The Washington Post - USA (2020-12-11)

FRIDAY, DECEMBER 11 , 2020 THE WASHINGTON POST EZ RE A

The coronavirus pandemic

BY ANN E. MARIMOW

A federal judge has rejected the
Trump administration’s effort to
reinstate rules requiring women
seeking abortion medication to
visit a doctor’s office or clinic in
person during the coronavirus
pandemic.
U.S. District Judge Theodore D.
Chuang in Maryland said the
health risks have “only gotten
worse” since he first blocked re-
strictions in the summer in re-
sponse to concerns about expo-
sure to the coronavirus.
Requiring an in-person visit to
a medical facility to obtain the
drugs needed to induce abortion,
Chuang said, is unduly burden-
some. He initially issued a nation-
wide injunction against the Food
and Drug Administration rule in
July, and stood behind his earlier
decision this week.
“While the progress on vac-
cines and medical treatments for
COVID-19 are cause for optimism
and may advance the day that the
Preliminary Injunction will no
longer be warranted, the impact
of these advances to date has not
meaningfully altered the current
health risks and obstacles to
women seeking medication abor-
tions,” he wrote in a 34-page opin-
ion issued Wednesday.

The Supreme Court in October

turned down the Trump adminis-

tration’s request to reimpose the

rule but sent the case back to

Chuang to quickly consider the

government’s request to “dis-

solve, modify, or stay the injunc-

tion, including on the ground that

relevant circumstances have

changed.”

In his ruling Wednesday, Ch-

uang emphasized that coronavi-

rus infection rates have only in-

creased since the summer. States

throughout the country are im-

posing more stringent public

health measures, he wrote, and

there are persistent barriers to

in-person visits, such as child care

and transportation.

“Where abortion patients in

the United States are dispropor-

tionately low-income and women

of color, the ongoing health risks

from exposure to COVID-19 are

even more pronounced,” he

wrote.

Chuang also noted that the

government has lifted restric-

tions for mandatory in-person

visits for patients seeking other

drugs, including certain con-

trolled substances such as opi-

oids.

Chuang’s order came in re-

sponse to a request from the

American College of Obstetri-

cians and Gynecologists. Medical

providers, represented by the

American Civil Liberties Union,

told the court there was no reason

for an in-person visit.

Medication abortions require

taking two drugs, mifepristone

and misoprostol, up to 10 weeks

into a pregnancy. They have been

in use since 2000, and in 2016, the

FDA eliminated the requirement

that the first drug be adminis-

tered in a hospital, clinic or doc-

tor’s office. FDA experts said it

was just as safe for a woman to

take the medications at home.

“With rising COVID-19 infec-

tions, hospitalizations, and

deaths in New York and across the

country, it is critical that the in-

person dispensing requirement

stays blocked — and we are grati-

fied that the court agreed,” Jason

Matuszak, president of the New

York State Academy of Family

Physicians, said in a statement.

“Health care providers are

making heroic efforts to provide

the safest possible care to our

patients at this unprecedented

time, and the federal government

should be making our jobs easier,

not harder,” he said.

The government told the court

that its views on how the drugs

should be dispensed has not

changed. Government lawyers

said the burdens facing abortion

patients during the pandemic,

such as the increased health risks

associated with travel to medical

facilities, and child-care and

transportation challenges have

“either been mitigated or re-

solved.”

The Justice Department did

not immediately respond to a

request for comment on the rul-

ing.

A three-judge panel of the U.S.

Court of Appeals for the 4th Cir-

cuit refused to block Chuang’s

earlier order.

At the Supreme Court, Ch-

uang’s earlier ruling drew criti-

cism from two of the court’s con-

servatives. Justice Samuel A. Alito

Jr., joined by Justice Clarence

Thomas, said the court’s action to

lift restrictions on abortion ac-

cess could not be squared with

restrictions on other activities

such as religious gatherings.

“While Covid-19 has provided

the ground for restrictions on

First Amendment rights, the Dis-

trict Court saw the pandemic as a

ground for expanding the abor-

tion right recognized in Roe v.

Wade,” Alito wrote.

[email protected]

Robert Barnes contributed to this

report.

Abortion medication restrictions remain blocked

BY LENNY BERNSTEIN

AND LENA H. SUN

The director of the Centers for
Disease Control and Prevention
allegedly ordered the destruction
of an email written by a top Trump
administration health official who
was seeking changes in a scientific
report on the coronavirus’s risk to
children, the head of a congres-
sional oversight subcommittee
charged Thursday.
In a l etter to CDC Director Rob-
ert R. Redfield and his superior,
Health and Human Services Sec-
retary Alex Azar, Rep. James E.
Clyburn (D-S.C.) expressed “seri-
ous concern about what may be
deliberate efforts by the Trump
Administration to conceal and de-
stroy evidence that senior political
appointees interfered with career
officials’ response to the coronavi-
rus crisis at the Centers f or Disease
Control and Prevention.”
The report was not altered or
withdrawn. But Clyburn, chairman
of the House select subcommittee
on the coronavirus crisis, cited an
interview three days ago with the
editor of the CDC’s most authorita-
tive publication, the Morbidity and
Mortality Weekly Report, known as
MMWR. Charlotte Kent, editor in
chief of that report, told investiga-
tors that while on vacation in Au-
gust, she received instructions to
delete the email written by Paul
Alexander, a senior adviser to Azar.
When Kent went to locate the
email, it had already been deleted,
she said, according to a transcript
of the interview provided by Cly-
burn. When she inquired about
who had ordered its deletion, she

was told the instructions had

come down from Redfield

through the chain of command.

“I heard from [REDACTED],

who, as I understood, heard from

Dr. [Michael F.] Iademarco, who

heard from Dr. Redfield to delete

it,” Kent told the investigators, ac-

cording to the transcript. Iade-

marco is director of the Center for

Surveillance, Epidemiology and

Laboratory Services at the CDC.

In a s tatement released Thurs-

day afternoon through HHS, Red-

field said: “Regarding the email in

question, I i nstructed CDC staff to

ignore Dr. Alexander’s comments.

As I t estified before Congress, I am

fully committed to maintaining

the independence of the MMWR,

and I s tand by that statement.”

The subcommittee’s ranking

Republican, Rep. Steve Scalise

(La.), issued a statement disputing

Clyburn’s charges. Scalise said

that the letter “drastically mis-

characterizes Dr. Kent’s inter-

view” and that Democrats on the

panel “continue to search for illu-

sory evidence” of obstruction by

Trump administration officials.

Kent declined to comment to

The Washington Post.

Clyburn’s letter also asserted

that HHS blocked other top CDC

officials from testifying to the

committee this week and has de-

layed sending requested docu-

ments for many months.

Clyburn also charged that an

edition of the MMWR on a corona-

virus outbreak at a G eorgia sum-

mer camp was held up for two days,

until after Redfield had testify to

Clyburn’s committee on July 31.

HHS said in a statement that

the “subcommittee’s characteriza-

tion of the conversation with Dr.

Kent is irresponsible. We urge the

subcommittee to release the tran-

script in full, which will show that

during her testimony Dr. Kent re-

peatedly said there was no politi-

cal interference in the MMWR

process.

“Moreover, during the inter-

view referenced in the le tter, a

staff member on the subcommit-

tee chose to violate basic common

practices of attorney-client privi-

lege that protect the interests of

the department, but more impor-

tantly the witness. Despite HHS

working diligently to accommo-

date the select subcommittee’s

many requests, the subcommittee

is not operating in good faith.”

Effo rts by Alexander and his

supervisor at HHS, Michael Capu-

to, to change, delay and block CDC

advice to the public on the pandem-

ic were reported this summer, dur-

ing a period of ba ttles b etween the

Trump administration, which was

seeking to reopen the country, and

the career scientists at the CDC.

In the end, language in the

MMWR was not altered, nor was

the report taken down, according

to a former CDC official with spe-

cific knowledge of the event who

spoke on the c ondition of a nonym-

ity to describe internal delibera-

tions at the time.

“That did not happen,” the for-

mer official said. Political appoin-

tees at HHS and the White House

pressured the CDC to change guid-

ance and news releases, the offi-

cial said, but “ the MMWR is where

the line was drawn.”

Alexander, in particular, was

adamant that CDC scientists were

reporting information to harm the

administration’s efforts. Accord-

ing to Clyburn, the Aug. 8 email

that Redfield allegedly sought to

delete read, in part: “CDC tried to

report as if once kids get together,

there will be spread and this will

impact school reopening.... Very

misleading by CDC and shame on

them. Their aim is clear.... This is

designed to hurt this [president]

for their reasons which I am not

interested in.”

Alexander has left HHS, and

Caputo is on medical leave.

The committee said it is seeking

to interview Redfield by Dec. 17

and still wants to speak with four

other CDC officials: Anne

Schuchat, principal deputy direc-

tor; Nina Witkofsky, a cting chief o f

staff; Trey Moeller, acting deputy

chief of staff; and Kate Galatas,

acting associate director for com-

munications.

[email protected]

[email protected]

Clyburn questions CDC chief’s order about email

JABIN BOTSFORD/THE WASHINGTON POST

CDC Director Robert Redfield

at the White House this week.

BY GRIFF WITTE

New Mexico on Thursday sus-

pended all nonessential surgeries

and activated “crisis care” stan-

dards, a move that clears the way

for a system of rationing amid a

coronavirus surge that has over-

whelmed the state’s capacities.

Under the twin orders by the

state’s health department, elec-

tive surgeries will be banned until

Jan. 4. Health-care providers,

mea nwhile, will be permitted to

begin implementation of a state-

wide plan for stretching the

state’s increasingly scarce health-

care resources. The system ulti-

mately could allow doctors to

determine which patients receive

care, depending on who is likeli-

est to survive.

The crisis-standards measure

announced Thursday, which was

deemed necessary by the “unsus-

tainable strain on health care

providers and hospitals,” will al-

low physicians and other health-

care providers to treat covid-

patients even if it is outside their

practice area.

Leaders of the state’s largest

hospitals have said that the sys-

tem is a last resort but will prob-

ably be needed given an acute

shortage of intensive care unit

beds. Nearly 1,000 New Mexicans

are hospitalized for coronavirus

treatment, triple the total from

the start of November.

Officials expressed confidence

Thursday that standards will not

suffer as a result of the shift. But

they also warned that the state’s

health-care system is operating

on the brink and that relief is

desperately needed.

“We are serving every New

Mexican who needs us,” Gov. Mi-

chelle Lujan Grisham (D) said at a

news briefing Thursday. “But we

are getting to a place where it’s

really dire, and we have to do

better.”

Lujan Grisham had told The

Washington Post of plans to acti-

vate crisis care in an interview

last week.

New Mexico’s move came as

hospitals nationwide face the ex-

treme pressures of a pandemic

that is spreading from coast to

coast at unprecedented levels,

with cases hitting new highs al-

most daily.

Since the pandemic began,

New Mexico’s g overnor has taken

dramatic action to try to limit the

spread of the virus in her state,

implementing some of the most

restrictive measures in the coun-

try.

Last month, she shut down

nonessential businesses, ended

in-person dining and implement-

ed a host of other measures as

part of an attempt to “reset” the

virus’s then-accelerating trans-

mission across New Mexico.

Lujan Grisham on Thursday

said that two-week effort had

been a success: While cases had

been growing exponentially at

the time of her order, they have

fallen by a third in the past two

weeks. The state’s positivity rate

has also declined significantly,

while the growth in hospital ad-

missions has slowed.

“All of this is exactly what we

were looking for in a reset,” she

said.

But she emphasized that the

state remained vulnerable: New

Mexico has fewer hospital beds

per capita than nearly any other

state in the country, as well as an

unusually large population of el-

derly and low-income residents

among its 2 million citizens.

“We are still in an extreme risk

situation,” she said. “That’s true

in New Mexico. That’s true in the

rest of the country.”

Lujan Grisham said the strains

on the system could affect not

only covid patients but anyone

needing health care, including

expecting mothers, accident vic-

tims and cancer patients. She

urged residents to stay home for

Christmas, and to wear masks

and maintain social distancing.

New Mexico reported an addi-

tional 23 covid deaths Thursday,

bringing its total since the start of

the pandemic to more than 1,800.

The state had nearly 1,800 new

cases on Thursday, with 916 peo-

ple in the hospital. Lujan Gr-

isham called that “a frightening

number.”

Statewide, there were only 33

ICU beds available in hospital

covid wards.

The state’s decision to activate

crisis standards was welcomed by

hospital leaders Thursday. But it

remained unclear how far they

would go in using the more flexi-

ble rules to meet surging de-

mand.

“Our team continues to be flex-

ible and creative in creating ca-

pacity to treat those in need of

care,” said Alexandria Sanchez,

public information officer for

University of New Mexico Health,

one of the state’s largest health-

care providers. “We appreciate

the governor’s declaration, and

will continue to do our best to

care for our community.”

Lujan Grisham said the expect-

ed launch of a vaccination cam-

paign next week represented a

“huge bright spot in our fight

against the pandemic.” But she

said spikes from Thanksgiving

and Christmas travel could mean

the worst stretch of the pandemic

could still lie ahead.

“We are bracing,” she said.

[email protected]

N.M. activates

‘crisis care’ to

free up ICU beds

The state has a lso

suspended nonessential

surgeries until Jan. 4

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