npr--2020-04-28--We Asked All 50 States About Their Contact Tracing Capacity. Here's What We Learned

We Asked All 50 States About Their Contact Tracing Capacity .
Here 's What We Learned States are eager to open up and get people back to work , but how do they do that without risking new coronavirus flare ups ?
Public health leaders widely agree that communities need to ramp up capacity to test , trace and isolate .
The idea behind this public health mantra is simple : Keep the virus in check by having teams of public health workers — epidemiologists , nurses , trained citizens — identify new positive cases , track down their contacts @ @ @ @ @ @ @ those who were exposed isolate themselves .
This is the strategy that 's been proven to work in other countries , including China , South Korea , and Germany .
For it to work in the U.S. , states and local communities will need ample testing and they 'll need to expand their public health workforce .
By a lot .
An influential group of former government officials released a letter Monday calling for a contact tracing workforce of 180,000 .
Other estimates of how many contact tracers are needed range from 100,000 @ @ @ @ @ @ @ states , Puerto Rico and the District of Columbia to ask them how many contact tracers they currently have and — and how many they were planning to add , if any .
We got data for 41 states and the District of Columbia , and found they have approximately 7,324 workers who do contact tracing on staff now , with plans to surge to a total of 35,582 .
`` It 's a start , '' Tom Frieden , former director of the Centers of Disease Control and Prevention says of these @ @ @ @ @ @ @ that are really thinking about this and scaling it up , there are others that are just beginning to think about it . ''
The raw numbers each state needs vary by population size , the number of positive cases , and whether measures like social distancing have effectively limited the contacts for each case , Frieden says .
According to the National Association of County and City Health Officials , which recently issued a position statement on contact tracing , 15 health workers per 100,000 people is a baseline number during normal @ @ @ @ @ @ @ this number should double to 30 per 100,000 people .
`` That 's probably a good guidepost for state and local health officials , '' says Crystal Watson , a senior scholar at the Johns Hopkins Center for Health Security , and a lead author of the center 's white paper on contact tracing capacity , though she cautions that these are estimates .
Big hiring efforts , but not everywhere Several states that took our survey are making big efforts to shore up their contact tracing workforces .
Notable examples include Louisiana @ @ @ @ @ @ @ to hire 700 people ; Texas , which has 1,150 contact tracers and is hiring another 2,850 to start ; and Kansas , which plans to bring on 400 .
`` I am really happy to see that there are a lot of places here that are thinking this through , and really putting a lot of effort into that next step , '' says Watson .
She also notes California 's goal of having 10,000 contact tracers and Ohio 's plan to reach a total of 1,750 .
Of the places that @ @ @ @ @ @ @ information in press releases , only four are positioned to surpass that 30 workers per 100,000 threshold : the District of Columbia , Michigan , Nebraska and North Dakota .
In fact , North Dakota stands out dramatically from the pack : after the planned hiring surge it will have 66 contact tracers on staff per 100,000 residents .
`` North Dakota leadership believes widespread testing capacity paired with a robust contact tracing infrastructure are key components to rising above this current health challenge , '' Vern Dosch , contact tracing administrator for @ @ @ @ @ @ @ NPR .
`` We are committed to investing in the human resources and technology needed to make it happen .
We are building tomorrow on facts , not fear . ''
Granted , North Dakota has among the smallest populations of all states — hiring 250 contact tracers to meet the need is certainly easier than onboarding 10,000 in California .
The average rate of contact tracers among the states we had data from was 12 per 100,000 people – just shy of the estimated need during normal times , and a third @ @ @ @ @ @ @ during the coronavirus pandemic .
The median was even fewer : seven contact tracers per 100,000 .
Watson warns states against playing this by ear .
`` This is really something we should n't undershoot , '' she says .
Of course , public health officials need to keep a close eye on transmission and cases — more cases mean you need more contact tracers — but Watson says investing in contact tracing now is the smart move .
`` We 're spending trillions of dollars on the economic aspects of this , @ @ @ @ @ @ @ .
`` But if we 're not willing to put in that same effort to the public health side to actually control this and to reduce the economic impacts — fighting this at its source — that does n't make sense to me . ''
A patchwork of staff and plans in flux Not every state responded to NPR 's request .
A few states – including Idaho and Indiana — did respond , but said they were not able to provide statewide numbers of contact tracers , because contact tracing is done @ @ @ @ @ @ @ for the Michigan health department explained state employees assist `` certain local health departments with case investigation and contact elicitation , which is the first step in the process of contact tracing , '' but the number of county staff that work to trace contacts was not available .
Other states that rely on county health departments to do contact tracing were only able to provide estimates of county staffing levels .
Oklahoma 's spokesperson explained the 150 number of tracers they provided `` is a ballpark as we have county nurses who @ @ @ @ @ @ @ '' Another state that was not able to provide contact tracer numbers was Georgia , which has already begun to ease social distancing measures .
Georgia spokesperson Nancy Nydam told NPR the state department of public health `` the total number of contact tracers will vary widely by [ health ] district , so we are not yet able to put an exact number to it . ''
She added that the state was engaging with medical students and possibly the National Guard , and that more information would be available in the @ @ @ @ @ @ @ several states noted that their plans were very much in flux .
`` As we are developing our plans , we are hiring and training an initial group of epidemiologists , '' a spokesperson for Colorado 's Joint Information Center responded to NPR in the survey , noting they are starting with 50 epidemiologists for now but may add more in the coming weeks .
A few states , including Minnesota , indicated they do not have current plans to hire more contact tracers .
Andrea Ahneman , a spokesperson for the COVID-19 @ @ @ @ @ @ @ had over 100 staffers now , and that `` this is plenty of capacity for current needs . ''
States that said they 're seeking to expand contact tracing capacity are getting creative about finding the workforce .
Nevada said it was recruiting volunteers for `` a dramatic expansion '' of its contact tracing capacity .
Oklahoma is training 4th year medical residents to do contact tracing .
Maine has recruited some recently retired epidemiologists .
Georgia and Iowa are planning to call on the National Guard .
About half of states surveyed @ @ @ @ @ @ @ smartphone or online apps to assist with contact tracing .
Few had decided on a specific app , but several mentioned the Google app that 's in development .
Some states indicated that they hoped the federal government could assist with the cost of licensing these apps .
How the federal government can help Asked what support each state could use from the federal government , several states — including Hawaii , Maine and Nevada — mentioned the need for funding to hire or train new contact tracers .
A spokeswoman for the @ @ @ @ @ @ @ use `` manpower and expertise , especially for training volunteers . ''
On the federal level , the Centers for Disease Control and Prevention provides staff to support local contact tracing efforts .
Director Robert Redfield told NPR last week the agency has around 500 staff currently deployed to help state and local health departments , and that it would support another 650 positions with $ 45 million in funds .
He has acknowledged decades of underfunding for public health and said that the federal government needs to `` augment personnel substantially .
@ @ @ @ @ @ @ is in talks with other agencies and organizations with big boots-on-the-ground workforces to expand capacity , but has not released details on these ideas .
Numerous groups and experts are calling for more action and funds from the federal government .
The group of former federal officials who wrote a letter Monday calling for increased contact tracing hires also say $ 46 billion in federal funding is needed to pay for the hires and resources to help infected and exposed people stay isolated .
Gottlieb told NPR Monday that although assembling as many @ @ @ @ @ @ @ daunting , it 's doable .
`` We already see the states making efforts to bring on thousands of new public health workers to do contact tracing , '' he said .
`` We 're going to need this number of people if we want to enter into the fall with the kinds of resources we need to try to trace infection to prevent large outbreaks . ''
Federal leadership on contact tracing is important , says Watson of the Center for Health Security .
`` This is unprecedented — this is not @ @ @ @ @ @ @ nation , '' she says .
`` It may be hard for some states to even think about how they get started on this , so guidance from the federal level is definitely needed . ''
Stephanie Adeline , Martha Bebinger , Natalie Krebs , Nicole Leonard , Aviva Okeson-Haberman , Sebastián Martinez Valdivia , Anh Nguyen , Bonnie Petrie , Paige Pfleger and Carmel Wroth contributed to this report .

States Nearly Doubled Plans For Contact Tracers Since NPR Surveyed Them 10 Days Ago
Enlarge this image toggle caption Ryan Kellman/NPR Ryan Kellman/NPR
Note: The graphic in this story is no longer being updated. For more recent data, go to our new post on this topic.
Updated May 7, 5:36 p.m. ET: This story was originally published on April 28. We've updated it throughout to reflect updates and new data from several states.
In late April, NPR surveyed all 50 states, Puerto Rico and the District of Columbia to ask them about their contact tracing workforce. That survey showed that states had, or planned to have, around 36,000 workers in total focused on contact tracing, a key strategy to contain the spread of the coronavirus and prevent outbreaks.
In ten days since NPR first published the results of this survey, we've received responses from several more states; in addition some states with big populations announced new plans to increase contact tracing.
In all, 44 states and the District of Columbia now have plans to expand their contact tracing workforce, reaching a total of 66,197 workers — an increase by 30,000 of the number that were planned last week when we first published.
Public health leaders widely agree that communities need to ramp up their capacity to test, trace and isolate, in order to safely ease up on social distancing measures and allow people to get back to work.
The idea behind this public health strategy is simple: Keep the virus in check by having teams of public health workers — epidemiologists, nurses, trained citizens — identify each new positive case, track down their contacts and help both the sick person and those who were exposed isolate themselves.
This is the strategy that's been proven to work in other countries, including China, South Korea, and Germany. For it to work in the U.S., states and local communities will need ample testing and they'll need to expand their public health workforce. By a lot.
An influential group of former government officials released a letter last week calling for a contact tracing workforce of 180,000 around the country. Other estimates of how many contact tracers are needed range from 100,000 to 300,000.
Of 44 states and the District of Columbia for which we now have data, states reported having at least 11,142 contact tracers working now. (Figures for most states originally surveyed have not been updated so the total number may be higher.) But states seem to be moving fast to increase staffing.
Among the recent updates to states plans, California announced a partnership with UCSF to put 3,000 people a week through its 20-hour contact tracing training, with a goal of ultimately having 20,000 contact tracers. New York state also announced a plan to hire as many as 17,000 workers, in partnership with Bloomberg Philanthropies, the Johns Hopkins School of Public Health and the nonprofit Resolve To Save Lives.
The raw numbers each state needs varies by population size, the number of positive cases, and whether measures like social distancing have effectively limited the contacts for each case, says Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention, who leads Resolve To Save Lives.
According to the National Association of County and City Health Officials, which recently issued a position statement on contact tracing, 15 health workers per 100,000 people is a baseline number during normal times, and during a pandemic, this number should double to 30 contact tracers per 100,000 people. Policymakers in several states including New York and Illinois have mentioned this benchmark in announcing their staffing goals.
Still, the calculus for how many tracers are needed may not be as simple as looking at population size — the size of a community's outbreak and the number of contacts per case would also influence the number of contact tracers needed. Melaney Arnold, a spokeswoman for the Illinois Department of Public Health, noted in her response to NPR that the hiring decisions are complicated and that the speed with which positive COVID-19 cases can be tested and isolated affect their projected staffing numbers.
Several contact tracer workforce worksheets are now available to policymakers: One calculator was unveiled Thursday from two public health heavyweights — the Association of State and Territorial Health Officials and National Association of County and City Health Officials — and the Mullan Institute at the George Washington University. And another calculator is published by Resolve to Save Lives.
Big hiring efforts, but not everywhere
Several states that took our survey are making big efforts to shore up their contact tracing workforces. Notable examples include Louisiana and Kentucky, which are both planning to hire 700 people; Texas, which has 1,150 contact tracers and is hiring another 2,850 to start; and Kansas, which plans to bring on 400.
"I am really happy to see that there are a lot of places here that are thinking this through, and really putting a lot of effort into that next step," says Crystal Watson, a senior scholar at the Johns Hopkins Center for Health Security and a lead author of the center's white paper on contact tracing capacity.
Of the places that responded to NPR or have released this information in press releases, eight are positioned to surpass that 30 workers per 100,000 threshold: Alaska, California, the District of Columbia, Illinois, Michigan, Nebraska, New York and North Dakota.
In fact, North Dakota and Alaska stand out dramatically from the pack: after the planned hiring surge North Dakota will have 66 contact tracers on staff per 100,000 residents, and Alaska will have 68.
"North Dakota leadership believes widespread testing capacity paired with a robust contact tracing infrastructure are key components to rising above this current health challenge," Vern Dosch, contact tracing administrator for North Dakota wrote in a statement to NPR. "We are committed to investing in the human resources and technology needed to make it happen. We are building tomorrow on facts, not fear."
Granted, North Dakota and Alaska have among the smallest populations of all states — hiring several hundred contact tracers to meet the need is certainly easier than onboarding 20,000 in California.
Including all planned staff additions, the average rate of contact tracers among the states we had data from would be 17 per 100,000 people – just above the estimated need during normal times, and half of what's projected to be needed during the coronavirus pandemic. The median is fewer: nine contact tracers per 100,000.
Watson warns states against playing this by ear. "This is really something we shouldn't undershoot," she says. Of course, public health officials need to keep a close eye on transmission and cases — more cases means you need more contact tracers — but Watson says investing in contact tracing now is the smart move.
"We're spending trillions of dollars on the economic aspects of this, which is important," she says. "But if we're not willing to put in that same effort to the public health side to actually control this and to reduce the economic impacts — fighting this at its source — that doesn't make sense to me."
A patchwork of staff and plans in flux
Not every state responded to NPR's request. A few states – including Idaho and Virginia — did respond, but said they were not able to provide statewide numbers of contact tracers, because contact tracing is done by local health departments.
A spokesperson for the Michigan health department explained that state employees assist "certain local health departments with case investigation and contact elicitation, which is the first step in the process of contact tracing," but the number of county staff that work to trace contacts was not available.
Other states that rely on county health departments to do contact tracing were only able to provide estimates of county staffing levels. Oklahoma's spokesperson explained that the 150 number of tracers they provided "is a ballpark as we have county nurses who do multiple jobs including contact tracing."
Another state that was not able to provide contact tracer numbers was Georgia, which has already begun to ease social distancing measures. Spokesperson Nancy Nydam of the Georgia Department of Public Health told NPR that "the total number of contact tracers will vary widely by [health] district, so we are not yet able to put an exact number to it." She added that the state was engaging with medical students and possibly the National Guard, and that more information would be available in the coming days.
In the survey, several states noted that their plans were very much in flux. "As we are developing our plans, we are hiring and training an initial group of epidemiologists," a spokesperson for Colorado's Joint Information Center responded to NPR in the survey, noting they are starting with 50 epidemiologists for now but may add more in the coming weeks.
A few states, including Minnesota, indicated they do not have current plans to hire more contact tracers. Andrea Ahneman, a spokesperson for the COVID-19 Response in Minnesota, wrote that the state had more than 100 staffers now and that "this is plenty of capacity for current needs." Minnesota later clarified to NPR that although it does not plan to hire new workers to do contact tracing, it does plan to reassign current state and local public health workers to do contact tracing, with a goal of reaching over 1,000 contact tracers over the next few weeks.
States that said they're seeking to expand contact tracing capacity are getting creative about finding the workforce. Nevada said it was recruiting volunteers for "a dramatic expansion" of its contact tracing capacity. Oklahoma is training fourth-year medical residents to do contact tracing. Maine has recruited some recently retired epidemiologists. Georgia and Iowa are planning to call on the National Guard.
About half of states surveyed indicated they were considering the use of smartphone or online apps to assist with contact tracing. Few had decided on a specific app, but several mentioned the Google app that's in development. Some states indicated that they hoped the federal government could assist with the cost of licensing these apps.
How the federal government can help
Asked what support each state could use from the federal government, several states — including Hawaii, Maine and Nevada — mentioned the need for funding to hire or train new contact tracers. A spokeswoman for the District of Columbia said that D.C. could use "manpower and expertise, especially for training volunteers."
On the federal level, the Centers for Disease Control and Prevention provides staff to support local contact tracing efforts. Director Robert Redfield told NPR last month that the agency has about 500 staff currently deployed to help state and local health departments, and that it would support another 650 positions with $45 million in funds. He has acknowledged decades of underfunding for public health and said that the federal government needs to "augment personnel substantially." He also mentioned that his agency is in talks with other agencies and organizations with big boots-on-the-ground workforces to expand capacity.
A group of Democratic senators sent a letter to the CDC asking for details on these plans, but a congressional staffer tells NPR they have not received a response.
Numerous groups and experts are calling for more action and funds from the federal government. The group of former federal officials who wrote a letter last week calling for increased contact tracing hires also say $46 billion in federal funding is needed to pay for the hires and resources to help infected and exposed people stay isolated. A bill introduced in the House of Representatives Thursday calls for $55 billion to hire a national "Health Force" to do contact tracing and other public health work.
Scott Gottlieb, a former Food and Drug Administration chief for President Trump, told NPR that although assembling as many as 180,000 contact tracers nationally may be daunting, it's doable. "We already see the states making efforts to bring on thousands of new public health workers to do contact tracing," he said. "We're going to need this number of people if we want to enter into the fall with the kinds of resources we need to try to trace infection to prevent large outbreaks."
Federal leadership on contact tracing is important, says Watson of the Center for Health Security. "This is unprecedented — this is not something we've done before as a nation," she says. "It may be hard for some states to even think about how they get started on this, so guidance from the federal level is definitely needed."
Stephanie Adeline, Martha Bebinger, Natalie Krebs, Nicole Leonard, Aviva Okeson-Haberman, Sebastián Martinez Valdivia, Anh Nguyen, Bonnie Petrie, Paige Pfleger and Carmel Wroth contributed to this report.


npr--2020-04-28--Public Health Labs Suffered Budget Cuts Prior To The Coronavirus Pandemic

When Alaska 's first COVID-19 case was discovered in March , the director of the state 's public health laboratory began scrambling to find enough technicians and microbiologists to confront the emerging pandemic .
State public health labs are the nation 's first line of defense against an infectious disease because they handle the early diagnostic tests .
But labs in Alaska and several other states were left short staffed after years of state budget cuts and inconsistent federal funding , according to an APM Reports analysis .
Bernard Jilly , director of the Alaska State Public Health Laboratories , @ @ @ @ @ @ @ the lab 's funding did n't keep up with inflation , which forced the state to cut staff .
The makeup of the lab 's workforce also changed .
Fewer higher-level scientists are working at the lab , according to budget documents .
When COVID-19 hit the state , Jilly was desperate to find help .
Though the federal government is now spending billions of dollars to increase capacity and staffing at state and local public health labs , it is n't as simple as posting a `` Help Wanted '' sign .
@ @ @ @ @ @ @ trees , and it takes a significant amount of time to train these people , '' Jilly said .
`` And once they 're gone , they 're gone . ''
In addition to dealing with supply chain problems plaguing labs across the U.S. , Jilly also had to get creative with staffing .
He rehired retired employees and recruited college faculty and students with lab experience .
He even delayed his planned March retirement to lead his staff during the crisis .
Jilly is n't alone in struggling to keep his public @ @ @ @ @ @ @ since the 1918 flu .
An APM Reports analysis found that labs in at least 10 states have been forced to deal with challenges that include budget reductions , staffing cuts , high turnover , lab closures and funding delays for equipment .
APM Reports combed through available budget documents , annual reports , inspector general reports and federal grants to get a handle on how public health laboratories are funded .
The picture is n't complete because of the different levels of detail that states provide about lab budgets .
But the @ @ @ @ @ @ @ worries about lab capacity in many states .
They include the following : • Georgia closed a regional public health lab , cut 23 lab employees between 2013 and 2018 , cited salary freezes as a reason for high turnover and had difficulty upgrading equipment , according to 2018 budget documents .
• California budget cuts have resulted in the closure of 10 local public health labs since 2003 .
• Florida cut a public health lab in Pensacola in 2015 .
State officials also expressed worries over high turnover in public health @ @ @ @ @ @ @ Iowa 's lab furloughed 11 staff members in 2019 and reported that continuity of funding `` continues to be a concern . ''
• Oklahoma 's public health lab was in danger of losing its accreditation in 2015 , according to news reports .
The state bought new equipment and authorized funding for a new lab , but the building was delayed because of the onset of COVID-19 , according a spokeswoman at the Oklahoma State Department of Health .
• In Virginia , lab turnover was `` excessive , '' and a @ @ @ @ @ @ @ unmanageable '' workload that was `` likely the cause of recent safety incidents and confidentiality breaches that possibly could have been prevented , '' according to budget documents .
Moreover , 25 states and the District of Columbia saw cuts to overall public health spending between 2008 and 2018 , according to data compiled by the State Health Access Data Assistance Center at the University of Minnesota .
The reductions came despite repeated warnings from government agencies and experts that the public health system was n't prepared for a pandemic or biological attack @ @ @ @ @ @ @ recent years that the lab capacity is just maxed out , '' said Mary Denigan-Macauley , director of the Government Accountability Office 's health care team .
`` You ca n't staff [ up ] for a pandemic .
That 's just not realistic . ''
APM Reports interviewed nine state and local public health lab directors who say they 've had to take extraordinary steps to meet demands to test for COVID-19 following reductions in funding .
Those steps include seven-day workweeks , forgoing other vital public health tests , shifting staff @ @ @ @ @ @ @ to do the lab work .
But they worry that the increased workload could reach a breaking point .
`` These are not simple tests .
They require a fairly good amount of focus , '' said Eric Blank , chief program officer of public health systems and programs at the Association of Public Health Laboratories .
The biggest task may still lie ahead .
Public health labs , in concert with other public health professionals , will have to help conduct the increased testing and surveillance that experts say will be the @ @ @ @ @ @ @ social distancing restrictions and resume economic activity .
The network of state and local public health labs across the U.S. has a critical role in the early stages of an infectious disease outbreak .
The labs must conduct the initial diagnostic testing — before private labs can get up and running with their own tests — so public health authorities can locate and contain clusters of disease .
When COVID-19 hit , public labs were severely hindered .
In February , the Centers for Disease Control and Prevention botched a test designed to @ @ @ @ @ @ @ back labs from doing the necessary testing to slow the virus ' spread .
A shortage of testing supplies also forced lab directors to ration tests , which left public health officials blind to where the virus was spreading .
The testing failures have been widely reported , but public health labs and departments in many states also saw their budgets or staff cut in recent years .
An APM Reports analysis shows that public health budgets in recent years surged during potential disease outbreaks — such as H1N1 , Zika and Ebola @ @ @ @ @ @ @ threats faded away .
The federal government authorized at least $ 13.45 billion to help state , local , tribal and territorial public health agencies deal with the COVID-19 outbreak , a portion of which will be directed to labs .
But lab directors say this boom-and-bust cycle makes it difficult to manage a laboratory .
They say the new funds will pay for overtime of existing lab professionals and for equipment .
But it will take time to hire qualified personnel .
`` We continue to go from crisis to crisis , @ @ @ @ @ @ @ service that 's needed all the time , '' said Frances Pouch Downes , a professor with the Biomedical Laboratory Diagnostics Program at Michigan State University and a former lab director in Michigan .
`` Would we do that with a fire department ? ''
Funding for public health labs goes beyond routine testing , Downes said .
It 's needed for equipment updates and maintenance , for emergency preparedness and for increased training to ensure that lab technicians and microbiologists can process multiple tests .
A look at funding over the past @ @ @ @ @ @ @ .
After the Sept. 11 terrorist attacks , state and federal governments ramped up funding for emergency preparedness that resulted in a spike for labs and other public health programs .
Do n't see the graphic above ?
Click here .
But fears of a bioterrorism attack soon waned .
Some state and city leaders cut funding for labs and other public health programs in the years following the 2008 recession to balance their budgets , and in some cases , those reductions were never restored — until COVID-19 .
Federal funding directed @ @ @ @ @ @ @ Labs receive two streams of funding from the federal government : the Public Health Emergency Preparedness grant and the Epidemiology and Laboratory Capacity grant .
PHEP funding declined 27 % between 2004 and 2020 .
The ELC grant — a much smaller pool of money — has generally increased over time , but the funding to states has fluctuated over the past five years as disease outbreaks occurred .
The funding shortfall came despite warnings by federal watchdogs that the nation was ill-equipped to manage a pandemic .
`` If you think back @ @ @ @ @ @ @ think any of us who went through that thought we would ever forget , '' said the GAO 's Denigan-Macauley .
`` So the concern is that once this passes , people will forget and budgets will go in different ways . ''
State and federal officials continue to express frustration at the slow pace of testing .
Much of the demand for testing now falls on commercial labs , which have the equipment to test in larger volumes .
But a breakdown in supplies — including cotton swabs , chemical reagents and @ @ @ @ @ @ @ at nearly all labs .
The demand will likely soon increase .
Experts have said repeatedly that lifting social distancing restrictions and stay-at-home orders will require robust testing and monitoring to ensure cases do n't spike once people return to work .
Do n't see the graphic above ?
Click here .
Public health lab directors told APM Reports that increased testing could be a severe challenge given their staffing constraints .
Even states that have increased funding for public health are struggling to ramp up testing .
For example , Minnesota increased @ @ @ @ @ @ @ nearly $ 11 million between 2010 and 2020 .
State officials there are also working with the Mayo Clinic and the University of Minnesota to increase testing — they recently announced plans to conduct 20,000 tests a day — but they are still woefully short of their goals .
On average , Minnesota has reported 1,473 tests a day in April .
That 's far below the 5,000-tests-per-day goal that Minnesota Gov .
Tim Walz initially said he wanted to see to ensure social distancing restrictions can be lifted .
Walz is one @ @ @ @ @ @ @ testing must be broadened from solely diagnosing the coronavirus to doing antibody tests that determine if people unknowingly had the virus .
But the surveillance work needed on both fronts will require help from another public health sector that has also seen significant budget cuts across the country .
Between 2008 and 2017 , the National Association of County and City Health Officials said nearly a quarter of local public health workers — 56,000 people — have lost their jobs because of budget cuts .
Those workers would have helped do the necessary @ @ @ @ @ @ @ it did n't spread .
The process of piecing together who else a sick person might have infected , known as contact tracing , can be exhaustive , especially in the midst of a major pandemic .
`` This level of contact tracing will be much more intense , '' said Adriane Casalotti , with the National Association of County and City Health Officials .
`` Because every minute that you 're not getting in touch with [ infected people ] and having them self-quarantine is another minute that they may be spreading @ @ @ @ @ @ @ the virus surveillance work to be successful , a massive expansion of workers and volunteers will be needed , Casalotti said .
Some estimates say as many as 300,000 people will need to be either hired or trained as volunteers .
Some of those volunteers are already working in public health labs across the country .
Monterey County , California 's public health lab now has six college students working for free after the lab director publicly worried about staffing shortages .
She said she 's appreciative of the students ' efforts but @ @ @ @ @ @ @ skills of her experienced colleagues .
`` I worry about these students because , yes , they 're skilled and they can perform these techniques , but they do n't have the years of training that it takes to work in an environment where we 're constantly working with highly infectious organisms here in this lab , '' said Donna Ferguson , laboratory director for Monterey County 's Health Department .
Ferguson said she expects the state and federal government will continue to spend money to increase testing availability at public health labs @ @ @ @ @ @ @ the funding will drop off again when the pandemic subsides .
`` I 'm not real optimistic that things are going to necessarily change for the better for public health labs after this is all said and done , '' she said .
`` People have very short-term memories .
We may get funding for another year , maybe two , and then after that it 'll be business back to normal . ''
Curtis Gilbert and Emily Hanford contributed to this report .

Public Health Labs Suffered Budget Cuts Prior To The Coronavirus Pandemic
Enlarge this image toggle caption Misha Friedman/Getty Images Misha Friedman/Getty Images
When Alaska's first COVID-19 case was discovered in March, the director of the state's public health laboratory began scrambling to find enough technicians and microbiologists to confront the emerging pandemic.
State public health labs are the nation's first line of defense against an infectious disease because they handle the early diagnostic tests. But labs in Alaska and several other states were left short staffed after years of state budget cuts and inconsistent federal funding, according to an APM Reports analysis.
Bernard Jilly, director of the Alaska State Public Health Laboratories, said that over the past decade, the labs' funding didn't keep up with inflation, which forced the state to cut staff. The makeup of the labs' workforce also changed. Fewer higher-level scientists are working at the labs, according to budget documents.
National Testing Capacity Will Determine Abilities Of States To Reopen Testing Capacity Will Determine Abilities Of States To Reopen Listen · 1:16 1:16
When COVID-19 hit the state, Jilly was desperate to find help. Though the federal government is now spending billions of dollars to increase capacity and staffing at state and local public health labs, it isn't as simple as posting a "Help Wanted" sign.
"They just don't grow on trees, and it takes a significant amount of time to train these people," Jilly said. "And once they're gone, they're gone."
In addition to dealing with supply chain problems plaguing labs across the U.S., Jilly also had to get creative with staffing. He rehired retired employees and recruited college faculty and students with lab experience. He even delayed his planned March retirement to lead his staff during the crisis.
Jilly isn't alone in struggling to keep his public health lab running amid the largest pandemic to affect the U.S. since the 1918 flu. An APM Reports analysis found that labs in at least 10 states have been forced to deal with challenges that include budget reductions, staffing cuts, high turnover, lab closures and funding delays for equipment. APM Reports combed through available budget documents, annual reports, inspector general reports and federal grants to get a handle on how public health laboratories are funded. The picture isn't complete because of the different levels of detail that states provide about lab budgets. But the available information shows that there have been worries about lab capacity in many states. They include the following:
Georgia closed a regional public health lab, cut 23 lab employees between 2013 and 2018, cited salary freezes as a reason for high turnover and had difficulty upgrading equipment, according to 2018 budget documents.
California budget cuts have resulted in the closure of 10 local public health labs since 2003.
Florida cut a public health lab in Pensacola in 2015. State officials also expressed worries over high turnover in public health labs in 2018 budget documents.
Michigan closed a regional lab in Houghton in 2010.
Iowa's lab furloughed 11 staff members in 2019 and reported that continuity of funding "continues to be a primary concern."
Oklahoma's public health lab was in danger of losing its accreditation in 2015, according to news reports. The state bought new equipment and authorized funding for a new lab, but the building was delayed because of the onset of COVID-19, according a spokeswoman at the Oklahoma State Department of Health.
In Virginia, lab turnover was "excessive," and a lack of supervisors led to an "unmanageable" workload that was "likely the cause of recent safety incidents and confidentiality breaches that possibly could have been prevented," according to budget documents.
Moreover, 25 states and the District of Columbia saw cuts to overall public health spending between 2008 and 2018, according to data compiled by the State Health Access Data Assistance Center at the University of Minnesota. The reductions came despite repeated warnings from government agencies and experts that the public health system wasn't prepared for a pandemic or biological attack.
"We have clearly demonstrated in recent years that the lab capacity is just maxed out," said Mary Denigan-Macauley, director of the Government Accountability Office's health care team. "You can't staff [up] for a pandemic. That's just not realistic."
APM Reports interviewed nine state and local public health lab directors who say they've had to take extraordinary steps to meet demands to test for COVID-19 following reductions in funding. Those steps include seven-day workweeks, forgoing other vital public health tests, shifting staff from other departments and hiring additional employees to do the lab work. But they worry that the increased workload could reach a breaking point.
"These are not simple tests. They require a fairly good amount of focus," said Eric Blank, chief program officer of public health systems and programs at the Association of Public Health Laboratories.
The biggest task may still lie ahead. Public health labs, in concert with other public health professionals, will have to help conduct the increased testing and surveillance that experts say will be the only way for the nation to ease social distancing restrictions and resume economic activity.
"From crisis to crisis"
The network of state and local public health labs across the U.S. has a critical role in the early stages of an infectious disease outbreak. The labs must conduct the initial diagnostic testing — before private labs can get up and running with their own tests — so public health authorities can locate and contain clusters of disease. When COVID-19 hit, public labs were severely hindered.
In February, the Centers for Disease Control and Prevention botched a test designed to detect the coronavirus. The problem set back labs from doing the necessary testing to slow the virus' spread. A shortage of testing supplies also forced lab directors to ration tests, which left public health officials blind to where the virus was spreading.
The testing failures have been widely reported, but public health labs and departments in many states also saw their budgets or staff cut in recent years. An APM Reports analysis shows that public health budgets in recent years surged during potential disease outbreaks — such as H1N1, Zika and Ebola — but dropped off once the immediate threats faded away. The federal government authorized at least $13.45 billion to help state, local, tribal and territorial public health agencies deal with the COVID-19 outbreak, a portion of which will be directed to labs.
But lab directors say this boom-and-bust cycle makes it difficult to manage a laboratory. They say the new funds will pay for overtime of existing lab professionals and for equipment. But it will take time to hire qualified personnel.
"We continue to go from crisis to crisis, instead of appreciating that this is a service that's needed all the time," said Frances Pouch Downes, a professor with the Biomedical Laboratory Diagnostics Program at Michigan State University and a former lab director in Michigan. "Would we do that with a fire department?"
Funding for public health labs goes beyond routine testing, Downes said. It's needed for equipment updates and maintenance, for emergency preparedness and for increased training to ensure that lab technicians and microbiologists can process multiple tests.
A look at funding over the past 20 years shows the funding roller coaster. After the Sept. 11 terrorist attacks, state and federal governments ramped up funding for emergency preparedness that resulted in a spike for labs and other public health programs.
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But fears of a bioterrorism attack soon waned. Some state and city leaders cut funding for labs and other public health programs in the years following the 2008 recession to balance their budgets, and in some cases, those reductions were never restored — until COVID-19.
Federal funding directed through state governments has also fluctuated. Labs receive two streams of funding from the federal government: the Public Health Emergency Preparedness grant and the Epidemiology and Laboratory Capacity grant. PHEP funding declined 27% between 2004 and 2020. The ELC grant — a much smaller pool of money — has generally increased over time, but the funding to states has fluctuated over the past five years as disease outbreaks occurred. The funding shortfall came despite warnings by federal watchdogs that the nation was ill-equipped to manage a pandemic.
"If you think back to Sept. 11, I don't think any of us who went through that thought we would ever forget," said the GAO's Denigan-Macauley. "So the concern is that once this passes, people will forget and budgets will go in different ways."
Labs key to ending social distancing
State and federal officials continue to express frustration at the slow pace of testing. Much of the demand for testing now falls on commercial labs, which have the equipment to test in larger volumes.
But a breakdown in supplies — including cotton swabs, chemical reagents and personal protective equipment — is hindering testing at nearly all labs. The demand will likely soon increase. Experts have said repeatedly that lifting social distancing restrictions and stay-at-home orders will require robust testing and monitoring to ensure cases don't spike once people return to work.
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Public health lab directors told APM Reports that increased testing could be a severe challenge given their staffing constraints. Even states that have increased funding for public health are struggling to ramp up testing. For example, Minnesota increased funding for its public health lab by nearly $11 million between 2010 and 2020.
State officials there are also working with the Mayo Clinic and the University of Minnesota to increase testing — they recently announced plans to conduct 20,000 tests a day — but they are still woefully short of their goals. On average, Minnesota has reported 1,473 tests a day in April. That's far below the 5,000-tests-per-day goal that Minnesota Gov. Tim Walz initially said he wanted to see to ensure social distancing restrictions can be lifted. Walz is one of several governors who have suggested that testing must be broadened from solely diagnosing the coronavirus to doing antibody tests that determine if people unknowingly had the virus.
But the surveillance work needed on both fronts will require help from another public health sector that has also seen significant budget cuts across the country. Between 2008 and 2017, the National Association of County and City Health Officials said nearly a quarter of local public health workers — 56,000 people — have lost their jobs because of budget cuts. Those workers would have helped do the necessary legwork to spot an outbreak and ensure it didn't spread. The process of piecing together who else a sick person might have infected, known as contact tracing, can be exhaustive, especially in the midst of a major pandemic.
"This level of contact tracing will be much more intense," said Adriane Casalotti, with the National Association of County and City Health Officials. "Because every minute that you're not getting in touch with [infected people] and having them self-quarantine is another minute that they may be spreading it to other people."
For the virus surveillance work to be successful, a massive expansion of workers and volunteers will be needed, Casalotti said. Some estimates say as many as 300,000 people will need to be either hired or trained as volunteers. Some of those volunteers are already working in public health labs across the country. Monterey County, California's public health lab now has six college students working for free after the lab director publicly worried about staffing shortages. She said she's appreciative of the students' efforts but worries they don't have the necessary skills of her experienced colleagues.
"I worry about these students because, yes, they're skilled and they can perform these techniques, but they don't have the years of training that it takes to work in an environment where we're constantly working with highly infectious organisms here in this lab," said Donna Ferguson, laboratory director for Monterey County's Health Department.
Ferguson said she expects the state and federal government will continue to spend money to increase testing availability at public health labs and commercial labs. But she worries the funding will drop off again when the pandemic subsides.
"I'm not real optimistic that things are going to necessarily change for the better for public health labs after this is all said and done," she said. "People have very short-term memories. We may get funding for another year, maybe two, and then after that it'll be business back to normal."
Curtis Gilbert and Emily Hanford contributed to this report. This story was originally published by APM Reports.


npr--2020-04-28--Testing Could Unlock A Return To Normal Life, But Obstacles Persist

Testing Could Unlock A Return To Normal Life , But Obstacles Persist Testing is the key that will unlock normalization for millions of Americans .
It 's the doorway between the disaster response mode of the pandemic and confidence about returning to work , school and life .
And it 's also still apparently weeks or more away from scaling to a level that will make a big difference for most people in most places .
Precisely how far away is n't clear , although President Trump and a pageant of guests attempted on Monday to sell the idea that @ @ @ @ @ @ @ The president , public health officials and a coterie of Big Business leaders said at the White House that sometime soon , testing throughput in the country could double or better , although they did n't say exactly when nor assess how much normalcy that might buy for how much of the United States .
The White House did unveil what it called a blueprint for state , local and private sector authorities to get from here to there .
Vice President Mike Pence acknowledged that progress had n't gone as swiftly as @ @ @ @ @ @ @ an earlier briefing .
But Pence also said the work is being executed now and that there 's enough testing capacity today for the small number of states closest to proceeding through the first of the federally prescribed `` phases '' to get out of disaster mode and back to whatever comes next .
Only time itself , however , may tell whether that 's so or whether there are more obstacles in store .
One of so many reasons the coronavirus disaster has been so disturbing is that it often seems impossible @ @ @ @ @ @ @ one time about exactly what is happening .
Are the cases and deaths undercounted — or overcounted ?
How meaningful are the flurry of statistics bandied about at news conferences like the one convened on Monday ?
All the back and forth about masks , personal protective equipment , ventilators and now , tests — who can make heads or tails of it ?
There almost certainly will be a definitive accounting from official government sources , but not for months or years .
The pandemic response will be an area of focus @ @ @ @ @ @ @ committees and journalists for a long time .
And it may only be through that prism , in hindsight , that it becomes possible to assess what to make of the claims by Trump and his presenters .
The White House was shelled last week after an unscripted moment at Thursday 's briefing in which Trump mused about shining ultraviolet light inside the body , or looking into dosing a patient with disinfectant , as treatments for coronavirus .
Friday 's briefing was terse and the president made no presentations on Saturday or @ @ @ @ @ @ @ Meanwhile , news stories appeared in which administration allies lamented the political damage they feared Trump might be doing to himself and Republicans with his freewheeling sessions .
So when no briefing at first was scheduled on Monday and White House Press Secretary Kayleigh McEnany told Fox News the administration was assessing its strategy for the sessions going forward , politics-watchers wondered whether the Trump show might have been cancelled .
Trump himself delivered a resounding answer : no — he was back for another identical session on Monday with many of the @ @ @ @ @ @ @ this subplot , however , is already a rerun : The New York Times first ran a story about Trump allies ' fears about the briefings on April 9 , including the critique that Trump was talking too long .
The following day , the president talked for more than two hours .
The briefing in brief : Here are highlights from Monday 's White House coronavirus task force briefing : • Companies tout expanding tests : In a series of short statements , the CEOs of Quest Diagnostics , LabCorp and Thermo @ @ @ @ @ @ @ gains in their testing capabilities by mid to late May .
Representatives from Walgreens , CVS , Rite Aid , Walmart , and Kroger also spoke of expanding testing locations to more states as well as the number of tests at their stores across the country .
NPR 's Tim Mak points out how the number of testing sites remains small as compared to the actual number of stores each retail pharmacy has .
• Trump addresses Azar 's early handling of the virus : President Trump indirectly acknowledged that Secretary of Health @ @ @ @ @ @ @ downplaying of the coronavirus in late Jan. was a mistake .
`` You have many people in the other party that have said the same thing and with even more confidence , '' the president said — `` so a lot of people did n't get that right . ''
The exchange follows reports about how Azar 's initial response to the coronavirus was problematic , including his choice to delay informing Trump about its severity early on .
The Washington Post also reported on Monday that warnings about COVID-19 were regularly included @ @ @ @ @ @ @ .
• There 's a rise in Americans consuming disinfectant .
Trump : `` I ca n't imagine why '' : After suggesting last week that injecting disinfectant products could help treat COVID-19 and then walking the comments back as `` sarcasm , '' a day later , Trump rejected reports that Americans were taking his words seriously .
Since Trump 's statements , there have been reports of increased calls regarding wrongful ingestion of such products .
When asked if he would take any responsibility for the events , the president said @ @ @ @ @ @ @ . ''
• Economic tailspin : Trump acknowledged estimates on Monday that the U.S. gross domestic product could take a hit in the second quarter unlike any seen since the Great Depression .
But the president sought to emphasize what he has called the pent-up demand waiting to revive the economy later this year .
Just under 30 million Americans are out of work and the virus mitigation countermeasures , including social distancing , have pummeled restaurants , brick-and-mortar retailers , travel , energy and much of the rest of the economy .
@ @ @ @ @ @ @ and Drug Administration Commissioner Stephen Hahn said Friday that antibody tests unauthorized by the FDA can be distributed if the manufacturer self-validates them .
`` They have to tell us that they validated their tests , '' Hahn said , adding that the tests are labeled as unauthorized in the packaging .
As of Friday , the FDA has authorized four tests — but Hahn 's remarks followed reports that problematic tests currently unapproved by the FDA are already being sold .
• Two top former federal health officials are calling for Congress @ @ @ @ @ @ @ and isolating in a future relief bill — which they call essential to preventing an echo spike in infections , reports NPR 's Franco Ordonez .
• The IRS has told some 10,000 employees to prepare to return to work as early as Monday and , as necessary , supply their own face masks , reports NPR 's Brian Naylor .
• Restaurants in Tennessee are back open to dine-in customers — but the Volunteer State also has recorded its single biggest day 's increase in infections , reports NPR 's Brakkton Booker @ @ @ @ @ @ @ are getting worse : Some 50 crewmembers aboard the destroyer USS Kidd are infected and the service is managing some 955 active cases aboard the aircraft carrier USS Theodore Roosevelt , Booker reports .
• NPR Exclusive : As part of an ongoing investigation over Amazon 's treatment of workers in a New York warehouse , the New York Attorney General 's Office characterized the company 's protection of employees during the COVID-19 crisis as `` inadequate , '' Alina Selyukh reports .

Testing Could Unlock A Return To Normal Life, But Obstacles Persist
Enlarge this image toggle caption Valerie Macon/AFP via Getty Images Valerie Macon/AFP via Getty Images
Testing is the key that will unlock normalization for millions of Americans.
It's the doorway between the disaster response mode of the pandemic and confidence about returning to work, school and life. And it's also still apparently weeks or more away from scaling to a level that will make a big difference for most people in most places.
Precisely how far away isn't clear, although President Trump and a pageant of guests attempted on Monday to sell the idea that victory is just around the corner.
The president, public health officials and a coterie of Big Business leaders said at the White House that sometime soon, testing throughput in the country could double or better, although they didn't say exactly when nor assess how much normalcy that might buy for how much of the United States.
The White House did unveil what it called a blueprint for state, local and private sector authorities to get from here to there.
Vice President Mike Pence acknowledged that progress hadn't gone as swiftly as he and other administration heavies promised in an earlier briefing.
But Pence also said the work is being executed now and that there's enough testing capacity today for the small number of states closest to proceeding through the first of the federally prescribed "phases" to get out of disaster mode and back to whatever comes next.
Only time itself, however, may tell whether that's so, or if there are more obstacles in store. One of so many reasons the coronavirus disaster has been so disturbing is that it often seems impossible to get a definitive sense at any one time about exactly what is happening.
Are the cases and deaths undercounted — or overcounted? How meaningful is the flurry of statistics bandied about at news conferences like the one on Monday? All the back and forth about masks, personal protective equipment, ventilators and, now, tests — who can make heads or tails of it?
There almost certainly will be a definitive accounting from official government sources, but not for months or years.
The pandemic response will be an area of focus for medical schools, logisticians, oversight committees and journalists for a long time. And it may only be through that prism, in hindsight, that it becomes possible to assess what to make of the claims by Trump and his presenters.
Enlarge this image toggle caption Mandel Ngan/AFP via Getty Images Mandel Ngan/AFP via Getty Images
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The White House was shelled last week after an unscripted moment at Thursday's briefing in which Trump mused about shining ultraviolet light inside the body or dosing a patient with disinfectant as treatments for coronavirus.
Friday's briefing was terse and the president made no presentations on Saturday or Sunday, as he sometimes does. Meanwhile, news stories appeared in which administration allies lamented the political damage they feared Trump might be doing to himself and Republicans with his freewheeling sessions.
So when no briefing at first was scheduled on Monday and White House Press Secretary Kayleigh McEnany told Fox News the administration was assessing its strategy for the sessions going forward, politics-watchers wondered whether the Trump show might have been canceled.
Trump himself delivered a resounding answer: No — he was back for another identical session on Monday with many of the same speakers and talking points.
Even this subplot, however, is already a rerun: The New York Times first ran a story about Trump allies' fears about the briefings on April 9, including the critique that Trump was talking too long. The following day, the president talked for more than two hours.
The briefing in brief:
Here are highlights from Monday's White House coronavirus task force briefing:
Companies tout expanding tests: In a series of short statements, the CEOs of Quest Diagnostics, LabCorp and Thermo Fisher Scientific discussed plans to achieve notable gains in their testing capabilities by mid to late May. Representatives from Walgreens, CVS, Rite Aid, Walmart and Kroger also spoke of expanding testing locations to more states, as well as the number of tests at their stores across the country. NPR's Tim Mak points out how the number of testing sites remains small compared to the actual number of stores each retail pharmacy has.
Trump addresses Azar's early handling of the virus: President Trump indirectly acknowledged that Secretary of Health and Human Services Alex Azar's initial downplaying of the coronavirus in late January was a mistake. "You have many people in the other party that have said the same thing and with even more confidence," the president said — "so a lot of people didn't get that right." The exchange follows reports about how Azar's initial response to the coronavirus was problematic, including his choice to delay informing Trump about its severity early on. The Washington Post also reported on Monday that warnings about COVID-19 were regularly included in Trump's top secret security briefings.
There's a rise in Americans consuming disinfectant. Trump: "I can't imagine why": After suggesting last week that injecting disinfectant products could help treat COVID-19 and then walking the comments back as "sarcasm," a day later Trump rejected reports that Americans were taking his words seriously. Since Trump's statements, there have been reports of increased calls regarding wrongful ingestion of such products. When asked if he would take any responsibility for the events, the president said, "I can't imagine that."
Economic tailspin: Trump acknowledged estimates on Monday that the U.S. gross domestic product could take a hit in the second quarter unlike any seen since the Great Depression. But the president sought to emphasize what he has called the pent-up demand to revive the economy later this year. Just under 30 million Americans are out of work, and the virus mitigation countermeasures, including social distancing, have pummeled restaurants, brick-and-mortar retailers, travel, energy and much of the rest of the economy.
Grading their own tests: Food and Drug Administration Commissioner Stephen Hahn said Friday that antibody tests unauthorized by the FDA can be distributed if the manufacturer self-validates them. "They have to tell us that they validated their tests," Hahn said, adding that the tests are labeled as unauthorized in the packaging. As of Friday, the FDA has authorized four tests — but Hahn's remarks followed reports that problematic tests currently unapproved by the FDA are already being sold.
Latest confirmed U.S. case and death totals
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Enlarge this image toggle caption Mark Humphrey/AP Mark Humphrey/AP
Other key coronavirus stories from NPR:


npr--2020-04-28--Pence Trips Show Challenges Of Returning To Political Normal

Vice President Pence is slated to leave the confines of Washington twice this week — the latest in a series of trips the White House is using as test runs for President Trump to get back on the road after the coronavirus brought political travel to a screeching halt .
Pence will tour the Mayo Clinic in Rochester , Minn. , on Tuesday and a GM ventilator plant in Kokomo , Ind.
, on Thursday .
Last week , he visited a ventilator factory in Wisconsin — a key battleground state in the November presidential election .
Last weekend , @ @ @ @ @ @ @ U.S. Air Force Academy in Colorado Springs , Colo. Trump is itching to get out of the White House .
`` I have n't left the White House in months , '' Trump said last week — a bit of an exaggeration , since he held a campaign rally as recently as March 2 .
Trump plans to deliver the commencement address at the U.S. Military Academy at West Point , N.Y. , in June .
The White House has n't ruled out other trips in the meantime , as it seeks to @ @ @ @ @ @ @ on the pandemic .
Pence 's trips have demonstrated both the political and logistical hurdles the administration faces trying to return to some kind of new political normal .
A source familiar with the vice president 's plans confirmed that Pence and Trump staffers are meeting regularly to talk about lessons they have learned from the Pence trips , such as new security and health protocols .
NPR accompanied Pence on his first two trips .
There were several new safety protocols evident .
For example , at Andrews Air Force Base , @ @ @ @ @ @ @ of passengers traveling with Pence and made sure no one showed symptoms of the virus .
Inside the terminal , almost everyone wears face masks , from those scanning bags to the officers who drive the truck carrying the stairs for Pence to board Air Force Two .
Some seating was staggered on the plane to reduce contact , though passengers were closer than the recommended 6 feet .
Pence did not wear a mask .
But Colorado Gov .
Jared Polis was wearing one when he greeted Pence at the airport .
@ @ @ @ @ @ @ .
The Air Force Academy band , some also wearing masks , played on .
But without the cheering crowds and doting parents , it felt more like a dress rehearsal .
The cadets dressed in blue-and-white uniforms marched to their seats , all spaced 8 feet apart .
In Madison , at the GE plant , factory workers who met Pence had their temperatures checked beforehand .
An extra long table was brought out for a panel discussion so participants could spread out .
The factory visit was a chance for Pence @ @ @ @ @ @ @ around the clock to boost production — and it was also an opportunity to show progress and push back on criticism from some governors for a slow response in medical supplies for the virus .
It was also an opportunity to show things are on the way to getting back to normal .
The choice of locations is also significant , said Johanna Maska , who helped organize and run trips for the Obama White House .
Wisconsin is a swing state critical to winning the November presidential election .
`` This White @ @ @ @ @ @ @ political statements in virtually everything that they do , '' said Maska , who is now CEO of the Global Situation Room , a communications and consulting firm .
`` They 're going to be trying to figure out how they can get President Trump traveling again , '' Maska said .
`` That is without a doubt , because every president wants to be able to travel . ''

Pence Trips Show Challenges Of Returning To Political Normal
Enlarge this image toggle caption Kamil Krzaczynski/AFP via Getty Images Kamil Krzaczynski/AFP via Getty Images
Vice President Pence is slated to leave the confines of Washington twice this week — the latest in a series of trips the White House is using as test runs for President Trump to get back on the road after the coronavirus brought political travel to a screeching halt.
Pence will tour the Mayo Clinic in Rochester, Minn., on Tuesday and a GM ventilator plant in Kokomo, Ind., on Thursday. Last week, he visited a ventilator factory in Wisconsin — a key battleground state in the November presidential election. Last weekend, he gave the commencement address at the U.S. Air Force Academy in Colorado Springs, Colo.
Trump is itching to get out of the White House. "I haven't left the White House in months," Trump said last week — a bit of an exaggeration, since he held a campaign rally as recently as March 2.
Trump plans to deliver the commencement address at the U.S. Military Academy at West Point, N.Y., in June. The White House hasn't ruled out other trips in the meantime, as it seeks to showcase how America is turning a corner on the pandemic.
Enlarge this image toggle caption David Zalubowski/AP David Zalubowski/AP
Pence's trips have demonstrated both the political and logistical hurdles the administration faces trying to return to some kind of new political normal.
A source familiar with the vice president's plans confirmed that Pence and Trump staffers are meeting regularly to talk about lessons they have learned from the Pence trips, such as new security and health protocols.
Enlarge this image toggle caption Morry Gash/AP Morry Gash/AP
NPR accompanied Pence on his first two trips. There were several new safety protocols evident. For example, at Andrews Air Force Base, masked officers in camouflage took the temperatures of passengers traveling with Pence and made sure no one showed symptoms of the virus.
Inside the terminal, almost everyone wears face masks, from those scanning bags to the officers who drive the truck carrying the stairs for Pence to board Air Force Two. Some seating was staggered on the plane to reduce contact, though passengers were closer than the recommended 6 feet.
Enlarge this image toggle caption David Zalubowski/AP David Zalubowski/AP
Pence did not wear a mask. But Colorado Gov. Jared Polis was wearing one when he greeted Pence at the airport. They bumped elbows instead of shaking hands.
The Air Force Academy band, some also wearing masks, played on. But without the cheering crowds and doting parents, it felt more like a dress rehearsal. The cadets dressed in blue-and-white uniforms marched to their seats, all spaced 8 feet apart.
Enlarge this image toggle caption David Zalubowski/AP David Zalubowski/AP
In Madison, at the GE plant, factory workers who met Pence had their temperatures checked beforehand. An extra long table was brought out for a panel discussion so participants could spread out.
The factory visit was a chance for Pence to praise employees who have been working around the clock to boost production — and it was also an opportunity to show progress and push back on criticism from some governors for a slow response in medical supplies for the virus.
It was also an opportunity to show things are on the way to getting back to normal.
Enlarge this image toggle caption Kamil Krzaczynski/AFP via Getty Images Kamil Krzaczynski/AFP via Getty Images
The choice of locations is also significant, said Johanna Maska, who helped organize and run trips for the Obama White House. Wisconsin is a swing state critical to winning the November presidential election.
"This White House has never shied away from making political statements in virtually everything that they do," said Maska, who is now CEO of the Global Situation Room, a communications and consulting firm.
"They're going to be trying to figure out how they can get President Trump traveling again," Maska said. "That is without a doubt, because every president wants to be able to travel."


npr--2020-04-28--'A Ticking Time Bomb': Advocates Warn COVID-19 Is Spreading Rapidly Behind Bars

In Arizona , a woman behind bars at the Perryville women 's prison reports hearing coughing echoing through the warehouse-style dorms all night .
In New Jersey , an immigrant detainee being held in the Essex County jail has been put on quarantine cleaning duty even though he 's been sick .
He fears he 's spreading the coronavirus .
And at the Etowah County jail in Alabama , Karim Golding , an immigrant detainee who 's fighting deportation to Jamaica , says he 's been feeling short of breath and worries he got coronavirus from the guards or new @ @ @ @ @ @ @ At the end of the day I want to be tested because I want to know — did you give me the coronavirus ? ''
Golding said .
`` Did you willfully give me the coronavirus and put my life at risk ? ''
Across the country , the spread of coronavirus behind bars is likely much more rampant than what 's known right now .
In prisons , jails and immigration detention centers , there is very little diagnostic testing .
And when widespread testing has been done in a few places @ @ @ @ @ @ @ infected huge numbers of the confined population .
One Ohio prison recently found that more than 70 % of inmates are positive for COVID-19 .
Felicity Rose , director of research and policy for criminal justice reform at the progressive advocacy group FWD.US , says the lack of testing is leading to a false sense of security .
`` We know that it 's spreading among staff and that staff are bringing it into and out of the facilities , '' Rose said .
`` We know there are people who are asymptomatic @ @ @ @ @ @ @ , but we just do n't know how many .
So it 's a ticking time bomb . ''
Inmates , detainees and their advocates say it 's impossible to maintain social distancing behind bars , and they say masks as well as soap and cleaning supplies are limited and sometimes not available at all .
In some places , if inmates try to make their own masks out of their t-shirts , they can be disciplined for `` destruction of state property . ''
State , local and federal officials say they @ @ @ @ @ @ @ population and staff , and that people behind bars can get immediate medical treatment when needed .
To force social distancing , many facilities have stopped visitation and lock detainees in cells for at least 23 hours a day , sometimes more , to limit the amount of time in common areas .
But one epidemiological model suggests coronavirus may be spreading rapidly in prisons , jails and detention centers unless more steps are taken , according to FWD.US , which advocates for changes to the criminal justice and immigration systems .
In @ @ @ @ @ @ @ predicts that 99 % of the Arizona inmate population will be infected within the next few weeks .
But so far , less than 1 % of 42,000 in Arizona prisons have been tested for COVID-19 .
The state reported on Monday that 44 inmates have tested positive .
Officials there do not disclose any information about staff testing or results .
According to unions representing correctional officers in the state , at least 20 officers have tested positive , though union leaders believe the number is much higher .
They say hundreds @ @ @ @ @ @ @ with COVID-19 symptoms and been sent home .
Compounding the problem , union leaders say , the correctional officers were barred for a time from wearing masks for fear that would cause panic among the inmates .
Officers can now bring their own masks in , but inmates are not allowed to wear any kind of mask .
Some have been tasked with making cloth masks for the officers .
Testing also has been limited among detainees being held by Immigration and Customs Enforcement , which often contracts with county jails for space @ @ @ @ @ @ @ 32,000 immigrants detained by ICE have been tested .
When they are tested , about 50 % are coming back positive .
The agency says more than 300 detainees and 35 employees at ICE detention centers have tested positive .
But ICE does not report how many contractors have gotten sick , including medical and corrections staff .
Officials at many prisons , jails and detention centers say they are following guidelines from the Centers for Disease Control and Prevention , and that testing can only be done when there are symptoms .
@ @ @ @ @ @ @ instance , an ICE spokesman says there are no suspected cases of COVID-19 .
But critics say the lack of testing is masking the problem .
The ACLU warns that as many as 200,000 people could die in the U.S. from COVID-19 — double the government estimate — unless more steps are taken to reduce prison and jail populations .
A number of states and localities have released older , medically compromised inmates who are not considered safety or flight risks .
ICE also has released hundreds of detainees , and in some @ @ @ @ @ @ @ their release .
Most immigrant detainees have no criminal record .
They are being held on civil immigration violations , and judges have found their detention in a pandemic to be excessive punishment .
But some states , such as Arizona , have refused to release inmates .
Instead , police and sheriff 's deputies are choosing to cite people rather than book them , and prosecutors are agreeing to hold fewer people awaiting trial in jail .
As a result , jail populations have declined .
In Maricopa County , which operates @ @ @ @ @ @ @ United States , the daily population has shrunk from 8,000 inmates to 5,000 in recent weeks .
Still , advocates say that 's not enough .
In Arizona , FWD.US recommends the state release at least 10,000 inmates , or one-quarter of the prison population , to make a significant impact in stopping the spread of the virus .
Jimmy Jenkins is a reporter for KJZZ .
Matt Katz is a reporter for WNYC .

'A Ticking Time Bomb': Advocates Warn COVID-19 Is Spreading Rapidly Behind Bars
Enlarge this image toggle caption Jimmy Jenkins/KJZZ Jimmy Jenkins/KJZZ
In Arizona, a woman behind bars at the Perryville women's prison reports hearing coughing echoing through the warehouse-style dorms all night.
In New Jersey, an immigrant detainee being held in the Essex County jail has been put on quarantine cleaning duty even though he's been sick. He fears he's spreading the coronavirus.
And at the Etowah County jail in Alabama, Karim Golding, an immigrant detainee who's fighting deportation to Jamaica, says he's been feeling short of breath and worries he got coronavirus from the guards or new detainees coming in and out.
"At the end of the day I want to be tested because I want to know — did you give me the coronavirus?" Golding said. "Did you willfully give me the coronavirus and put my life at risk?"
Across the country, the spread of coronavirus behind bars is likely much more rampant than what's known right now. In prisons, jails and immigration detention centers, there is very little diagnostic testing.
And when widespread testing has been done in a few places, the results show the virus has infected huge numbers of the confined population. One Ohio prison recently found that more than 70% of inmates are positive for COVID-19.
Felicity Rose, director of research and policy for criminal justice reform at the progressive advocacy group FWD.US, says the lack of testing is leading to a false sense of security.
"We know that it's spreading among staff and that staff are bringing it into and out of the facilities," Rose said. "We know there are people who are asymptomatic and are able to pass it along, but we just don't know how many. So it's a ticking time bomb."
Inmates, detainees and their advocates say it's impossible to maintain social distancing behind bars, and they say masks as well as soap and cleaning supplies are limited and sometimes not available at all. In some places, if inmates try to make their own masks out of their T-shirts, they can be disciplined for "destruction of state property."
State, local and federal officials say they are taking steps to protect the detained population and staff, and that people behind bars can get immediate medical treatment when needed. To force social distancing, many facilities have stopped visitation and lock detainees in cells for at least 23 hours a day to limit the amount of time in common areas.
But one epidemiological model suggests coronavirus will spread rapidly in prisons, jails and detention centers unless more steps are taken, according to FWD.US, which advocates for changes to the criminal justice and immigration systems.
In Arizona, for instance, the model predicts that 99% of the Arizona inmate population will be infected within the next few weeks. But so far, less than 1% of 42,000 in Arizona prisons have been tested for COVID-19. The state reported on Monday that 44 inmates have tested positive.
Officials there do not disclose any information about staff testing or results. According to unions representing correctional officers in the state, at least 20 officers have tested positive, though union leaders believe the number is much higher. They say hundreds of employees have shown up to work with COVID-19 symptoms and been sent home.
Compounding the problem, union leaders say, is that the correctional officers were barred for a time from wearing masks for fear that would cause panic among the inmates. Officers can now bring their own masks in, but inmates are not allowed to wear any kind of mask. Some have been tasked with making cloth masks for the officers.
Testing also has been limited among detainees being held by Immigration and Customs Enforcement, which often contracts with county jails for space. Overall, about 2% of 32,000 immigrants detained by ICE have been tested. When they are tested, about 50% are coming back positive.
The agency says more than 300 detainees and 35 employees at ICE detention centers have tested positive. But ICE does not report how many contractors have gotten sick, including medical and corrections staff.
Officials at many prisons, jails and detention centers say they are following guidelines from the Centers for Disease Control and Prevention, and that testing can only be done when there are symptoms. At the Etowah County jail, for instance, an ICE spokesman says there are no suspected cases of COVID-19.
But critics say the lack of testing is masking the problem.
The ACLU warns that as many as 200,000 people could die in the U.S. from COVID-19 — double the government estimate — unless more steps are taken to reduce prison and jail populations.
A number of states and localities have released older, medically compromised inmates who are not considered safety or flight risks.
ICE also has released hundreds of detainees, and in some cases federal judges have intervened and ordered their release. Most immigrant detainees have no criminal record. They are being held on civil immigration violations, and judges have found their detention during a pandemic to be excessive punishment.
But some states, such as Arizona, have refused to release inmates. Instead, police and sheriff's deputies are choosing to cite people rather than book them, and prosecutors are agreeing to hold fewer people awaiting trial in jail.
As a result, jail populations have declined. In Maricopa County, which operates the fourth largest jail system in the United States, the daily population has shrunk from 8,000 inmates to 5,000 in recent weeks.
Still, advocates say that's not enough. In Arizona, FWD.US recommends the state release at least 10,000 inmates, or one-quarter of the prison population, to make a significant impact in stopping the spread of the virus.
Jimmy Jenkins is a reporter for KJZZ. Matt Katz is a reporter for WNYC.