University of Maryland School of Public Health Highlights COVID-19 Work from CHHS’ Kimberly Stinchcomb and Clark J. Lee

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The University of Maryland School of Public Health interviewed two CHHS staff members, Kimberly Stinchcomb, MPH, CPH and Clark J. Lee, JD, MPH, CPH about the work they are doing to respond to the ongoing COVID-19 epidemic in Maryland. Kimberly graduated from the School of Public Health in 2016. Clark graduated in 2014.

Kimberly is working full-time with the Prince George’s County Department of Health. Clark J. Lee is working full-time with the Montgomery County Department of Health.

 

 

 

 

Safe Zooming in Quarantine Times

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By CHHS Extern Nicky Arenberg Nissin

With billions of people around the globe staying home due to the Covid-19 pandemic, an increasing amount of social and business meetings have moved to the different video conferencing platforms available today. Among this wide software offer, Zoom has become one of the most popular options: as the go-to app for many schools and colleges, employers, and even some governments, this app has also become one of the most commonly used for social and cultural gatherings. With Zoom’s ubiquity on these pandemic-times, several privacy and security issues have been identified.

For instance, Zoom’s privacy policy has recently been the target of concerns by Consumer Reports (CR) and the Electronic Frontier Foundation (EFF). The main complaint was that app’s terms included the right to collect the video and text content of Zoom meetings, and to share it or use it for advertisement or other business purposes. In the same vein, a Vice investigation exposed that Zoom’s iOS app was sending some user data and analytics to Facebook, regardless of whether they had a linked Facebook account or not. Zoom’s reaction was to quickly make some changes; the company updated their iOS app to stop this sharing with Facebook, and–maybe more importantly–they made some “clarifying updates” to their privacy policy, ostensibly addressing these issues.

Another thing to consider is the power other users and meeting host have to record video, audio, screenshots and chat messages during sessions. By having an open mic or camera, Zoom users are exposed to having their privacy breached during meetings, the contents of private communications compromised, and–as we have seen lately–to potentially become viral sensations. To address this privacy issue, the best practice is for users to activate their mic only when speaking, and–if one decides to activate the camera as well–to use the app’s built-in feature that lets them choose a photo as their video background. This way–by controlling the audio and video being broadcasted to the rest of the meeting–users can minimize the risk of having unintended disclosures or leaks of private information.

The new reality of work and social Zooming has also come with cybersecurity problems. On one hand, there has been a surge in Zoom site spoofing and phishing attacks by cybercriminals, specifically targeting people working from home. These are pretty run-of-the-mill attacks–like the common Netflix or App Store spoof phishing emails–and they can be avoided in the same ways.

On the other hand, internet trolls have started to crash into Zoom meetings by exploiting the app’s settings. In fact, this problem has become so prevalent that Zoom specially created a guide for users to avoid getting uninvited guests. It is evident that the unwanted display of pornography, threatening language or hate speech during a meeting can be disrupting; moreover, the fact that these trolls can also record and publish user reactions to them is concerning, especially on the many K-12 schools using the app.

As the Covid-19 pandemic continues to expand, our dependence on the tools that–like Zoom–allow us to study, work, and socialize from home will deepen. In turn, users will be increasingly vulnerable to these and other privacy and security issues. As we have seen in the past few days, law enforcement is already aware of this situation, and have started investigating the associated criminal activity. In the meantime, users must learn how to use this technology safely and responsibly, keeping up with the associated risks and their management.

Episode 2: How Governors Used Executive Orders to Respond to COVID-19

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In this episode, Christine and Trudy talk to Maggie Davis, Senior Law & Policy Analyst, about the extraordinary measures governors are taking to slow the spread of the novel coronavirus in the U.S., including some of the ways states are addressing their own unique concerns.

Note: Shortly after this episode wrapped, Florida and Georgia issued executive orders.

Hotwash Episode Two Transcript

NEW Hotwash Podcast: Episode 2

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Join CHHS Public Health Program Director Trudy Henson, and Senior Law & Policy Analysts Maggie Davis and Christine Gentry for a discussion on Governor’s emergency powers during the COVID-19 pandemic. Episode 2 of the is now available on our podcast page.

Hotwash Episode Two Transcript

CHHS Public Spreadsheet: 50 State Summary of COVID-19 Actions

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CHHS is pleased to present an up-to-date spreadsheet, summarizing the actions of each of the 50 United States (and the District of Columbia) in response to the COVID-19 pandemic. The table will be updated as new information becomes available.

What we are tracking:

  • Emergency declarations
  • State-at-home orders
  • School closures
  • Closures of non-essential businesses
  • Limitations on public gatherings
  • Policy changes related to medical surge and treatment
  • Policy changes to maintain the supply chain
  • Public benefits
  • Consumer protections

If you see any errors or omissions, please contact Maggie Davis at mddavis@law.umaryland.edu

Defense Production Act: A Solution to the COVID-19 Personal Protective Equipment Shortage?

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On Friday, March 20 President Donald Trump invoked the Defense Production Act to help increase production of much needed equipment to address the COVID-19 pandemic. The Defense Production Act of 1950 (“DPA”) was enacted to prepare and respond to “both domestic emergencies and international threats to national defense”1 by developing the capacity to procure essential equipment to addressing an emergency.  Through the DPA, the President is authorized to prioritize certain existing contracts held by the government as well as allocate resources in a manner in which he deems “necessary or appropriate to promote the national defense.”2 In addition to prioritizing fulfillment of existing government contracts, the President is authorized to control general distribution of scarce materials in the civilian market if those materials are critical to the national defense. In addressing the COVID-19 pandemic, which continues to expand as hospitals face critical shortages of test kits and personal protective equipment (PPE), the DPA offers an additional tool for the federal government in increasing capacity.  

The DPA provides the Trump Administration the following discrete powers to rapidly increase production of the test kits and personal protective equipment necessary to curb the COVID-19 pandemic:  

  • Prohibition on Hoarding Scare Materials 

Last week, as many jurisdictions enacted policies implementing strict social distancing, many Americans stockpiled essential goods in preparation for the COVID-19 pandemic. In addition to essentials like toilet paper, some Americans have also purchased PPE that our healthcare system vitally needs. Sellers like Amazon have been selling out of N95 respirators, resulting in shortages at hospitals across the country and leading to healthcare workers operating in unsafe conditions on the frontline of the pandemic.  Under the DPA, the President is authorized to ration some of these vital supplies, making it unlawful to stockpile designated goods beyond what is deemed reasonable for home consumption or business use. In other words, the President has the power to limit the amount of hand sanitizer, sterile gloves, or respirators purchased for personal benefit rather than the collective safety of our healthcare workers and first responders.  

  • Prioritization of Contracts 

One of the main powers of the DPA authorizes the President to prioritize the fulfillment of government contracts by a vendor. For example, the federal government has existing contracts with large suppliers that provide goods ranging from personal protective equipment to administrative supplies. Under the DPA, the President can instruct the supplier to focus all production on the necessary PPE for addressing the pandemic.  

  • Loans to Enhance Production 

In addition to prioritizing contracts, the DPA authorizes the President to guarantee loans to businesses in order to increase their production capabilities. This could include loans that hire more workers, purchase materials, or equipment to expedite or expand the production of necessary goods like N95 respirators, ventilators, and ventilator valves.  

Additionally, the President is authorized to impose price controls on the scare goods necessary for addressing this pandemic with Congressional approval. Penalties for failing to comply with actions set out by the DPA could result in a $10,000 fine or up to one-year imprisonment.  

The DPA is a vital tool to accelerate production of materials necessary for addressing the COVID-19 pandemic. As Dr. Bill Frist outlined Friday, the federal response over the weekend will be critical in addressing the PPE shortages our healthcare personnel face during the COVID-19 pandemic. However, there are inevitably lags between the measures to enhance production and providing the supplies to our hospitals and healthcare facilities in need. To ensure that our healthcare providers are appropriately protected, the rest of the population should follow the CDC guidance for their community and refrain from purchasing unnecessary PPE and consider donating PPE that they do not need to a local hospital that does. 

President Trump at the White House

The Meaning of Last Week’s COVID-19 Emergency Declaration

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By CHHS Extern Sharon Sidhu

President Trump declared a national emergency over the coronavirus COVID-19 pandemic on Friday afternoon, “unleash[ing] the full power of the federal government.”

This action, under the authority of the Stafford Act, opened up access to up to $50 billion for states, territories, and localities, to use towards the shared fight against the spread of COVID-19. The Stafford Act frees up federal funds when federal assistance is needed to supplement State and local efforts in providing emergency services for the protection of lives, public health and safety, or to contain the threat of a catastrophe in the United States.

The White House wrote a letter to the director of the FEMA, and the secretaries of the Department of Homeland Security, Department of Treasury and the Department of Health and Human Services outlining four major takeaways from the emergency declaration.

First, the letter states FEMA may take emergency protective measures and provide assistance under the authority of Sections 502 and 503 of the Stafford Act. Under Section 502, the President can direct any Federal agency to use its resources (including personnel, equipment, supplies, and facilities) “in support of State and local emergency assistance efforts to save lives, protect property and public health and safety, and lessen or avert the threat of a catastrophe, including precautionary evacuations.” This includes providing technical and advisory assistance to State and local governments for the performance of essential community services, issuance of warnings of risks or hazards, dissemination of public health and safety information, and management of immediate threats to public health and safety. Section 502 also prompts the federal government to assist State and local governments in the distribution of medicine, food and other consumable supplies, and emergency assistance. Section 503 limits the amount of federal assistance not to exceed $5 million for a single emergency, unless the President deems it necessary, which in the case of COVID-19, President Trump has.

Second, the letter encourages all State and local governments to activate their Emergency Operation Centers and to review their emergency preparedness plans. President Trump’s declaration also instructs hospitals nationwide to activate their emergency preparedness contingency plans in order to meet the needs of Americans who have and may have contracted COVID-19. President Trump also said the Health and Human Services Secretary Alex Azar will be able to “waive provisions of applicable laws and regulations to give doctors, all hospitals, and health care providers maximum flexibility to respond to the virus.” These waivers include waivers to access limits on numbers of beds and lengths of stays in hospitals, as well as waivers to rules on bringing in additional physicians at certain hospitals as needed.

Third, the letter instructs the Department of Treasury to provide relief from tax deadlines to Americans who have been adversely affected by the COVID-19 emergency, pursuant to 26 U.S.C. 7508(A)(a), which grants the Department of Treasury to postpone certain deadlines for those who have been affected by a federally declared disaster.

Finally, in his letter, President Trump encouraged all governors and tribal leaders to consider requesting Federal assistance under section 401(a) of the Stafford Act. Section 401(a). Section 401(a) requires requests for a declaration by the President that a major disaster exists to be made by the Governor of the affected State. The request needs to be based on the conclusion that the disaster “is of such severity and magnitude that effective response is beyond the capabilities of the State” such that Federal assistance is necessary. The President may grant the request of the Governor and declare that a major disaster or emergency exists, and thereafter direct federal funds to provide relief assistance, as well as assistance in the distribution of medicine, food, and emergency assistance to the states.

 

Latest Update on COVID-19 in Maryland

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By CHHS Extern Emma Evans Eiden

Just one week after announcing Maryland’s first three cases of COVID-19, Maryland has identified its first community transmission case of the virus bringing the total number of COVID-19 cases to 12.  A Prince George’s county resident, with no travel outside of the state, tested positive on Wednesday.

During a Thursday afternoon press conference, Governor Hogan announced major updates to Maryland’s COVID-19 response plan.  MEMA is elevated to its highest activation level.  The Governor issued an executive order to activate the National Guard.  All nonessential state employees will enter telework duty, if eligible, and public access to state buildings will be restricted.  Maryland prisons will be closed to all visitors.  The Governor has also ordered all senior activity centers to close.

Governor Hogan also issued a state-wide prohibition on events and gatherings of over 250 people.  All certifications and permit expiration dates, including for driver’s licenses, will be extended until after the state of emergency ends.  Hospitals must implement new visitor policies, including a one visitor limit per patient, no minor visitors, and no visitors who have recently traveled internationally.  The Governor urged that essential services, such as grocery stores and gas stations, should remain open.

State Superintendent of Schools, Dr. Karen Salmon, announced state-wide school closures beginning Monday, March 16 through Friday, March 27.  Plans are in process to ensure that free-and-reduced meals will continue and to ensure childcare for essential emergency response personnel.

Maryland Department of Health Deputy Secretary Fran Phillips outlined three goals for what she described as these “extraordinary measures”: slow the spread of infection, protect vulnerable people, and maintain essential services.  Dr. David Marcozzi of the University of Maryland Medical Center endorsed the Governor’s plan and recommended that similar measures for the private sector.  Dr. Marcozzi also assured the public that the health system is prepared to handle care for all individuals requiring care.

MDH issued a letter to clinicians on Wednesday, March 11 urging patient evaluation via phone or other telemedicine platforms.  Any patient with respiratory symptoms should immediately receive a facemask.  COVID-19 testing is now available in commercial and hospital settings, and providers should direct samples to those sites whenever possible.

The MDH loading dock will remain open on Saturday and Sunday to accept COVID-19 test samples.  MDH is no longer reporting the number of processed samples and negative results.  Of the 12 positive cases, two patients remain hospitalized.  Three patients have fully recovered and have passed the required quarantine window.

 

 

COVID-19 Reaches Maryland

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By CHHS Extern Emma Evans Eiden

Thursday night, Governor Larry Hogan announced three confirmed cases of COVID-19 in the State of Maryland.  While residents are encouraged to continue their daily routines, including work and school, the Governor declared a state of emergency to mobilize funds and activate full coordination between the Maryland Department of Health (MDH), the Maryland Emergency Management Agency (MEMA), and other agencies.  Also under the Governor’s emergency authority, on Friday the Maryland Insurance Commissioner was directed to eliminate all patient costs and pre-authorization requirements for COVID-19 testing.

The first three cases were identified in Montgomery County and were contracted on a cruise that returned on February 20, 2020.   At the time the three individuals returned, only travelers who visited China were being screened for the virus.  The patients developed flu-like symptoms and were contacted earlier this week after the CDC determined that the cruise was exposed to the corona virus.  The patients are now under quarantine in their homes. Contact tracing continues to identify additional exposures.

After the Governor’s announcement, Montgomery County officials including County Executive Marc Elrich reiterated that there is currently no cause for panic, while urging reasonable precautions in the event that additional cases are found in the county.  For example, residents should have enough food, medications, and other supplies to remain at home for up to two weeks.  Montgomery County Public Schools remain open but the school system is prepared to deploy a modified digital curriculum in the event of closures.

Dr. Travis Gayles, Montgomery County Health Officer and Chief of Public Health Services, is responsible for determining if and when to close county buildings, including schools.  Dr. Gayles explained that there is currently no evidence of community spread of the disease, and the existing travel related cases are clinically doing well which suggests a mild to moderate form of the virus.

In a Friday evening press conference, Governor Hogan announced that the three Maryland cases were contracted on an Egyptian cruise on the Nile River which is also linked to six cases in Texas. Two instances of public contact by the Maryland patients have been identified so far. One of the Maryland patients attended an event in Philadelphia, PA where contact was made with local students. Pennsylvania health officials were notified, and five schools in the Philadelphia suburbs closed as a result.  Another Maryland patient attended an event at a retirement community, the Village at Rockville, with over 70 attendees on Saturday, February 29.  Governor Hogan encouraged attendees of the Rockville event to contact the MEMA call center.

On Sunday, Governor Hogan’s office announced two additional positive results in the state, both were contracted during overseas travel.  One of the new cases is located in Montgomery County, and the patient doing well at home after a brief hospitalization. The second case is located in Harford County, and the patient, who is over 80 years old, remains hospitalized.  The hospitalized patient contracted the disease on travel to Turkey, and it is the first known case to come from that country.  Officials believe the risk of community exposure remains low but are advising individuals over the age of 60 years old and those with compromised immune systems to stay home as much as possible because they are significantly more susceptible to COVID-19 and experience higher mortality rates.

During a Monday afternoon press conference, Governor Hogan announced that he had just signed into law emergency legislation, unanimously passed by the Maryland legislature, authorizing the use of $50,000,000 of Maryland’s “rainy day fund” for the COVID-19 response. State employees have been directed to cancel all out-of-state travel, and all state agencies are preparing to enter a period of mandatory telework.

Governor Hogan explained that there are six additional Marylanders under self-quarantine who were on the Nile River Egyptian cruise line during different dates from the initial three Maryland cases.  Two of those individuals are exhibiting symptoms, but all six will be tested for COVID-19.  Also, there are 12 Marylanders aboard the Grand Princess cruiseship, which is currently docked off the coast of California, who will be transferred to military bases for examination and quarantine but are not exhibiting symptoms.

On Monday evening, a sixth Marylander was confirmed positive for COVID-19.  The patient contracted the disease during out of state travel and is now located in Prince George’s County.

Last Tuesday, March 3, a memo informed Maryland health officials and providers that the MDH Laboratory was authorized to perform the 2019-Novel Coronavirus Real-time RT-PCR Diagnostic Panel.  Samples may be collected locally then transported to the MDH laboratory.  A provider must consult with an MDH epidemiologist prior to collecting and submitting a sample.  The sender is responsible for compliance with all requirements and regulations for packaging and shipping a potentially infectious sample; however, MDH may provide some transport and courier services.  Training and certification is required to package potentially infectious materials, and the certification must be renewed through the CDC every two years.

Criteria for a person under investigation (PUI) for coronavirus include a combination of clinical and epidemiological factors.  Currently there are three different criteria for PUIs:

  1. Fever OR respirator symptoms (not necessarily requiring hospitalization) AND contact with a person with a confirmed case of COVID-19;
  2. Fever AND respiratory symptoms requiring hospitalization AND travel to China, Iran, Italy, Japan or South Korea within 14 days of onset; or
  3. Fever AND respiratory symptoms requiring hospitalization with no alternative diagnosis AND no known source of exposure.

As of Monday, MDH has processed 73 patient samples, with 6 positive results.

Episode 1: 100 Years After the Great Molasses Flood

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How bad could a flood of molasses really be? In this kickoff episode, Trudy and Christine explore some emergency management basics in context of the Great Molasses Flood.

Hotwash Episode One Transcript