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Good afternoon, and welcome to another Deep Dive on the coronavirus pandemic and how it's reshaping American life. This week we dig deeper into how the crisis impacts the haves and have nots.

  • I hope you and your loved ones are healthy and safe.
  • And to have all the health care news that matters delivered to your inbox every morning, be sure to subscribe to Vitals, Axios' health care newsletter.

Breaking: The U.S. has overtaken Italy for the highest publicly-recorded death toll in the world from the coronavirus. Go deeper.

Today's Smart Brevity™ count: 1,510 words, a 5-minute read.

1 big thing: The gaping virus inequality

Illustration: Aïda Amer/Axios

America is facing what feels like a Darwinian moment where the strong in business, wealth and health are more likely to survive, while many others will sadly wither, Axios CEO Jim VandeHei and I write.

  • Many of the people who are disproportionately hurt by the virus have the least control over or say in the system.

Why it matters: The pandemic is exposing — and deepening — many of the nation's great divides.

Sadly, it’s predominantly the old — and the previously or already ill — who are getting hit the hardest.  

  • As we told you in last week's Deep Dive, it's exposed long-standing health care inequities and communities of color and low-income families are bearing the brunt.
  • All week, we saw a stream of new data showing a shockingly disproportionate toll among African Americans.

But the imbalance transcends demographics:

  • Those without health insurance are less likely to get tested or seek treatment, increasing their mortality rate.
  • Those with weak governors or mayors, slow to react or stubborn to face reality, will suffer and die from belated social distancing and stay-at-home mandates.  
  • Those with strong health and immune systems are likelier to survive. Here, as in Italy, it is likely those who develop the strong antibody that defeats the virus will be first back to work and to return to normal life. 

The Darwinian dynamic feels especially acute for business. Millions of companies and jobs will be wiped away, with mainly the strong — or well connected — able to hang on.

  • Those companies with strong connections and lobbyists will get bailouts to stay alive. 
  • Those smaller businesses with good connections to banks will be first in line for government money to stay afloat. 
  • Those with strong balance sheets — and not inflated paper value or hype — will thrive and attract more emergency capital from investors. 
  • Those mom and pop shops with good local businesses but thin margins will struggle mightily and many will go under without substantial aid delivered quickly. The hourly workers who make them possible will suffer, too. 
  • Those workers who can easily transition to remote work will be fine. Those in blue collar jobs that can only be done in person are not only more vulnerable to the virus but also losing their jobs and insurance.

The bottom line: As with so much in American life, the coronavirus draws out the sharp divides between the nation's haves, and have nots, as who you are, who you know and where you live can make the difference in everything, including life and death.

2. What's next in the race for a coronavirus treatment

Illustration: Aïda Amer/Axios

Clinical trial data for a potential coronavirus treatment is set to be released by drugmaker Gilead in the next couple of weeks — that's the next big benchmark in a breakneck race to develop a drug that will help arrest the global pandemic, Axios health care business reporter Bob Herman writes.

Why it matters: The only way to truly get back to normal is through a treatment or, ideally, a vaccine. And the World Health Organization has said Gilead's drug, called remdesivir, is the "most promising candidate."

Though there's some concern that the trials, being conducted in China, aren't as strong as researchers had hoped, Gilead seems to be expecting good things. It has ramped up production and supply.

What's next: Several other drugs are in late-stage trials, but the biggest hope rests with a vaccine.

Treatments:

  • Existing anti-inflammatory drugs should have data from tests this summer and since the drugs are already widely used, they have big existing manufacturing operations
  • More than six months away are new treatments via an oral drug that Emory University will start human testing of soon. U.S. hospitals are also testing hydroxychloroquine, but we simply don't know yet whether the drug works, politics aside.

Vaccines:

  • Multiple companies are developing and testing vaccines which might not be widely available for at least 12 months. One CEO disclosed in an SEC filing its vaccine could be ready for emergency use for health professionals by this fall.
  • Experts say it's unrealistic to expect a mass-produced vaccine before 2021.

The bottom line: The science behind developing coronavirus treatments has never moved this fast. But that doesn't mean expediency will supersede knowledge, and social distancing is buying time to do more rigorous research.

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3. Social distancing is working
Data: IHME; Chart: Danielle Alberti/Axios

Leading coronavirus modeling has recently lowered its projection for the number of American deaths, a sign that social distancing is working.

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4. Q&A: exercise, laundry, soap, and vaccines

Illustration: Aïda Amer/Axios

Axios' Rashaan Ayesh is answering readers' questions about the coronavirus. Drop us a line at coronavirus@axios.com and check back here next Saturday.

Q: Should I go outside to exercise?

Q: How should I do laundry?

  • The CDC recommends:
    • Avoid shaking dirty clothes.
    • Clean and disinfect clothing hampers.
    • Use the hottest water and dryer settings recommended for the fabric.
    • Dry clothes completely.
    • If you wash a sick person's clothes, wear disposable gloves and wash your hands right away.
  • Wirecutter recommends staying 6 feet from others and wiping down high-touch surfaces in communal laundry rooms, and letting dirty laundry sit for a few days before using a laundry service, as viruses don't survive very long.

Q: Can I use dish detergent or body wash as soap?

  • Dish detergent, body wash and hand soap typically have similar detergent molecules that make them effective against germs. The difference is how harsh they are on your skin.

Q: Can I make hand sanitizer at home?

  • Experts do not recommend making hand sanitizer.
  • You can make your own disinfectant spray or wipes, the CDC says. Mix 5 tablespoons of unexpired household bleach per gallon of water.

Q: Could the pneumonia vaccine offer protection against COVID-19?

  • According to the WHO, the coronavirus is so different, it needs its own vaccine.

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5. How the virus is disrupting the global food supply

Illustration: Sarah Grillo/Axios

The journey from field to plate has been interrupted in our locked down world, Axios World Editor David Lawler writes.

Why it matters: With some crops rotting in fields and others subject to export bans, the coronavirus crisis could cause shortages in richer countries and hunger in poorer ones.

In Europe, as in North America, the harvest depends on migration. 

  • German asparagus, French strawberries and Italian tomatoes are picked by Poles, Romanians, Bulgarians.
  • Harder borders are now limiting movement, and workers are reluctant to travel due to fears of infection or quarantine.
  • Officials across Western Europe have declared farmhands critical workers. They've also called on newly unemployed people to take to the fields — the French agriculture minister called for a “shadow army” of waiters, hairdressers and hotel staff.
  • It's not so simple. “Dutch people are used to working Monday to Friday, nine to five. But the asparagus keeps growing seven days a week,” one farmer told the Economist.

In India, the food supply depends on tens of millions of people working in farms, transporting food, and selling it in wholesale markets and at small stands.

  • When the national lockdown snapped into place, gaps appeared all along that chain.
  • “All the eateries on the highways are closed. I have nothing to eat,” a truck driver attempting to deliver tomatoes to New Delhi told the Wall Street Journal. “Everyone says we should keep delivering essential supplies. But the supply link can continue only if we survive.”

Fearing a prolonged crisis, some countries have halted exports of key foodstuffs — rice from Vietnam, wheat from Kazakhstan, fish from Cambodia.

  • That could have serious downstream effects for poor countries that import most of their food, the Washington Post notes, though other big exporters plan to keep trade flowing.

The bottom line: "There is enough food, but food and other essential commodities must keep moving," John Crisci, supply chain director at the UN World Food Program tells Axios. "We cannot let this health crisis turn into a food crisis."

Bonus chart: Stocks in the time of coronavirus
Data: FactSet; Chart: Andrew Witherspoon/Axios
6. Getting food to seniors and others at risk

Illustration: Sarah Grillo/Axios

L.A. residents, including those over 60, can have their groceries delivered by taxi free of charge. In Smyrna, Georgia, police officers are dropping off groceries.

Why it matters: Senior citizens, people with disabilities, and people with compromised immune systems face additional challenges in safely getting groceries during this pandemic so communities are starting work to deliver necessities, writes Axios' Naomi Shavin.

What's happening:

  • L.A. County had a program that used taxis to transport senior citizens and residents with disabilities to appointments. This week, the county began using that infrastructure to offer free grocery and meal delivery.
  • Smyrna Police Department Sergeant Louis Defense III helped start a grocery and medicine delivery program to serve seniors, people with disabilities, and vulnerable residents.
  • Individuals are stepping up, too, to create networks to match people who need deliveries with those who can make them.

What they're saying: "There are so many agencies who can do the same thing," Sergeant Defense said. "Our academies are closed right now, and we have rookies that need something to do. This steeps them in our philosophy of true community-oriented policing."