Domestic Public Health Response to COVID-19: Current Status

A Snapshot of the Domestic Public Health Response to COVID-19, as of March 25, 2020

International Events and World Health Organization (WHO) Selected Actions
https://www.who.int/emergencies/diseases/novel-coronavirus-2019

United States Selected Actions and Status
See websites linked below.

April 16, 2020

Selected events and actions. All dates are calendar year 2020.

• Several emergency declarations are in effect, including a Public Health Emergency under Section 319 of the Public Health Service Act, declared on January 31 (retroactively dated to January 27); nationwide emergency declarations on March 13 and subsequent and selected major disaster declarations pursuant to the Stafford Act; and a National Emergency declaration pursuant to the National Emergencies Act on March 13, dated to March 1. Waivers are in effect under Section 1135 of the Social Security Act to aid the health care system with surge capacity.
• President Donald Trump has formed the President's Coronavirus Task Force and appointed Vice President Mike Pence as the coordinator and Dr. Deborah Birx as response coordinator.
• The White House has advised Americans to ; announced on January 29.
• President Trump invoked the Defense Production Act (DPA) on March 18 and delegated authority to the Secretary of Health and Human Services (HHS) to prioritize and allocate health and medical resources as needed.
• The White House has advised Americans to work and engage in schooling from home when possible and to avoid gatherings of 10 or more people, discretionary travel, and restaurants through April 30.
• The White House, in collaboration with the Centers for Disease Control and Prevention (CDC), has released guidelines for "Opening Up America Again" on April 16.

Domestic Response Activities—FEMA, HHS, and Support Agencies

Coordination and General Public Health

On March 21, the Vice President announced that the Federal Emergency Management Agency (FEMA) is leading federalavoid gatherings of 10 or more people, discretionary travel, and restaurants, food courts, and bars for 15 days, as of March 16.
• President Trump invoked the Defense Production Act (DPA) on March 18, and delegated authority to the Secretary of Health and Human Services (HHS) to prioritize and allocate health and medical resources as needed.
• As of March 21, the Federal Emergency Management Agency (FEMA) leads federal operations on behalf of the White House Coronavirus Task Force, with HHS providing subject matter expertise. FEMA is supporting federal, state, and local partners by providing situational awareness, planning, logistics, and supply chain support. AdditionallyIn addition, FEMA is providing assistance to states and territories for emergency protective measures authorized pursuant to the President's emergency and major disaster declarationdeclarations under the Stafford Act. The CDC has issued guidances under the Stafford Act.

• CDC has issued guidance for the general public, schools, health care providers, health departments, pregnant women and children, travelers, and others.
• CDC has developed a diagnostic test kit for the virus and distributed it to public health laboratories pursuant to an Emergency Use Authorization (EUA) issued by the U.S. Food and Drug Administration (FDA) on February 4. Issues with test performance limited access to testing at a local level through the month of February.
• FDA has issued several EUAs for COVID-19 diagnostic tests (including for both commercial test kits and laboratory-developed tests, or LDTs) and personal protective equipment (PPE).
• FDA has CDC has also recommended that all Americans wear nonmedical cloth masks when in public settings where 6-foot social distancing is difficult to maintain (e.g., grocery stores).
• CDC has begun to publish a weekly data report, and has published research reports on U.S. and international cases and public health interventions.
• CDC has issued several guidances related to COVID-19 case reporting, including for confirmed cases and certifying deaths.
• HHS has made several funding announcements following supplemental appropriations, including an initial round of $30 billion in funding for the CARES Act Provider Relief Fund.

Diagnostic Testing

• CDC developed a diagnostic test kit for the virus and distributed it to public health laboratories pursuant to an Emergency Use Authorization (EUA) issued by the U.S. Food and Drug Administration (FDA) on February 4. Initial quality issues with this test delayed early testing and case identification.
FDA has taken actions to expand testing. FDA issued guidance on February 29 to authorize certain CLIA (Clinical Laboratory Improvement Amendments) certified labs to validate and use their own COVID-19 laboratory-developed tests for clinical diagnosis before EUA is granted. On March 16, FDA expanded this policy to cover the manufacture, distribution, and use of commercial test kits prior to EUA authorization. In this guidance, FDA also authorizes states to further authorize laboratories within their own state to develop and perform tests for COVID-19 pursuant to state law and without the objection of the FDA.
• On March 21, FDA issued an Emergency Use Authorization for a rapid point-of-care COVID-19 diagnostic test, projected to be more widely available in April.
• COVID-19 diagnostic testing is currently conducted by public health, commercial, and clinical laboratories.
• FEMA and HHS established Community Based Testing Sites (CBTS), which now have the option of being transferred to state leadership.

Medical Countermeasures

• FDA has issued several EUAs for COVID-19 diagnostic tests (including for serologic and point-of-care tests), ventilators and related medical devices, respirators and respirator decontamination systems, and treatments for COVID-19.
Medical countermeasures (diagnostics, vaccines, and therapeutics) are in development, including those supported by the National Institutes of Health (NIHNIH) and the Biomedical Advanced Research and Development Authority (BARDABARDA). An NIH-supported vaccine is in Phase 1 clinical trials (early-stage testing in humans). Widespread availability of a vaccineAvailability of a vaccine is projected to be at least a year away, while initial results of clinical trials of potential treatments are said to be expected by May.
• Drugs with possible antiviral properties Treatments have been made available under FDA expanded access (also known as compassionate use) to certain COVID-19 patients while clinical trials are underway.
• The HHS Assistant Secretary for Preparedness and Response (ASPR) has deployed medical products and supplies from the Strategic National Stockpile (SNS) to state and local jurisdictions and has indicated that it is working with industry to expand manufacturing capacity.
• The Department of Defense has transferred some stockpiled respirators and ventilators for civilian use, and has assigned U.S. Navy hospital ships to deploy. The U.S. Army Corps of Engineers is assisting in providing alternate health care facilities in New York and planning for such facilities in California, and is performing initial planning and engineering support to address medical facility shortages nationwide.

Supply Chain and Health Care Surge

• FEMA is coordinating supply chain activities through several efforts, including Project Airbridge and deployment of assets from the Strategic National Stockpile, with the HHS Assistant Secretary for Preparedness and Response (ASPR).
• FDA has issued a series of enforcement policies via guidance to make products available, waiving regulatory requirements for personal protective equipment (PPE), hand sanitizer, and other FDA-regulated products and activities. CDC has also issued guidance on optimizing PPE use.
• In early April, the DPA was used to increase ventilator production and a contract was made to private companies (General Motors and Philips) to produce ventilators. Under DPA, export of critical PPE has also been limited.
• The Department of Defense has transferred stockpiled respirators and ventilators for civilian use and deployed U.S. Navy hospital ships, field hospitals, and medical augmentation teams to infection hot spots, such as New York, New Jersey, Washington, Michigan, and Louisiana.  In addition, over 30,000 members of the National Guard are conducting COVID-19 response operations at the direction of their governors.
• FEMA has tasked the U.S. Army Corps of Engineers (USACE) to construct and convert sites into alternate health care facilities in 14 states, providing for roughly 15,700 additional beds. USACE anticipates completing the sites associated with around 11,700 beds by April 25.

• Travel restrictions and quarantine requirements are in effect for certain travelers who have been in mainland China, the Islamic Republic of Iran, the Schengen area of the European Union, the United Kingdom, and the Republic of Ireland within 14 days prior to arrival, pursuant to proclamations issued by President Trump.
• Enhanced health screenings are in place at 13 major U.S. airports. Health screenings and referrals are in place at all air, land, and sea ports of entry by the Department of Homeland Security (DHS).
• The United States has agreements with Canada and Mexico to limit all nonessential travel across the borders, effective March 21.
• The State Department has advisedDHS).
• CDC issued an order (along with implementing regulations) suspending the "introduction" of foreign nationals from countries with COVID-19. Two DHS orders restrict nonessential travel by foreign nationals into the United States through ports of entry on the land borders with both Canada and Mexico.
The State Department has advised Americans to avoid all international travel and for those abroad to return home immediately or prepare to remain abroad for an indefinite period of time.

• CDC recommends that travelers avoid all nonessential travel to all global destinations

  Congress

  The Coronavirus Preparedness and Response Supplemental Appropriations Act (P.L. 116-123), enacted March 6, providesprovides a total of $7.767 billion in appropriations:, including $6.497 billion for HHS (including a contingent amount)contingent amount), $20 million for the Small Business Administration, and $1.250 billion for foreign operations. The act also expands telehealth services. Prior to enactment, health response efforts were primarily supported by the Centers for Disease Control and Prevention (CDC)CDC Infectious Diseases Rapid Response Reserve Fund allotment of $105 million and HHS transfers of $136 million.
• The Families First Coronavirus Response Act (H.R. 6201FFCRA; P.L. 116-127), enacted March 18, includes provisions related to health care coverage and delivery, among other things. It also includesrequires coverage of COVID-19 testing under most federal health care programs, and provides $1 billion for the HHS Public Health and Social Services Emergency Fund (PHSSEF) for COVID-19 testing for the uninsured.
• Congress is considering the
• The Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136), enacted on March 27, provides a $2.2 trillion economic package that includes $172 billion additional supplemental appropriations for HHS to support public health and medical response activities, including coverage or purchase of a COVID-19 vaccine, when available. It establishes a $100 billion Provider Relief Fund for hospitals and other health care providers. It also includes several health-related authorities, some related to medical supply chain issues.
Another supplemental appropriations measure is being considered and would reportedly include additional health-related funding Coronavirus Aid, Relief, and Economic Security Act (CARES Act; H.R. 748), an economic package that includes additional supplemental appropriations for public health and medical response activities.