COVID-19 Update
April 13, 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 Kim 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 and on YouTube.

Over the Easter weekend, the Iowa Department of Public Health was notified of 317 new positive cases for a total of 1,587 positive cases. There are now a total of 16,005 negative cases reported. Friday through Sunday there were 12 additional deaths reported. A status report of monitoring and testing of COVID19 in Iowa is provided by IDPH and can be found here.

On Friday, Governor Reynolds issued an order regarding the shortage of Personal Protective Equipment (PPE). The order allows disregarding of typical CDC guidelines to stretch the limited supply of PPE available. If health care providers find supplies stretched thin, the directive then orders them to reuse equipment including gowns, eye protection and face masks between patients, and ignore expiration dates on some equipment. It encourages decontaminating N95 respirators via hydrogen peroxide, ultraviolet light and moist heat for reuse. If no medical-grade items are available, the order also allows for the use of homemade masks in concert with face shields and homemade gowns that comply with IDPH guidelines. This order comes on top of nonessential medical and dental services previously being suspended. She also issued another proclamation continuing the state’s emergency declaration. The proclamation provides additional regulatory relief necessary to respond to this public health disaster. This includes provisions to give health facilities greater flexibility, remove certain in-person regulatory requirements, and permit community colleges and school districts to adjust to the suspension of in-person instruction.
 
According to BIO, five other states including New York have orders regarding PPE, ranging from Colorado’s requirement for businesses to inventory available PPE, to New Jersey’s order allowing the state to commandeer this equipment as a last resort.

This article from the Des Moines Register highlights the unsettling uncertainty surrounding the state’s budget outlook, and what Iowa’s legislators will be faced with when they return to the capitol at some point before August 31, when they must now craft a new budget for next year. Depending on revenue projections, which will certainly be negatively impacted by business closures and even with the infusion of $1.25 Billion to the state from the Federal CARES Ac and the state’s emergency fund, de-appropriation for state agencies and a much lower budget won’t be off the table.

Latest on the Virus

• A new report on 53 COVID-19 patients given the antiviral drug remdesivir sheds little light on whether the drug works. The drug has been considered a promising candidate to treat coronavirus patients. It was developed for Ebola, but did not work well against that disease. Studies in mice and monkeys have suggested that it could fight COVID-19, and laboratory tests showed that it could stop the virus from invading cells. In the new report, because there was no control group of patients with matching symptoms who did not receive the drug, it is impossible to tell whether the remdesivir helped those who were treated.
• The FDA issued an emergency use authorization for a blood purification system to treat patients 18 years of age or older with confirmed COVID-19 admitted to intensive care with confirmed or imminent respiratory failure. The authorized product works by reducing the amount of cytokines and other inflammatory mediators, like small active proteins in the bloodstream that control a cell’s immune response by filtering the blood and returning the filtered blood to the patient. The proteins that are removed are typically elevated during infections and can be associated with a “cytokine storm” that occurs in some COVID-19 patients, leading to severe inflammation, rapidly progressive shock, respiratory failure, organ failure, and death.

Legislation

Supplemental 3.5 – Interim Emergency Coronavirus Relief

Timeline: Yesterday morning, Leader McConnell attempted to pass the bill by unanimous consent in the Senate. Senator Cardin objected. Senator Van Hollen then attempted to pass by unanimous consent the Democratic bill, to which McConnell objected. The Senate then recessed until Monday. There’s increasing urgency to pass additional funding for the SBA’s Paycheck Protection Program. As of yesterday, over have a million loans had been approved for a total of $133 billion. At the current pace ($30 billion/day), funding for the program will be exhausted in the coming week.

Process: The hope was that negotiations would begin over the weekend or early this week that allow for a bipartisan agreement on what can move as part of an “interim package”. After a call with Secretary Mnuchin, Leader Schumer issued a statement indicating a level of hope for a bipartisan agreement to come together early this week. Speaker Pelosi and Chairman DeFazio also had a call today with Secretary Mnuchin. There is an openness on what could be included, and even an idea that things could move in a piecemeal fashion, with several mini-packages passing by unanimous consent or voice vote over the coming weeks, while work continues on the larger CARES 2/Phase 4 package. Passage in this way would allow Congress to continue to address emergent and changing needs until the Members are able to return and work on larger legislation.

Policy: Republicans have supported simply adding more funding to the SBA program, while Democrats have advocated for the inclusion of funding for hospitals and state and local governments among other things. Republican bill here. Democratic bill here. Summary of the Democratic bill here. Speaker Pelosi and Leaders Schumer outlined the following to be included in the bill:

• $100 billion for hospitals, community health centers, and health systems, as well as production and distribution of testing and personal protective equipment (PPE);
• $150 billion for state and local governments for management of the crisis as well as to make up for lost revenue;
• A 15% increase to the maximum SNAP benefit;
• Removing obstacles to voting.

Something else to watch: Reps. Chris Pappas and Brian Fitzpatrick will be leading a letter to House and Senate leadership requesting the inclusion of language in the next coronavirus relief bill that would make 501(c)(6)s eligible for Economic Injury Disaster Loans and the Paycheck Protection Program. They sent out a Dear Colleague requesting co-signers earlier this week.

Supplemental IV – CARES 2.0.

Timeline/Process: The work on this bill continues and committees/members are pressing forward, with new requests from offices still coming in. Timing is still very up in the air. While the official calendar still has both chambers returning the week of April 20, there’s certainly increasing awareness of that time frame possibly coinciding with when D.C. may reach the peak, so floor schedules are increasingly likely to shift.

Policy: While the next package will likely stay within the outline of CARES, including plus ups for programs funded and created under the bill, the increasingly grave impacts of coronavirus may push lawmakers to consider the inclusion of other provisions and the creation of new programs. The bill Speaker Pelosi introduced while CARES was being negotiated included multiple provisions and funding increases that did not make it into the final bill. Some of those provisions and increases are being considered for the next package.

The New Democrat Coalition has outlined three main priorities for the next supplemental: CARES Act plus-ups (i.e. automatic stabilizers, automatic payroll protection loans), a national recovery strategy (national testing, virus tracing, preparedness efforts for those reentering workforce), and healthcare coverage and affordability.

The Congressional Progressive Caucus sent a letter to Speaker Pelosi asking for the following to be included in the next supplemental:

• Support for Small Business and Workers
  • Repealing waiver authority that overrides prohibitions on stock buybacks and other limits on companies that receive economic stabilization money;
  • Create a federal Paycheck Guarantee program.
• Individual/Families Relief
  • Provide monthly direct cash assistance of at least $2,000/month per person, $1,000 per child for up to a year;
  • Provide at least $30k in student loan debt cancellation for individuals;
  • Extend moratorium on evictions/foreclosures to include all types of housing (including commercial evictions);
  • Prevent utility/internet shutoffs;
  • Limits on small business debt collection.
• Public Health
  • Include hazard pay, increase PPE, childcare assistance;
  • Funding aimed at developing protocols/production of testing/contract tracing etc;
  • Ensuring health care coverage and no out of pocket costs;
  • Expand support for state/local/tribal/territorial governments, including those smaller than 500,000 and D.C.;
  • Emergency funding for CHCs.
• Safe Elections
  • Implement vote-by-mail option for federal elections in 2020;
  • Passage of certain parts of the Voting Rights Advancement Act;
• Investments in state election efforts ($3.6 billion).
  Assistance for people regardless of tax or immigration status, age, or disability status;
• Parity for tribal, U.S. territory, and D.C. residents;

Supplemental V – Economic Stimulus

While Chairman DeFazio (T&I) has said he aims to introduce an infrastructure bill by May, that timeline is looking increasingly optimistic. The House Transportation and Infrastructure Committee is moving forward with that timeline and is aiming to have the bill be as comprehensive as possible as a starting place. A large package like this needs to be legislated in regular order, so moving forward while remote is a challenge. WRDA may be included in the package but is moving through an appropriations-like process already, with requests coming in from various offices.

Passed Legislation

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.

New information and guidance:

• House Ways and Means factsheet on Economic Impact Rebate portal here
• IRS guidance on deferral of payroll taxes here

Treasury and Federal Reserve Policies: Yesterday, the Treasury Department and the Federal Reserve Board jointly announced (Treasury, Fed) several new policies implemented through § 13(3) of the Federal Reserve Act, aimed at promoting $2.3 trillion in business liquidity.

These policies appear to include liquidity both related and unrelated to the CARES Act, but in many cases the Federal Reserve and Treasury have taken amounts allocated by CARES and leveraged those amounts to issue larger volumes of liquidity. Some highlights and additional details on these policies:

• Main Street Lending (MSL): New Fed facility will provide $600b in new loans to mid-size businesses, using leverage from $75b of the $454b emergency stabilization fund capital allocated through CARES to small and mid-size businesses:
  • Fed will offer four-year loans through banks, with payments deferred for up to one year;
  • Eligible businesses are those with 10,000 or fewer employees OR revenues of less than $2.5 billion;
  • Subject to stock buyback, dividend, and compensation restrictions but apparently not to the workforce retention requirements from CARES;
  • Firms that have received SBA/PPP loans will be eligible to seek MSL loans as well;
  • Two separate term sheets under the program:
    • Main Street New Loan Facility (MSNLF) maximum loan up to lesser of (i) $150m, (ii) 30% of existing undrawn debt, or (iii) amount when added to outstanding undrawn debt does not exceed 6x 2019 EBITDA;
    • Main Street Expanded Loan Facility (MSELF): maximum loan of up to lesser of (i) $25m, (ii) amount when added to outstanding undrawn debt does not exceed 4x 2019 EBITDA;
• Municipal Liquidity Facility (MLF): New Fed facility will provide $500b in short-term debt to US states, using leverage from $35b - that may or may not come from the CARES $454b emergency stabilization fund but probably does not come from the § 5001 $150b state and local fund
  • Term sheet link;
• Paycheck Protection Program Liquidity Facility (PPPLF): New Fed facility will extend credit to lenders issuing components the existing volume of $350b in PPP loans, through term financing and taking the loans as collateral at face value;
  • Term sheet link;
• Asset liquidity: Enhancements of existing programs to purchase debt:
  • Primary and Secondary Market Corporate Credit Facilities (PMCCF and SMCCF):
    • Existing programs used by the Fed to purchase corporate debt;
    • $750b in liquidity, using leverage from $75b (up from a previous $20b) in equity investment from Treasury;
    • PMCCF term sheet link; SMCCF term sheet link; 
  • Term Asset-backed securities Lending Facilities (TALF):
    • Existing program whereby Fed lends money to investors to buy consumer debt-backed securities;
    • New classes of debt now allowed which were generally excluded in 2008;
    • $100b in liquidity, using leverage from $10b in equity investment from Treasury - an amount previously allocated which was not increased in today's announcement;
    • term sheet link.

Education Department: Secretary DeVos indicated 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 will be distributing the funding to colleges, which will then distribute the aid among students. The Department did not issue guidance on how colleges are to structure the program, but colleges will be required to sign a form certifying that the funds were used in accordance with the law. See here for the specific allocations for each college.
 
HHS Hospital Funding: HHS issued guidance earlier this morning announcing the formula and mechanism in which hospitals will receive the first $30 billion in relief funding. The money will not have to be repaid and can be used for a variety of uses. The first tranche will go to hospitals based on their Medicare FFS reimbursements in 2019. As total FFS payments were approx. $484 billion in 2019, a provider can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments they received by 484 and multiply that ratio by 30. If the providers total 2019 Medicare FFS payments were Y, then (Y ÷ 484) x 30 = amount of relief. State by state breakdown of first payment here.
 
HHS is working on developing a plan in the next seven to ten days for how to disburse another $30 billion for Medicaid-heavy providers and potentially a focus on pumping money to providers in hotspots.
 
Title I – Small Business Loans

• The Treasury Department has released affiliation guidelines for the small business loan program. 
• The Treasury Department released an interim final rule on the small business provisions in the bill. Applications opened for eligible entities two weeks ago and opened last week for independent contractors and the self-employed. With such high demand, it’s likely that funding will be exhausted within the next few days. As of 4pm on Thursday, over half a million loans had been approved for a total of $133 billion. At that pace ($30 billion/day), funding for the program will be exhausted this week. 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
  • April 8 FAQ here

Title II – Individual and Business Tax Relief

• IRS has indicated that the earliest Americans could receive relief payments from CARES is this week. Those who will receive their relief through paper checks could take as long at 20 weeks to receive payment.
• 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
• Senate Finance Committee FAQ on the Employee Retention Tax Credit here
• House Ways and Means FAQ on Rebates here
• House Ways and Means FAQ on Unemployment Compensation here

Title III – Public Health Systems, Education, and Healthcare

• Factsheet on accelerated and advance payments for providers/suppliers here
• House Energy and Commerce Republican Factsheet on relief for hospitals here

Title IV – Economic Stabilization

• 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.
• Treasury Q&A on Loans to Air Carriers and Eligible Businesses and National Security Businesses here. Loan application here.

Division B – Appropriations

• Last week the FCC announced a two-part, $200 million COVID-19 telehealth program. The press release may be found here; and the FCC order approved on Wednesday can be found here.
• House Appropriations overview for local governments/nonprofits here

Oversight

• Speaker Pelosi announced the creation of a House Select Committee on the Coronavirus Crisis, which will be focused on oversight of how the funds appropriated in CARES and other supplementals is spent. Majority Whip Clyburn will chair the committee. Other members of the committee have yet to be announced.
• Leader Schumer announced on Monday that he will appoint Bharat Ramamurti to the Congressional Oversight Commission. The Commission was created by CARES to oversee implementation of the economic relief provisions in the bill. Ramamurti was the Deputy Policy Director for Economic Policy on the presidential campaign of Sen. Elizabeth Warren (D-MA).

Other resources:

• Speaker Pelosi COVID toolkit here
• Updated Senate Republican Policy Committee memo here
• Senate Republican COVID Policy Response overview here
• Leader Schumer coronavirus resources page 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

Session: House is in a pro forma session until April 20. D.C. is currently under a shelter-in-place order, and Maryland and Virginia have similar orders in place. In a Dear Colleague last week, Speaker Pelosi advised members to keep their schedule flexible and said that, in order to make up for lost time, the House may meet during weeks previously scheduled as District Work Periods. The Senate is in recess until April 20.

Appropriations/NDAA: As of right now, the appropriations markup schedule is unchanged. Last week, House appropriators received topline numbers. Subcommittees are working through requests, while those with less COVID-19 related jurisdiction have the most bandwidth to work through requests. The schedule will likely slip as attention has been focused on coronavirus relief legislation. The House may try to hold markups soon after whenever the next package is passed, when members have returned D.C. This year’s NDAA markup has been “indefinitely postponed”. Reps. Adam Smith and Thornberry (HASC Chair and RM) sent a letter to the committee members saying that they will schedule the date of the markup once the House schedule for the next few months becomes clear. SASC Chairman Inhofe has said he aims to writing the FY21 NDAA by the end of May but is flexible considering the circumstances.

Remote voting: Speaker Pelosi and Leader McConnell have both voiced opposition to members’ voting remotely, but as the pandemic makes travel more treacherous, in-person voting has become more difficult. Remote voting is being discussed to some extent in both chambers. 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 in-person, including procedures for voting in shifts for roll call votes. Leader McConnell, as of right now, is not supportive of any form of remote voting. 

Other Floor Action: The House issued guidance last week indicated that Floor materials are to be submitted through a secure email address instead of dropped off at the Speaker’s Lobby or Cloakrooms. Members are still allowed to drop off materials in person. Speaker’s Dear Colleague on the guidance here. 

Hearings and Meetings: 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 Rules Committee Democrats released a one-pager guidance on “paper hearings”, which stated “paper hearings” are not official hearings. The guidance also pointed out that committees must vote in-person to report legislation or nominations. The Senate Sergeant at Arms is exploring technology that would allow for remote hearings, though Leader McConnell remains opposed to any form of remote voting. Under current rules, the House does not allow virtual hearings. Chairman McGovern has been contemplating changing the rules on this and could issue guidance soon. The House Administration Committee is working on a report on best tools to be able to do virtual meetings. The Senate has advised offices to avoid using the video conferencing app Zoom over data security concerns. The Senate has not yet officially banned the application though.

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

Tested Positive (2): Rep. Mike Kelly (R-PA), Rep. Nydia Velazquez (D-NY), Rep. Neal Dunn (R-FL)

Recovered (4): Sen. Rand Paul (R-KY), Rep. Joe Cunningham (D-SC), Rep. Ben McAdams (D-UT), Rep. Mario Diaz-Balart (R-FL)

Currently Self-Quarantined (9): Rep. Josh Gottheimer (D-NJ), Rep. Ayanna Pressley (D-MA), Rep. Mikie Sherrill (D-NJ)

Completed Quarantine (34): 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)

Other Federal Actions

• HHS announced they are beginning the delivery of the initial $30 billion in relief funding to providers in support of the national response to COVID-19 as part of the distribution of the $100 billion provider relief fund provided for in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The initial $30 billion in immediate relief funds started being delivered to providers at the end of last week.
• The CDC announced the extension of a no sail order for cruise ships. The order says it shall continue in operation until the earliest of (1) the expiration of the HHS Sec.’s declaration that COVID-19 constitutes a public health emergency; (2) the CDC Director rescinds or modifies the order based on specific public health or other considerations; or (3) 100 days from the date of publication in the Federal Register. The agency has reported that there are 100 cruise ships at sea off of U.S. coasts, with 80,000 crew members on board. Twenty ships at port or anchorage in the U.S. have known or suspected cases of COVID-19.
• The CDC has published this week’s “COVIDView,” a weekly surveillance summary of U.S. COVID-19 activity.
• The CDC updated its travel recommendations by country.
• CMS is proposing a rule to continue their efforts to strengthen Medicare by aligning payments for inpatient psychiatric facilities (IPFs) with the costs of providing care. The proposed rule would update Medicare payment policies and rates for the IPF Prospective Payment System (PPS) for Fiscal Year (FY) 2021. CMS is publishing this proposed rule consistent with the legal requirements to update Medicare payment policies for IPFs on an annual basis.
• CMS issued a proposed rule [CMS-1737-P] for Fiscal Year (FY) 2021 that updates the Medicare payment rates and the quality programs for skilled nursing facilities (SNFs).
• The FDA issued the second emergency use authorization (EUA) to decontaminate compatible N95 or N95-equivalent respirators for reuse by health care workers in hospital settings. This EUA will support decontamination of approximately 750,000 N95 respirators per day in the U.S.
• House Majority Leader Steny Hoyer sent a letter to the Chair and Vice Chair of the National Governors Association, Governors Larry Hogan of Maryland Andrew Cuomo of New York, urging them to direct the leaders of all 50 states, D.C., Puerto Rico, and U.S. territories to collect demographic data on racial disparities and the coronavirus.

Updates from the States

• Out of the cases under investigation detected by U.S. surveillance, there are total cases: 459,165  travel-related: 2,138 “close contact”: 10,956 The CDC now updates data Monday through Friday and data closes out the day before reporting.
  • The CDC is reporting 16,570 deaths in the U.S. related to COVID-19.
• New York State’s total number of cases rose by nearly 11,000 over the last 24 hours, the largest single-day increase yet. The state now has a total of 170,812. The 777 new deaths in New York over the last day also pushed the state’s death toll to 7,844. Fortunately, the estimate for how many hospital beds would be needed has not been met. This is due, in part, to the adherence of the state’s social distancing standards.
• Michigan Gov. Gretchen Whitmer said the state would forbid people from traveling between homes beginning tomorrow. Gov. Whitmer has also extended the state’s “Stay Home, Stay Safe” order through the end of the month.
• Kentucky Gov. Andy Beshear has asked his state’s church-goers to please forego Easter church services this Sunday. Those who do attend mass gatherings, he said, will be forced to self-quarantine for two weeks.
• San Francisco Mayor London Breed said today that 70 people have tested positive for COVID-19 at one of the city’s largest homeless shelters. The number includes two staff members.
• One public school in California is still open. While many states have canceled school for the remainder of the year, some governors have yet to make decisions about state-wide closures. This map continues to track state-by-state school closures.
• This week, Georgia Gov. Brian Kemp announced his plan to extend the state of emergency through May 13^th to mitigate the spread of COVID-19. It was previously set to be lifted on April 13^th.
  • Multiple other governors have made similar announcements this week, all of which are highlighted in the MultiState tracker below.
• Useful state data:
  • These charts show cumulative coronavirus cases and deaths for metropolitan areas over time.
  • 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

• Turkey’s government imposed an around-the-clock weekend curfew in 31 cities, but the announcement came so close to the start of the curfew that thousands of residents went to stores and formed the exact kinds of crowds the policy is attempting to avoid.
• Italian Prime Minister Giuseppe Conte has extended his country’s lock down until May 3^rd. The strict social distancing measures were originally supposed to be lifted on April 14^th.
• A violent mess broke out in an already poor area of Nairobi, Kenya, where many people’s incomes have disappeared during the pandemic. A crowd of people tried to force through the gate of a food distribution site in Kibera, a crowded slum where many people live without basic amenities like running water. Security forces fired tear gas and injured several people.
• Thousands of Muslims attended Friday Prayer in defiance of the Pakistani government’s orders to stay at home to try to contain the spread of the coronavirus. Pakistan has more than 4,600 confirmed cases and 68 deaths, but little testing has been done and the real number is likely higher.
• South Korean voters were required to stand at three-foot intervals, rub their hands with liquid sanitizer, and put on disposable plastic gloves that​ officials were distributing outside voting booths for Friday’s election. Officially, the election for South Korea’s 300-member National Assembly takes place on Wednesday. But millions of voters were allowed cast ballots on Friday and Saturday, in advance voting that served as a kind of dress rehearsal.
• In a historic move, every pub in Britain is closed in an effort to mitigate the spread of COVID-19.
• Yemen reported its first case of COVID-19 today.
• Global Cases:  1,521,252               Total Deaths:  92,798

Lifestyle and Economy

• Apple and Google said they are teaming up to build software into smartphones that can tell people if they were recently in contact with someone who was infected with COVID-19. People would opt in to use the tool and voluntarily report if they became infected. The app would then alert phones that had recently come into proximity with that person’s device.
• Patrick Soon-Shiong, the owner of the L.A. Times, has purchased St. Vincent Medical Center and will reopen it as a COVID-19 treatment center.
• As supply chain issues continue, shoppers may see more shortages of unexpected products, including laptops, toilet paper, and medicines. Now, manufacturers are experiencing a shortage of raw materials, which is leading to an already-existing shortage of products. Some shortages are also being caused by shoppers hoarding and stockpiling particular items while anticipating extended quarantines.
• Health departments, hospitals, and companies around the world are rolling out the next wave in coronavirus tests, which look in a person’s blood for signs of past infection, in hopes of better gauging how widespread the pandemic is and who might be counted among the recovered. The new tests promise to give public-health and hospital officials a better idea of how widely the new coronavirus has spread and who can safely treat patients and stop social distancing.
• Forbes is keeping a running list of all major international airline COVID-19-related change and cancellation policies.
• The New York Times has started its own tracker of cases in the U.S. to fill in the gaps left by agency data.
• Lists of canceled conferences and events can be found here (music), here (tech), here (general), and here (sports/entertainment).

Helpful Articles/Media

• Daily WHO Situation Report (4/10)
• Why daily death tolls have become unusually important in understanding the coronavirus pandemic
• Safety at the Time of the COVID-19 Pandemic: How to Keep our Oncology Patients and Healthcare Workers Safe
• If a coronavirus vaccine arrives, can the world make enough?
• Listen to Dr. Tony Fauci on NPR
• COVID-19, school closures, and child poverty: a social crisis in the making
• Covid-19 – The Law and Limits of Quarantine
• A video about the research being done to create a vaccine for COVID-19.
• Understanding pathways to death in patients with COVID-19
• In response to COVID-19, Milken Institute Chairman Michael Milken is engaging a range of industry leaders and medical experts to help us better understand and confront a crisis that has not only altered our current day to day, but will change the course of how we work, socialize, and fight disease for years to come. Check out the podcast here.
• The effective use of telemedicine to save lives and maintain structure in a health care system
• SARS-CoV-2 Vaccines: Status Report
• The COVID-19 Pandemic in the USA Clinical Update Developing Covid-19 Vaccines at Pandemic Speed
• Projecting hospital utilization during the COVID-19 outbreaks in the U.S.
• A look at the answer to the question, “why stay isolated for two weeks after possible exposure?”
• Fair Allocation of Scarce Medical Resources in the Time of Covid-19 (New England Journal of Medicine)
• Prevent Epidemics has a fantastic annotated bibliography of COVID-19 publications that includes links to the original articles. View its resources here.
• Johns Hopkins data capture.
• Other tracking data here.
• 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.