Widespread testing, contact tracing, an effective treatment for hospitalized COVID-19 patients, abundant personal protective equipment (PPE) for frontline workers, and eventually a vaccine are all critical for controlling outbreaks and saving lives. A two-week downward trajectory in cases is the widely accepted criteria for beginning to relax social distancing orders. In this discussion, health leaders from across the region explain how these puzzle pieces fit together and the research, development, and production efforts behind securing each piece, with status updates from Maryland, Virginia, and the District.

Moderator: Jack McDougle, President & CEO of the Greater Washington Board of Trade

Speakers:

• Dr. Lisa Lockerd Maragakis, Senior Director of Infection Prevention, The Johns Hopkins Health System
• Dr. Georges C. Benjamin, Executive Director, American Public Health Association
• Dr. Laurie Forlano, Deputy Commissioner for Population Health, Virginia Department of Health
• Fran Phillips, R.N., Deputy Secretary for Public Health Services, Maryland Department of Health
• Dr. John Davies Cole, State Epidemiologist, District of Colombia

Our economic recovery will depend on a robust, functional transportation system—and that system is currently in financial jeopardy as would-be travelers stay home. In this virtual conversation, Tom Dohrmann, cofounder and lead of McKinsey & Company’s Public Sector Practice, shares analysis from McKinsey on national trends. He then moderates a conversation with Paul Wiedefeld, General Manager and CEO of WMATA; Ricky Smith, Executive Director of BWI Thurgood Marshall Airport; and Jack Potter, President and CEO of the Metropolitan Washington Airports Authority (MWAA).

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On current passenger numbers and facility operations

The pandemic has stopped most travel in its tracks—a much larger reduction in travel than after the terrorist attacks of September 11, 2001 or the financial crisis of 2008, according to analysis from McKinsey. The panelists confirmed that Metro and all three regional airports are currently only serving a fraction of their normal number of passengers. Metro rail is down 94%, Metro Bus is down 74%, BWI is down 92% (which is actually up from 97% last week) and MWAA’s airports, Regan National and Dulles International, are down 97%.

The dramatic reduction in riders and passengers combined with social distancing requirements has changed operations at Metro and the airports. Trains are now running less frequently, most stores in the airports are closed, masks are required or strongly encouraged, and Plexiglas dividers have been installed on busses and throughout the airports to protect bus drivers and other workers who interface with the public.

Ricky Smith, Executive Director of BWI Thurgood Marshall Airport, noted that airports are a part of a national and international network and are therefore only as safe as the airports they connect to. Therefore, a consistent, national approach to airport sanitation and operations is needed. FAA and TSA are exploring a system-wide plan now.

On cash flow and capital investments

Revenue has obviously taken a nose-dive for Metro and the airports. Metro is projecting $800 million in losses through 2021. Paul Wiedefeld, General Manager and CEO of WMATA, noted that Metro is attempting to maximize funding from the CARES Act so that it depends less on DC, MD, and VA, which are also facing budget crises.

Jack Potter, President and CEO of the Metropolitan Washington Airports Authority (MWAA), explained that most airports have very large debt burdens—up to 40% of their costs are servicing debt. The airports will therefore dip into the net remaining revenue carried over from previous years to meet this obligation. CARES Act funds are also helping.

Despite financial woes, Metro and the airports are continuing to make investments in their facilities to keep them functional and safe. Though some capital investments projects have been put off due to financial restrictions, many are moving forward as planned—and in fact, the reduction in travelers is allowing some projects to move forward more quickly than they would have under normal conditions. Paul Weidefeld said that Metro is moving forward with phase two of the Silver Line and the platform repairs west of Ballston.

Forecasts for the fall and beyond

Jack Potter said that MWAA projects that air travel will be back to 50% of what is considered normal by the end of 2020. They are modeling numerous scenarios for 2021, from a healthy rebound with 80-90% recovery to a sluggish, 30-50% recovery. He said that they are attempting to be flexible, to continually research and analyze, and avoid the temptation to rush to conclusions.

Paul Weidefeld acknowledged that Metro riders must feel safe if they are to return to taking the metro. He noted that Metro cleaning crews are now cleaning during the day, an activity usually reserved for the night, so that riders see the work being done in front of them. Metro will also enforce mask use and will try to limit the number of riders so that everyone can practice social distancing. He asked that employers with workers who are working from home bring those workers back to an office setting gradually so that Metro is not overwhelmed with too many riders to safely serve.

This virtual briefing explores the pandemic’s impact on the mental health of workers, families, patients, and healthcare providers in our region. Featuring:

• Monica Schmude, President, Mid-Atlantic Market, Cigna
• Dr. Steve Miller, Chief Clinical Officer, Cigna
• Robin Kelleher, President & CEO, Hope For The Warriors
• Dr. Marissa Leslie, System Chief of Psychiatry, Adventist HealthCare
• Darcy Gruttadaro, Director, Center for Workplace Mental Health, American Psychiatric Association Foundation

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Mental health trends during COVID-19

Unsurprisingly, the COVID-19 pandemic is taking a big toll on the mental health of most people. Dr. Steve Miller, Chief Clinical Officer at Cigna, opened the session by reviewing the data: Reported loneliness is impacting 75% of individuals, up from 50% before the pandemic. Most Americans are experiencing anxiety, depression, or problems sleeping, with Generation Z and Millenials hit the hardest. In the first 30 days of the crisis, even when the number of cases in the United States were low, prescriptions for drugs to treat these disorders were up significantly (between 35-15% depending on the drug). Alcohol and drug abuse are also increasing.

The pandemic has also been especially hard for front-line healthcare workers who are fighting to save lives every day. Dr. Marissa Leslie, System Chief of Psychiatry at Adventist HealthCare, described bravery and solidarity among front-line workers at Adventist but noted that they often feel a sense of responsibility for medical outcomes. This can cause moral injury in the face of the devastation caused by COVID-19.

How the healthcare sector is responding

The pandemic has given providers and patients incentive to try telehealth, the practice of virtual medical visits. Dr. Miller reported that satisfaction levels have been high with telehealth and that many are finding it to be valuable, accessible, and affordable. Telehealth is also allowing medical care practitioners to reach people who they typically had a difficult time reaching. This may be a lingering upside to the pandemic.

Dr. Leslie noted that she has observed her teenage clients respond especially well to virtual visits. She theorized that this is because they are more comfortable in their own rooms and feel more like they are initiating the visit when it is on their device rather than after being shuttled to a doctor’s office by their parent.

Mental health problems in the workplace and what employers can do

Darcy Gruttadaro, Director of the Center for Workplace Mental Health at the American Psychiatric Association Foundation, explained that interest in workplace mental health was already escalating before the pandemic due to mounting evidence that anxiety, depression, sleeplessness, and substance abuse all have serious impacts on company productivity.

She recommended a model for how companies can help their employees take care of their mental health, which follows the acronym LEAD:

• Leadership: Top-ranking leaders must set the culture at the organization. They are encouraged to talk about their own feelings and anxieties in appropriate ways and to encourage staff to take care of themselves.
• Effective communication: In times of uncertainty and stress, employers must provide a steady stream of clear information for employees to whatever extent possible.
• Adapting to change: They say that the only constant in life is change, and that is certainly true now. Employers should help their employees adapt to changing circumstances.
• Double down on services and support: The mental health system is difficult to navigate. Employers should make sure that their employees have access to mental health providers and other assistance through their health plans and employee resources.

The panelists were asked how employers can recognize if an employee is struggling. Darcy stressed the importance of recognizing changes in behavior. Though employers should expect to see some changes in staff behavior given the current circumstances, they should take notice if an employee exhibits behavior that is uncharacteristic for a prolonged period of time, such as a drop in performance, unexplained absences, and unusual isolation. This kind of change is a warning sign, and an opportunity to start a conversation. Employers should not try to diagnose the employee, but rather should demonstrate compassion and point the employee towards help.

Robin Kelleher, President and CEO of Hope For The Warriors also suggested that leaders make sure to have video calls with their employees regularly so that they can look for visual cues that their employees need extra help. She also recommended making time for virtual happy hours, birthday celebrations, and other social events to help increase engagement and a feeling of being connected.

What we can learn from the veteran community

Military service can be stressful and traumatic for our service members and their families. Robin spoke about what she and her organization have learned in working with the veteran community for many years. They have found that it may take six to 18 months for a traumatic event to manifest as a change in behavior. They have also learned that it is important to engage the whole family as they experience a stressful event together. Understanding the timelines and symptoms of behavioral health impacts after a stressful or traumatic episode is key for providing effective support.

Resources mentioned on this briefing call

America’s State of Mind Report (Express Scripts)

Loneliness in the Workplace Factsheet (Cigna)

Resilient Nation (Hope for the Warriors)

COVID-19 Tips from the Center for Workplace Mental Health (American Psychiatric Association Foundation)

Jamil Jaffer, Senior Vice President at IronNet Cybersecurity, describes how cybersecurity threats have evolved and how the public and private sectors can work together to effectively address these new risks and challenges.

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For state and local jurisdictions, the COVID-19 pandemic is a double threat: it endangers public health, and the loss of tax revenue from closed businesses slashes state and municipal budgets at a time when public services are sorely needed. This briefing features Virginia Secretary of Finance, Aubrey Layne; Chief Financial Officer of the District of Columbia, Jeff DeWitt; and Maryland Comptroller, Peter Franchot. These three leaders will share how they are approaching this crisis and what the path to fiscal, economic, and public health looks like in their jurisdictions.

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The financial hit to state/District budgets

DC, Maryland, and Virginia are all collecting significantly less tax revenue than they normally would since revenues are way down, especially in the hospitality sector. DC’s CFO, Jeff Dewitt, said that overall, the restaurant industry is only doing about 12% of its normal revenues. This is usually peak season for hotels, but half are closed, and the other half are only running 5-10% occupancy.

DC is projecting its tax revenue to be reduced by 722 million dollars for the current fiscal year. Virginia and Maryland are both preparing for losses in the billions through the rest of 2020.

All three financial leaders described working with multiple projections based on different scenarios, but they seemed to expect that we will continue to see widespread business closures through September or October.

Though all three governments have ample liquidity, they will be challenged. Maryland Comptroller Peter Franchot said that he is advising Governor Hogan to spend the states entire rainy-day fund, but he still said with certainty that the Maryland government is facing furloughs and layoffs. District CFO Jeff Dewitt stressed the need for DC to receive adequate funding from the federal government after being shortchanged by the CARES Act because what they are due to receive will not cover the low end of their cost estimate for COVID-19 response. Virginia’s Secretary of Finance, Aubrey Layne, said that states would be in a better place if they could use the CARES Act funds could be used with more flexibility; they are unable to use those funds to make up for revenue losses.

Deep budget cuts are inevitable. When asked how they are going to approach setting priorities for allocating funds, the finance leaders agreed that it is important to be realistic. Addressing the public health crisis and maintaining continuity of critical government functions is top priority. Governments will need to face the disappointment of not being able to do much of what they had planned at the beginning of the year. Maryland Comptroller Peter Franchot also said that Maryland will likely refocus on the needs of small business and family budgets.

The path to reopening

All three financial leaders confirmed that getting the pandemic under control is the first step to reopening the economy. They agreed that a scenario in which we reopen too soon, see a second spike in transmissions, and need to close businesses and other facilities a second time is the most costly and disruptive scenario, according to their models.

Ample testing and contact tracing are key to reopening. All three jurisdictions are working hard to procure the testing supplies and personnel they need, but the financial leaders share concerns that more should be done on the federal level. The current approach places a great deal of responsibility on the states and puts them in competition with each other.

The District, Maryland, and Virginia will each follow recommendations from the White House and CDC to reopen the economy in phases. However, Virginia Secretary of Finance Aubrey Layne expressed frustration with mixed messages coming from the White House, citing the President’s tweets to “Liberate Virginia.” Maryland Comptroller Peter Franchot also expressed concern over recent demonstrations calling for Governors to lift restrictions and said that he has advised Governor Hogan to stay the course and put public safety first.

All three leaders agreed that restoring consumer confidence will be a challenge—another reason why decisions to relax restrictions on business and public gatherings must be made thoughtfully and with the support of public health experts.

It was also agreed that the approach must be regional. It would make little sense to reopen restaurants in one jurisdiction while they are closed in another, for example. The three governments must work together to ensure that policies are coherent across the whole region, given the frequency with which workers, residents, and visitors cross our borders.

The COVID-19 pandemic has disrupted food supply chains and household food budgets across the country. In this one-hour briefing, Radha Muthiah, President and CEO of the Capital Area Food Bank, describes the forces behind these disruptions, how her organization has responded, and what we can collectively do to help our food system and the families who depend on it. Margaret Rogers, co-head of Arabella’s Good Food practice and co-coordinator of Washington Regional Food Funders, draws on her experience leading the Farm to Fork Initiative to describe how good public policy can make our food system more resilient and equitable.

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Food insecurity in Greater Washington and the Capital Area Food Bank’s response

Going into the pandemic, the Capital Area Food Bank faced a huge challenge: surging demand and dwindling supply. Many people across our region have lost their jobs or seen their hours or wages cut, increasing the number of people in need of food assistance. People who typically rely on the food bank were also attempting to stock up for two weeks, just like most of the country, in case they fall ill and are unable to leave their homes. Keeping up with this demand has been especially difficult because many of the distribution centers the food bank typically relies on have been closed. Grocers have also had to cut back the amount of food they donate to the food bank by up to 75% to keep pace with demand in their own stores.

To continue to feed families in need, the Capital Area Food Bank had to be very nimble and make changes to their operations. They have been purchasing much more food than they typically do to supplement what is donated to them. They began packaging emergency food boxes which contain about 20 to 25 pounds of food and can feed a family of four for about 3-4 days, which allows them to more easily distribute food in a contactless manner. To date they have distributed about 18,000 boxes. They have set up pop-up distribution nodes in hard-to-reach areas where their typical distribution hubs are closed, and they have engaged taxi and rideshare (Lyft and Uber) drivers to help get food to seniors.

All of this was made possible by the ingenuity and dedication of the Capital Area Food Bank team, and because of the generosity of our community. The food bank would be unable to purchase enough food without contributions from area businesses and individuals, and they rely heavily on volunteers for packing and distribution.

Impacts to our food supply chain

The food supply chain has been dramatically disrupted by the pandemic. Many food producers have lost their customers because restaurants, hotels, schools, and other large buyers have closed. Some meat processing plants have shut down because their employees are sick with COVID-19. These factors have led to large quantities of food being dumped. Fortunately, this is likely a short-term problem. The supply chain will likely adjust and redirect more food to grocers as time goes on, and restaurants will eventually reopen. But in the short term, there will be significant financial losses for farmers and food producers.

Federal assistance to families & farmers

The Federal government has taken several steps to help struggling families. The CARES Act provided a $1200 stimulus check to most individuals, which is helpful in the short-term. The expanded unemployment benefits are very helpful for as long as they will last. Congress increased funding for the Supplemental Nutrition Assistance Program (SNAP) so that it can serve more people, but it has not increased the SNAP allowance per household.

The USDA announced the Coronavirus Food Assistance Program in mid-April. This program will provide $16 billion in direct relief to farmers and food producers. It will then work with national food distributors to direct produce, meat, and dairy to organizations providing food to families in need, like the Capital Area Food Bank. The distributors are currently bidding on the program and will be chosen by mid-May. The program is designed to keep farmers and food producers in business while directing food to those who need it.

Lessons learned for the future

This crisis has exposed vulnerabilities in our food system. Both Margaret and Radha expressed a desire to see the United States learn from this experience so that we can be more resilient in the next crisis. Margaret believes that we need to invest in regional food systems rather than rely so heavily on consolidated mass-producers. This would shorten the food supply chain and reduce risks. Radha pointed out that the USDA should move faster in relaxing guidelines in future crises so that organizations like the Capital Area Food Bank can be nimbler in how they respond to shifting community needs. She also suggested that leaders across the region have clearer, predefined procedures for responding to an emergency so that the network of stakeholders involved can act more quickly.

On April 22, Senators Mark Warner (D-VA) and Chris Van Hollen (D-MD) graciously spent an hour online with Board of Trade members and friends to discuss Congress’s work to lead the country through the COVID-19 pandemic and ensuing economic crisis. Below is a summary of the key points they each made.

Note: This briefing call was not recorded.

Discussion Summary

On a nation-wide testing regime:

The Senators agreed that in order to reopen our economy, we need a robust testing system. This includes diagnostic testing to diagnose sick people, surveillance testing that also tests people who are not showing symptoms to gauge the rate of virus transmission in a population, and antibody testing to identify people who have recovered from the virus and may be immune.

Through widespread and ample testing, we can safely begin to reopen our economy and allow schools and businesses to reopen. The CDC and the White House have advised that communities observe a two-week decline in cases before relaxing restrictions. Senator Warner noted that as a former Governor, he is alarmed to see some Governors of other states, such as Georgia, begin relaxing restrictions before this criterion is met.

Senator Van Hollen noted that most information he has seen on Maryland and the National Capital Region indicates we will not experience our peak of the virus until mid-May.

The Senators argued that the United States has not been testing nearly enough citizens and that we are behind other industrialized countries. Senator Van Hollen stressed that we should be conducting half a million tests per day nationally in order to return to normalcy, citing experts. (To date, the United States has tested nearly 4.5 million people.)

The Senators explained that this is a supply chain problem. COVID-19 tests require supplies such as swabs, reagents, and transport kits, and they need to be processed in a lab. Even when there is lab capacity, there are not always enough supplies to increase testing. The Senators explained that they asked for $25 billion to be included in this week’s legislation (which they call bill 3.5) to invest in the testing supply chain.

The Senators also argued that we need a centralized, national testing regime because requiring states to procure their own supplies puts them in competition with each other and drives up prices of supplies. Both Senators also posited that the need for widespread testing and contact tracing could be an opportunity to deploy our AmeriCorps and Peace Corps volunteers.

On the Paycheck Protection Program (PPP) and other measures to help small businesses:

Senator Van Hollen acknowledged that it was very predictable that the PPP fund would run out of money quickly. Senator Warner noted that there were 1.7 million grants given out, but there are 11 million firms with under 500 employees in the United States.

The Senators discussed ways to improve this program. In the bill that passed in the Senate on Tuesday and is likely to pass in the House today, another $310 billion will be allocated to the PPP. This time, more of the funds will flow through smaller lenders, said Senator Van Hollen. The intention is to make sure the money gets to more “mom and pop” shops rather than large, publicly traded companies.

Both Senators agreed that Treasury Secretary Steve Mnuchin was a good negotiating partner, but they disagreed with two restrictions that the Treasury placed on small businesses when using the PPP funds. First, they disagreed with the cap that was placed on what could be spent on fixed costs and later forgiven, claiming that this did not reflect the needs of small business owners. Second, they voiced serious concern with the Treasury’s requirement that the PPP funds be spent within eight weeks. The Senators believe that this will incentivize businesses to hire back workers before they can be put back to work, and then let them go again in eight weeks should business still be at a stand-still. They believe that small businesses should have the flexibility to use these funds when they are preparing to ramp up again. In the meantime, the more generous unemployment insurance was meant to help workers.

Senator Mark Warner is currently advocating for a completely different approach, which is to provide direct grants to small businesses to cover their payroll costs, without using banks as intermediaries. He argues that this may be a smarter way to structure assistance in a phase four bill.

Senator Van Hollen advised small businesses to apply for both PPP and the SBA’s Economic Injury Disaster Loans (EIDL) for now. They are not meant to be mutually exclusive. If you receive the EIDL and the $10,000 grant that comes with it and then later receive a PPP loan, $10,000 is simply deducted from the amount that is forgiven in the PPP loan. If you applied for a PPP loan or EIDL and have not yet received one because the money ran out, check with your lender for the PPP loan and the SBA for the EIDL to see if you need to refresh or renew your application.

On funding for states and the District:

The Senators said they were unable to get additional funding for state and local governments and the District in this week’s “3.5” bill, but that the President has agreed that this will be included in the phase four bill. Senator Van Hollen voiced a commitment to dealing with DC’s $700 million shortchange retroactively and on a forward basis. He said that many Republican senators are willing to work with them on this.

Warner also raised concern over a provision in the last bill that prohibits state and local governments from using relief money to supplement revenue loss. Hospitals and companies can use the relief funds to supplant revenue loss, but states cannot. Warner is concerned that this will impact first responders and other critical municipal services and noted that Hogan has raised the same concern.

On reopening the economy:

The Senators stressed that the first priority is establishing a national, robust testing regime. They also noted that as restrictions are relaxed, many decisions will need to be made about how to protect employees and consumers. Employers and lawmakers should be thinking through those requirements now. Senator Warner said he hopes to see a regional approach to reopening, noting that Virginia is a large state with different circumstances in the southern counties compared to the D.C. suburbs. Senator Van Hollen commended a regional approach to COVID-19 and noted that he was pleased to see leaders working together and listening to healthcare experts.