May 05, 2020

Good morning.

Today's word count is 1,355, or a 5-minute read.

1 big thing: The coronavirus is dividing rich and poor hospitals

Illustration: Sarah Grillo/Axios

Many hospitals may not make it out of the coronavirus pandemic, Axios' Bob Herman reports.

The big picture: The most vulnerable organizations — especially those that treat more old, poor and non-white patients — are teetering on the edge of existence and have to compete with larger, affluent hospitals for federal aid.

Where it stands: Wealthy hospital systems are sitting on billions of dollars in cash and investments, and they "are strongly positioned to take full advantage of whatever method the government sets for distributing the remainder of the bailout funds," Jordan Rau of Kaiser Health News recently reported.

  • Smaller, independent facilities have long lived in the shadows of bigger systems. The coronavirus is more clearly exposing inequality in the industry, as some hospitals get large bailout sums and additional aid from financiers while others literally fall apart.

The buzz: Bailout funds are rolling in, and they have been a lifeline for hospitals that had to postpone non-urgent procedures and for those treating large numbers of coronavirus patients.

  • But many economists and health policy experts have been shocked by the federal government's disbursement.
  • The feds initially sent money out based on Medicare billing, and then pivoted to allocating the entire first $50 billion of bailout funding based on a hospital's share of net patient revenue.
  • "That is a direct reward to those hospitals that have more market power and have been able therefore to negotiate higher rates from the private insurance companies," said Paul Levy, the former CEO of Beth Israel Deaconess Medical Center in Boston.

What we're watching: The most politically connected hospital groups, which have large hospitals as core members, are already attempting to shape the next bailout package.

The bottom line: "We're helping the rich get richer and the poor stay poorer," Levy said.

Go deeper: The corporatization of hospital systems

2. The coronavirus isn't behind us

Two new projections indicate that we've still got a long road ahead of us.

Driving the news: The Centers for Disease Control and Prevention is projecting that by June 1, the U.S. will see a surge in daily new coronavirus cases from about 25,000 to 200,000, and an increase in daily deaths from about 1,750 to about 3,000, according to an internal document obtained by the New York Times.

  • The model was created by Johns Hopkins professor Justin Lessler, according to WashPost.
  • The projections in the report underscore the fear that relaxing social distancing guidelines could put the U.S. back where it was in mid-March, when the surge in new cases threatened to overwhelm the health care system in some areas, Axios' Marisa Fernandez writes.

Separately, the Institute for Health Metrics and Evaluation at the University of Washington's School of Medicine nearly doubled its prediction of coronavirus fatalities, jumping to 134,000 coronavirus-related deaths by August.

  • Christopher Murray, the director of IMHE, said that the main reason the prediction spiked is because of states' “premature relaxation of social distancing," Politico reports.

My thought bubble: It may be tempting to think that we're reaching the end of the coronavirus tunnel, based on how political leaders are talking and acting. But according to every model I've seen, we're not.

3. The latest in the U.S.

Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios. This graphic includes "probable deaths" that New York City began reporting on April 14.

In a matter of weeks, the coronavirus crisis has triggered indelible shifts in the way America works, Axios' Erica Pandey reports.

The U.S. Treasury will need to borrow a record $2.99 trillion this quarter to pay for coronavirus relief efforts, it announced Monday.

Multiple promising vaccines for the coronavirus are in development, Peter Marks, the director of the Food and Drug Administration's biologics center, said during an Axios virtual event Monday.

Legislatures around the world have been experimenting with remote deliberation during the pandemic, but Congress still insists on in-person voting, Axios' Bryan Walsh reports.

Carnival announced Monday it will restart some cruises departing from the U.S. on Aug. 1.

4. The latest worldwide

Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

The world now appears to be moving beyond peak lockdown, with at least 12 countries loosening restrictions yesterday, Axios' Dave Lawler reports.

Trust in government has now surpassed trust in business in countries around the world, according to new "Trust Barometer" data from Edelman, Axios' Sara Fischer reports.

Spain and Italy, the European countries hardest-hit by the novel coronavirus, began reopening their economies in stages yesterday.

The leaders of nations, banks and organizations gathered Monday via video conference for an EU-led summit, collectively pledging 7.4 billion euros ($8 billion) toward research for a coronavirus vaccine, AP reports. The U.S. was noticeably absent.

Three months after Vietnam detected its first case of coronavirus, the country of more than 95 million hasn't reported a death from the virus and most of its 270 confirmed cases have recovered, the Wall Street Journal reports.

5. Second-guessing the death toll

Data: Ipsos/Axios survey, margin of error of ±3.2 percentage points; Chart: Naema Ahmed/Axios

Most Americans say they doubt the U.S. death count, but whether they think it's actually higher or lower depends on whether they're Democrats or Republicans, according to the latest installment of the Axios-Ipsos Coronavirus Index.

Why it matters: This may be the most jarring evidence to date about just how deeply partisanship has infected our collective ability to trust institutional sources and agree on science and facts. Trust in government is abstract, but death counts are real, Axios' Margaret Talev writes.

  • People whose primary news source is the Fox News channel are most likely to say that U.S. deaths attributed to coronavirus are inflated.

Week 8 of our national weekly survey also finds trust in the federal government slipping to new lows, across party lines.

  • Trust in state governments dropped most in Florida, Georgia and Texas — where governors pushed fast re-openings — and held highest in California, New York and New Jersey, where governors resisted.

Reality check: The available data suggests those who believe we're undercounting coronavirus deaths may be right, says Axios health care editor Sam Baker.

  • Many deaths aren't officially attributed to the coronavirus because not enough people have been tested for the virus. Preliminary evidence suggests it has in fact killed thousands more people than official records indicate.
  • Several hard-hit states have seen about 50% more deaths than normal over the past few weeks, per Centers for Disease Control and Prevention data.

Go deeper.

6. Antibody tests subject to new regulation

The Food and Drug Administration is tightening its oversight of coronavirus antibody tests.

  • Driving the news: Commercial manufacturers of antibody tests will now be required to receive emergency use authorization from the FDA.

Why it matters: Antibody testing, which reveals whether someone has had the coronavirus, has been plagued by reports of inaccurate or unreliable tests.

  • The FDA is also now providing performance recommendations to test makers.

Yes, but: An FDA official cautioned that even under the new guidance, the tests will still run the risk of high false positives in areas where the virus has only infected a small portion of the population.

  • Employers who are trying to figure out how to bring employees back to work should use antibody testing as only one component of a broader strategy, and should also consider confirmatory testing, the official added.

"It may be necessary for some individuals to have two serology tests performed to generate reliable results," the FDA's Anand Shah and Jeff Shuren wrote in a blog post yesterday.

  • "I wouldn't put any stock in any single result" from an antibody test, former FDA commissioner Scott Gottlieb told CNBC yesterday. "Quite frankly, if it was me I'd repeat it three times."

Go deeper: How coronavirus antibody tests will help

7. Antibiotic pipeline in peril from coronavirus

Data: Axios research; Chart: Naema Ahmed/Axios

This pandemic may be caused by a virus, but desperate measures to save patients often include overprescribing antibiotics, which is raising concerns about furthering antibiotic resistance.

Why it matters: Antimicrobial resistance (AMR) forces clinicians to look for other drugs to treat patients, but the antibiotic pipeline is in dire straits, Axios' Eileen Drage O'Reilly reports.

  • The COVID-19 pandemic is exposing how few options there are and the need for investment to be prepared for more antibiotic resistant infections to emerge, industry experts tell Axios.

What's happening: Antibiotics are being thrown at COVID-19 patients partly because growing research points to secondary infections, like sepsis, as being responsible for a portion of the deaths.

  • There's not enough data to determine if those were AMR infections, but there's great worry the increased usage of the drugs will lead to greater resistance, says Greg Frank, director of infectious disease policy at Biotechnology Innovation Organization.

The bottom line: "Having a full and effective arsenal of antibiotics, antimicrobials and antifungals is an important component of being prepared for the next pandemic," Frank tells Axios.

Go deeper.