U.S. Rep. Colin Allred, center, at a panel in March with DCHHS Chief Dr. Philip Huang and UT Southwestern's Trish Perl. (Photo courtesy Allred)

Coronavirus

Q&A With U.S. Rep. Colin Allred: We Must ‘Shift From a Defensive Posture’

The Dallas congressman on being realistic about how long the COVID-19 pandemic will last, and how an aggressive strategy of contact tracing and testing will save us.

U.S. Rep. Colin Allred, D-Dallas, believes we aren’t approaching the coronavirus pandemic with the aggression necessary to stop it. Indeed, these last two months have felt like we’re on our heels, doing whatever we can to avoid others and stay inside as the economy craters and our public health officials scramble to secure testing and personal protective equipment.

We haven’t been able to test broadly, spending weeks on a metered basis that portioned out testing to first responders, then the high-risk symptomatic residents, and then finally grocery store and delivery and retail workers. Our public sites are still are not testing asymptomatic people at large. Although your doctor can still steer you to a test from a private lab.

Our contact tracing is ticking up, and Gov. Greg Abbott packaged his order to reopen the economy with a plan to hire 4,000 people whose jobs will be tracking anyone who came into contact with a COVID-19 patient. He spoke about strategically deploying to hot spots.

Allred worries that this isn’t enough. He looks at South Korea, which had its first case a day before America did. But while we have had a little over 76,000 people die from the disease, South Korea has had just 256. How? Aggression. The New Yorker detailed South Korea’s approach, which was akin to tracking and hunting an animal:

There, people talk about COVID-19 as if it were a person. Leaders at the Korean Centers for Disease Control and Prevention have told me that the virus is sneaky, nasty, and durable—and that it has to be hunted down. In Singapore and China, large teams of public-health workers are on a war footing, confronting the virus like the mortal enemy it is. In the face of such an enemy, America’s passivity has been puzzling and unworthy of the best episodes in our history. The time has come for us to get into the fight. It’s not too late: we can still mobilize and start hunting down the virus.

Allred speaks in a similar manner. He doesn’t suggest that we all be monitored through an app on our smart phones, a la South Korea’s mandate. But he is pushing a proposed plan from President Trump’s former FDA chief Scott Gottlieb and Andy Slavitt, President Obama’s head of Medicare. They want $46.5 billion in federal funding to pay for mass testing and contact tracing. It would allot billions to pay for hotel rooms for Americans to quarantine in, then pay those people a per diem for their time.

Allred believes it would trigger some much-needed offense. But first, we have to get real about this virus. It isn’t going away any time soon. No matter what sector of the economy is open. The below has been edited for length and clarity. 

Gov. Greg Abbott is opening sections of the economy, some well before he said he would, while at the same time admitting that this will likely increase exposure to the coronavirus. And then you have local governments and public health officials scrambling to issue guidance on what is safe and what isn’t. As a congressman in Washington D.C., how do you approach this situation?

Well, what we have lacked from the very beginning, from the federal level on down, is a comprehensive plan that can be explained to the American people. They need to understand why we’re doing what we’re doing, how long they’ll be expected to look out for this, what the risks will be when we start to emerge from it, and what the long-term risks are going to be until we have the vaccine.

And it began with the president dismissing it and saying it’s 15 people from China, it’s going to go away, you know, one day, you’ll wake up and it’ll be gone like magic. It’s gone on from there with a lack of national-scale planning of the logistics needed with the international supply chains that are necessary to put together the PPE (personal protective equipment) supplies, the reagents and testing supplies needed to perform the tests, and to marshal those and distribute them to places that are in need. Instead, we’ve caused states and localities to compete against each other.

What we’re seeing now, I think, is the natural outcome from a lack of honest discussion with the American people not only about what we’re facing, but how long we’re going to be facing it and about how serious it is. And so, you know, you see people frustrated. I understand the frustration with the stay at home orders, with social distancing and being asked to wear masks, because the impression that was given was that this is going to be over very soon. But people lost their jobs, people can’t see their family members, their small businesses closed and they don’t know if they’re going to reopen. This was absolutely a sacrifice. But they weren’t told what the sacrifice was for, or how long they’d be asked to sacrifice.

Hopefully it’s not too late to lay out a comprehensive plan.

To your point about not having a plan, the Associated Press yesterday morning reported that the Trump administration had shelved the CDC’s reopening guidance that it was handing down to states. The states are deciding their own reopening game plan. Where does a comprehensive plan fit into that scenario and what does it look like?

Well, first of all, the CDC has the very best epidemiologists, biologists and experts not only in the United States, but in the world. The entire world looks to the CDC. The fact that the CDC guidelines are not being released should concern everyone because as talented and as great as our local public health officials are—and I’m a big fan of Dr. Philip Huang (the head of Dallas County Health and Human Services)—the CDC has whole divisions that are committed for decades to identifying dangerous strains of virus in other parts of the world to try and stop them from coming to the United States.

This was not new for the CDC, they’ve been aware of the threat from coronaviruses for decades. And they’ve been tracking this and following us, and so we should be listening to them. What I’m trying to put forward in Congress is a plan to explain to folks what we can put in place to restore some level of consumer confidence.

If we’re going to reopen in this haphazard way, then there has to be a plan to protect the workers who are asked to go back to work and to give people confidence that if they’re going out, they’re not risking their lives every single time. In Texas and around the country, people do very much feel like it’s a risk for them to engage in the economy. So you can make whatever declarations you want about opening this part of the economy or that part of the economy, but if people don’t come, it won’t matter. All you’ll be doing is talking into the wind.

And so there’s been a plan that’s been put forward by Dr. Scott Gottlieb, who was the former commissioner of the FDA under President Trump, and Andy Slavitt, who was in charge of Medicare under President Obama. It’s basically around testing, tracing and treatment/isolation and quarantine. We’ve already put forward $25 billion for testing; it’s already an enormous amount of money, but we’re going to have more money for testing in this upcoming bill.

“What we’re seeing now, I think, is the natural outcome from a lack of honest discussion with the American people not only about what we’re facing, but how long we’re going to be facing it and about how serious it is.”

U.S. Rep. Colin Allred

We’re going to take about $50 billion and use it for contact tracing and to help folks isolate and quarantine. If you talk to any healthcare official about what are they doing right, in South Korea, in Germany, in some of the countries that have done much better than we have in terms of controlling the spread of the virus, they tested on a much higher per capita scale. They aggressively traced everyone who’d come into contact with someone who was positive, and they helped them quarantine or isolate, to reduce the spread of the virus.

We have $12 billion to hire 180,000 contract tracers, which would be deployed across the country. They would have to be trained, and we also have a plan for that, for the workforce training. Another $4 billion or so will pay to rent hotel rooms, because most people actually cannot isolate or quarantine in their own home if they’re living with others who don’t have the virus.

We have $30 billion for up to 18 months of income support for folks who are being asked to isolate and quarantine, which basically pays out like a per diem, similar to if you were doing jury duty, to make sure that people aren’t missing out on their paycheck while they’re quarantined. We are asking them to do a public service to try and keep themselves from infecting others.

Slavitt and Gottlieb signal bipartisan support, but do you see a full Congress going for it?

Scott Gottlieb is one of the main proponents of this plan. He is not only the former FDA Commissioner for the Trump administration, he’s currently advising the Republican governors of Maryland and Massachusetts. It’s really not a partisan plan. And I hope that doesn’t become part of it. Because contact tracing, isolation, and treatment is what has been done all around the world, and it’s what public health agencies have done for decades with any serious infectious disease.

You mentioned that the last bill included $25 billion to go toward testing. Locally, Judge Jenkins asked for the materials to do 6,700 daily tests at Parkland and UT Southwestern. We have the machines, but not the materials. He’s gotten crickets back, basically. So is it enough to allocate dollars for testing? Or is there something broken in the supply chain?

There are two different choke points for testing. There’s PPE, which we have not had enough of.

We’ve tried to find and buy PPE. We work very hard, but there still is a severe shortage. Parkland is still recycling N-95 masks, which is against the manufacturer’s intent for those masks. [Ed. Note: A Parkland spokeswoman confirms this. “We are sterilizing N-95 masks for reuse.”] The PPE shortage was, and continues to be, a big problem for us. The other side of it is the reagents and the swabs and all the things that go into the kit to conduct the tests. We have the machines at UT Southwestern and Parkland to do many more tests per day than we are currently doing. But we aren’t able to do them because we can’t get the materials.

And so those are the two choke points that we’ve had throughout this process. Unfortunately, both the reagents and the PPE and even the swabs are mostly manufactured overseas.

So is there anything that you’re hearing that is encouraging that some of these resources could start flowing back in? Or do we just have to wait and see?

Well, now there is some good news on the horizon. The PPE shortages are not as severe as they were. Although we still have a shortage. It looks like China is ramping back up on their production. Remember, one of the areas in China that was hit harder was Wuhan, which also produces many of the things that we’re talking about. Also northern Italy, a place with manufacturers that was very hard hit by this virus. So we’re starting to see the international supply chains come back together. And there’s  project Air Bridge that the Trump administration has put together, where they’re flying over, you know, hundreds of tons of PPE, and that will hopefully start to ease some of the problem there. And some of the tests that are coming online are less invasive, they don’t require the same amount of PPE for the folks who are actually administering the test. And they don’t require the same kind of deep nasal swab, which we’ve had trouble getting.

On the flip side, we now have to transition from asking symptomatic folks and the critical workforce to come to us to community monitoring and getting out in the community, particularly in the places that we’ve identified positive tests coming from. We have to conduct widespread testing, just to find the asymptomatic folks who may be out there. We need to do serological testing to find out folks who had COVID-19 so we can have an understanding of where it was and where it’s going.

That is going to be the next step of this. In South Korea, they talk about the virus like it’s an enemy, and they want to hunt it down and hold it down. And that’s what we need to be doing. We need to be thinking about the virus as something that’s actively moving through our community, that we have to go on the offensive against. Social distancing and stay at home orders save a lot of lives and they’ve saved our healthcare system from being overwhelmed. But they are not offensive in nature. We’re still seeing rising cases. And that’s part of the reasons that we have to go out there and actively fight this virus.

Gottlieb’s plan calls for a significant ramp up in contact tracers, which sounds a lot like what you’re discussing here. Gov. Abbott has said that he wants to hire 4,000 in the next month or so. Gottlieb sounds like he wants to hire a lot more than that.

Well, we have 29 million people in Texas. In North Texas, we have so many people that even a few thousand contact tracers could be very easily overwhelmed. The studies coming out now are saying that for every positive test, there’s likely 10 or 20 folks who also are positive that are not identified. So let’s just take the low end and look at the numbers that we are seeing right now in Dallas County. We’ve been in the 200s each day this week. You pretty quickly start to understand that that probably means that we have 2,000 cases that day.

You have to treat and get out there and identify and trace as you can. There are some healthcare experts who say that 180,000 is not enough for contact tracing workforce for the entire country. Some of them are saying 250,000 or 300,000. And that may end up being the number.

But the point is a shift in thinking about it, a shift from a defensive posture, a posture of there’s going to be spread, there are going to be people dying, there’s not much we can do about it. And we have to restart the economy because the other true consequences of having a closed economy are also very bad.

“We need to be thinking about the virus as something that’s actively moving through our community, that we have to go on the offensive against.”

U.S. Rep. Colin Alrred

We have to say that we’re going to do everything we can to save as many lives, we’re going to do everything we can to fight this virus as the enemy that it is. South Korea had its first case on January 20 and we had ours on January 21. The U.S. has gone in a very different direction than they have. They are restarting parts of their economy. They’re still wearing masks, they’re still socially distancing. But they’re able to restart many parts of their economy. They’re playing baseball, as you’re seeing on ESPN.

We are in a very different position where we are increasing our number of cases each day. We’re approaching 3,000 deaths a day. We’ve lost more Americans to this virus than we lost in Vietnam. And we’re well over a million cases and we are experiencing hot spots in places that we weren’t previously. We have widespread community spread in our country. We can’t just sit on the defensive. We are gonna have to go after this thing.

The other the other thing I wanted to talk with you about was mortgage and renter aid. The city of Dallas opened its lottery this week and got 16,000 applicants when it had money for 1,000. The same is expected for the county’s. Do you expect more federal dollars to refill those coffers quickly?

We have to provide an enormous amount of support to our states and our cities. That’s the big fight. You might have seen (Senate Majority Leader) Mitch McConnell saying that states should be able to declare bankruptcy and making a kind of specious claim that it’s only blue states that need this money. That’s absolutely not true. The loss in revenue alone is going to cause deep cuts in state and city budgets. We’re already seeing that happening. The Republican head of the National Governors Association, the governor of Maryland, has called on this funding. This is not a partisan issue.

I was on a call two weeks ago with Gov. Abbott, where he asked the Texas delegation to make sure that Texas gets its funding, because the loss in revenue is enormous. And then there are these additional costs that they were incurring, trying to prevent folks from being evicted, trying to prevent folks from losing their homes during this crisis. And that’s the right thing to do.

One of the things that we absolutely don’t want to do when we’re asking people to socially distance or to stay home as much as possible, is to kick them out of their home. We’re going to try very hard to cover these losses and revenues and these additional costs of the states and the cities are incurring.

We had $150 billion for states in the CARES package. I think we’re going to put forward a much higher number than that in CARES 2.0. But I want to stress this, because I think it’s the most important thing to keep in mind. None of the programs that we are trying to put in place to mitigate the economic pain, whether it’s a paycheck protection program, or whether it’s our improved unemployment benefits, or whether it’s eviction protection and mortgage protection—all of these are dependent on beating the virus as quickly as possible and returning to the closest semblance of normal life as we can.

The focus always has to be that yes, we need to take every mitigating step necessary, but the prime focus always has to be to reduce the spread of the virus, to wrestle it down to the ground, and to allow the economy to come back as much as possible. That’s the only way that we’re going to get through this. There is never going to be enough stimulus that we can provide that will be able to get us through.

Our economic health and our public health are directly tied together.

We need to be honest with the folks in Dallas and across the country to communicate the scale and the length of what we’re facing here. This is not a short term fight. When I’m talking about a return to some semblance of normal, I’m not actually talking about where we were six months ago; that’s probably not going to be possible until we have a vaccine. And even the fastest estimates, I think, have us getting a vaccine maybe early next year. There are rosy expectations about how maybe the summer will kill the virus. Well, that hasn’t happened in Singapore or other hot and humid climates around the world.

Dr. Robert Redfield, the director of the CDC, has said that we will likely see a renewed resurgence of the virus this fall that will coincide with the annual flu season. And so it’ll be even more taxing for our healthcare system. So we have to be ready for that. And we need the expectation set for that. And I hope folks understand that this is the greatest challenge facing the United States since the second World War. We have to start thinking that way. This is going to take all of us. It’s going to take an entire mobilization, an entire shift in thinking, to really grasp of the size and the scope of the challenge here. But we will beat it. And I know we will. And I know that we will lead the world out of this, as well.

That’s going to require us to take it much more seriously.

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