COVID-19 Update
March 30, 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.

Iowa Update

Governor Kim Reynolds will hold a press conference today at 2:30 p.m. The press conference will be livestreamed and posted in full on Governor Reynolds’ Facebook Page, YouTube and Iowa PBS.
 
The Iowa Department of Public Health (IDPH) has been notified of 88 additional positive cases of Iowans with COVID-19, for a total of 424 positive cases. There have been a total of 6,162 negative tests to date, which includes testing reported by the State Hygienic Lab and other labs. 
 
According to IDPH, two Iowans with COVID-19 passed away last night, one elderly adult (81+) of Linn County, one elderly adult (81+) of Washington County. 
 
According to IDPH, the locations and age ranges of the 88 individuals include:

• Audubon County, 1 older adult (61-80 years)
• Benton County, 1 middle-aged adult (41-60 years), 1 older adult (61-80 years), 1 elderly adult (81+)
• Cedar County, 1 older adult (61-80 years)
• Cerro Gordo County, 1 middle-aged adult (41-60 years)
• Clinton County, 1 middle-aged adult (41-60 years)
• Crawford County, 1 older adult (61-80 years)
• Dallas County, 3 adults (18-40 years), 1 middle-aged adult (41-60 years)
• Dubuque County, 3 middle-aged adults (41-60 years), 2 older adults (61-80 years),
• Guthrie County, 1 middle-aged adult (41-60 years)
• Iowa County, 1 older adult (61-80 years)
• Jackson County, 1 adult (18-40 years)
• Jasper County, 1 elderly adult (81+)
• Johnson County,  2 middle-aged adults (41-60 years), 3 older adults (61-80 years)
• Jones County, 1 adult (18-40 years)
• Linn County, 9 adults (18-40 years), 8 middle-aged adults (41-60 years), 6 older adults (61-80 years), 6 elderly adults (81+)
• Monona County, 1 child (0-17 years), 1 adult (18-40 years), 1 older adult (61-80 years)
• Muscatine County, 1 middle-aged adult (41-60 years), 2 older adults (61-80 years)
• Polk County, 2 children (0-17 years), 2 adults (18-40 years), 6 middle-aged adults (41-60 years), 1 older adult (61-80 years)
• Scott County, 1 adult (18-40 years), 2 middle-aged adults (41-60 years), 3 older adults (61-80 years)
• Shelby County, 1 adult (18-40 years), 1 older adult (61-80 years)
• Tama County, 1 adult (18-40 years) 
• Van Buren County, 1 older adult (61-80 years)
• Washington County, 1 adult (18-40 years), 3 middle-aged adults (41-60 years), 1 older adult (61-80 years)

A status report of monitoring and testing of COVID19 in Iowa is provided by IDPH and can be found here. In addition, a public hotline has been established for Iowans with questions about COVID-19. The line is available 24/7 by calling 2-1-1 or 1-800-244-7431. The state of Iowa has started sharing the number of negative tests conducted at outside labs, and is providing additional information on the conditions of those infected with COVID-19. 
 
Over the weekend, additional cases of COVID-19 continued to climb. Senator Joni Ernst joined Governor Reynolds’ Sunday press conference via phone, to answer questions about recently passed federal legislation outlined in this newsletter last week, the CARES Act. Governor Reynolds relayed that she has her team looking at the legislation and its implications for Iowans.

Legislation

Supplemental IV and onward

Timeline: Speaker Pelosi and others have agreed on drafting a fourth supplemental – unclear what will be included yet. On the House floor today, Speaker Pelosi called COVID-III a “down payment,” saying that the nation will need infusions of funding for hospitals, health care workers, and emergency services personnel. However, Leader McCarthy has said that drafting a fourth supplemental may be “premature”. The House is in recess until March 31. The Senate is in recess until April 20.

It’s likely that the next COVID-19 bill focuses on rebuilding the country’s infrastructure and recovery from the current crisis. In addition to infrastructure, a bill could include investment in clean energy (Democrats had previously pushed to include clean energy tax credits, climate resilient infrastructure and other measures in COVID-III). Other Democratic priorities may include federal action on housing and childcare affordability. Republican priorities may include additional tax relief for businesses and individuals, as well as rollback of and flexibility for certain industries and regulations.

Passed Legislation

Supplemental III – COVID-III, Coronavirus Aid, Relief, and Economic Security (CARES) Act

After the Senate passed the bill unanimously (96-0) Wednesday night, the House passed the package Friday. The House had three hours of debate, where members emphasized the problems with the bill but, for the most part, reiterated their support. Democrats voiced their concern about leaving out taxpaying immigrants, the amount of money dedicated to corporations, and the lack of an election contingency plan (i.e vote-by-mail process). Some conservatives pointed to the high price tag and a few stated their flat-out opposition for the bill. Most members, while pointing to the problems they had with the bill, urged their peers to support the measure as it provided critical emergency funding for public health infrastructure, small businesses, and workers.
 
In a tweet earlier today, Rep. Massie indicated he intended to call for a roll call on the vote. Multiple members, including, it appears, Speaker Pelosi and Leader McCarthy, attempted to persuade him to not call for recorded vote. However, after debate ended, he requested a recorded vote, which failed (one fifth of members needed to stand in support of that motion for it to pass). Rep. Massie then objected on the basis that a quorum (two-thirds of the House, i.e. 216 members) was not present (and therefore voting could not occur). House leadership had marshalled enough members back to D.C. for a quorum to be present, and thus the bill was passed by voice vote. At 4pm Friday the President signed the bill into law.

Final text here. BIO’s summary of specific provisions affecting biotech companies here.
Republican section by section here. Democratic summary here. Section summaries below:

• Small Business Loans (Title I) – Committee section by section here and one pager here, minority one pager here
• Individual Relief (Title II) – summary here
• Business Tax Relief (Title II) – summary here
• Health Care Infrastructure Support (Title III) – majority summary here, minority summary here
• Education (also Title III) – majority summary here, minority summary here
• Senate Finance Jurisdiction Health Provisions (still Title III) – section by section here
• Economic Stabilization (Title IV) – summary here
  • See here for summary on specific worker protections
• Appropriations – majority section by section here, minority summary here

Committees’ summaries below:

• Senate Agriculture Committee minority summary here
• Senate Banking Committee majority summary here, minority summary here
• Senate Commerce Committee minority summary here
• Senate Homeland and Government Affairs Committee minority summary here
• Senate Committee on Indian Affairs summary here
• Senate Judiciary Committee minority summary here
• Senate Veterans Affairs Committee minority summary here

Supplemental II – COVID-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 – COVID-I, Coronavirus Supplemental

Signed by the President March 6. Text here, summary here.

Congress

Session: House is in recess until March 31. Senate is in recess until April 20.

Appropriations: As of right now, the appropriations markup schedule is unchanged. Most House bills have subcommittee markup dates the weeks of April 21 and April 28, while the Senate has not yet set its markup dates.

Remote voting: Speaker Pelosi and Leader McConnell have both voiced opposition to members’ voting remotely, but as more members of Congress have begun self-quarantining and the pandemic makes travel more treacherous, in-person voting has become more difficult. Remote voting is being discussed to some extent in both chambers. On Monday, the House Committee on Rules Majority released a staff report on voting options. The report discusses unanimous consent, proxy voting, as well as the logistics (and security concerns) of remote voting. Additionally, the House Sergeant at Arms and the Attending Physician released guidance for voting, including procedures for voting in shifts for roll call votes. In the Senate, Sens. Durbin, Portman, and Klobuchar working on a way for Senators to vote remotely, but Leader McConnell, as of right now, is not supportive. 

Hearings: While most hearings and markups for the next week or so have been cancelled, some committee staff are working to see whether holding hearings virtually is possible. The Senate Armed Services Committee has developed a “paper hearing” model in lieu of in-person hearings.

Members of Congress in Quarantine or Treatment (new additions in bold)

Tested Positive (5): Joe Cunningham (D-SC), Mike Kelly (R-PA), Sen. Rand Paul (R-KY), Rep. Ben McAdams (D-UT), Rep. Mario Diaz-Balart (R-FL)

Currently Self-Quarantined (28): Rep. Julia Brownley (D-CA), Rep. Jason Crow (D-CO), Rep. Matt Gaetz (R-FL), Rep. Doug Collins (R-GA), Rep. Steve Scalise (R-LA), Rep. Ann Wagner (R-MO), Rep. Ben Ray Luján (D-NM), Rep. Kathleen Rice (D-NY), Rep. Kendra Horn (D-OK), Rep. Matt Cartwright (D-PA), Rep. Ben McAdams (D-UT), Rep. Gwen Moore (D-WI), Rep. Frederica Wilson (D-FL), Rep. Stephanie Murphy (D-FL), Rep. Drew Ferguson (R-GA), Rep. Joe Cunningham (D-SC), Rep. Tom Cole (R-OK), Rep. David Schweikert (R-AZ), Rep. Anthony Brindisi (D-NY), Rep. David Price (D-NC), Rep. Andy Kim (D-NJ), Sen. Rick Scott (R-FL), Sen. Cory Gardner (R-CO), Sen. Mike Lee (R-UT), Sen. Mitt Romney (R-UT), Rep. Katie Porter (D-CA), Rep. Josh Harder (D-CA), Rep. Seth Moulton (D-MA)

Completed Quarantine (6): 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. Paul Gosar (R-AZ)

Other Federal Actions

• President Trump has extended the federal government’s social-distancing guidelines through the end of April.
• The CDC issued a domestic travel advisory for residents of New York, New Jersey, and Connecticut. Individuals from those three states are urged to refrain from non-essential domestic travel for two weeks effective yesterday. The travel advisory does not apply to essential employees.
  • CISA updated their guidance on the essential critical infrastructure workforce on Saturday.
• CMS announced the expansion of its accelerated and advanced payment program for Medicare participating health care providers and suppliers, to ensure they have the resources needed to combat COVID-19. The program expansion includes changes from the recently enacted CARES Act.
• CMS sent a letter to the nation’s hospitals on behalf of Vice President Pence requesting that they increase their data reporting. The Administration is requesting that hospitals report COVID-19 testing data to HHS, in addition to daily reporting regarding bed capacity and supplies to the CDC National Healthcare Safety Network (NHSN) COVID-19 Patient Impact and Hospital Capacity Module.
• The FDA published a statement providing a status update and details on recent actions, including a partnership with FEMA on supply chain issues.
• White House officials coordinated the delivery of 130,000 N95 masks, 1.8 million face masks and gowns, 10 million gloves, and thousands of thermometers to New York, New Jersey, and Connecticut. A commercial airline carrying the PPE and medical supplies arrived from Shanghai.
  • Flights will arrive in Chicago tomorrow and Ohio on Tuesday, and supplies will be distributed from there to other states using private sector distribution. Not all incoming supplies will come from China. The U.S. is working with manufacturers in Thailand, Malaysia, Vietnam, and other countries as well.
  • Significantly more PPE and medical equipment is still urgently needed.
• President Trump and VP Pence met with supply chain executives from FedEx, Owens & Minor, Charles Mills, Medline Industries, UPS, and others, in an effort to talk through current COVID-19-related supply chain issues.
• President Trump invoked the Defense Production Act to require General Motors to produce more ventilators. Hospitals across the country have expressed an acute need for materials to help manage the increased number of hospitalizations, and the ventilators are crucial for treating the respiratory issues associated with COVID-19.
  • The President also named Peter Navarro as the national Defense Production Act policy coordinator for the federal government. He said Navarro has been doing that job over the past few weeks but announced him as the coordinator for the first time this afternoon.
• The FDA issued an Emergency Use Authorization (EUA) to allow for the emergency use of certain ventilators, anesthesia gas machines modified as ventilators, and positive pressure breathing devices modified as ventilators (collectively referred to as “ventilators”), ventilator tubing connectors, and ventilator accessories that the FDA determines meet specified criteria for safety, performance, and labeling in health care settings.
• The CDC published an article in its Morbidity and Mortality Weekly Report (MMWR) that examines pre- and asymptomatic cases of COVID-19 in the nursing home residents in King County, Washington. The findings highlight the difficulty of identifying the virus and mitigating the spread based on symptom diagnosis alone.
• Judge Dolly M. Gee of the United States District Court ordered the government to “make continuous efforts” to release migrant children from custody. She cited reports that four children being held at a federally licensed shelter in New York had tested positive for COVID-19.

Updates from the States

• Out of the cases under investigation detected by U.S. surveillance, there are total cases: 85,356  travel-related: 712  “close contact”: 1,326 The CDC now updates data Monday through Friday and data closes out the day before reporting.
  • The CDC is reporting 1,246 deaths in the U.S. related to COVID-19.
  • Although it has not been verified by the CDC, it is being widely reported that the U.S. has topped 100,000 cases.
• The United States Conference of Mayors surveyed officials in 213 municipalities and found serious shortages that underscored the “scope and severity” of the COVID-19 crisis. More than 90 percent — or 192 cities — said they did not have an adequate supply of face masks for police officers, firefighters, and emergency workers. In addition, 92 percent of cities reported a shortage of test kits and 85 percent did not have a sufficient supply of ventilators available to local health facilities.
• Eight states are currently closed for the remainder of the school year, with multiple others being closed into May or until further notice. This resource continues to track school closures. Particularly in places like New York City, where around 114,000 children live in shelters or unstable housing, school closures remain a health and safety concern.
• CMS approved its 34^th state Section 1135 Medicaid waiver request. The waivers offer states flexibilities to focus their resources on combatting the COVID-19 pandemic. Today, Connecticut, Delaware, Minnesota, Pennsylvania, and Wyoming received waivers.
• Louisiana officials are fast-tracking licenses for new doctors and nurses, and in one case moving up the date a medical school's students will receive their diplomas, to increase the number of health care providers in the fight against the coronavirus.
• Utah Gov. Gary Herbert is the most recent to have issued a statewide “stay safe, stay home” (not quite to the level of shelter-in-place) order. The order will remain in effect until April 13^th.
  • 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.

International Affairs

• South Africa implemented a stay at home order for the next three weeks. The lockdown of 59 million people is the biggest action taken on the continent thus far to combat COVID-19. South Africa confirmed its first case only three weeks ago, but already has over 1,000.
• France announced that its lockdown would be extended until at least April 15^th, and prime minister Edouard Philippe said it could be extended again if necessary.
• Italy’s daily death toll continues to rise, reaching 950 between Thursday and Friday alone. The national death toll is now over 9,000, far higher than in any other country.
• Four people have died aboard Holland America cruise ship the Zaandam off the coast of Panama. The cruise liner is currently waiting to cross the Panama Canal after it was not allowed to dock in South America. It has also not been given permission to cross the canal to dock in Ft. Lauderdale, Florida. The ship departed from Argentina on March 7^th and was originally scheduled to reach Chile on March 21^st, but was forced to reroute as more nations close their ports to ships with outbreaks on board.
• A few days after authorities relaxed lockdowns in Hubei province, China, violence erupted on a bridge between the Hubei and Jiangxi provinces. The confrontation came after authorities in Jiangxi blocked entry to people from Hubei.
• Global Cases:  509,164    Total Deaths:  23,335

Helpful Articles/Media

• Des Moines Register Op-ed by former Secretary Vilsack on the rural bioeconomy and how biomanufacturing can help with the response to COVID-19
• An essay by Walter Isaacson on the new scientific frontier accelerated by COVID-19 (WSJ)
• Daily WHO Situation Report (3/27)
• Principal deputy director of the CDC Dr. Anne Schuchat gives an interview warning that New York’s COVID-19 outbreak is only a preview of the bigger picture.
• Treating COVID-19—Off-Label Drug Use, Compassionate Use, and Randomized Clinical Trials During Pandemics (JAMA)
• Fair Allocation of Scarce Medical Resources in the Time of Covid-19 (New England Journal of Medicine)
• Why the Coronavirus Has Been So Successful (The Atlantic)
• Coronavirus Drugs, Vaccine Are Many Months Away, Health Experts Say
• In this article by Dr. Tom Frieden, he explains how we must continue to adapt our strategy to combat COVID-19 as we learn more about it.  
• Still not sure what social distancing is? Watch this video.
• A figure in Prevent Epidemics highlights the association between age and severity of COVID-19 illness.
• If it wasn’t already hard enough to get tested, hospitals are running low on the swabs needed to perform COVID-19 tests.
• Prevent Epidemics has a fantastic annotated bibliography of COVID-19 publications that includes links to the original articles. View its resources here.
• Why outbreaks like coronavirus spread exponentially, and how to “flatten the curve”
• Johns Hopkins data capture (and, while you’re admiring that Hopkins resource, Coronavirus plea from Johns Hopkins: please take social distancing seriously to save lives)
• U.S. Hospitals Face Major Challenges as Coronavirus Spreads
• This document contains useful information from the White House Coronavirus Task Force on measures to keep workplaces, schools, homes, and commercial establishments safe.
• Shortage of personal protective equipment endangering health workers worldwide
• Check the CDC’s page on information for travel for further insight into restrictions for individuals leaving and returning to the U.S., and take a look at their guidance for businesses and employers.
• COVID-19 – Navigating the Uncharted (co-authored by Drs. Tony Fauci, Clifford Lane, and Robert Redfield)
• If any businesses are interested in offering assistance to CDC during the response, contact the CDC Foundation here.
• Businesses, hospitals, universities, and anyone else looking for a direct line to the CDC, you can contact the 24/7 hotline at 770-488-7100.