Apr 14, 2020

Axios Vitals

Good morning.

Today's word count is 1,001, a 4-minute read.

1 big thing: Taking care of coronavirus patients post-hospital

Illustration: Eniola Odetunde/Axios

Hospitals have been clearing beds to care for the influx of coronavirus patients, but there's a looming capacity and equipment problem for the vast majority of patients who recover and need to be discharged to another facility, Axios' Bob Herman reports.

Reality check: "I don't know that there's a nursing home in the country right now that is really able to admit an individual who is COVID-19-positive," said David Grabowski, a Harvard professor who studies post-acute care.

The big picture: Millions of people with chronic health conditions get care through home health agencies, nursing homes, assisted living facilities, rehab centers and long-term hospitals.

  • A flood of coronavirus patients who need extra care in these places after a hospital stay would put a strain on the system.
  • Many nursing homes, which have poor track records with infection control, will be in the spotlight after the federal government relaxed regulations for how quickly they could admit patients from hospitals.
  • Nursing homes also are especially vulnerable places for the disease to spread and kill: The epicenter of the U.S. outbreak was a nursing home in Kirkland, Washington.

What's next: Grabowski and many other post-acute experts are warning that precautions must be taken.

  • Every patient who is discharged from a hospital to another care facility, regardless if they had COVID-19, should get tested for it.
  • Low-income workers at these facilities will need more paid sick leave, and they will need more protective gear to prevent the spread.
  • States should create specialized post-hospital facilities that only house COVID-19 patients to keep the risk of spread lower — something that Connecticut and Massachusetts are already doing.

The bottom line: Hospitals have invested a lot of time and resources into freeing up beds, expanding intensive care units and acquiring ventilators. The same thinking should apply for care that's needed after the hospital.

2. The latest coronavirus red flag: contact tracing

Illustration: Eniola Odetunde/Axios

Widespread contact tracing will be key to the next phase of our coronavirus response, but the U.S. is severely behind.

Why it matters: Contact tracing — tracking down the people who have interacted with a coronavirus patient, so they can quarantine — helps prevent the virus from spreading.

As with diagnostic testing, the U.S. missed its chance to do this before the coronavirus caseload got too high.

  • But once we begin to lift our social distancing measures, we'll have to immediately implement these basic public health measures to avoid the caseload from immediately ramping back up.

Where it stands: Neither the federal government nor most state and local governments have a plan to drastically increase contact tracing.

  • A recent report by Johns Hopkins' Center for Health Security estimated that the public health workforce would need to add about 100,000 new workers to do contact tracing.
  • We also don't have the diagnostic testing capacity that experts say we'd need to safety phase into normal life.

What they're saying: Centers for Disease Control and Prevention director Robert Redfield told NPR last week that the agency is working on a plan to ramp up contact tracing.

Yes, but: Some states and communities are trying to get ahead of the curve.

The bottom line: "Failing to invest in and train more workers for contact tracing now could extend this crisis months," said Chris Meekins, a former Trump administration health official who is now an analyst at Raymond James.

3. The latest in the U.S.
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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios

The number of novel coronavirus cases in the U.S. now exceeds 582,000, with more than 2.9 million tests having been conducted as of this morning, per Johns Hopkins. Over 44,000 Americans have recovered from the virus.

Only public health authorities will be able to create apps using Apple and Google's new contact-tracing technology, and governments won't be able to force people to use the tech, the companies clarified Monday.

The Supreme Court will hear oral arguments via teleconference in May, it announced Monday.

A Navy sailor who had been assigned to the aircraft carrier USS Theodore Roosevelt died Monday of complications from the coronavirus, the Navy announced.

Pressed on how he will force governors to re-open their state economies during the coronavirus crisis, President Trump said at a press briefing Monday: "When somebody is the president of the United States, the authority is total."

Preempting President Trump, two groups of states are working on regional plans to lift their lockdowns as conditions permit.

4. The latest worldwide
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Data: The Center for Systems Science and Engineering at Johns Hopkins, the CDC, and China's Health Ministry. Note: China numbers are for the mainland only and U.S. numbers include repatriated citizens and confirmed plus presumptive cases from the CDC.

54% of American workers, 41% of Brits, 44% of Germans and 35% of Swedes are "very concerned" about their job security due to the coronavirus crisis, according to polling from Kekst CNC, an international strategic communications firm, shared exclusively with Axios.

While some politicians have been criticized for a lack of leadership during the coronavirus crisis, Nicaraguan President Daniel Ortega takes that to an extreme, Axios' Dave Lawler reports.

The global coronavirus crisis is testing the world's democracies in myriad ways, but one is particularly fundamental: how to hold elections, Dave writes.

5. Americans face coronavirus risks
Data: Ipsos/Axios survey, margin of error of ±3.3 percentage points; Chart: Andrew Witherspoon/Axios

Seven in 10 people now consider going to the grocery store a risky act — and a majority of Americans say they've started wearing masks outside their homes at least sometimes — in the latest installment of the Axios-Ipsos Coronavirus Index.

The big picture: In Week 5 of our national poll, we're seeing in more detail just how people are adapting to common fears and changes about the "new normal," Axios' Margaret Talev writes.

There's more evidence that the virus is affecting society unevenly.

  • 57% of those still leaving the home to work as they normally would say they feel that doing their job is moderately or very risky, compared with 13% of those working from home.
  • African Americans (50%) and Hispanics (47%) are more likely than non-Hispanic whites (37%) to see their work as risky to their health or well-being.
  • People furloughed or laid off or whose employers closed were more likely to report rising household debt, domestic disagreements and watching more TV.
  • "Those who still work out in the world are particularly concerned about the risks they are running, and those laid off are reporting increasing debt and familial conflict," said Cliff Young, president of Ipsos U.S. Public Affairs.

Masks, more than gloves, are becoming part of Americans' daily uniform when they suit up to leave home.

  • 56% said they wear a mask occasionally, sometimes or all the time (30% said all the time), while only 37% said they ever wear gloves out.

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