Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.
Under pressure from President Donald Trump, the Food and Drug Administration on Sunday issued an emergency use authorization for “investigational convalescent plasma” treatment for COVID-19. This is not an outright approval — it is temporary pending more drug trial outcomes.
The president said the FDA found the treatment to be “safe and very effective,” but that is not what FDA said. The FDA actually said, “This product may be effective in treating COVID-19 and that the known and potential benefits of the product outweigh the known and potential risks of the product.”
Note the words “may be” effective.
The Mayo Clinic, which is conducting the plasma tests, said, “It’s not yet known if convalescent plasma therapy will be an effective treatment for COVID-19. You might not experience any benefit.”
Just four days ago, Dr. Anthony Fauci and the National Institutes of Health signaled that the preliminary findings about convalescent plasma for COVID-19 were not convincing enough to keep using the treatment beyond the clinical trials that are underway. But the NIH does not control the FDA and it is the FDA that approves medical treatments. Last week the president accused the FDA of slow-walking plasma treatments until after the November elections.
The treatment is based on the idea that infusions of plasma from those who have recovered from COVID-19 would be rich with antibodies. Injecting that plasma into ill patients would jumpstart the sick person’s immune system into fighting the virus while the patient’s own immune system gets up to speed.
To be sure, there is a lot of optimism about whether this would work, but after 35,000 patients (half of them critically ill) were infused with the plasma, close to one out of 10 of the patients died within a week of the infusion. (Keep in mind, more than half the infusions were given to patients who were in intensive care units and a fourth of them are on ventilators. In other words, they were critically ill and may not have survived with or without plasma treatment.)
To use the COVID-19 antibody plasma treatment, physicians must have FDA permission.
In light of the first round of analysis, the NIH cautioned that we should tone down our enthusiasm about plasma treatments until researchers can look at the data from what is now 70,000 and growing patients.
When laypersons look at the data, there might not seem like much to grab as good news, but researchers say there is. Here is the reason for hope about plasma treatment: When critically ill patients were given plasma within three days of diagnosis of COVID-19, 8.7% of them died. But if the treatment was delayed until four or more days, the fatality rate was 11.9%. In the Sunday news conference, President Trump said that is a 35% improvement, though StatNews couldn’t find FDA documents to back that number. Still, researchers get excited about a difference like that, as small as it might seem, because it could signal that the earlier the injection the better the recovery rate.
The Washington Post talked with Carlos del Rio, executive associate dean of the Emory School of Medicine, who said that the use of plasma from infected donors cannot be called a “breakthrough.”
He called plasma an “interesting strategy” and said the data so far was a “nice hint” that it could be helpful but stressed that it was “not going to win the game.”
“The problem is, the president, in my mind, has lost total credibility because of what he’s done with hydroxychloroquine. He’s touted so many things that don’t work,” del Rio said. “The reality is what we have today to treat COVID is extremely limited.”
This is the second time the president has pushed to get emergency FDA approval for an unproven treatment. The first time it was for hydroxychloroquine sulfate, which the FDA ultimately said was not only ineffective in treating COVID-19 but was connected to potentially harmful side effects, including heart problems.
There are some local ways for you to look into this story. Blood centers all over America are gathering plasma from people who have COVID-19 antibodies. Talk to donors about their hope that they can help. The infusions are being used at 2,700 sites around the country involving 14,000 physicians. Talk to the blood and tissue centers that dispense to your local hospitals to find out how much plasma they have handled so far in this trial period.
KSAT-TV in San Antonio produced a story last week about a local man who credits the plasma treatment with saving his life. The story includes the observation that only 900 of the 33,000 people who could donate plasma in San Antonio have done so. KPRC in Houston has a similar story on a Houston man who credits plasma treatment with his recovery, although doctors cautiously pointed out that they do not know if the man would have recovered without the plasma treatment.
See a list of publications about convalescent plasma therapy by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine.
Dual hurricanes make landfall
Is it possible to add one more thing to the list of urgent and important stories you will cover this week?
- Two hurricanes are heading for the Gulf Coast while a pandemic is still unfolding.
- The Republican National Convention convenes this week.
- Schools are struggling to reopen.
- A million people a week file for unemployment.
- Congress is deadlocked over rescuing the postal service and a stimulus bill to keep people from losing their homes is dead in the water for now.
One more thing — on Saturday, the National Weather Service issued a red flag fire warning for much of the northern half of California through 11 p.m. Monday. Frequent lightning strikes add to the already out of control wildfires that have become the second- and third-largest blazes the state has seen. More than 340,000 acres have burned, the fires are only 10% contained and more than 20,000 homes are threatened.
For those of us who live along the Gulf Coast, a Category 1 storm gets our attention but does not cause alarm. But back-to-back hurricanes are a different matter.
Hurricane Marco’s center is fairly small and may not, on its own, cause huge problems. Forecasters are thinking it will bring a half-foot of rain and 4 to 6 feet of storm surge. Winds will likely be around 40 to 65 miles per hour and a little higher at the center.
Hurricane Laura, as I write this column, may land 24 to 48 hours after Marco right along the Louisiana and Texas borders. It will likely be stronger, maybe a Category 2 storm by landfall. With every update the track moves further west. Authorities worry that the water from the first storm may not have time to drain before Laura arrives.
New Orleans said its pumps are mostly working, but officials warned that the system that keeps the city from flooding is old and unreliable. I want you to read this passage from Sunday’s Times-Picayune/New Orleans Advocate:
Flooding in June resurrected concerns about the New Orleans Sewerage and Water Board power and pumps. An explosion late last year also put Turbine 5 out of service. A key system weak point remains any problem with the giant turbines housed at its South Claiborne Avenue plant.
Back in June, (Sewerage & Water Board of New Orleans) Executive Director Ghassan Korban said his biggest concern about the system’s power supply revolved around “workhorse” Turbine 4.
“So, we have redundancy in the system. It’s not the redundancy that we need; it’s not the redundancy we had a year ago,” Korban said at the time. “We are going into this season with a more fragile system and a less redundant system than ever before.”
Aug. 29 is the 15th anniversary of Hurricane Katrina. Here we are, a decade and a half later, and the New Orleans flood pumps are still fragile.
What unfolds in the path of these two storms may teach us a lot about managing evacuations, shelters and recovery in a pandemic.
Some big questions:
- How will relief agencies respond to these storms in a pandemic? Will charity groups send teams to deliver food and help rebuild whatever is washed away?
- Will the Federal Emergency Management Agency be up to the task of responding to the needs?
- The Centers for Disease Control and Prevention has guidelines and recommendations for evacuation centers. How has your community responded to those recommendations, especially if you are in a hurricane-prone area?
- Will utility crews move more slowly in restoring power because they have to be COVID-cautious?
- Will water rescue teams take precautions in pulling people from their homes, having to assume everybody they encounter might be infected with COVID?
- How will/should dual hurricanes affect the tone and content of the RNC’s celebration?
- The House has a deadline coming up at the end of September to fund the National Flood Insurance Program.
Hurricane coverage challenges newsrooms in normal circumstances. Imagine covering it with producers, reporters and photojournalists working remotely with power and internet outages and the communications interruptions that come with it all.
Journalists, there is so much going on this week. Check on each other. Quiet does not always mean OK.
Hotels warn of foreclosures
One-fourth of hotels are behind on their mortgage payments. That is a record. The hotel industry is edging close to a collapse and is begging Congress for a lifeline.
For good reason, journalists have largely focused on the retail and home mortgage crises. But hotels are cornerstones of any city, hubs for activity and are big job and tax generators.
According to a new national report compiled by analytics company Trepp, the hotel industry is facing a historic wave of foreclosures as the COVID-19 pandemic continues to devastate small business hotel owners and its workforce.
The hotel segment is facing a historic number of delinquencies and is the most heavily hit sector of the commercial mortgage-backed securities market. Nearly 4,000 hotel industry leaders sent an urgent letter to Congress urging immediate action to help hotels avoid foreclosure and the loss of tens of thousands of jobs.
The Trepp analysis lists the 20 metro markets with the biggest hotel loan delinquency totals by dollars and by percentages. Naturally, expensive places like New York City will have much larger dollar totals, but look at the percentages in Minneapolis and Rochester.
Let’s put this in perspective. Hotel Management said if you look at the number of hotels that are more than a month behind on their mortgage payments, it is more than 50% higher than the number of troubled hotels in the Great Recession. You may think of hotels as being big corporate companies but 61% of hotels in the U.S. are small businesses.
Let’s look at Trepp’s data in one other way. Compare hotel loan delinquency to retail, industrial and apartment building owners.
Four hotel associations sent Congress a letter outlining the depth of the issue. Take a look at the names at the bottom of the letter and you will find 4,000 names of people near you who can speak to this situation.
Here are some excerpts:
- “The human toll on our employees and our workforce is devastating, with less than half currently employed. The economic impact to our industry is equally as dramatic, estimated to be nine times greater than the Sept. 11 terrorist attacks.”
- Hotel demand may not recover until 2023.
As of July 30, more than half of all hotel rooms were empty across the country.
The American Hotel and Lodging Association provided the next two charts along with a state-by-state breakdown of hotel jobs lost so far in 2020.
There are 33,561 hotels in America and they are on track to lose half of their 2020 income. About 4.8 million hotel workers have lost their jobs since February.
Larger hotels say they require special help. They said that the last round of Paycheck Protection Program loans didn’t help them because the hotels with commercial mortgage-backed securities (called CMBS) didn’t qualify for forbearance because their loans are complicated. But nearly a third of the $300 billion in loans owed by hotels are CMBS loans.
I know this sounds like inside baseball, but it is important that you know that what has been done to date has not helped hotels much.
Why should you care? Story ideas near you.
Prior to the pandemic, U.S. hotels supported one in 25 American jobs. Remember, hotels are a huge customer for everything from food and alcohol to utilities, internet services and office supplies.
Hotels also pay property taxes. In March, the hotel industry warned the White House that up to half of the hotels in the country could close after 2020. What would that mean to property taxes? Hotel owners are already planning to ask for lower property taxes because property today is not worth what it was a year ago when occupancy was high. Will your local governments be open to those appeals? What will the hotels have to prove to get a break?
Hotels generate tourism taxes, including room taxes and state and local sales taxes. States that will lose the most tax income in this pandemic year include:
- California (-$1.9 billion)
- New York (-$1.3 billion)
- Florida (-$1.3 billion)
- Nevada (-$1.1 billion)
- Texas (-$940 million)
Hotel occupancy is an indication of the tourism and convention industries.
Oxford Economics estimated that “due to the sharp drop in travel demand, hotel operations and room occupancy, state and local tax revenues will drop $16.8 billion in 2020.”
Homeowner and renter foreclosure protection is unsettled, too
Politico reported that The Department of Housing and Urban Development will extend foreclosure protection for 8.1 million Americans who have HUD-insured home loans. HUD insures loans for low- and modest-income borrowers.
Do not confuse this with Fannie Mae and Freddie Mac backed loans, which include nearly half of all home loans in the country. Politico pointed out the HUD decision will be far more limited than the eviction moratorium that protected renters in the early days of the pandemic:
Thus, it involves far fewer homes than did the four-month eviction moratorium that lapsed at the end of last month. That moratorium was included in the CARES Act, which itself applied to about a quarter of the nation’s 44 million rental units before it expired July 25.
What’s new in the CDC’s new COVID guidelines for schools?
Over the weekend, school systems digested the CDC’s new guidelines on how to reopen. The guidelines include some important updates.
The new guidelines include this: “CDC does not currently recommend universal symptom screenings (screening all students grades K-12) be conducted by schools.” The reason, the CDC said, is that such screenings won’t tell us much since lots of children won’t show symptoms of being infected even if they are carrying the virus. In May, the CDC recommended daily temperature and symptom checks for all students.
The updated guidelines also backed off recommendations that students not eat in school cafeterias but now say cafeterias can be safe if kids sit 6 feet apart and if schools use touchless checkout systems, which schools said they can’t afford.
One of the most important updates is the CDC’s new expanded attention to school ventilation systems. In the past, the CDC’s back-to-school guidelines barely mentioned ventilation, but they now include a big bulleted-list of recommendations that schools use HEPA filters, ultraviolet lights, turn fans on high, open windows and even think carefully about ventilation on school buses. The CDC’s list includes:
- When weather conditions allow, increase fresh outdoor air by opening windows and doors. Do not open windows and doors if doing so poses a safety or health risk (e.g., risk of falling, triggering asthma symptoms) to children using the facility.
- Use fans to increase the effectiveness of open windows.
- Decrease occupancy in areas where outdoor ventilation cannot be increased.
- Consider running the HVAC system at maximum outside airflow for 2 hours before and after the school is occupied.
- Ensure restroom exhaust fans are functional and operating at full capacity when the school is occupied.
- Use portable high-efficiency particulate air (HEPA) fan/filtration systems to help enhance air cleaning (especially in higher risk areas such as the nurse’s office).
- Use portable high-efficiency particulate air (HEPA) fan/filtration systems to help enhance air cleaning (especially in higher risk areas such as nurse’s office and special education classrooms).
- Consider using ultraviolet germicidal irradiation (UVGI) as a supplement to help inactivate SARS-CoV-2, especially if options for increasing room ventilation are limited.
- Ventilation considerations are also important on school buses.
All of this might sound doable and even common sense, except that in aging school buildings, ventilation systems are out of date and hard to adapt to new technology like the CDC is suggesting.
Will universities expel partygoers?
Syracuse University suspended almost two dozen students after a back-to-school party last week that school administrators said might put the whole semester at risk.
Just read the growing number of emails written by seething university leaders who spent the year building COVID-19 safety plans only to see incoming students ignore the plans and spread the virus and you will understand why universities may expel students if they can prove that the students broke the rules.
The University of Tennessee said it “will not hesitate” to expel students who break the rules and attend parties. Tulane University, the site of a July blowout party, warned students returning for the new semester that it will enforce the safety rules, including expulsion.
Keep in mind that if a student is expelled or suspended, it could carry steep financial consequences. Students may lose scholarships and still be held accountable for housing costs, class fees and tuition.
Kevin Kruger, the president of the National Association of Student Personnel Administrators, told USA Today:
Busting big off-campus parties presents another challenge: Who faces punishment? Is it only the host or everyone who attends? And if you threaten punishment, how do you manage the contact tracing that’s essential to limiting an outbreak?
“You’ve added a factor that would maybe make students reluctant to tell anybody where they were or who they’re with if they were going to be consequences,” Kruger said.
But, the USA Today story said, unless schools back up their threats, students and staff who are vulnerable to the virus won’t feel safe:
Sternly worded warnings and an ambiguous threat of punishment will be inadequate to reassure some students. Samantha Price, a junior at the University of Mary Washington in Virginia, has Type 1 diabetes, which makes attending classes in person during a pandemic a threatening prospect.
Fearing that too many of her peers don’t realize the consequences of their actions, she has scheduled all her classes online in the fall.
We’ll be back tomorrow with a new edition of Covering COVID-19. Sign up here to get it delivered right to your inbox.
Al Tompkins is senior faculty at Poynter. He can be reached at email@example.com or on Twitter, @atompkins.