A Snapshot of the Domestic Public Health Response to COVID-19, as of March 18, 2020

Note: All dates below are in 2020.

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

• WHO declared the COVID-19 outbreak to be a Public Health Emergency of International Concern (PHEIC) on January 30.
• WHO announced the official name for the disease, COVID-19, on February 11.
• WHO raised its global risk assessment for the outbreak to "very high," its highest risk level, on February 28.
• WHO declared the global COVID-19 outbreak a "pandemic" on March 11.
• Globally, over 200,000 cases have been confirmed in over 150 countries, with over 8,500 deaths reported.

United States Actions and Status
https://www.hhs.gov/about/news/index.html; https://www.cdc.gov/coronavirus/COVID-19/summary.html; and https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/novel-coronavirus-COVID-19.

• Several emergency declarations are in effect, including a Public Health Emergency under Section 319 of the Public Health Service Act; an Emergency Declaration pursuant to Section 501(b) of the Stafford Act; and a National Emergency declaration pursuant to the National Emergencies Act. Waivers are in effect under Section 1135 of the Social Security Act to aid the health care system with surge capacity.
• President Donald Trump announced the formation of the President's Coronavirus Task Force, and appointed Vice President Mike Pence as the coordinator and Dr. Deborah Brix as response coordinator.
• Congress and the President enacted the Coronavirus Preparedness and Response Supplemental Appropriations Act (P.L. 116-123) on March 6, which provides a total of $7.767 billion in appropriations: $6.497 billion for HHS (including contingent amount), $20 million for the Small Business Administration, and $1.250 billion for foreign operations. Expanded telehealth services in Division B of the act additionally have a cost estimate of $490 million over the course of FY2020 through FY2022. Prior to enactment, health response efforts were primarily supported by the Centers for Disease Control and Prevention (CDC) Infectious Diseases Rapid Response Reserve Fund allotment of $105 million and HHS transfers of $136 million.
• The House and Senate passed The Families First Coronavirus Response Act, H.R. 6201, which includes several provisions related to health care coverage and delivery. Discussions about additional measures to provide response assistance are underway.
• 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 have limited access to testing at a local level. 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.
• 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.
• Medical countermeasures (diagnostics, vaccines, and therapeutics) are in development, including those supported by the National Institutes of Health (NIH) and the Biomedical Advanced Research and Development Authority (BARDA). An NIH-supported Moderna vaccine is in Phase 1 clinical trials (early-stage testing in humans). Gilead's Remdesivir antiviral therapy is in Phase 3 clinical trials and available under expanded access (also known as compassionate use). Widespread availability 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.
• Travel restrictions and quarantine requirements are in effect for certain travelers who have been in mainland China, the Islamic Republic of Iran, 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 DHS.
• CDC has issued guidance for the general public, schools, health care providers, health departments, pregnant women and children, travelers, and others.
• Containment and mitigation efforts are underway in several state and local jurisdictions. Several states have mandated cancellation of events, closures of schools, bars, and/or restaurants, among other actions. Several counties in Northern California are under a shelter-in-place order.
• The White House has advised Americans to avoid gatherings of 10 or more people, discretionary travel, and restaurants, food courts, and bars.
• Over 7,500 cases have been reported in 50 states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands, with over 100 deaths reported. Given limitations with testing, these are likely to be underestimates of disease spread.