDC first announced that a mystery pneumonia had spread in a Chinese market, and the nation has been transformed.
Lockdowns have been applied and lifted. Millions are out of work. More than 125,000 Americans are already dead, and weeks of declining cases have abruptly reversed, including record surges in Southern states.
— The optimistic take: We’re far better prepared to handle this upswing. There are many more supplies and tests than when Covid-19 first walloped America in March; hospital staff increasingly have the protective equipment that they initially lacked; and researchers are beginning to identify medications to treat coronavirus.
Those are also the messages amplified by the White House, including in its first coronavirus task force briefing since the end of April, POLITICO’s Alice Miranda Ollstein and David Lim report.
“We have made truly remarkable progress in moving our nation forward,” said Vice President Mike Pence at HHS on Friday. “We slowed the spread. We flattened the curve. We saved lives.”
Meanwhile, the fatality rate has fallen, and the surge of new cases is being driven by young Americans, who appear at far less risk of complications or death.
— The realistic take: We’re in serious trouble. The soaring number of cases can’t be explained solely by more testing, and health officials like infectious-disease expert Tony Fauci have warned that young Americans are bound to spread the virus to more vulnerable populations.
"The window is closing," HHS Secretary Alex Azar said on NBC's "Meet the Press." "We have to act, and people as individuals have to act responsibly. We need to social-distance. We need to wear our face-coverings if we're in settings where we can't social-distance, particularly in these hot zones."
Even once-confident Republican governors have changed their tune. The outbreak “has taken a very swift and very dangerous turn in Texas over just the past few weeks,” Texas Gov. Greg Abbott said on Sunday. He has also acknowledged his regrets about re-opening bars, given that they became hotbeds of infection.
— The pessimistic take: This is setting up to be a reprise of February and March, with cases soaring now, hospitalizations and deaths likely to soon follow and President Donald Trump again dismissing basic realities about the virus, such as the protective power of masks, while instead stoking a culture war over their use.
Even senior Republicans are beginning to plead with Trump: Set an example for your skeptical followers.
“There are times when he could wear a mask or the vice president could wear a mask,” Sen. Lamar Alexander said on CNN on Sunday. “I think it would be a sign of strength.”
On the other side of the aisle, House Speaker Nancy Pelosi and other progressives have escalated their criticism of the White House’s recent lack of action. Prominent MSNBC host Chris Hayes on Friday, for the first time, called on Trump to resign for his handling of the outbreak.
— How SCOTT GOTTLIEB sees it: The former Trump appointee and FDA commissioner sounded a serious note on “Face the Nation” on Sunday.
“Deaths are actually coming down, but that's not likely to stay that way,” Gottlieb said. “This spread is likely to seep into more vulnerable communities and we're likely to see total daily deaths start to go back up again.”
“We have a hard six months ahead of us,” he added.
Among the biggest red flags:
THERE AREN’T ENOUGH CONTACT TRACERS YET — States are scrambling to contain Covid spikes without enough workers to track outbreaks, POLITICO’s Dan Goldberg and Alice Miranda Ollstein report.
— Case study: Arizona. “This [tracing] situation is a disaster,” Rep. Greg Stanton (D-Ariz.), whose Phoenix-area district is being swamped with new cases, wrote in a letter to local officials on Thursday. “From late March until early June, those who may have been exposed to an infected patient received no outreach at all from public health officials.”
— Experts’ goal this spring had been at least 100,000 contact tracers to safely reopen the country. But CDC Director Robert Redfield told Congress last week that fewer than 30,000 have been hired so far.
AND COMMERCIAL LABS ARE WORRIED ABOUT THE TESTING JUMP — The increasing demand for tests will likely strain supplies in the coming weeks, the president of the trade group that represents commercial labs said on Saturday.
“This significant increase in demand could extend turnaround times for test results,” said Julie Khani of the American Clinical Laboratory Association, which represents the labs performing the bulk of the nation's coronavirus testing.
FIRST IN PULSE: HEALTH GROUPS DEMAND GREATER TESTING IN UNDERSERVED AREAS — More than 120 health care advocacy groups are pressing Congress to direct more testing and contact tracing resources to minority communities and underserved areas, citing the pandemic’s disproportionate impact on Americans of color.
In a letter to congressional leaders, the organizations requested funding boosts and new incentives for providers to bring testing to underserved communities, as well as the creation of more mobile testing units and hiring of community health workers to aid testing and tracing.
“Those who are the most likely to need help during this crisis are also the least likely to have access to it,” wrote the coalition, which includes the AARP, Black Lives Matter Global Network and UNIDOS.
TRUMP STILL WEIGHING HOW TO HANDLE COVID AND CHURCHES — White House officials have wrestled with whether to treat houses of worship the same as other essential businesses, or leave them alone and risk additional transmission of the deadly coronavirus — including in communities that are largely supportive of the president, POLITICO’s Gabby Orr reports.
Churches have been clear hot spots of the virus, but Trump has faced pressure from his conservative Christian supporters to keep them open.
BRAD SMITH TEED UP TO JOIN DOMESTIC POLICY COUNCIL — The leader of the CMS innovation center is being positioned to also serve as a top domestic policy aide on health care, POLITICO’s Adam Cancryn and Dan Diamond scooped on Friday.
Smith, a health care entrepreneur who joined the Trump administration in January, won fans inside the White House for his work on the coronavirus response. He would replace Maria Bonner, who left the White House last week, as the council’s top health policy aide, but is expected to also remain in his HHS roles as innovation center chief and adviser to Azar.
— Eyes on the innovation center: Some administration officials see Smith’s expected selection as a signal that the center’s pace will inevitably slow down as he balances multiple jobs. However, the calculus inside the administration is that it’s too late in the term to find a new innovation center chief, and it’s less disruptive to simply keep Smith in multiple roles.
TEXAS MEDICAL CENTER TWEAKS ICU REPORTING AMID CORONAVIRUS SURGE — TMC institutions halted public updates for three days after hitting 100 percent of their base ICU capacity, Mike Morris and Zach Despart report for the Houston Chronicle.
The change came after Abbott, the Texas governor, privately shared his frustration around headlines prompted when executives at the TMC — which collectively represent the world's largest medical institution — warned they were running out of ICU beds. The system has continued to tweak its publicly available data, seemingly an effort to tamp down concerns. Hospital leaders say they're trying to limit confusion.
— PULSE's observation: Don't overlook the role of elective procedures, which bring in additional revenue that hospitals have sought to preserve after months of financial distress.
After TMC executives warned about surging coronavirus cases last week, Abbott promptly moved to limit elective procedures in Texas counties, saying it was a precautionary move. Hospital executives then quickly walked back their warnings.
TODAY: HOUSE SET TO VOTE ON SWEEPING HEALTH BILL — Democrats are expected to pass H.R. 1425, a package intended to stabilize Obamacare's health care markets. But it's largely a messaging bill — amplified by the Trump administration's repeated efforts to strike down the Affordable Care Act in court — and it isn't expected to clear the GOP-controlled Senate.
ON TAP TUESDAY: OKLAHOMA’S MEDICAID EXPANSION VOTE — Voters in the deep-red state could approve Medicaid expansion for at least 200,000 poor adults, defying state and Trump administration officials fighting to limit the Obamacare program, POLITICO’s Rachel Roubein and Dan Goldberg report.
— If the ballot initiative passes, Oklahoma would become the first state to broadly expand government-based health insurance during a pandemic that’s stripped many people of coverage. It could also scuttle Oklahoma’s attempt to be the test case for the Trump administration’s plan to let states convert part of their Medicaid programs into block grants.
However, a top state health official said the state wouldn’t necessarily withdraw the plan, citing legal questions around whether it would need to do so.
— How the vote is playing on the ground: Backers of the measure have adjusted their campaign to the coronavirus era — hosting socially distanced events like virtual phone banks and happy hours over Zoom — but they’re sticking with messages, such as health care access, that resonated with voters in previous expansion referendums, Rachel and Dan report.
But Republican Gov. Kevin Stitt has said the state’s coronavirus-related budget crunch would make it impossible to pay for Obamacare's Medicaid expansion without raising taxes or cutting services like education or infrastructure.
Names in the News
JOSH JORGENSEN heads to National Rural Health Association. Jorgensen, who previously was a legislative aide for Sen. Mike Rounds (R-S.D.), will be government affairs manager.
Inside a Houston hospital as covid cases surge: Younger patients are beginning to stream in, with many unsure how they contracted the virus, Sheri Fink writes for the New York Times.
The U.S. is trying to fight a 21st century pandemic with prehistoric clinical trials — and achieving the kind of efficiency you might expect, argues Luciana Borio in BioCentury.
"Are you still interested in signing a bill?" Chuck Grassley confronted Trump last week about the lack of action on drug pricing, NYT's Noah Weiland reports.
Lessons from Texas' now-stalled efforts to reopen show how difficult the path is ahead: logistical nightmares on elevators, parking crunches and risk of crowds, Collin Eaton and Chip Cutter report for WSJ.
The Trump campaign removed social-distancing stickers before the president's Oklahoma rally, Dave Brooks scooped for Billboard magazine.
The ripple effects of Trump's planned WHO withdrawal: "This decision, made by a high-income country, could have deadly implications for low- and middle-income countries," Nambi Ndugga and Austin Frakt write in the JAMA Health Forum.