By U.S. Sen. Bob Casey and U.S. Sen. Pat Toomey Every day, seniors living in nursing homes are dying from the novel coronavirus, or COVID-19, at a rate disproportionate to those living in the community. Countless nursing home aides, nurses, and doctors are risking infection while providing care. According to the latest reports, more than 20,000 nursing home residents have already died from COVID-19, and workers are scared to return to work. Immediate action is necessary to prevent more people from succumbing to this virus. First, states and nursing homes should consider adopting the practice of cohorting, which is underway in a handful of states including Pennsylvania. With cohorting, nursing homes can separate residents with COVID-19 and those presumed to have the virus from those who have not been exposed, utilizing separate wings in an existing facility or leveraging nontraditional settings such as hotels and dormitories. A longer-term strategy will be needed to assist nursing homes in infection control. In the meantime, cohorting has the potential to protect nursing home residents who are not stricken with the virus, while allowing government officials to better target the deployment of personal protective equipment, testing and other essential resources to care for those infected with COVID-19. The federal government has dedicated significant resources to testing and protective gear and, as a result, we have seen some corresponding improvements in capacity and supply. That said, there are still too few tests available, it takes too much time to receive results and protective gear supply chains remain strained. While the Centers for Disease Control and Prevention recently revised its COVID-19 testing guidance to give greater priority to people living and working in congregate settings, national, widespread testing is integral to curbing the spread of this deadly virus. The workers caring for nursing home residents deserve the peace of mind that they will not have to wait up to a week or more before receiving their test results or orders of gowns, masks and gloves while a COVID-19 outbreak strikes their workplace. Adequate testing can inform staffing decisions, and an ample supply of protective gear can ensure the safety of both workers and residents. With testing and protective gear needs fulfilled, nursing homes will be better prepared to implement effective cohorting strategies. Improvements should not stop there. Long before this pandemic, we started working together to improve the care provided in a subset of nursing homes that "substantially fail" to meet federally required care standards and resident protections. Such substandard facilities comprise a little-known federal initiative called the Special Focus Facility program, which was intended to help these nursing homes improve. While more than 400 nursing homes qualify for the program, only 88 receive enhanced oversight and were disclosed to the public. We are proud of our work to release the list of these previously undisclosed homes for the first time and for securing a commitment from the Centers for Medicare and Medicaid Services to release this list each month moving forward. That said, further improvements to this program are needed to ensure quality improvement for all underperforming nursing homes. In response to COVID-19, Pennsylvania is providing nursing homes with technical support on infection control practices. Every single nursing home that persistently falls short needs more such consultation, on all parameters of care, and not only in times of crisis. In the midst of this epidemic, these overdue solutions must be considered alongside a greater emphasis on the availability of testing and protective gear. The challenge facing our nation's nursing homes, their workforce and their residents and families is unlike any our country has ever seen. Bringing our nation's nursing homes urgently needed resources is now a matter of life and death. We have a responsibility to deliver.

By Sen. Pat Toomey 2020 was shaping up to be a great year for Garman Builders. The custom home builder in Lancaster County had recently expanded to employ nearly 100 workers and had planned to build 200 new homes this year. Then the COVID-19 outbreak happened. Garman was forced to shut down and send its employees home even though workers in construction, like most outdoor-centric professions, can maintain social distance on job sites. Many business closures, forced by state governments, were painful but necessary to help slow the spread of COVID-19 and prevent hospitals from becoming overburdened with critically ill patients. In Pennsylvania, the good news is that the worst is likely behind us. According to the influential Institute for Health Metrics and Evaluation COVID-19 projection model, demand for hospital services peaked on April 16 when 40% of beds were empty and 70% of ventilators went unused. Provided that commonsense social distancing measures remain in place for the foreseeable future, there will be no New York-like catastrophe in the commonwealth. Now as we begin to re-emerge from this pandemic, lawmakers must keep in mind the old medical maxim: First, do no harm. That adage applies not just to public health, but also to our economy. The decision to slow the spread of COVID-19 is causing substantial economic harm. Nationally, over 20 million people are out of work. One in every 5 Pennsylvania workers have filed for unemployment. An economic contraction rivaling the Great Depression is underway. Congress responded to this sobering reality by passing several bills that gave an unprecedented $3 trillion in aid to workers, employers of all sizes, health care systems and states. But government spending is not a substitute for an economy. It's also not sustainable. A society cannot shut down commerce for an extended period without inducing very severe consequences. Deaths of despair will rise. Our standard of living will fall. Food shortages, and even social unrest, are unwelcome possibilities, too. I was pleased Gov. Tom Wolf is thinking about these issues and released a plan to reopen the economy last week. I also offered a framework for reopening Pennsylvania that, similar to Mr. Wolf's plan, contemplates a gradual, phased and local resumption of economic activity based on data analysis and feedback I've collected from county officials, employers, workers and health care providers. My framework also includes several recommendations for improving upon Mr. Wolf's plan. Here's how to reopen our economy safely. First, our guiding principle should be that a business can reopen only if it can keep its employees and customers safe. Second, strict precautions to protect vulnerable, at-risk populations, such as those who live at nursing homes and assisted living centers, ought to remain in place. Finally, reopening should occur in the counties and regions with the lowest or consistently declining numbers of COVID-19 cases. With these principles in mind, there are employers that can safely resume activity now. Any outdoor-centric business in the commonwealth capable of adhering to safety measures and social distancing practices, like Garman Builders, ought to be permitted to reopen. In having shut down virtually all construction - including many road and transportation projects - Pennsylvania was an outlier. Second, nearly two-thirds of Pennsylvania counties have very few cases of COVID-19 or have seen significant declines over the past two weeks. Employers in these places can safely reopen provided that they meet the objective criteria provided by the Centers for Disease Control and Prevention for protecting their employees and customers. There's no scientific justification for keeping all workers at home in Bedford County, which has averaged slightly more than one COVID-19 case per day for the past two weeks, while allowing people in Lawrence County (one COVID-19 case per day) to return to work. While restaurants, taverns and places that can't accommodate social distancing will need to remain partially shuttered, for now, numerous factories and professional service firms in low-COVID-19 counties could reopen by providing workers with space to operate safely. There are other sectors of our economy that could reopen, too. Allowing underutilized hospitals and health care providers to resume medically necessary surgeries and procedures like hip replacements and cancer screenings would alleviate pain in suffering patients, prevent premature deaths and send an important economic lifeline to cash-strapped health care systems and their employees. The uncomfortable truth is that the virus will likely continue to spread - shutdown or not - just as other respiratory diseases spread. However, with both the safety protocols that I have laid out, which most Pennsylvanians will happily comply with, and having vulnerable people (older adults and people of any age who have serious underlying medical conditions) staying home, we can avoid a rapid outbreak that threatens hospital capacity. These steps will allow younger, healthier workers who are unlikely to become seriously ill to return to work. When this happens, circumstances will not be as they were as recently as January. Workers and customers will have to wear masks and gloves. Temperature-taking should become a staple of workplaces. More robust testing, isolating the infected and contact tracing must continue to be scaled up and deployed as quickly as possible. And, most important, commonsense social distancing practices, which keep people at least 6 feet apart from one another, must continue. We should also keep in mind that the United States is becoming better equipped to deal with COVID-19 now than we were when the virus first arrived earlier this year. Doctors and researchers have a better understanding of the disease and how to treat it. Our testing capacity, while not yet universal, is growing daily. And there appears to be progress on therapeutics to treat COVID-19. The extreme measures that state governments took to prevent hospitals from being overrun were necessary and helped saved lives. We can continue to protect the public and minimize the loss of life while starting the process of reopening the economy if we follow commonsense safety protocols. The time to begin that process is now. Pat Toomey is the junior U.S. senator from Pennsylvania.

By Pat Toomey Congress will likely approve President Trump's U.S.-Mexico-Canada Agreement, but it won't get my vote. The USMCA's many flaws arise from its unprecedented intent. It is the only trade pact ever meant to diminish trade. Since Nafta's implementation, American exports to Mexico have grown more than fivefold. But imports grew even more, widening the trade deficit. The Trump administration finds this unacceptable, even though the trade deficit is mostly meaningless. Hence USMCA has a myriad of provisions to warm the hearts of protectionists. For starters, USMCA terminates free trade in cars and auto parts. To avoid new tariffs, the Mexican auto sector would have to comply with onerous new content requirements (country rules of origin) and pay wages far above prevailing Mexican rates. These provisions, by design, would make Mexican factories uncompetitive. They would also raise car prices, shrink North American auto exports and eventually reduce U.S. auto employment. Another first is USMCA's 16-year expiration date. That will chill trade and investment by introducing considerable uncertainty about the future terms of trade. Evidently, that's the idea in USMCA. Another flaw is the drastic reduction of the Investor-State Dispute Settlement mechanism. U.S. investors don't always get a fair adjudication of their business disputes in foreign courts, even in Canada and Mexico. That's why Nafta, like almost every other trade agreement, created a multilateral resolution process for U.S. investors. To the delight of Canada and Mexico, USMCA nearly abolishes it. That will diminish the ability of U.S.-based multinational companies to make money in those countries. Some in the administration believe that is somehow good for America. Then there are the changes Speaker Nancy Pelosi and the AFL-CIO sought, to which U.S. Trade Representative Robert Lighthizer happily agreed. First are the laws to facilitate unionization of Mexican factory workers. Previous trade agreements left trading partners' labor laws for them to decide. But USMCA goes well beyond requiring labor-organizing laws. U.S. taxpayers will pay $45 million a year to enforce these Mexican laws. In keeping with the protectionist theme, accusations of Mexican labor law violations will presumptively be deemed to have adverse effects on trade and may result in, you guessed it, tariffs and even embargoes. Imagine the mischief protectionists will make of this, including targeting U.S. firms operating subsidiaries in Mexico. No wonder union leaders and Congress's chief protectionists are supporting USMCA after opposing nearly every previous trade agreement. Mrs. Pelosi also succeeded in eliminating protection for biologic drugs. U.S. law provides 12 years of protection from copycats (equivalent to patent protection). Mr. Lighthizer had negotiated for 10 years in USMCA. Speaker Pelosi insisted on changing that to zero. Zero it is. USMCA contains modernizing features for digital trade and some very modest easing of Canadian agricultural restrictions on certain American farm products. But these changes didn't require the protectionist features of USMCA. I still believe free trade is far better for my constituents than restrictive, managed trade and hope USMCA's protectionism doesn't become the template for future trade agreements. Mr. Toomey, a Republican, is a U.S. senator from Pennsylvania.