In an effort to provide a central resource to you with accurate and recent news concerning COVID-19, I am adding this resource page to my website.
Please know that I understand your concern about the spread of the virus, and I am continuing to monitor it very closely. Each day, I will be sending out a "Doctor's Note" with the latest updates. You can receive this daily message by signing up to receive "The Weekly" on the home page of my website.
Additional, I have put together a resource guide for health care professionals that can be accessed here.
As always, I appreciate hearing from you whether on this issue or another that is important to you.
In the coming days and weeks, I will do my best to keep you up-to-date on this pandemic.
Paid Leave: Employers with less than 500 employees are required to provide paid leave to their employees under the FFCRA, with certain exemptions for employers with less than 50 employees. All employees must receive two weeks fully paid leave for COVID19 quarantines and family care. After a month of employment employees are eligible for Family and Medical Leave Act leave for up to 10 weeks at two-thirds pay.
• Information for employers can be found here.
• Information for employees can be found here.
• FAQs for paid leave under the Families First Coronavirus Response Act.
Small Business Loans:The Small Business Administration (SBA) has designated COVID-19 as a qualifying event for Economic Injury Disaster Loans (EIDL). EIDL offers up to $2M with up to a 30-year term and a flat interest rate of 3.75 percent or below. EIDL loans are processed on a first come first serve basis. Terms are determined on a case-by-case basis, based upon a borrower’s ability to repay. SBA follows standards set by the North American Industry Classification System (NAICS) to determine small business status.
• SBA COVID-19 Information.
• EIDL Loan Applications.
• Contact SBA disaster assistance customer service center at 1-800-659-2955 (TTY: 1-800-877-8339) or e-mail: disastercustomerservice@sba.gov.
Congress authorized a new Paycheck Protection Program to provide $350 billion in 100 percent federally guaranteed loans for 8 weeks of assistance to small businesses and 501(c)(3) nonprofits that have less than 500 employees. This program also applies to sole-proprietorships, independent contractors, and self-employed individuals. Entities can borrow the lesser of $10 million or 2.5 times the average monthly payroll based on last year’s payroll with an interest rate of 4 percent with all principal, interest, and fee payments deferred for 6 months. The portion of the loan used for payroll, mortgage interest, rent, and utilities can be forgiven.
• Note: Entities can receive a Paycheck Protection Program loan AND an EIDL loan if they are used for different things.
• Borrowers should talk to their preferred financial lender NOT the Small Business Administration in order to apply for this loan.
• The application for borrowers can be found here.
Unemployment Insurance: The Department of Labor (DOL) has recently granted states more flexibility in how to distribute UI, including under COVID-19 related circumstances such as temporary furloughs, quarantines, or if an employee temporarily leaves employment due to a risk of exposure or infection or to care for a family member. Federal law does not require an employee to quit in order to receive benefits due to the impact of COVID-19.
• Information on Texas’ UI program can be found here.
• Apply for UI here.
Assistance for Distressed Businesses:In the CARES Act, Congress authorized and funded a $500 billion funding facility to allow the Treasury Secretary to provide loans and loan guarantees to all businesses that have been directly affected by COVID-19. Up to $46 billion is for the airline industry and businesses critical to national security, and $454 billion is for distressed businesses of all sizes.
• Information on applying for these loans is expected shortly and will be provided at that time. In the meantime, please do not hesitate to contact our office at 202-225-7772.
Farmer Assistance: In the CARES Act, Congress authorized and funded $9.5 billion for the U.S. Department of Agriculture to take action to ensure farmers in Texas have the resources they need to succeed in these trying times. The USDA is working to create additional flexibilities in farm loans and crop insurance. Farmers can still apply for conservation programs or disaster assistance if necessary.
The CARES Act also authorized and funded $14 billion for the Commodity Credit Corporation, which funds programs such as the Price Loss Coverage and Dairy Margin Coverage.
• USDA’s FAQs can be found here.
• Information on Federal Assistance for Farmers.
President Trump and Secretary Mnuchin announced that all federal tax returns and payments that are due April 15, 2020, are now due July 15, 2020. Any tax payments will be deferred without accruing interest or being levied a penalty.
• Guidance information can be found here.
• In addition, Texas Comptroller Glenn Hegar issued a statement on using online tools to pay Texas sales tax.
• More information on Coronavirus tax relief.
As of March 13, 2020, the Department of Education has temporarily stopped the interest on all federal student loans for six months and has halted wage garnishments and collection actions for borrowers in default for at least 60 days.
• More information can be found here.
Housing Relief:The Federal Housing Finance Agency (FHFA) has moved to limit the impact of the COVID-19 crisis on homeowners and renters. FHFA has directed Fannie Mae and Freddie Mac to suspend foreclosures and evictions for all federally backed single family mortgages for 60 days, offer mortgage forbearance for multifamily property owners who don’t evict tenants unable to pay rent due to COVID-19, and provide payment forbearance for up to 12 months.
• Information from the FHFA can be found here.
Transportation: The Department of Transportation has provided hours of service regulatory relief and truck weight increases for commercial vehicle drivers, is providing assistance to transit agencies through the Federal Transit Administration, and issued guidance to maintain pipeline safety and the safe operation of emergency response vehicles during this public health emergency. For more information, please visit.
Smart Traveler Enrollment Program (STEP), Department of State:The Department of State urges all U.S. citizens traveling or residing abroad to register for messages through STEP. Those abroad may also reach out to the closest U.S. Embassy or Consulate with their name, date of birth, passport number, location, who they are traveling with, and specific circumstances. The State Department will be in touch with those registered through STEP and continue to monitor developments in countries affected by COVID-19.
• Register for STEP here.
Travel Advisories:The Centers for Disease Control and Prevention and the Department of State have issued a number of travel advisories, both international and domestic.
On March 26, 2020, Governor Abbott instituted a self-quarantine edict for anyone entering Texas from New York, New Jersey, Connecticut, or New Orleans.
There are numerous symptom checkers to help determine if you might have COVID-19:
• CDC has a self-checker tool and explains what to do if you are sick.
• Apple teamed up with CDC and the White House Coronavirus Task Force to produce a website and an app to help individuals navigate this Coronavirus.
If you think you need to be tested for COVID-19, your test will be free, regardless of your health insurance coverage status. Please call your doctor before going to get tested.
COVID-19 Diagnostic Tests: For questions about development of COVID-19 diagnostic tests, there are several resources available:
•24/7 Hotline for Diagnostics: call the FDA toll-free line at 1-888-463-6332 (1-888-INFO-FDA), then choose option (*).
• Frequently Asked Questions about COVID-19 Diagnostic Tests
• Emergency Use Authorization (EUA) for COVID-19 Diagnostic Tests:If you need additional information for completing the EUA template, would like to know how to submit Pre-EUA/EUA submissions to FDA, or wish to consider an alternative specimen type, you may contact the Division of Microbiology Devices at (301) 348-1778 or email: CDRH-EUA-Templates@fda.hhs.gov.
Personal Protective Equipment:Call toll-free line at 1-888-463-6332 (1-888-INFO-FDA), then choose option (*) for further information.
Swabs:FDA has identified that a nasopharyngeal specimen is the preferred choice for swab-based SARS-CoV-2 testing.
If a nasopharyngeal specimen is not available, then any of the following are acceptable:
• oropharyngeal specimen collected by a healthcare professional (HCP);
• mid-turbinate specimen by onsite self-collection or HCP (using a flocked tapered swab); or
• anterior nares specimen by onsite self-collection or HCP (using a round foam swab).
Drug Shortages: Contact CDER’s Division of Drug Information (DDI) at 855-543-3784, 301-796-3400, or druginfo@fda.hhs.gov. Also, FDA's Drug Shortage web page has information related to current shortages.
Food: Food industry stakeholders may find information on common questions about food safety and COVID-19 here. If you need to contact FDA’s Center for Food Safety and Applied Nutrition about a COVID-19 related question, you can submit a question here.
Inspections: If you have questions regarding the postponement of inspections under an agreement or contract with the FDA, they should contact: OPFeedback@fda.hhs.gov.
The Environmental Protection Agency (EPA) maintains a list of known disinfectants that could be useful in combatting COVID-19.
• This list can be found here.
• EPA’s FAQs can be found here.
Local governments have established guidance to protect Texans. Denton Country, Tarrant County, and Dallas County have updated information as this outbreak develops.
Situation Summary
This is an emerging, rapidly evolving situation and CDC will provide updated information as it becomes available, in addition to updated guidance.
Updated March 15, 2020
Background
CDC is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus that was first detected in China and which has now been detected in more than 100 locations internationally, including in the United States. The virus has been named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”).
On January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared the outbreak a “public health emergency of international concernexternal icon” (PHEIC). On January 31, Health and Human Services Secretary Alex M. Azar II declared a public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to COVID-19. On March 11, WHO publiclyexternal icon characterized COVID-19 as a pandemic. On March 13, the President of the United States declared the COVID-19 outbreak a national emergencyexternal icon.
Source and Spread of the Virus
Coronaviruses are a large family of viruses that are common in people and many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with MERS-CoV, SARS-CoV, and now with this new virus (named SARS-CoV-2).
The SARS-CoV-2 virus is a betacoronavirus, like MERS-CoV and SARS-CoV. All three of these viruses have their origins in bats. The sequences from U.S. patients are similar to the one that China initially posted, suggesting a likely single, recent emergence of this virus from an animal reservoir.
Early on, many of the patients at the epicenter of the outbreak in Wuhan, Hubei Province, China had some link to a large seafood and live animal market, suggesting animal-to-person spread. Later, a growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread. Person-to-person spread was subsequently reported outside Hubei and in countries outside China, including in the United States. Some international destinations now have ongoing community spread with the virus that causes COVID-19, as do some parts of the United States. Community spread means some people have been infected and it is not known how or where they became exposed. Learn what is known about the spread of this newly emerged coronaviruses.
The complete clinical picture with regard to COVID-19 is not fully known. Reported illnesses have ranged from very mild (including some with no reported symptoms) to severe, including illness resulting in death. While information so far suggests that most COVID-19 illness is mild, a reportexternal icon out of China suggests serious illness occurs in 16% of cases. Older people and people of all ages with severe chronic medical conditions — like heart disease, lung disease and diabetes, for example — seem to be at higher risk of developing serious COVID-19 illness.
A pandemic is a global outbreak of disease. Pandemics happen when a new virus emerges to infect people and can spread between people sustainably. Because there is little to no pre-existing immunity against the new virus, it spreads worldwide.
The virus that causes COVID-19 is infecting people and spreading easily from person-to-person. Cases have been detected in most countries worldwide and community spread is being detected in a growing number of countries. On March 11, the COVID-19 outbreak was characterized as a pandemic by the WHOexternal icon.
This is the first pandemic known to be caused by the emergence of a new coronavirus. In the past century, there have been four pandemics caused by the emergence of novel influenza viruses. As a result, most research and guidance around pandemics is specific to influenza, but the same premises can be applied to the current COVID-19 pandemic. Pandemics of respiratory disease follow a certain progression outlined in a “Pandemic Intervals Framework.” Pandemics begin with an investigation phase, followed by recognition, initiation, and acceleration phases. The peak of illnesses occurs at the end of the acceleration phase, which is followed by a deceleration phase, during which there is a decrease in illnesses. Different countries can be in different phases of the pandemic at any point in time and different parts of the same country can also be in different phases of a pandemic.
There are ongoing investigations to learn more. This is a rapidly evolving situation and information will be updated as it becomes available.
Situation in U.S.
Different parts of the country are seeing different levels of COVID-19 activity. The United States nationally is currently in the initiation phases, but states where community spread is occurring are in the acceleration phase. The duration and severity of each phase can vary depending on the characteristics of the virus and the public health response.
Risk depends on characteristics of the virus, including how well it spreads between people; the severity of resulting illness; and the medical or other measures available to control the impact of the virus (for example, vaccines or medications that can treat the illness) and the relative success of these. In the absence of vaccine or treatment medications, nonpharmaceutical interventions become the most important response strategy. These are community interventions that can reduce the impact of disease.
The risk from COVID-19 to Americans can be broken down into risk of exposure versus risk of serious illness and death.
Risk of exposure:
The immediate risk of being exposed to this virus is still low for most Americans, but as the outbreak expands, that risk will increase. Cases of COVID-19 and instances of community spread are being reported in a growing number of states.
People in places where ongoing community spread of the virus that causes COVID-19 has been reported are at elevated risk of exposure, with the level of risk dependent on the location.
Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure.
Close contacts of persons with COVID-19 also are at elevated risk of exposure.
Travelers returning from affected international locations where community spread is occurring also are at elevated risk of exposure, with level of risk dependent on where they traveled.
Risk of Severe Illness:
Early information out of China, where COVID-19 first started, shows that some people are at higher risk of getting very sick from this illness. This includes:
More cases of COVID-19 are likely to be identified in the United States in the coming days, including more instances of community spread. CDC expects that widespread transmission of COVID-19 in the United States will occur. In the coming months, most of the U.S. population will be exposed to this virus.
Widespread transmission of COVID-19 could translate into large numbers of people needing medical care at the same time. Schools, childcare centers, and workplaces, may experience more absenteeism. Mass gatherings may be sparsely attended or postponed. Public health and healthcare systems may become overloaded, with elevated rates of hospitalizations and deaths. Other critical infrastructure, such as law enforcement, emergency medical services, and sectors of the transportation industry may also be affected. Healthcare providers and hospitals may be overwhelmed. At this time, there is no vaccine to protect against COVID-19 and no medications approved to treat it. Nonpharmaceutical interventions will be the most important response strategy to try to delay the spread of the virus and reduce the impact of disease.
CDC Response
Global efforts at this time are focused concurrently on lessening the spread and impact of this virus. The federal government is working closely with state, local, tribal, and territorial partners, as well as public health partners, to respond to this public health threat.
CDC is implementing its pandemic preparedness and response plans, working on multiple fronts, including providing specific guidance on measures to prepare communities to respond to local spread of the virus that causes COVID-19. There is an abundance of pandemic guidance developed in anticipation of an influenza pandemic that is being adapted for a potential COVID-19 pandemic.
Highlights of CDC’s Response
CDC established a COVID-19 Incident Management System on January 7, 2020. On January 21, CDC activated its Emergency Operations Center to better provide ongoing support to the COVID-19 response.
The U.S. government has taken unprecedented steps with respect to travel in response to the growing public health threat posed by this new coronavirus:
Foreign nationals who have been in China or Iran within the past 14 days cannot enter the United States.
U.S. citizens, residents, and their immediate family members who have been in China or Iran within in the past 14 days can enter the United States, but they are subject to health monitoring and possible quarantine for up to 14 days.
On March 11external icon, a similar policy was expanded to include 26 European countries for a period of 30 days.
On March 14external icon, a similar policy was issued to include the United Kingdom and the Republic of Ireland.
On March 8, CDC recommended that people at higher risk of serious COVID-19 illness avoid cruise travel and non-essential air travel.
Additionally, CDC has issued the following additional specific travel guidance related to COVID-19.
On March 8, CDC issued a Health Alert Network (HAN).
On March 10, CDC issued updated infection control guidance for healthcare settings, including guidance on the use of personal protective equipment (PPE) during a shortage.
CDC has deployed multidisciplinary teams to support state health departments case identification, contact tracing, clinical management, and public communications.
CDC has worked with federal partners to support the safe return of Americans overseas who have been affected by COVID-19.
This is a picture of CDC’s laboratory test kit for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). CDC tests are provided to U.S. state and local public health laboratories, Department of Defense (DOD) laboratories and select international laboratories.
This is a picture of CDC’s laboratory test kit for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). CDC tests are provided to U.S. state and local public health laboratories, Department of Defense (DOD) laboratories and select international laboratories.
An important part of CDC’s role during a public health emergency is to develop a test for the pathogen and equip state and local public health labs with testing capacity.
CDC developed an rRT-PCR test to diagnose COVID-19.
As of the evening of March 10, 79 state and local public health labs in 50 states and the District of Columbia have successfully verified and are currently using CDC COVID-19 diagnostic tests.
Combined with other reagents that CDC has procured, there are enough testing kits to test more than 75,000 people.
In addition, CDC has two laboratories conducting testing for the virus that causes COVID-19. CDC can test approximately 350 specimens per day.
Commercial labs are working to develop their own tests that hopefully will be available soon. This will allow a greater number of tests to happen close to where potential cases are.
Older people and people with severe chronic conditions should take special precautions because they are at higher risk of developing serious COVID-19 illness.
If you are a healthcare provider, use your judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Factors to consider in addition to clinical symptoms may include:
Does the patient have recent travel from an affected area?
Has the patient been in close contact with someone with COVID-19 or with patients with pneumonia of unknown cause?
Does the patient reside in an area where there has been community spread of COVID-19?
If you are a healthcare provider or a public health responder caring for a COVID-19 patient, please take care of yourself and follow recommended infection control procedures.
If you are a close contact of someone with COVID-19 and develop symptoms of COVID-19, call your healthcare provider and tell them about your symptoms and your exposure. They will decide whether you need to be tested, but keep in mind that there is no treatment for COVID-19 and people who are mildly ill are able to isolate at home.
If you are a resident in a community where there is ongoing spread of COVID-19 and you develop COVID-19 symptoms, call your healthcare provider and tell them about your symptoms. They will decide whether you need to be tested, but keep in mind that there is no treatment for COVID-19 and people who are mildly ill are able to isolate at home.
COVID-19 is a new disease and we are still learning how it spreads, the severity of illness it causes, and to what extent it may spread in the United States.
How COVID-19 Spreads
Person-to-person spread
The virus is thought to spread mainly from person-to-person.
Between people who are in close contact with one another (within about 6 feet).
Through respiratory droplets produced when an infected person coughs or sneezes.
These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
Can someone spread the virus without being sick?
People are thought to be most contagious when they are most symptomatic (the sickest).
Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.
Spread from contact with contaminated surfaces or objects
It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.
How easily the virus spreads
How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious (spread easily), like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, spreading continually without stopping.
The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas.
Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.
Situation in U.S.
Different parts of the country are seeing different levels of COVID-19 activity. The United States nationally is currently in the initiation phases, but states where community spread is occurring are in the acceleration phase. The duration and severity of each phase can vary depending on the characteristics of the virus and the public health response.
Frequently Asked Questions on COVID-19 Testing at Laboratories
1. Where do public health laboratories get access to testing kits to detect the virus that causes Coronavirus Disease 2019 (COVID-19)?
CDC provides the test kits for public health laboratories (PHLs) to perform real-time RT-polymerase chain reaction (rRT-PCR) detection of the SARS-CoV-2 virus (the virus that causes COVID-19) in respiratory specimens. CDC received Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA) on February 4, 2020 for use of this rRT-PCR test to detect the virus in upper and lower respiratory specimens. These test kits are available through the International Reagent Resource (IRR)external icon. For over ten years, CDC has provided test kits and reagents to PHLs through the IRR. This resource was established to support state and local public health laboratories, Department of Defense laboratories, and other qualified laboratories participating in public health surveillance and studies. Clinical and commercial laboratories conducting COVID-19 testing access test reagents from commercial reagent manufacturers which have received EUA from the FDA. Genomic RNA material for validation purposes can be obtained from BEI Resources as indicated in question 7 below.
2. What is the CDC’s International Reagent Resource (IRR)?
The International Reagent Resource (IRR) was established by the Centers for Disease Control and Prevention (CDC) to provide registered users with reagents, tools and information for studying and detection of Influenza and other pathogens, including the SARS-CoV-2 virus that causes Coronavirus Disease 2019 (COVID-19). The IRR acquires, authenticates, and produces reagents that scientists need to carry out basic research and develop improved diagnostic tests, vaccines, and detection methods. By centralizing these functions within the IRR, access to and use of these materials in the scientific and public health community is monitored and quality control of the reagents is assured. The International Reagent Resourceexternal icon is managed under a CDC contract by American Type Culture Collection (ATCC).
3. What reagents do public health laboratories need to perform testing to detect the virus that causes Coronavirus Disease 2019 (COVID-19)?
Public health laboratories in the U.S. performing COVID-19 testing of respiratory specimens are provided the following reagents from the CDC’s International Reagent Resource (IRR):
Equipment and Extraction Kits – These kits are used in the preparation of specimens
QIAGEN with QIAmp DSP Viral RNA Mini Kit (obtained from IRR)
QIAGEN EZ1 Advanced XL with EZ1 DSP Virus Kit (obtained from IRR)
QIAGEN QIAcube with QIAmp DSP Viral RNA Mini Kit (obtained from IRR))
Roche MagNA Pure LC with Total Nucleic Acid Kit
Roche MagNA Pure Compact with Nucleic Acid Isolation Kit I
Roche MagNA Pure 96 with DNA and Viral NA Small Volume Kit
rRT-PCR Test Kits (CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel) – These kits include vials of test reagents that detect the virus that causes COVID-19 in respiratory specimens (obtained from IRR)
Reagents –
Master Mix Kits (rRT-PCR Enzyme Mastermix (TaqPath™ 1-Step RT-qPCR Master Mix, CG) – These kits contain the enzymes and other components needed to run the PCR test. (obtained from IRR)
Human Specimen Control (HSC) (obtained from IRR)
EUA Positive Control (obtained from IRR)
4. How do clinicians get access to COVID-19 testing?
As availability of diagnostic testing for COVID-19 increases, clinicians will be able to access laboratory tests for diagnosing COVID-19 through clinical laboratories performing tests authorized by FDA under an Emergency Use Authorization (EUA). Clinicians should consult with the laboratories that routinely perform their diagnostic services to see how best to access testing for COVID-19.
5. Where can additional information about laboratory testing guidance from CDC be found?
CDC has published the following interim guidelines, but this is a very dynamic response so please check CDC’s website for the most up to date information:
6. Where do clinical and commercial laboratories get access to testing supplies to detect the virus that causes Coronavirus Disease 2019 (COVID-19)?
FDA
7. Where do test developers get the genomic RNA needed to validate test performance for FDA?
Currently, genomic RNA material can be used for validation purposes at biosafety level 2 laboratories (BSL-2). Genomic RNA material is available through BEI Resourcesexternal icon. Registrationexternal icon with BEI Resources is required to request SARS-CoV-2 materials.BEI Resources is prioritizing and fast tracking all SARS-CoV-2 registrations with a 12 to 72-hour turnaround time for all SARS-CoV-2 related registrations. Please contact BEI Resources at contact@beiresources.org or 1-800 359-7370 for questions.
Developers are required to sign a material transfer agreement prior to the release of materials.
All BEI Resources reagents are provided worldwide. There is no cost for the reagents themselves. However, shipping and handling charges may apply.
If a kit to detect the virus (SAR-CoV-2) is needed, then contact IRR as indicated in FAQ#1 above.
