{ "id": "IN11253", "type": "CRS Insight", "typeId": "INSIGHTS", "number": "IN11253", "active": true, "source": "EveryCRSReport.com", "versions": [ { "source": "EveryCRSReport.com", "id": 624956, "date": "2020-05-13", "retrieved": "2020-05-19T13:39:57.715778", "title": "Domestic Public Health Response to COVID-19: Current Status", "summary": "The Coronavirus Disease 2019 (COVID-19) pandemic is affecting communities throughout the United States, with total case counts growing daily. More than 1.3 million cases, including more than 82,000 deaths, have been reported in the United States. Containment and mitigation efforts by federal, state, and local governments have been undertaken to \u201cflatten the curve\u201d\u2014that is, to slow widespread transmission that could overwhelm the nation\u2019s health care system. Currently, \u201csocial distancing\u201d restrictions that have been in place for almost two months are being eased in some jurisdictions as economic consequences mount. Efforts to identify and quarantine close contacts of cases are underway in some places, although testing capacity remains limited. Nursing homes, prisons, jails, and similar congregate settings are emerging as points of rapid spread of infection.\nThis CRS Insight presents selected information and resources relevant to the domestic public health response to COVID-19 in containing and mitigating the spread and impact of the disease. As the situation evolves, this Insight will be updated. For further information on other issues related to COVID-19, see the CRS Coronavirus Disease 2019 homepage.\nA Snapshot of the Domestic Public Health Response to COVID-19, as of May 13, 2020\nSelected events and actions. All dates are calendar year 2020. All dollar amounts are discretionary appropriations.\nCongress-Relevant Laws and Legislation\nThe Coronavirus Preparedness and Response Supplemental Appropriations Act (P.L. 116-123), enacted March 6, provides a total of $7.767 billion in appropriations, including $6.497 billion for HHS (including a contingent amount). The act also expands telehealth services. Prior to enactment, health response efforts were primarily supported by the CDC Infectious Diseases Rapid Response Reserve Fund allotment of $105 million and HHS transfers of $136 million. \nThe Families First Coronavirus Response Act (FFCRA; P.L. 116-127), enacted March 18, includes provisions related to health care coverage and delivery, among other things. It requires 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. \nThe Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136), enacted on March 27, includes $142 billion in additional supplemental appropriations for HHS to support public health and medical response activities, including specified funding for 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. \nThe Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139), enacted on April 24, includes $75 billion for the Provider Relief Fund and $25 billion for expanding COVID-19 testing capacity and contact tracing, with funding going to states, territories, and tribes, as well as to HHS. The act also requires several data reports on COVID-19 cases from HHS. \nThe Chair of the House Appropriations Committee, Representative Lowey, introduced the Health and Economic Recovery Omnibus Emergency Solutions Act (HEROES Act) on May 12, which includes many authorizing provisions related to core public health functions (e.g., contact tracing, surveillance, laboratory capacity), testing, and research and development into new medical countermeasures. The bill would appropriate an additional $100 billion for the Provider Relief Fund and $75 billion for a national testing and contact tracing program, along with additional amounts for other HHS purposes.\nEmergency and Major Disaster Declarations and White House Response\nSeveral 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; renewed on April 21); nationwide emergency declarations on March 13 and subsequent 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.\nPresident Donald Trump formed the President\u2019s Coronavirus Task Force and appointed Vice President Mike Pence as the coordinator and Dr. Deborah Birx as response coordinator; announced on January 29. \nOn March 18, the Administration first invoked the Defense Production Act (DPA) and delegated authority for its use to HHS. Since then, HHS, FEMA, DOD, and the USDA have all directly engaged in DPA actions on prioritization, allocation, anti-hoarding/price gouging, and expansion of productive supply.\nThe White House, in collaboration with the Centers for Disease Control and Prevention (CDC), has released guidelines for \u201cOpening Up America Again\u201d on April 16.\nThe White House released the Opening Up America Again Testing Overview and Testing Blueprint on April 27, which includes guidance for states on expanding and implementing COVID-19 testing.\nDomestic Response Activities\u2014FEMA, HHS, and Support Agencies\nCoordination and General Public Health\nOn March 21, Vice President Pence announced that the Federal Emergency Management Agency (FEMA) is leading 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. In addition, FEMA is providing assistance to states and territories for emergency protective measures authorized pursuant to the President\u2019s emergency and major disaster declarations under the Stafford Act. Certain states are also receiving assistance for crisis counseling under the Stafford Act major disaster declarations.\nThe CDC has issued guidances for the general public, workplaces, health care providers, health departments, pregnant women and children, travelers, and others. 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). \nHHS has made several funding announcements following supplemental appropriations, including distributions totaling $72 billion for the CARES Act Provider Relief Fund, and has launched the COVID-19 Uninsured Program Portal as of April 27.\nTesting, Surveillance, and Contact Tracing\nFEMA and HHS lead a joint Laboratory Diagnostics Task Force to coordinate diagnostic testing-related activities, including carrying out the White House testing blueprint and aiding in jurisdictional testing plans. \nFEMA and HHS established Community Based Testing Sites (CBTS), which now have the option of being transferred to state leadership. \nCDC has begun to publish a weekly data report, and has published research reports on U.S. and international cases and public health interventions. \nCDC has issued several guidances related to COVID-19 case reporting, including for confirmed cases and certifying deaths. \nCDC has issued guidance and published training by the Association of State and Territorial Health Officials (ASTHO) related to contact tracing.\nNIH announced the Rapid Acceleration of Diagnostics (RADx) initiative on April 29, a prize competition for diagnostic test innovation. \nMedical Countermeasures\nFDA has issued several Emergency Use Authorizations (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. \nMedical 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). For example, an NIH-supported vaccine has received FDA permission to begin Phase 2 clinical trials (mid-stage testing in humans) per a company statement, although widespread availability of a vaccine is projected to be about a year away at the earliest. In addition, based in part on initial positive results from an NIH clinical trial, the investigational drug remdesivir has been made available via EUA to some hospitalized patients with severe COVID-19. \nFDA created a special emergency program, the Coronavirus Treatment Acceleration Program (CTAP), to speed approval of drugs and therapies to treat COVID-19.\nNIH has announced the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) partnership on April 17. \nTreatments have been made available under FDA expanded access (also known as compassionate use) to certain COVID-19 patients while clinical trials are underway. \nNIH has published treatment guidelines for COVID-19 patients in collaboration with other federal agencies and several medical associations. \nMedical Supply Chain and Health Care Surge\nFEMA is coordinating medical 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).\nFDA 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. \nIn response to the COVID-19 emergency, DPA authorities have been variously employed to address medical, food, and defense industry supply chain issues, although the Administration\u2019s implementation pattern has been relatively narrow in application. In addition, the full extent of DPA implementation is not necessarily clear, as agencies differ in reporting DPA actions.\nThe 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 40,000 members of the National Guard are conducting COVID-19 response operations at the direction of their governors.\nFEMA tasked the U.S. Army Corps of Engineers (USACE) to convert available sites into alternate health care facilities requested by numerous states. Completed facilities have expanded available beds by roughly 15,600. Certain media reports claim that some of the facilities may be put on standby, repurposed as testing sites, or decommissioned in the coming weeks. \nTravel and Immigration Related Policies and Restrictions\nTravel 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. \nThe 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.\nCDC issued an order (along with implementing regulations) suspending the \u201cintroduction\u201d 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.\nOn April 22, President Trump issued a proclamation suspending entry into the United States of certain aliens (foreign nationals) who are seeking lawful permanent resident (LPR) status (i.e., immigrants).", "type": "CRS Insight", "typeId": "INSIGHTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/IN11253", "sha1": "3b4299bf434eb0c21787f185d6d4aab95f693f6f", "filename": "files/20200513_IN11253_3b4299bf434eb0c21787f185d6d4aab95f693f6f.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/IN11253", "sha1": "44cba66fa02627262f1b200c9e6423413af2df63", "filename": "files/20200513_IN11253_44cba66fa02627262f1b200c9e6423413af2df63.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4880, "name": "FDA Product Regulation & Medical Research" }, { "source": "IBCList", "id": 4882, "name": "Public Health Emergency Preparedness & Response" } ] }, { "source": "EveryCRSReport.com", "id": 622620, "date": "2020-04-20", "retrieved": "2020-04-20T22:19:35.728368", "title": "Domestic Public Health Response to COVID-19: Current Status", "summary": "The COVID-19 pandemic is affecting communities throughout the United States, with case counts changing daily. Over 760,000 cases have been reported in 50 states, the District of Columbia, Puerto Rico, Guam, the Northern Mariana Islands, and the U.S. Virgin Islands, with over 35,000 deaths reported (Data from compiled state and local reports.) Containment and mitigation efforts by federal, state, and local governments have been undertaken to \u201cflatten the curve\u201d\u2014that is, to slow widespread transmission that could overwhelm the nation\u2019s health care system.\nThis CRS Insight presents selected information and resources relevant to the domestic public health response to COVID-19 in containing and mitigating the spread and impact of the disease. As the situation evolves, this Insight will be updated. For further information on other issues related to COVID-19, see the CRS Coronavirus Disease 2019 homepage.\nA Snapshot of the Domestic Public Health Response to COVID-19, as of April 16, 2020\nSelected events and actions. All dates are calendar year 2020.\nEmergency and Major Disaster Declarations and White House\nSeveral 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 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.\nPresident Donald Trump formed the President\u2019s Coronavirus Task Force and appointed Vice President Mike Pence as the coordinator and Dr. Deborah Birx as response coordinator; announced on January 29. \nPresident 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. \nThe 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.\nThe White House, in collaboration with the Centers for Disease Control and Prevention (CDC), has released guidelines for \u201cOpening Up America Again\u201d on April 16.\nDomestic Response Activities\u2014FEMA, HHS, and Support Agencies\nCoordination and General Public Health\nOn March 21, the Vice President announced that the Federal Emergency Management Agency (FEMA) is leading 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. In addition, FEMA is providing assistance to states and territories for emergency protective measures authorized pursuant to the President\u2019s emergency and major disaster declarations under the Stafford Act.\nThe CDC has issued guidances for the general public, schools, health care providers, health departments, pregnant women and children, travelers, and others. 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).\nCDC has begun to publish a weekly data report, and has published research reports on U.S. and international cases and public health interventions. \nCDC has issued several guidances related to COVID-19 case reporting, including for confirmed cases and certifying deaths. \nHHS has made several funding announcements following supplemental appropriations, including an initial round of $30 billion in funding for the CARES Act Provider Relief Fund.\nDiagnostic Testing\nCDC 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.\nFDA 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.\nCOVID-19 diagnostic testing is currently conducted by public health, commercial, and clinical laboratories. \nFEMA and HHS established Community Based Testing Sites (CBTS), which now have the option of being transferred to state leadership. \nMedical Countermeasures\nFDA 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.\nMedical 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 vaccine is in Phase 1 clinical trials (early-stage testing in humans). 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.\nTreatments have been made available under FDA expanded access (also known as compassionate use) to certain COVID-19 patients while clinical trials are underway. \nSupply Chain and Health Care Surge\nFEMA 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).\nFDA 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. \nIn 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.\nThe 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.\nFEMA 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. \nTravel-Related Policies and Restrictions\nTravel 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. \nEnhanced 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). \nCDC issued an order (along with implementing regulations) suspending the \u201cintroduction\u201d 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.\nThe 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 \nCongress\nThe Coronavirus Preparedness and Response Supplemental Appropriations Act (P.L. 116-123), enacted March 6, provides a total of $7.767 billion in appropriations, including $6.497 billion for HHS (including a contingent amount). The act also expands telehealth services. Prior to enactment, health response efforts were primarily supported by the CDC Infectious Diseases Rapid Response Reserve Fund allotment of $105 million and HHS transfers of $136 million. \nThe Families First Coronavirus Response Act (FFCRA; P.L. 116-127), enacted March 18, includes provisions related to health care coverage and delivery, among other things. It requires 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. \nThe 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. \nAnother supplemental appropriations measure is being considered and would reportedly include additional health-related funding.", "type": "CRS Insight", "typeId": "INSIGHTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/IN11253", "sha1": "be958306b59a0dbc705e75fe9c3b1d3e15169b63", "filename": "files/20200420_IN11253_be958306b59a0dbc705e75fe9c3b1d3e15169b63.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/IN11253", "sha1": "92632f64109977468bdebc0fe1c4e766a34d3184", "filename": "files/20200420_IN11253_92632f64109977468bdebc0fe1c4e766a34d3184.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4880, "name": "FDA Product Regulation & Medical Research" }, { "source": "IBCList", "id": 4882, "name": "Public Health Emergency Preparedness & Response" } ] }, { "source": "EveryCRSReport.com", "id": 621040, "date": "2020-03-25", "retrieved": "2020-03-26T22:05:14.787532", "title": "Domestic Public Health Response to COVID-19: Current Status and Resources Guide", "summary": "The global outbreak of Coronavirus Disease 2019, COVID-19, is affecting communities throughout the United States, with case counts growing daily. Containment and mitigation efforts by federal, state, and local governments have been undertaken to \u201cflatten the curve\u201d\u2014that is, to curb widespread transmission that could overwhelm the nation\u2019s health care system.\nThis CRS Insight presents selected information and resources relevant to the domestic public health response to COVID-19 in containing and mitigating the spread and impact of the disease. As the situation evolves, CRS will continue to publish and update products relevant to the current needs of Congress. This Insight will be updated accordingly.\nThis Insight does not provide information on the international response to COVID-19, or on economic or other nonhealth policy issues related to COVID-19. This Insight also does not address issues related to health insurance and financing, or human services. For further information on those issues, see the CRS Coronavirus Disease 2019 homepage.\nA Snapshot of the Domestic Public Health Response to COVID-19, as of March 25, 2020\nNote: All dates below are in 2020.\nInternational Events and World Health Organization (WHO) Selected Actions\nhttps://www.who.int/emergencies/diseases/novel-coronavirus-2019\nWHO declared the COVID-19 outbreak to be a Public Health Emergency of International Concern (PHEIC) on January 30.\nWHO announced the official name for the disease, COVID-19, on February 11.\nWHO declared the global COVID-19 outbreak a \u201cpandemic\u201d on March 11.\nGlobally, over 441,000 cases have been confirmed in 172 countries, with over 19,000 deaths reported. (Data from compiled national and subnational reports.)\n\nUnited States Selected Actions and Status\nSee websites linked below. \nEmergency and Major Disaster Declarations and White House\nSeveral emergency declarations are in effect, including a Public Health Emergency under Section 319 of the Public Health Service Act; nationwide emergency declarations and selected major disaster declarations pursuant to 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.\nPresident Donald Trump has formed the President\u2019s Coronavirus Task Force and appointed Vice President Mike Pence as the coordinator and Dr. Deborah Birx as response coordinator.\nThe White House has advised Americans to avoid gatherings of 10 or more people, discretionary travel, and restaurants, food courts, and bars for 15 days, as of March 16.\nPresident 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.\nAs 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. Additionally, FEMA is providing assistance to states and territories for emergency protective measures authorized pursuant to the President\u2019s emergency and major disaster declaration under the Stafford Act.\n\nDepartment of Health and Human Services (HHS) and Support Agencies\nCDC has issued guidance for the general public, schools, health care providers, health departments, pregnant women and children, travelers, and others.\nCDC 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. \nFDA 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). \nFDA 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.\nOn 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. \nMedical 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 vaccine is in Phase 1 clinical trials (early-stage testing in humans). 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.\nDrugs with possible antiviral properties have been made available under FDA expanded access (also known as compassionate use) to certain COVID-19 patients while clinical trials are underway. \nThe 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. \nThe 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.\n\nTravel-Related Policies and Restrictions\nTravel 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. \nEnhanced 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). \nThe United States has agreements with Canada and Mexico to limit all nonessential travel across the borders, effective March 21.\nThe 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. \n\nCongress\nThe Coronavirus Preparedness and Response Supplemental Appropriations Act (P.L. 116-123), enacted March 6, 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. The act also expands telehealth services. 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. \nThe Families First Coronavirus Response Act (H.R. 6201; P.L. 116-127), enacted March 18, includes provisions related to health care coverage and delivery, among other things. It also includes $1 billion for the HHS Public Health and Social Services Emergency Fund (PHSSEF) for COVID-19 testing for the uninsured. \nCongress is considering the 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. \n\nU.S. Cases and Deaths\nOver 55,000 cases have been reported in 50 states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands, with over 800 deaths reported. Given testing limitations, these may undercount actual disease spread. (Data from compiled state and local reports.)\n\n\nFor general background, see CRS Report R46219, Overview of U.S. Domestic Response to Coronavirus Disease 2019 (COVID-19), coordinated by Sarah A. Lister and Kavya Sekar. (Note that parts of this report have become outdated as the COVID-19 situation has evolved.)\nFederal Agency Websites\nGeneral\nThe White House, https://www.whitehouse.gov/.\nUSA.gov, \u201cGovernment Response to Coronavirus, COVID-19,\u201d https://www.usa.gov/coronavirus.\nRelevant Agency Websites\nHHS Assistant Secretary for Preparedness and Response (ASPR): \u201cCOVID-19: Coronavirus Disease 2019,\u201d https://www.phe.gov/emergency/events/COVID19/Pages/default.aspx.\nCenters for Disease Control and Prevention (CDC): \u201cCoronavirus Disease 2019 (COVID-19),\u201d https://www.cdc.gov/coronavirus/2019-ncov/index.html; and \u201cCDC Newsroom,\u201d https://www.cdc.gov/media/index.html.\nCenters for Medicare and Medicaid Services (CMS), \u201cCurrent Emergencies,\u201d https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page; \u201cCoronavirus Disease 2019 (COVID-19).\u201d\nDepartment of Defense (DOD), \u201cCoronavirus DOD Response,\u201d https://www.defense.gov/Explore/Spotlight/Coronavirus/. \nFederal Emergency Management Agency (FEMA), \u201cCoronavirus (COVID-19) Response,\u201d https://www.fema.gov/coronavirus.\nFood and Drug Administration (FDA), \u201cCoronavirus Disease 2019 (COVID-19),\u201d https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/coronavirus-disease-2019-covid-19.\nHealth Resources and Services Administration (HRSA), \u201cEmergency Preparedness and Recovery Resources for Health Centers,\u201d https://bphc.hrsa.gov/emergency-response.\nIndian Health Service (IHS), \u201cCOVID-19 Update as of March 16, 2020,\u201d https://www.ihs.gov/newsroom/announcements/2020-announcements/covid-19-update-as-of-march-16-2020/.\nNational Institutes of Health (NIH), \u201cCoronavirus Disease 2019 (COVID-19),\u201d https://www.nih.gov/health-information/coronavirus.\nOther Information Sources\nJohns Hopkins University Coronavirus Resource Center, https://coronavirus.jhu.edu/.\nHarvard Health Coronavirus Resource Center, https://www.health.harvard.edu/diseases-and-conditions/coronavirus-resource-center.\nUniversity of Minnesota Center for Infectious Disease Research and Policy (CIDRAP), http://www.cidrap.umn.edu/infectious-disease-topics/covid-19#news.", "type": "CRS Insight", "typeId": "INSIGHTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/IN11253", "sha1": "42123021a7f4b9a9f74874cf5dfcf77008f03ab5", "filename": "files/20200325_IN11253_42123021a7f4b9a9f74874cf5dfcf77008f03ab5.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/IN11253", "sha1": "b10eaf15eb338346fa9141a53c5d9a18a8d396d5", "filename": "files/20200325_IN11253_b10eaf15eb338346fa9141a53c5d9a18a8d396d5.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4880, "name": "FDA Product Regulation & Medical Research" }, { "source": "IBCList", "id": 4882, "name": "Public Health Emergency Preparedness & Response" } ] }, { "source": "EveryCRSReport.com", "id": 620635, "date": "2020-03-18", "retrieved": "2020-03-23T22:25:30.434448", "title": "Domestic Public Health Response to COVID-19: Current Status and Resources Guide", "summary": "The global outbreak of Coronavirus Disease 2019, COVID-19, is affecting communities throughout the United States, with case counts growing daily. Containment and mitigation efforts by federal, state, and local governments have been undertaken to \u201cflatten the curve\u201d\u2014that is, to curb widespread transmission that could overwhelm the nation\u2019s health care system.\nThis CRS Insight presents selected international and U.S. government actions and related events, CRS products, and federal websites relevant to the domestic public health response to COVID-19. As the situation evolves, CRS will continue to publish and update products relevant to the current needs of Congress. This Insight will be updated accordingly.\nThis Insight does not provide information on the international response to COVID-19, nor on economic or other non-health policy issues related to COVID-19. This Insight also does not address issues related to health insurance and financing. For further information on those issues, see the CRS Coronavirus Disease 2019 homepage.\nA Snapshot of the Domestic Public Health Response to COVID-19, as of March 18, 2020\nNote: All dates below are in 2020.\nInternational Events and World Health Organization (WHO) Actions\nhttps://www.who.int/emergencies/diseases/novel-coronavirus-2019\nWHO declared the COVID-19 outbreak to be a Public Health Emergency of International Concern (PHEIC) on January 30.\nWHO announced the official name for the disease, COVID-19, on February 11.\nWHO raised its global risk assessment for the outbreak to \u201cvery high,\u201d its highest risk level, on February 28.\nWHO declared the global COVID-19 outbreak a \u201cpandemic\u201d on March 11.\nGlobally, over 200,000 cases have been confirmed in over 150 countries, with over 8,500 deaths reported. \nUnited States Actions and Status\nhttps://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.\nSeveral 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.\nPresident Donald Trump announced the formation of the President\u2019s Coronavirus Task Force, and appointed Vice President Mike Pence as the coordinator and Dr. Deborah Brix as response coordinator. \nCongress 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. \nThe 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.\nCDC 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. \nFDA 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.\nMedical 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\u2019s 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.\nTravel 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. \nEnhanced 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. \nCDC has issued guidance for the general public, schools, health care providers, health departments, pregnant women and children, travelers, and others.\nContainment 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. \nThe White House has advised Americans to avoid gatherings of 10 or more people, discretionary travel, and restaurants, food courts, and bars.\nOver 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. \n\nCRS Products on COVID-19 Domestic Health Issues \nGeneral\nCRS Report R46209, Coronavirus Disease Outbreak (COVID-19): CRS Experts, by Matthew B. Barry. \nPublic Health and Health System Response\nCRS Report R46219, Overview of U.S. Domestic Response to Coronavirus Disease 2019 (COVID-19), coordinated by Sarah A. Lister and Kavya Sekar. (Parts of this report have become outdated as the COVID-19 situation has evolved.)\nCRS Legal Sidebar LSB10415, COVID-19: Current Travel Restrictions and Quarantine Measures, by Edward C. Liu.\nCRS Report R46261, Development and Regulation of Domestic Diagnostic Testing for Novel Coronavirus (COVID-19): Frequently Asked Questions, by Amanda K. Sarata. \nCRS In Focus IF10745, Emergency Use Authorization and FDA\u2019s Related Authorities, by Agata Dabrowska.\nCRS Report R46239, Telehealth and Telemedicine: Frequently Asked Questions, by Victoria L. Elliott. \nCRS Insight IN11238, Coronavirus Disease 2019 (COVID-19) Poses Challenges for the U.S. Blood Supply, by Jared S. Sussman. \nRelated Issues\nCRS Insight IN11229, Stafford Act Assistance for Public Health Incidents, by Bruce R. Lindsay and Erica A. Lee.\nCRS Insight IN11231, The Defense Production Act (DPA) and COVID-19: Key Authorities and Policy Considerations, by Michael H. Cecire and Heidi M. Peters. \nFederal Agency Websites\nGeneral\nThe White House, https://www.whitehouse.gov/.\nUSA.gov, \u201cGovernment Response to Coronavirus, COVID-19,\u201d https://www.usa.gov/coronavirus.\nDepartment of Health and Human Services\nAdministration for Community Living (ACL): \u201cCoronavirus Disease 2019 (COVID-19),\u201d https://acl.gov/COVID-19.\nAssistant Secretary for Preparedness and Response (ASPR): \u201cCOVID-19: Coronavirus Disease 2019,\u201d https://www.phe.gov/emergency/events/COVID19/Pages/default.aspx.\nCenters for Disease Control and Prevention (CDC): \u201cCoronavirus Disease 2019 (COVID-19),\u201d https://www.cdc.gov/coronavirus/2019-ncov/index.html; and \u201cCDC Newsroom,\u201d https://www.cdc.gov/media/index.html.\nCenters for Medicare and Medicaid Services (CMS),. \u201cCurrent Emergencies,\u201d https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page; \u201cCoronavirus Disease 2019 (COVID-19).\u201d \nFood and Drug Administration (FDA): \u201cCoronavirus Disease 2019 (COVID-19),\u201d https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/coronavirus-disease-2019-covid-19.\nHealth Resources and Services Administration (HRSA): \u201cEmergency Preparedness and Recovery Resources for Health Centers,\u201d https://bphc.hrsa.gov/emergency-response.\nIndian Health Service (IHS), \u201cCOVID-19 Update as of March 16, 2020,\u201d https://www.ihs.gov/newsroom/announcements/2020-announcements/covid-19-update-as-of-march-16-2020/.\nNational Institutes of Health (NIH): \u201cCoronavirus Disease 2019 (COVID-19),\u201d https://www.nih.gov/health-information/coronavirus.\nOther Relevant Agencies\nDepartment of Homeland Security (DHS): \u201cCoronavirus (COVID-19)\u201d https://www.dhs.gov/coronavirus.\nDepartment of Veterans Affairs (VA), \u201cNovel Coronavirus Disease (COVID-19),\u201d https://www.publichealth.va.gov/n-coronavirus/.\nTransportation Security Administration (TSA), \u201cCoronavirus (COVID-19) information,\u201d https://www.tsa.gov/coronavirus.", "type": "CRS Insight", "typeId": "INSIGHTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/IN11253", "sha1": "83d367787755b8a9148e2ab961500ce58b8cf024", "filename": "files/20200318_IN11253_83d367787755b8a9148e2ab961500ce58b8cf024.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/IN11253", "sha1": "b1850c729a24c4434a36f72f0218574afa78f152", "filename": "files/20200318_IN11253_b1850c729a24c4434a36f72f0218574afa78f152.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4880, "name": "FDA Product Regulation & Medical Research" }, { "source": "IBCList", "id": 4882, "name": "Public Health Emergency Preparedness & Response" } ] } ], "topics": [ "Appropriations", "CRS Insights" ] }