COVID-19 Update
May 21, 2020

IowaBio wants to provide our members useful information during the COVID-19 public health emergency. This newsletter compiles information on state, federal and industry action to combat the virus and its impacts.

If your company is helping respond to COVID-19, IowaBio wants to know about it. Please, send any information about what your biotechnology company or organization is doing to help, to Jessica Hyland at Jessica@iowabio.org.

If IowaBio can assist you in getting information out, connecting with public officials, or support your company in another way, please do not hesitate to reach out.

Past IowaBio COVID-19 Update newsletters are now available at www.iowabio.org/COVID19 and can be found under the Industry News tab on the IowaBio website.

Iowa Update

Governor Reynolds will hold a press conference today from the State Emergency Operations Center (SEOC) in Johnston, IA at 11:00 a.m. to provide an update to the state of Iowa on COVID-19. That press conference will be livestreamed and posted in full on Governor Reynolds’ Facebook Page

Currently, IDPH has reported on the state’s coronavirus dashboard, 15,890 Iowans have tested positive, up 389 from our update yesterday morning, with a total of 114,152 Iowans tested.  20 more deaths were reported since our update yesterday, bringing the total to 400 deaths.  Now 8,471 Iowans have recovered. The latest on hospitalizations, including how many patients have been admitted in the last 24 hours can be found here.

Yesterday at her press conference Governor Reynolds announced the lifting of additional restrictions allowing businesses to reopen. Effective Friday, zoos, museums, aquariums, and swimming pools will reopen for lap swimming and swimming lessons. May 28 bars can reopen for indoor or outdoor seating at 50 percent capacity. Summer school activities can also resume June 1, she announced. All businesses must implement appropriate public health measures. Casinos are not included in the reopening, yet. They will be working with casinos to develop guidance for reopening. Amusement parks are also not included. Her full proclamation can be found here.

DNR Director Kaylan Lyon announced Iowa State Park campgrounds will be open for all campers starting May 22. Only six overnight campers in a group will be allowed unless the family has more than six members. Youth group campgrounds and visitors centers will be closed. The most up-to-date information on each park is on the DNR website, she said.

Governor Reynolds touted testing and additional information gathered by the state—testing over 60,000 Iowans since May 1. Full capacity will be 5,000 tests a day through Test Iowa. 1 in 29 Iowans have been tested. She said their ability to target the virus down to a zip code will allow targeted reaction to the virus. She said they are seeing great trends in the data on the virus.

Federal Legislation
Supplemental IV – The Heroes Act (HR 6800)

Timeline/Process/Politics: Senate Republicans have continued to publicly assert that Congress should continue to wait before passing another bill. However, Leader McConnell’s staff has acknowledged Senate Republicans’ increasing interest and urgency in considering another package in the coming weeks. The timeline may compact as Senate Republicans get more nervous about electoral possibilities and McConnell faces pressure from more vulnerable members of his caucus. Additionally, the impetus of negotiations may be a climbing unemployment rate and a White House that wants to win reelection – when the Senate returns in the beginning of June, McConnell may be facing a whole batch of dismal economic statistics.

Just because Republicans are warming to the idea of beginning negotiations does mean Congress is anywhere close to passing a bill. Democrats and Republicans remain far apart on most of the larger items like liability protections, unemployment insurance, and state and local government funding.
 
Policy: The Heroes Act passed the House last Friday, May 15, but Leader McConnell has indicated that they won’t be considering the bill as a base for negotiations. The bill nonetheless outlines Democratic priorities (to a certain extent). Heroes Act text (as of 5/12/2020) here. Section by section here. One pager here. State and Local one pager here. NCAI’s summary on tribal provisions here. Manager’s amendment here. House Rules Committee report here.

Republicans are continuing to refine the contours of the liability protection issue. Sen. Cornyn’s staff has indicated that a draft will be released in 2-3 weeks and that conversations with outside groups are continuing. Discussion have only begun at the staff level. As for jurisdiction, there is some overlap between the Senate Judiciary Committee (SJC) and the Health, Education, Labor, and Pensions (HELP) Committee. Leader McConnell likely wants to get his caucus completely onboard before moving forward. Interestingly, during the President’s lunch with the Senate GOP caucus Tuesday, the President did not mention anything about liability protections.
 
There is a split among Democrats on a willingness to engage on the issue. There continues to be active conversations within the moderate wing of the party on what a reasonable proposal might look like. House leadership has been having quiet conversations with members, previewing that there be a requirement to compromise on the issue. Members of the Blue Dog Coalition have been having informal calls discussing what reasonable liability protection provisions might look like. New Dem Chair Derek Kilmer has pointed out that while the first package had liability protections for medical equipment, the caucus calls concerning the provision were divisive.

As a refresher, see below for highlights the liability plan the U.S. Chamber of Commerce is pushing.

• Safe-harbor from certain health privacy requirements to allow reopening/contact tracing;
• Protection from anti-discrimination rules, as employers may use age or underlying health conditions to make reopening decisions;
• Clarify scope of OSHA requirements on providing PPE to all employees;
• Safe-harbor for temporary workplace policy changes, limit application of the WARN Act;
• Protection against exposure claims (i.e. if a customer/employee is exposed to COVID-19 at business facility and as a result of the business’s action (or lack of), the individual becomes sick);
• Expansion of products covered under the PREP Act for product liability purposes;
• Expand CARES Act medical liability to all healthcare providers/facilities;
• Automatic stay of securities litigation related to COVID-19 pandemic until  the President’s public emergency declaration is rescinded;
• MOU between DOJ and SBA on hold harmless language for financial services providers helping to distribute PPP loans.

Legislation to Watch
The House plans to bring members back every two weeks and continue oversight of the administration. What’s considered on the floor, as indicated by what’s scheduled for next week, is pairing COVID-19-related bills with non-COVID-related must-pass legislation (NDAA, appropriations etc.). Look for COVID-19-related bills to be led by Democratic frontliners and be bipartisan, as Speaker Pelosi will be looking to give them wins going into the November election.
 
Next week when the House is back in session, it will vote on the Senate-passed FISA bill (H.R.6172) and possibly the Paycheck Protection Flexibility Act (H.R. 6886). The bill is led by Reps. Dean Phillips (D-MN) and Chip Roy (R-TX) and would modify sections of the Paycheck Protection Program. See below for highlights of the bill. Press release here.

• Allow loan forgiveness for expenses beyond the 8-week covered period.  
• Remove the limitation that restricts non-payroll expenses (rent, utilities) to 25% of the loan. 
• Eliminate limitations that restrict loan terms to 2 years. 
• Allow businesses that take PPP loans to be eligible for payroll tax deferment.  
• Extend the rehiring deadline to align with the enhanced Unemployment Insurance to offset its effects. 

Passed Legislation
New Implementation Information and Guidance

• 5/20 – In reviewing the PPP loan forgiveness application, our team has found some information that may prove useful to organizations receiving PPP loans. Information below:
  • In determining the forgiveness amount, the SBA will forgive the LESSER of three things:
    • The total of the following:
      • Payroll costs incurred or paid during the Covered Period or Alternative Payroll Covered Period PLUS
      • Amount of mortgage interest payments paid during Covered Period on real or personal property on an obligation incurred prior to 2/15/20 PLUS
      • Amount of business rent or lease payments for real or personal property paid during covered period pursuant to agreements in place prior to 2/15/20 PLUS
      • Amount of business utility payments paid during the covered period for business utilities for which service began before 2/15/20 MINUS
      • Any salary/hourly wage reduction amount required (this calculation is spelled out in the application) MULTIPLIED BY
      • FTE Reduction quotient (this calculation is spelled out in the application).
    • The PPP loan amount.
    • Total Payroll costs divided by 0.75.
  • The covered period begins on the date the loan proceeds are disbursed to the borrower.
  • In some portion of the loan forgiveness calculation, the application requires the borrower to use the Covered Period. In other portions of the loan forgiveness calculation, certain borrowers can choose the Covered Period of the Alternative Payroll Covered Period. Those borrowers with a biweekly (or more frequent) payroll schedule can elect to calculate eligible payroll costs using the 8-week period that begins on the first day of their first pay period following the PPP loan disbursement date. Those borrowers who choose the Alternative Payroll Covered Period for payroll calculation MUST apply the Alternative Payroll Covered Period whenever there is a reference to that or Covered Period – i.e., they must apply it consistently throughout the loan forgiveness calculation.
• 5/20 – Tribes have begun to receive instructions for responding to Treasury’s second data request last night. An email from Treasury should have gone to whomever at the Tribe submitted Treasury’s first data request. The portal closes at 11:59 p.m. Alaskan time on Tuesday, May 26.
• 5/20 – HHS announced that the Health Resources and Services Administration (HRSA) has provided $225 million to Rural Health Clinics (RHCs) for COVID-19 testing. The funding came from COVID 3.5 (formally titled “Paycheck Protection Program and Health Care Enhancement Act”). Press release here.
• 5/18 – The Department of Housing and Urban Development (HUD) announced nearly $77 million in a fourth wave of CARES Act funding, supporting up to 8,300 additional vouchers. Provided through HUD's Section 811 Mainstream Housing Choice Voucher Program, this wave of relief funds will provide affordable housing to non-elderly people living with disabilities. Press release here.
• 5/16 – SBA released updated information on PPP and EIDL loans from both CARES and COVID 3.5 rounds of lending. EIDL COVID-19 Loan data here. PPP Data here.

 
Previously Reported Implementation Information and Guidance
Small Business Loans & Treasury Main Street Lending

• 5/15 – Treasury released the loan forgiveness application for businesses that have received loans under the Paycheck Protection Program. Application here.
• 5/11 – SBA released updated PPP statistics, including recent state by state information here.
• 5/8 – SBA’s Inspector General released a report on the implementation of the Paycheck Protection Program. The report found the Administration’s administration of the program did not align with the law in four ways: prioritization of underserved/rural markets, loan proceeds eligibility for forgiveness, guidance on loan deferment, and registration of loans. Report here.
• 5/7 -- The Washington Post reported that the SBA has imposed a new loan limit on the department’s Economic Injury Disaster Loans (EIDL), moving the loan limit from $2 million to $150,000. The department also announced that it would only be accepting applications from agricultural businesses onward.
• 5/6 – Treasury released an updated FAQ for the Paycheck Protection Program. FAQ here.
• 5/3 – Treasury and SBA released a data set for the most recent tranche of P3 funds. Data here.
• 4/30 – The IRS issued guidance that most expenses funded by forgiven Paycheck Protection Program (PPP) loans are non-deductible for federal income tax purposes.
• 4/30 – The Federal Reserve released the term sheets and other information relating to its expansion of scope and eligibility of the Main Street Lending Program. Term sheets and other information here. Other information on other facilities and programs here.
• 4/29 – SBA announced that from 4:00-11:49pm on 4/29, SBA systems would only accept loans from lending institutions with asset sizes less than $1 billion dollars. The move was aimed at ensuring access to the PPP loan program for smaller lenders and their customers.
• 4/28 – SBA announced it would no longer accept PPP loan applications submitted by robotic processing systems.
• Treasury released an interim final rule for the Paycheck Protection Program on how lenders will calculate loan amounts for employers with seasonal employees. Rule here.
• 4/24 – SBA issued a procedural guidance on participation sales here.
• 4/24 – SBA released an interim final rule on requirements for Promissory Notes, Authorizations, Affiliation, and Eligibility. Interim Final Rule here. Additional eligibility criteria and requirements for certain loans here.
• 4/24 – Data on Economic Injury Disaster Loans here, EIDL Advance here.
• 4/23 – The Treasury Department asked all publicly traded companies that received funds under the program to return the funds within two weeks.
• The Treasury Department released an interim final rule on the small business provisions in the bill. See here for a memo Cornerstone put together on the interim final rule.
• Treasury FAQs on the Paycheck Protection Program
  • Top-line overview of the program here
  • Lender information here, Borrower information here, borrower application here

State, Local, and Tribal Government Funding

• 5/15 – In a court document filed Friday, Treasury indicated that it will open a portal this week for tribes to submit information outlined in last week’s data request. Tribes will have five business days to submit the data (expected submission deadline is May 26). Treasury expects to process the data and determine allocations within a week of the submission deadline (by June 4). Treasury will disburse payments one business day after Treasury has finished computing amounts. In a call today, Treasury indicated that they will hold back funding for Alaskan Native Corporations (ANCs). Treasury also explained that the data request for employees should include both government employees and tribal-entity employees, while the expenditure data should only include government expenditures.
• 5/14 – Treasury issued a data request to disburse the second round of funding for tribes in the Coronavirus Relief Fund. The data request includes information on employees and expenditures. Portal will likely open sometime next week. More information here.
• 5/12 – Treasury released its list of payments to states and qualifying localities for the Coronavirus Relief Fund. List here.
• 5/8 – Treasury still has a remaining $3.2 billion to distribute among tribes and plans plans to submit a new data request soon, with a portal open soon after. The next round of funding will be based on employment and expenditure data of Tribes and tribally-owned entities.
• 5/5 – Treasury released distribution details regarding the tribal portion of the Coronavirus Release Fund. The first 60% of the fund will be distributed to tribes based on population used in the Indian Housing Block Grant (IHBG) and will include a floor of $100,000. The remaining 40% will be distributed based on the number of individuals employed by the Tribe, including employees of tribally owned entities. Treasury still needs to collect and verify employment data before distributing the second round of funding. Amounts for ANCs will not be distributed, as litigation is still pending. Press release here. Details here.
  • More than a dozen tribes have sued the Treasury Department over its guidance identifying Alaska Native Corporations (ANCs) as eligible entities for the fund. Last Wednesday, Secretary Mnuchin said that the department would not be releasing funding until Tuesday, April 28 – two days after the deadline outlined in the CARES Act. The court on Monday preliminarily enjoined Treasury from disbursing funds to ANCs.
• 5/5 – Treasury released an updated FAQ regarding distribution of CARES Act state/local funds. FAQ here.
• 4/27 – USDA announced that Kansas and Virginia have been approved to operate Pandemic Electronic Benefit Transfer (EBT), authorized by the Families First Coronavirus Response Act (FFCRA), which provides assistance to families of children eligible for free or reduced-price meals dealing with school closures.
• 4/22 – Treasury issued guidance on the state/local/tribal governments fund here. The guidance further defines what expenses qualify as “necessary expenditures” and provides examples as well as examples of ineligible expenses.
• 4/13 – Treasury launched its web portal for payments to state, local, and tribal governments. Treasury announced that eligible government entities must provide required information by Friday, April 17 to receive payment within the 30-day window allowed under CARES and those that miss that deadline may not receive funding. Submission page here. Some highlights from the announcement below:
  • Funds are only allowed to be used for expenses which
    • Are necessary expenses during the coronavirus emergency,
    • Were not accounted in the most recent budget (as of March 27, 2020), and
    • Were incurred between 3/1/2020 – 12/30/2020.
  • Eligible local governments are those below the state level (county, municipality etc.) with a population higher than 500,000. See here for data sources and the distribution methodology.  See here for a list of eligible local government units.
  • Amounts paid to governments will be based on population and the amounts allocated to states will be reduced by the total amount provided to local governments in the state. 

Oversight

• 5/18 – The Congressional Oversight Commission (COC) issued its first report. The Commission was created by the CARES Act to conduct oversight of the Treasury Department and the Federal Reserve’s implementation of Division A , Title IV , Subtitle A of the CARES Act, which provided $500 billion for Treasury and the Federal Reserve for loans and loan guarantees to the airline industry, businesses critical to national security, and medium-sized businesses through lending facilities. Report here. Cover letter here.
• 5/7 – The remaining members of the House Select Committee on Coronavirus Crisis were named. Minority Whip Scalise’s priorities for the committee here. Full Committee membership below:
  • Chair Jim Clyburn (D-SC) – Chair
  • Maxine Waters (D-CA)
  • Carolyn Maloney (D-NY)
  • Nydia Velázquez (D-NY)
  • Bill Foster (D-IL)
  • Jamie Raskin (D-MD)
  • Andy Kim (D-NJ)
  • Steve Scalise (R-LA) – Ranking Member
  • Rep. Jim Jordan (R-OH)
  • Rep Blaine Luetkemeyer (R-MO)
  • Rep. Jackie Walorski (R-IN)
  • Rep. Mark Green (R-TN)
• 4/29 – Speaker Pelosi announced the Democratic members of the House Select Committee on the Coronavirus Crisis, to be chaired by Majority Whip Jim Clyburn.

Public Health Systems, Education, and Healthcare

• 5/13 – HRSA announced the winners of $15 million in telehealth grants that were authorized through the CARES Act. Press release here. Awards here.
• 5/1 – As part of the $100 billion dedicated to hospitals and health providers in CARES, HHS is distributing funding to “hotspot” hospitals and providers. HHS will be distributing $12 billion to 395 hospitals who provided inpatient care for 100 or more COVID-19 patients through April 10, 2020. $2 billion of the funding will be distributed based on low-income/uninsured data (Medicare and Medicaid disproportionate share and uncompensated care payments).
• 4/27 – Outline of the Provider Relief Fund with additions from COVID 3.5 here.
• 4/27 – Education Sec. Betsy DeVos announced that more than $300 million in discretionary grant funds will be available for states to use to create adaptable, innovative learning opportunities for K-12 and postsecondary learners in response to COVID-19. The grants will be funded through the Education Stabilization Fund (ESF), authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
• 4/26 – CMS announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program (AAP) and suspending its Advance Payment Program to Part B suppliers effective immediately. Press release here.
  • The announcement came as a surprise to Democrats, who were actively negotiating with the department officials on modifying the program.
• 4/23 – As part of negotiations on 3.5, the Administration made commitments on how the next $60 billion in the health relief fund will be distributed. HHS has committed that it will send out an additional $60 billion dollars in the coming weeks, much of it coming within the next 10 days.
• 4/23 – As part of negotiations on 3.5, the Administration made commitments on changes to Medicare advance payment policies. The administration committed that, by the end of this week, Secretary Mnuchin and Chief of Staff Meadows will release a letter stating that they will:
  • Use their administrative authority to reduce the interest rate down from what is currently 10.25 percent to a rate that is more in line with a traditional federal interest rate.
  • Use their administrative authority to extend the repayment period beyond 12 months.
  • Work with Congress and support legislation in Corona 4 that will place the liability for these payments in Treasury’s General Revenue fund, rather than the Medicare Hospital Insurance and Supplemental Medical Insurance Trust Funds. The expansion of these programs must not adversely affect Medicare’s solvency or result in premium increases for seniors.
• 4/22 – CARES Act Provider Relief Fund overview here. State by state breakdown of first payment here.
• 4/9 – Secretary DeVos indicated that she would be moving to "immediately distribute" the $6 billion in CARES for emergency financial aid grants to college students. The grants can be used by college students for technology, course materials, food, housing, and healthcare. DeVos distributed the funding to colleges, which are meant to then distribute the aid among students. See here for the specific allocations for each college.

Individual and Business Tax Relief

• IRS guidance on deferral of payroll taxes here
• House Ways and Means factsheet on Economic Impact Rebate portal here
• IRS’s FAQ page on individual economic relief here
• Treasury Guidance on Employee Retention Tax Credit here
• Treasury FAQ on Employee Retention Tax Credit here (updated 4/29)

Economic Stabilization

• 4/30 – Transportation Secretary Elaine Chao announced the FAA will begin awarding the AIP and other discretionary grants funding through the CARES Act. Press release here. Complete list of grants here. Map of airports receiving funding here.
• 4/10 – Treasury Q&A on Loans to Air Carriers and Eligible Businesses and National Security Businesses here. Loan application here.
• 3/30 – The Treasury Department released guidance on payroll support to airline industry employees, and on loans to the airline industry and businesses critical to national security. Guidance for payroll support here. Guidance on procedures and minimum requirements for loans here. Treasury press release here.

Supplemental 3.5 – Interim Emergency Coronavirus Relief, formally titled “Paycheck Protection Program and Health Care Enhancement Act” (HR 266)
The President signed the bill into law on April 24. Text here. Section by section here. Summary of hospital and testing provisions here. DPCC one pager here. Senate Democrats summary of health provisions. Overview of commitments regarding health funding and Medicare advance payments the Administration made as part of negotiations.
 
Supplemental III – Coronavirus Aid, Relief, and Economic Security (CARES) Act
After a unanimous vote by the Senate, the House passed the bill on March 27 and the President signed the bill into law shortly after. Final text here. Democratic summary here. Republican section by section here.
 
Supplemental II – Families First Coronavirus Response Act (HR 6201)
The Senate passed the House bill on March 18 and the President signed the bill into law that evening. Bill text here. Factsheet here. Bill section by section here. A summary of paid leave provisions, incorporating changes made by technical correction, is here.
 
Supplemental I – Coronavirus Supplemental
Signed by the President March 6. Text here, summary here.
 
Congress
Hearings/Floor Activity: The House plans to bring members back every two weeks and continue oversight of the administration. What’s considered on the floor will likely be a pairing of COVID-19-related bills with non-COVID-related must-pass legislation (NDAA, appropriations etc.). Look for COVID-19-related bills to be led by Democratic front liners and be bipartisan, as Speaker Pelosi will be looking to give them wins going into the November election.
 
Next week the House will be back May 27 and 28 to vote on the FISA bill through proxy voting. After May 28, House Members will receive 72 hours’ notice to return to D.C. for additional votes.
 
Appropriations: HAC is still a couple of weeks away from formulating a real markup schedule. If that’s the case, we’re not likely to see markups commence until mid-to-late June at best. It will take some time to develop and implement committee guidance and procedures for the new remote latitude afforded through the House Rules change. The plan remains to move through COVID Phase 4 before turning to FY21. We still expect a rapid-fire markup process. The hope is that all 12 subcommittees can go through subcommittee markups over the course of a week – whenever the markups begin – with most of the full committee markups in the following week. HAC-D will likely go in the middle of the pack, largely due to the fact they still need to work on the classified annex which hasn’t been addressed yet as staff cannot work in classified spaces.
 
The FY21 Senate Appropriations schedule has slipped indefinitely, and the staff are no longer saying bills will be marked up prior to July 4th recess. Chairman Shelby has publicly said that the Homeland Security and the MilCon-VA spending bills are unlikely to move forward due to political disagreements over funding for the border wall. The Defense bill is unlikely to go through the formal markup process and may post a Chairman’s recommendation and explanatory statement online as was done in FY18. Last week, Leader McConnell and Chairman Shelby announced that they had reached an agreement to exempt VA health programs from the budget caps by designating it as emergency spending. This would save $11-$12 billion on the non-defense discretionary side and increase the odds of producing bipartisan bills. Another plan would be to agree to a budget cap adjustment similar to the Overseas Contingency Operations (OCO). If appropriators cannot reach an agreement, domestic subcommittees will be significantly hurt as it will go toward non-defense discretionary spending. There is still no agreement on subcommittee allocations for the 12 spending bills.
 
NDAA: HASC and SASC are finalizing their bills. Both HASC and SASC are looking to markup NDAA 2021 the week of June 8, with the goal to have a bill to floor before the 4th of July recess. SASC plans to markup June 8-10 and HASC plans to markup June 10-12. Dates could still slip based on the availability of floor time. SASC is finishing the Subcommittee Chair and Ranking Members briefings on their bill sections. Next week will be a final review of the bill then printing the markup books the first week of June.
 
Remote voting/virtual protocols: Last week, the House passed the McGovern-Lofgren resolution (H.Res 965) to allow proxy voting and remote hearings and markups. The House passed the bill by a party line vote (217-189). House Republicans have not been enthusiastic about the prospect of remote markups and Floor action. The Senate has not moved forward with any proxy voting or remote procedures.
 
Members of Congress in Quarantine or Treatment (new additions in bold)

Tested Positive (0):

Currently Self-Quarantined (1): Sen. Lamar Alexander (R-TN)

Recovered (7): Sen. Rand Paul (R-KY), Rep. Joe Cunningham (D-SC), Rep. Ben McAdams (D-UT), Rep. Mario Diaz-Balart (R-FL), Rep. Mike Kelly (R-PA), Rep. Nydia Velazquez (D-NY), Rep. Neal Dunn (R-FL)

Completed Quarantine (37): Sen. Ted Cruz (R-TX), Rep. Mark Meadows (R-NC), Sen. Lindsay Graham (R-SC), Rep. Don Beyer (D-VA), Rep. Sharice Davids (D-KS), Rep. Doug Collins (R-GA), Rep. Paul Gosar (R-AZ), Sen. Cory Gardner (R-CO), Sen. Rick Scott (R-FL), Rep. Matt Gaetz (R-FL), Rep. Jason Crow (D-CO), Rep. Julia Brownley (D-CA), Rep. Ben Ray Luján (D-NM), Rep. Gwen Moore (D-WI), Rep. Stephanie Murphy (D-FL), Rep. John Yarmuth (D-KY), Rep. Adam Schiff (D-CA), Rep. Vincente Gonzalez (D-TX), Rep. Drew Ferguson (R-GA), Rep. David Schweikert (R-AZ), Rep. Anthony Brindisi (D-NY), Rep. David Price (D-NC), Rep. Ann Wagner (R-MO), Rep. Kathleen Rice (D-NY), Rep. Matt Cartwright (D-PA), Rep. Tom Cole (R-OK), Rep. Steve Scalise (R-LA), Rep. Frederica Wilson (D-FL), Rep. Andy Kim (D-NJ), Rep. Kendra Horn (D-OK), Sen. Mike Lee (R-UT), Sen. Mitt Romney (R-UT), Rep. Katie Porter (D-CA), Rep. Seth Moulton (D-MA), Rep. Lizzie Fletcher (D-TX), Rep. Josh Gottheimer (D-NJ), Rep. Ayanna Pressley (D-MA), Rep. Mikie Sherrill (D-NJ)

Other Federal Actions

• Through HRSA, HHS provided $225 million to Rural Health Clinics (RHCs) for COVID-19 testing.  These investments will support over 4,500 RHCs across the country to support COVID-19 testing efforts and expand access to testing in rural communities. RHCs are a special designation given to health care practices in underserved rural areas by CMS that help ensure access to care for rural residents. The funding is from the Paycheck Protection Program and Health Care Enhancement Act that was signed into law last month. A state-by-state breakdown of the funding is available here. 
• Agriculture Sec. Sonny Perdue announced today that households in 13 new states – Connecticut, Georgia, Illinois, Indiana, Maryland, Massachusetts, Michigan, New Jersey, Ohio, Oklahoma, Pennsylvania, Tennessee, and Virginia – will soon be able to purchase food online with their SNAP benefits. Once operational, online purchasing will be available in 36 states and D.C., home to more than 90 percent of SNAP participants. Sec. Perdue also announced an expansion of independently owned and operated retail stores beyond those included in the original pilot. Soon, more SNAP authorized retailers, under multiple store banners, will be accepting SNAP benefits online.
• The GAO published a new Science & Tech Spotlight article focused on COVID-19 testing. 
• Responding to the Senate Finance Committee, the GAO submitted a report on infection control in nursing homes. The study concluded that infection control deficiencies were widespread and persistent in nursing homes prior to the COVID-19 pandemic.
• CDC is hosting live stakeholder calls to help communities plan for, respond to, and recover from the COVID-19 pandemic:
  • Workplaces and Mass Transit: May 21st (tomorrow), 4 PM
• The CDC continues to update and publish new COVID-19 documents to its dashboard. Today, the CDC published updated information about communities, schools, workplaces, and events, wrote new recommendations for talking to kids about COVID-19, added helpful updates to the staffing resources page, and posted revisions to the information for pediatric health care providers (among other resources).  
• Several Presidential proclamations established restrictions on the entry of certain travelers into the U.S. in an effort to help slow the spread of COVID-19. Per the CDC, foreign nationals who have been in any of these countries during the past 14 days may not enter the U.S.
• There is one remaining COVID-19 hearing slated to take place in Congress this week, after the House Appropriations VA hearing was postponed. Memos will be available upon request:
  • Tomorrow (5/21) 9:30 AM – Senate Aging Hearing: "Caring for seniors amid the COVID-19 crisis" 

Updates from the States

• Out of the cases under investigation detected by U.S. surveillance, there are 1,528,235 total cases and 91,664 deaths The CDC data closes out the day before reporting. 
• At this point, all 50 states have started to reopen in some capacity. 
• California Gov. Gavin Newsom’s (D) Task Force on Business and Jobs Recovery sent a letter to congressional leaders asking them to pass $1 trillion in direct relief for state and local governments. The letter, signed by 91 California leaders, outlines the budgetary challenges facing state, local, and tribal governments caused by the COVID-19 pandemic. 
  • Gov. Newsom also signed an EO waiving the deadline to verify grade point average and waive certain certification requirements and selective service registration verification for Cal Grant applicants.
• Kansas Gov. Laura Kelly (D) signed an EO moving Kansas into Phase 2 of “Ad Astra: A Plan to Reopen Kansas.” Phase 2, effective this Friday, will be modified to include data-driven restrictions necessary to prevent community transmission of COVID-19.
• Kentucky Gov. Andy Beshear (D) announced that the state’s Healthy at Work website now includes guidance for barbershops, cosmetology, hair salons, tanning salons, and tattoo parlors. The state also will be expanding June 1st reopening guidance to include aquatic centers (excluding public pools), fishing tournaments, and auto/dirt track racing. June 8th marks the projected return for museums, outdoor attractions, aquariums, libraries, and distilleries. June 11th will bring back the Kentucky Horse Park, Kentucky State Park campgrounds, and Otter Creek.
• Maine Gov. Janet Mills (D) announced today the following updates to her administration’s plan to restart Maine’s economy: 1) Maine residents may enjoy campgrounds beginning Memorial Day weekend; and 2) the Administration is delaying the full reopening of gyms, fitness centers, and nail salons in light of emerging research and experiences in other states of COVID-19 transmission related to these establishments.
• Montana Gov. Steve Bullock (D) announced the state will move to Phase Two of the Reopening the Big Sky plan and will lift the 14-day out-of-state travel quarantine beginning June 1st. 
• South Carolina Governor Henry McMaster (R) announced that attraction facilities will be permitted to open throughout the state beginning this Friday. The governor’s announcement comes after AccelerateSC has been meeting for nearly a month to determine the safest ways to reinvigorate the state’s economy.
• Ohio Gov. Mike DeWine (R) said Ohio National Guard units will be deployed to nursing homes across the state as the death toll continues to rise among long-term care residents.
• Useful state data:
  • The NYT is tracking which states are reopening and which are still shut down.
  • These charts show cumulative coronavirus cases and deaths for metropolitan areas over time.
  • Use Johns Hopkins University’s COVID-19 U.S. map as a resource for media, policymakers, and communities to view a collection of critical public health data in one online destination and better understand and track the COVID-19 pandemic in populations both large and small across the country.
  • NASHP has developed a COVID-19 State Action Center which serves as a state-level policy dashboard. Governing is also keeping a running tally of coronavirus news and impacts at the intersection of the health and economic crises in the states and localities.
  • This site from the Kaiser Family Foundation provides state-level information on cases/deaths, social distancing measures, health policy actions, and more.
  • This resource from Bloomberg Law is a database of State Quarantine and Public Health Laws related to the COVID-19 response.
  • This series of maps shows how states are responding to COVID-19, and this tracker, created and maintained by MultiState Associates, has an up-to-date list of executive orders and various travel restrictions.
  • Finally, this site offers COVID-19 projections assuming full social distancing and can be broken down by state.

International Affairs

• The WHO reported 106,000 cases in the last 24 hours – the most in a single day since the beginning of the pandemic. Nearly two-thirds of the cases are associated with just four countries.
• In Santiago, Chile, protesters gathered to call attention to a lack of food and government aid during the recently implemented COVID-19 "lockdown" in Chile’s capital city. Following the protest, Chilean President Sebastián Piñera reportedly committed to increasing aid to the affected population, with a focus on supporting the most vulnerable.
• Brazil’s Minister of Health, Nelson Teich, resigned from his position after only several weeks in office. Dr. Teich and his predecessor were reportedly pressured by Brazilian President Jair Bolsonaro to promote the use of hydroxychloroquine and to work with the state governors to lift social distancing restrictions, which may have contributed to their respective decisions to resign.
• Health officials in Jilin Province, China, have implemented “lockdown” measures, reminiscent of those implemented in Wuhan, following a recent cluster of COVID-19 cases that began on May 7th. The new measures may potentially affect approximately 1.5 million residents. Additionally, medical response teams have been deployed from other cities in Jilin Province to support the response, and several hospitals have been designated to treat COVID-19 patients.
• Mexico City's government acknowledged that its COVID-19 death toll is higher than federal data show, and it has named a special commission to review all fatalities in the capital connected to the virus. Mexico's data only includes confirmed cases. That number is exceptionally low, however, because Mexico has conducted fewer tests than almost any other developed nation.
• Spain’s Ministry of Health issued an order requiring all persons aged 6 years and older to wear a mask in public spaces (both indoor and outdoor) where it is not possible to maintain social distancing. In the face of some “lockdown” protests, Spanish Prime Minister Pedro Sanchez also requested that the national parliament extend emergency authorities for an additional two weeks.
• The EU’s health and aviation bodies have issued a new set of guidelines for air travel, recommending the use of face masks and the practice “scrupulous and frequent” hand hygiene on flights in order to increase safety of travelers and aviation personnel during the pandemic.
• Greek Prime Minister Kyriakos Mitsotakis and Tourism Minister Harry Theoharis announced a roadmap to kickstart the country’s tourism sector, which accounts for roughly 20 percent of Greece's GDP. Greece says it is ready to reopen the country to some foreign visitors on June 15th.
• Global Cases:  5,019,676        Total Deaths:  328,565

Lifestyle, Science, and Economy

• Ford Motors sent workers home at Chicago and Dearborn plants today after employees tested positive for COVID-19. The two employees who tested positive had passed a temperature check the day before. 
• National Nurses United recently conducted a survey in which they found that many nurses remain fearful of becoming ill because they do not have the equipment they need to remain safe. The survey, conducted between April 15th and May 10th, includes responses from both union members and nonunion nurses in all 50 states. The findings showed that a staggering 87 percent of respondents reported having to reuse PPE, including respirators, a practice that the nurses said would not have been allowed before the pandemic.
• Health experts are warning that stagnant plumbing systems in emptied office buildings could pose a threat when employees return. Bacteria — including the type that causes the respiratory condition Legionnaires’ disease — can build up if not properly addressed.
• As people avoid visits to the doctor due to COVID-19, childhood vaccines continue to be a concern in the U.S. and around the world. This week, New York City Mayor Bill de Blasio reported that, from March 23rd to May 9th, the number of vaccine doses administered to children dropped 63 percent compared with the same time last year, and by 91 percent for children older than 2. Cases of measles and chickenpox in particular are both expected to increase as a result of the pandemic. 
• Following last week's online Advanced Placement test fiasco in which many students were unable to submit their answers, a group of students, their parents, and FairTest, a nonprofit critical of standardized testing, have sued the College Board and the Educational Testing Service.
• Resolve to Save Lives has released, “Staying Alert: Navigating COVID-19 Risk Toward a New Normal.” In the report, RSL recommends a four-tiered, color-coded system that grades the current state of risk from red, “4-Very High Risk,” to green, “1-New Normal.” The system is summarized here.
• A research letter published in Emerging Infectious Diseases reported results from a study that documented the presence of infectious SARS-CoV-2 virus in fecal matter. Further research is still needed to investigate if transmission mechanisms of this variety could pose a serious threat, and if prevention measures need to be put in place to mitigate exposure to SARS-CoV-2 via COVID-19 patients’ feces.
• WHO has published a new Case Report Form for “Suspected cases of multisystem inflammatory syndrome (MIS) in children and adolescents temporally related to COVID-19” intended for use by public health professionals for collecting standardized data on clinical presentations, severity and outcomes.
• Qatar Airways said that cabin crew will now be wearing safety goggles, masks, gloves, and full protective suits over their uniforms.
• Continue to look at the NIH Office of Portfolio Analysis’s (OPA) expert-curated portfolio of COVID-19 publications and preprints. The portfolio includes peer-reviewed articles from PubMed and preprints from medRxiv, bioRxiv, ChemRxiv, and arXiv. It is updated daily with the latest available data and enables users to explore and analyze the rapidly growing set of advances in COVID-19 research.
• Forbes is keeping a running list of all major international airline COVID-19-related change and cancellation policies.
• RetailDive tracks store reopenings in the U.S. 

Helpful Articles/Media

• Daily WHO Situation Report (5/20)
• Why do some COVID-19 patients infect many others, whereas most don’t spread the virus at all?
• 9 ways Covid-19 may forever upend the U.S. health care industry
• From CDC's Morbidity and Mortality Weekly Report: 
  • Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020
  • High COVID-19 Attack Rate Among Attendees at Events at a Church — Arkansas, March 2020
  • COVID-19 in Correctional and Detention Facilities — United States, February–April 2020
• "Looking for Clues" with CDC's CMO for COVID-19 response.
• NIH Director: Defeating COVID-19 requires unprecedented action and collaboration
• Watch a video replay of Clinical Trials in Public Health Emergencies: the Ebola and COVID Experiences
• Here is last week’s COVIDView from CDC, a weekly summary and interpretation of key indicators that have been adapted to track the COVID-19 pandemic in the U.S.
• NIH Director's Blog: COVID-19 Brings Health Disparities Research to the Forefront
• Soaring Prices, Rotting Crops: Coronavirus Triggers Global Food Crisis
• From CDC's MMWR: Identification and Monitoring of International Travelers During the Initial Phase of an Outbreak of COVID-19 — California, February 3–March 17, 2020
• Virus Survivors Could Suffer Severe Health Effects for Years
• A strategic approach to COVID-19 vaccine R&D, with Drs. Tony Fauci and Francis Collins as co-authors
• When Coronavirus Hits Food Deserts
• In a virtual town hall with the American Academy of Family Physicians, ASTHO CMO Marcus Plescia presented on the intersect between public and private sectors in the COVID-19 response.
• Rapid COVID-19 vaccine development
• Giving blood thinners to severely ill Covid-19 patients is gaining ground
• Anne Schuchat, MD, Principal Deputy Director of the Centers for Disease Control and Prevention (CDC), discusses evolution of CDC guidance and latest developments in the COVID-19 pandemic.
• Watch an NIH video about COVID-19 Diagnostics: The Challenge of Rapid, High-Volume Detection of SARS-CoV2
• Effect of Convalescent Plasma Therapy on Viral Shedding and Survival in COVID-19 Patients
• What Antibody Studies Can Tell You — and More Importantly, What They Can’t
• Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals (this would change the reopening of large buildings if found to be consistent)
• From Dr. Tom Frieden: How to reopen society as soon and safely as possible
• The Other COVID Risks: How Race, Income, ZIP Code Influence Who Lives Or Dies
• Examining the social impact of COVID-19
• The Implications of COVID-19 for Mental Health and Substance Use
• COVID-19 exacerbating inequalities in the US
• The characteristics of household transmission of COVID-19
• ‘We need an army’: Hiring of coronavirus trackers seen as key to curbing disease spread
• Suicide Mortality and Coronavirus Disease 2019—A Perfect Storm?
• Safety at the Time of the COVID-19 Pandemic: How to Keep our Oncology Patients and Healthcare Workers Safe
• The effective use of telemedicine to save lives and maintain structure in a health care system
• Projecting hospital utilization during the COVID-19 outbreaks in the U.S.
• Johns Hopkins data capture.
• Other tracking data here.