CHHS is pleased to present an up-to-date spreadsheet, summarizing the actions of each of the 50 United States (and the District of Columbia) in response to the COVID-19 pandemic. The table will be updated as new information becomes available.
What we are tracking:
- Emergency declarations
- State-at-home orders
- School closures
- Closures of non-essential businesses
- Limitations on public gatherings
- Policy changes related to medical surge and treatment
- Policy changes to maintain the supply chain
- Public benefits
- Consumer protections
If you see any errors or omissions, please contact Maggie Davis at firstname.lastname@example.org
On Friday, March 20 President Donald Trump invoked the Defense Production Act to help increase production of much needed equipment to address the COVID-19 pandemic. The Defense Production Act of 1950 (“DPA”) was enacted to prepare and respond to “both domestic emergencies and international threats to national defense”1 by developing the capacity to procure essential equipment to addressing an emergency. Through the DPA, the President is authorized to prioritize certain existing contracts held by the government as well as allocate resources in a manner in which he deems “necessary or appropriate to promote the national defense.”2 In addition to prioritizing fulfillment of existing government contracts, the President is authorized to control general distribution of scarce materials in the civilian market if those materials are critical to the national defense. In addressing the COVID-19 pandemic, which continues to expand as hospitals face critical shortages of test kits and personal protective equipment (PPE), the DPA offers an additional tool for the federal government in increasing capacity.
The DPA provides the Trump Administration the following discrete powers to rapidly increase production of the test kits and personal protective equipment necessary to curb the COVID-19 pandemic:
- Prohibition on Hoarding Scare Materials
Last week, as many jurisdictions enacted policies implementing strict social distancing, many Americans stockpiled essential goods in preparation for the COVID-19 pandemic. In addition to essentials like toilet paper, some Americans have also purchased PPE that our healthcare system vitally needs. Sellers like Amazon have been selling out of N95 respirators, resulting in shortages at hospitals across the country and leading to healthcare workers operating in unsafe conditions on the frontline of the pandemic. Under the DPA, the President is authorized to ration some of these vital supplies, making it unlawful to stockpile designated goods beyond what is deemed reasonable for home consumption or business use. In other words, the President has the power to limit the amount of hand sanitizer, sterile gloves, or respirators purchased for personal benefit rather than the collective safety of our healthcare workers and first responders.
- Prioritization of Contracts
One of the main powers of the DPA authorizes the President to prioritize the fulfillment of government contracts by a vendor. For example, the federal government has existing contracts with large suppliers that provide goods ranging from personal protective equipment to administrative supplies. Under the DPA, the President can instruct the supplier to focus all production on the necessary PPE for addressing the pandemic.
- Loans to Enhance Production
In addition to prioritizing contracts, the DPA authorizes the President to guarantee loans to businesses in order to increase their production capabilities. This could include loans that hire more workers, purchase materials, or equipment to expedite or expand the production of necessary goods like N95 respirators, ventilators, and ventilator valves.
Additionally, the President is authorized to impose price controls on the scare goods necessary for addressing this pandemic with Congressional approval. Penalties for failing to comply with actions set out by the DPA could result in a $10,000 fine or up to one-year imprisonment.
The DPA is a vital tool to accelerate production of materials necessary for addressing the COVID-19 pandemic. As Dr. Bill Frist outlined Friday, the federal response over the weekend will be critical in addressing the PPE shortages our healthcare personnel face during the COVID-19 pandemic. However, there are inevitably lags between the measures to enhance production and providing the supplies to our hospitals and healthcare facilities in need. To ensure that our healthcare providers are appropriately protected, the rest of the population should follow the CDC guidance for their community and refrain from purchasing unnecessary PPE and consider donating PPE that they do not need to a local hospital that does.
By CHHS Extern Sharon Sidhu
President Trump declared a national emergency over the coronavirus COVID-19 pandemic on Friday afternoon, “unleash[ing] the full power of the federal government.”
This action, under the authority of the Stafford Act, opened up access to up to $50 billion for states, territories, and localities, to use towards the shared fight against the spread of COVID-19. The Stafford Act frees up federal funds when federal assistance is needed to supplement State and local efforts in providing emergency services for the protection of lives, public health and safety, or to contain the threat of a catastrophe in the United States.
The White House wrote a letter to the director of the FEMA, and the secretaries of the Department of Homeland Security, Department of Treasury and the Department of Health and Human Services outlining four major takeaways from the emergency declaration.
First, the letter states FEMA may take emergency protective measures and provide assistance under the authority of Sections 502 and 503 of the Stafford Act. Under Section 502, the President can direct any Federal agency to use its resources (including personnel, equipment, supplies, and facilities) “in support of State and local emergency assistance efforts to save lives, protect property and public health and safety, and lessen or avert the threat of a catastrophe, including precautionary evacuations.” This includes providing technical and advisory assistance to State and local governments for the performance of essential community services, issuance of warnings of risks or hazards, dissemination of public health and safety information, and management of immediate threats to public health and safety. Section 502 also prompts the federal government to assist State and local governments in the distribution of medicine, food and other consumable supplies, and emergency assistance. Section 503 limits the amount of federal assistance not to exceed $5 million for a single emergency, unless the President deems it necessary, which in the case of COVID-19, President Trump has.
Second, the letter encourages all State and local governments to activate their Emergency Operation Centers and to review their emergency preparedness plans. President Trump’s declaration also instructs hospitals nationwide to activate their emergency preparedness contingency plans in order to meet the needs of Americans who have and may have contracted COVID-19. President Trump also said the Health and Human Services Secretary Alex Azar will be able to “waive provisions of applicable laws and regulations to give doctors, all hospitals, and health care providers maximum flexibility to respond to the virus.” These waivers include waivers to access limits on numbers of beds and lengths of stays in hospitals, as well as waivers to rules on bringing in additional physicians at certain hospitals as needed.
Third, the letter instructs the Department of Treasury to provide relief from tax deadlines to Americans who have been adversely affected by the COVID-19 emergency, pursuant to 26 U.S.C. 7508(A)(a), which grants the Department of Treasury to postpone certain deadlines for those who have been affected by a federally declared disaster.
Finally, in his letter, President Trump encouraged all governors and tribal leaders to consider requesting Federal assistance under section 401(a) of the Stafford Act. Section 401(a). Section 401(a) requires requests for a declaration by the President that a major disaster exists to be made by the Governor of the affected State. The request needs to be based on the conclusion that the disaster “is of such severity and magnitude that effective response is beyond the capabilities of the State” such that Federal assistance is necessary. The President may grant the request of the Governor and declare that a major disaster or emergency exists, and thereafter direct federal funds to provide relief assistance, as well as assistance in the distribution of medicine, food, and emergency assistance to the states.
By CHHS Extern Emma Evans Eiden
Just one week after announcing Maryland’s first three cases of COVID-19, Maryland has identified its first community transmission case of the virus bringing the total number of COVID-19 cases to 12. A Prince George’s county resident, with no travel outside of the state, tested positive on Wednesday.
During a Thursday afternoon press conference, Governor Hogan announced major updates to Maryland’s COVID-19 response plan. MEMA is elevated to its highest activation level. The Governor issued an executive order to activate the National Guard. All nonessential state employees will enter telework duty, if eligible, and public access to state buildings will be restricted. Maryland prisons will be closed to all visitors. The Governor has also ordered all senior activity centers to close.
Governor Hogan also issued a state-wide prohibition on events and gatherings of over 250 people. All certifications and permit expiration dates, including for driver’s licenses, will be extended until after the state of emergency ends. Hospitals must implement new visitor policies, including a one visitor limit per patient, no minor visitors, and no visitors who have recently traveled internationally. The Governor urged that essential services, such as grocery stores and gas stations, should remain open.
State Superintendent of Schools, Dr. Karen Salmon, announced state-wide school closures beginning Monday, March 16 through Friday, March 27. Plans are in process to ensure that free-and-reduced meals will continue and to ensure childcare for essential emergency response personnel.
Maryland Department of Health Deputy Secretary Fran Phillips outlined three goals for what she described as these “extraordinary measures”: slow the spread of infection, protect vulnerable people, and maintain essential services. Dr. David Marcozzi of the University of Maryland Medical Center endorsed the Governor’s plan and recommended that similar measures for the private sector. Dr. Marcozzi also assured the public that the health system is prepared to handle care for all individuals requiring care.
MDH issued a letter to clinicians on Wednesday, March 11 urging patient evaluation via phone or other telemedicine platforms. Any patient with respiratory symptoms should immediately receive a facemask. COVID-19 testing is now available in commercial and hospital settings, and providers should direct samples to those sites whenever possible.
The MDH loading dock will remain open on Saturday and Sunday to accept COVID-19 test samples. MDH is no longer reporting the number of processed samples and negative results. Of the 12 positive cases, two patients remain hospitalized. Three patients have fully recovered and have passed the required quarantine window.
By CHHS Extern Emma Evans Eiden
Thursday night, Governor Larry Hogan announced three confirmed cases of COVID-19 in the State of Maryland. While residents are encouraged to continue their daily routines, including work and school, the Governor declared a state of emergency to mobilize funds and activate full coordination between the Maryland Department of Health (MDH), the Maryland Emergency Management Agency (MEMA), and other agencies. Also under the Governor’s emergency authority, on Friday the Maryland Insurance Commissioner was directed to eliminate all patient costs and pre-authorization requirements for COVID-19 testing.
The first three cases were identified in Montgomery County and were contracted on a cruise that returned on February 20, 2020. At the time the three individuals returned, only travelers who visited China were being screened for the virus. The patients developed flu-like symptoms and were contacted earlier this week after the CDC determined that the cruise was exposed to the corona virus. The patients are now under quarantine in their homes. Contact tracing continues to identify additional exposures.
After the Governor’s announcement, Montgomery County officials including County Executive Marc Elrich reiterated that there is currently no cause for panic, while urging reasonable precautions in the event that additional cases are found in the county. For example, residents should have enough food, medications, and other supplies to remain at home for up to two weeks. Montgomery County Public Schools remain open but the school system is prepared to deploy a modified digital curriculum in the event of closures.
Dr. Travis Gayles, Montgomery County Health Officer and Chief of Public Health Services, is responsible for determining if and when to close county buildings, including schools. Dr. Gayles explained that there is currently no evidence of community spread of the disease, and the existing travel related cases are clinically doing well which suggests a mild to moderate form of the virus.
In a Friday evening press conference, Governor Hogan announced that the three Maryland cases were contracted on an Egyptian cruise on the Nile River which is also linked to six cases in Texas. Two instances of public contact by the Maryland patients have been identified so far. One of the Maryland patients attended an event in Philadelphia, PA where contact was made with local students. Pennsylvania health officials were notified, and five schools in the Philadelphia suburbs closed as a result. Another Maryland patient attended an event at a retirement community, the Village at Rockville, with over 70 attendees on Saturday, February 29. Governor Hogan encouraged attendees of the Rockville event to contact the MEMA call center.
On Sunday, Governor Hogan’s office announced two additional positive results in the state, both were contracted during overseas travel. One of the new cases is located in Montgomery County, and the patient doing well at home after a brief hospitalization. The second case is located in Harford County, and the patient, who is over 80 years old, remains hospitalized. The hospitalized patient contracted the disease on travel to Turkey, and it is the first known case to come from that country. Officials believe the risk of community exposure remains low but are advising individuals over the age of 60 years old and those with compromised immune systems to stay home as much as possible because they are significantly more susceptible to COVID-19 and experience higher mortality rates.
During a Monday afternoon press conference, Governor Hogan announced that he had just signed into law emergency legislation, unanimously passed by the Maryland legislature, authorizing the use of $50,000,000 of Maryland’s “rainy day fund” for the COVID-19 response. State employees have been directed to cancel all out-of-state travel, and all state agencies are preparing to enter a period of mandatory telework.
Governor Hogan explained that there are six additional Marylanders under self-quarantine who were on the Nile River Egyptian cruise line during different dates from the initial three Maryland cases. Two of those individuals are exhibiting symptoms, but all six will be tested for COVID-19. Also, there are 12 Marylanders aboard the Grand Princess cruiseship, which is currently docked off the coast of California, who will be transferred to military bases for examination and quarantine but are not exhibiting symptoms.
On Monday evening, a sixth Marylander was confirmed positive for COVID-19. The patient contracted the disease during out of state travel and is now located in Prince George’s County.
Last Tuesday, March 3, a memo informed Maryland health officials and providers that the MDH Laboratory was authorized to perform the 2019-Novel Coronavirus Real-time RT-PCR Diagnostic Panel. Samples may be collected locally then transported to the MDH laboratory. A provider must consult with an MDH epidemiologist prior to collecting and submitting a sample. The sender is responsible for compliance with all requirements and regulations for packaging and shipping a potentially infectious sample; however, MDH may provide some transport and courier services. Training and certification is required to package potentially infectious materials, and the certification must be renewed through the CDC every two years.
Criteria for a person under investigation (PUI) for coronavirus include a combination of clinical and epidemiological factors. Currently there are three different criteria for PUIs:
- Fever OR respirator symptoms (not necessarily requiring hospitalization) AND contact with a person with a confirmed case of COVID-19;
- Fever AND respiratory symptoms requiring hospitalization AND travel to China, Iran, Italy, Japan or South Korea within 14 days of onset; or
- Fever AND respiratory symptoms requiring hospitalization with no alternative diagnosis AND no known source of exposure.
As of Monday, MDH has processed 73 patient samples, with 6 positive results.
Part IV of the CHHS Webinar Series on the CoVID 19 outbreak is below. CHHS Public Health Program Director Trudy Henson, Senior Law & Policy Analyst Christine Gentry, and Public Policy & External Affairs Program Director Ben Yelin provide updates on the outbreak, and discuss Continuity of Operations (COOP).
If your organization is interested in drafting or revising your Continuity of Operations (COOP) Plan, please check out our page: https://www.mdchhs.com/consulting/continuity-of-operations-coop-program/
Part III of the CHHS Webinar Series on the CoVID 19 outbreak is below. CHHS Public Health Program Director Trudy Henson, and Senior Law & Policy Analyst Christine Gentry discuss legal issues with quarantine and isolation.
CHHS Public Health Program Director Trudy Henson and Senior Law & Policy Analyst Hassan Sheikh discussed the ongoing issues related to the coronavirus, in Part II of the CHHS webinar series.
Watch the video here:
By CHHS Extern Benita David-Akoro
Over the last few weeks, the novel coronavirus known as 2019-nCoV has received significant media attention. 2019-nCoV is a coronavirus originating in Wuhan, China, but now with confirmed cases in at least twenty other countries. Yesterday, the World Health Organization announced it was declaring the 2019-nCoV outbreak a Public Health Emergency of International Concern, a declaration it declined to make just over a week ago. The decision to declare a PHEIC coincided with a sharp rise in cases and a spread of the virus to other countries; WHO’s director-general cited concerns with the virus’ spread into countries with less-robust healthcare systems as one reason for declaring a PHEIC.
Globally, there is need to take action: as of January 31, 2020, the Johns Hopkins 2019-nCoV surveillance tracker reports 9,976 confirmed cases with an estimated 213 fatalities since it was first detected in December 2019. These numbers now surpass the November 2002 to July 2003 outbreak of SARs. In that outbreak, public health officials reported 8,098 infections of SARS globally, with 774 SARS-related deaths.
Public health officials worldwide agree that swift and effective measures are necessary to curtail the spread of the virus. Countries with reported cases of infections have taken various steps – from investigation to screening, quarantine and risk communication. In the US, the CDC is taking measures to ensure the early and immediate detection of the virus, including issuing a level 3 travel warning for China—recommending that travelers avoid all nonessential travel to China—and implementing public health entry screenings at 20 airports and land crossings.
Many affected countries, including the United States, have learned significant lessons from previous outbreaks and have robust public health preparedness & response plans at the ready. Currently, the U.S. has identified 6 cases, five of which were acquired outside of the U.S., and one which was transmitted from an infected patient to their spouse. Elsewhere, countries have taken sweeping measures to control the virus’ spread: Chinese authorities have declared a quarantine in Wuhan, a city of 11 million people, and imposed travel restrictions in other smaller cities in the province. Russia has closed its border with China; and some airlines have suspended flights into the country.
Certainly, the 2019-nCoV outbreak has already affected travel, economic activity, and global markets. Perhaps of more concern are the shortages of medical supplies, such as surgical masks, gloves, and disinfectants, as well as food and other household supplies. While some preparation is important, panic can lead to unintended consequences: as seen during the 2014 Ebola outbreak, surge in demand of personal protective equipment by the general public and even officials purchasing resources in preparation, can create shortages for responders and healthcare providers caring for patients in the affected areas. Additionally, misinformation about the effectiveness of prevention methods, such as disposable surgical facemasks, may lead to underutilization of more effective prevention methods, such as hand washing.
The spread of the 2019-nCoV is certainly cause for concern in a novel virus outbreak, and precautions and planning are essential to curtail the virus’ spread. Many U.S. health officials, however, are reminding people that domestically, seasonal influenza currently remains a much bigger concern, which, comparatively, kills 650,000 people worldwide every year, and in the U.S. alone this season, is responsible for 8,000 deaths. And, of course, it’s an important reminder that as you go about your day, whether you are looking at potential policies and plans for implementation if the 2019-nCoV spreads to your jurisdiction, or whether you are going about your regular day: washing your hands remains the best way to prevent the spread of viruses—whether it be the flu, or the novel coronavirus.