May 18, 2020

Axios Vitals

Good morning.

Today's word count is 1,311, or a 5-minute read.

1 big thing: Most states still aren't doing enough testing
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Data: The COVID Tracking Project, Harvard Global Health Institute; Chart: Naema Ahmed/Axios

Most states still aren't doing enough coronavirus testing, especially those that have suffered from larger outbreaks, according to recent testing targets calculated by the Harvard Global Health Institute.

Between the lines: It's much harder to contain the virus once a lot of people have it — which is why we needed strong social distancing in the first place. But knowing who is infected is the foundation of containment going forward, and most states are still behind.

The big picture: Nationally, the U.S. needs to be doing about 900,000 tests a day, according to the Harvard estimate, which was released earlier this month.

  • But not all states need to be doing the same amount of tests. The goal Harvard suggested for each state — the number of tests they should have done on May 15 was calculated based on the size of its outbreak as of early May.
  • That means that New York needs to be doing a much larger number of tests each day than Wyoming, even after accounting for the states' huge population discrepancy.

Why it matters: Most states have already begun reopening to some extent, even without key public health tools — like testing and contact tracing — fully built up.

  • That increases the chance that the virus will spread undetected as people begin interacting with one another again.
  • And these premature measures may just increase the number of tests a state needs, especially because the estimates were based on the assumption states would remain closed until May 15.
  • “The moment you relax, the number of cases will start climbing. And therefore, the number of tests you need to keep your society, your state from having large outbreaks will also start climbing," Harvard's Ashish Jha warned.
2. And now for some good-ish news on testing
Data: The COVID Tracking Project; Chart: Andrew Witherspoon/Axios

The number of daily tests being done nationally is steadily increasing, even though it's still well below what most experts say is needed.

Yes, and: Most states are showing advances on two of the key criteria for being able to safely reopen parts of their economies: They’re testing more people and finding fewer infections, my colleagues Andrew Witherspoon and Sam Baker reported this weekend.

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. This graphic includes "probable deaths" that New York City began reporting on April 14.

President Trump is leaning toward preserving his total funding cut for the World Health Organization after being on the brink of announcing he'd restore partial funding, Axios' Jonathan Swan reports.

Native Americans across the U.S. are struggling to battle the coronavirus pandemic, as decades of poverty, poor health care and pre-existing medical conditions leave them vulnerable to high rates of infection, Axios' Rashaan Ayesh reports.

Thirteen sailors onboard the aircraft carrier U.S.S. Theodore Roosevelt have tested positive for the coronavirus for a second time, Politico reports. Those sailors had recently returned from weeks of self-isolation following earlier positive COVID-19 diagnoses.

White House economic adviser Peter Navarro claimed on NBC's "Meet the Press" Sunday that lockdowns to curb the spread of the coronavirus will "indirectly" kill more people than the virus itself.

Health and Human Services Secretary Alex Azar said on CNN's "State of the Union" Sunday that while the government and the private sector are committing their "full power" to developing a coronavirus vaccine, it will not be the sole determinant of Americans' ability to return to normal life.

Groceries, drug stores and retailers are trying a variety of methods to enforce face mask mandates and protect employees, following customer complaints and assaults across the U.S., the Wall Street Journal reports.

An at-home coronavirus collection kit made by health care startup Everlywell has received emergency authorization from the Food and Drug Administration, the agency announced Saturday.

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

Churches, mosques and temples around the world — including the Vatican — are continuing to livestream religious services amid the coronavirus pandemic, AP reports.

India extended its almost two-month coronavirus lockdown until the end of May on Sunday, although the government's National Disaster Management Authority said in a statement that new guidelines may be issued to help restart economic activity, AP reports.

The United Kingdom has hired 17,200 people to help track down individuals who have been in close contact with people who tested positive for the coronavirus, government minister Michael Gove told the BBC on Sunday.

5. AFL-CIO sues feds over workplace safety

With some states reopening for business and millions of people heading back to work, the nation's largest labor organization is demanding the federal government do more to protect workers from contracting the coronavirus on the job, Axios' Joann Muller scoops.

What's happening: The AFL-CIO, a collection of 55 unions representing 12.5 million workers, says it is suing the federal agency in charge of workplace safety to compel them to create a set of emergency temporary standards for infectious diseases.

Driving the news: The lawsuit against the Labor Department's Occupational Safety and Health Administration (OSHA) is expected to be filed on Monday in the U.S. Court of Appeals in Washington, D.C.

  • Citing an urgent threat to "essential" workers and those being called back to work as government-imposed lockdowns are lifted, the AFL-CIO is asking the court to force OSHA to act within 30 days.
  • It wants a rule that would require each employer to evaluate its workplace for the risk of airborne disease transmission and to develop a comprehensive infection control plan that could include social distancing measures, masks and other personal protective equipment and employee training.

Labor Secretary Eugene Scalia, in a letter to AFL-CIO President Richard Trumka, said employers are already taking steps to protect workers, and that OSHA's industry-tailored guidelines provide more flexibility than a formal rule for all employers.

Read more.

6. How a Medicare buy-in could become more popular

Illustration: Sarah Grillo/Axios

The economic disruption caused by the coronavirus pandemic could help create a much stronger push to let some older Americans buy into Medicare, the Kaiser Family Foundation's Drew Altman writes in today's column.

By the numbers: 2.4 million adults between the ages of 55 and 64 lost their jobs just since March, bringing the unemployment rate in this group to 12.5% — up from 3.4% in March.

Between the lines: Many of these people will struggle to find affordable coverage, and a slow recovery will leave many without job-based health coverage for a long time.

  • Medicaid will cover many of the newly uninsured, though not in states that haven’t expanded the program.
  • The Affordable Care Act will help many others maintain coverage, but those plans often come with high deductibles.
  • COBRA is available to people who lost jobs that offered insurance, but it’s often prohibitively expensive.

Millions of uninsured 55 to 65 year-olds could add new urgency to calls for a Medicare buy-in if Democrats control the White House and Congress in 2021.

  • Narrower options consistently poll better than more sweeping expansions of public coverage, and older adults are a politically powerful group.

Yes, but: All the old fault lines would still be at play if such an effort got serious consideration.

  • Some Democrats prefer Medicare for All. Republicans and hospitals have typically opposed all Medicare expansions.
7. 1 political thing

Photo illustration: Eniola Odetunde/Axios. Photo: Pool/Getty Images

Don't be fooled by the whimsical scarf collection. Administration officials say they've been taken aback by Deborah Birx's masterful political skills — including a preternatural ability to get what she wants while telling people what they want to hear, Jonathan reports.

Why it matters: She's better than any of the other public health officials at talking to Trump.

  • While MAGA-land has spent weeks trying to get Anthony Fauci fired, Birx has been far more adept at influencing the president and shaping the administration's response to the global coronavirus pandemic.

Between the lines: Fauci speaks his mind with little if any consideration of politics. Colleagues say Birx strategically emphasizes the points Trump wants to hear — and she can play multiple angles on any given issue.

  • Birx is far from a folk hero. Her public praise of the president has drawn her criticism from the left as a brown-noser and a hack.
  • Officials credit Birx for playing an important role in convincing Trump in late March to buck his instincts and extend social distancing guidelines by 30 days. (But he soon undermined that advice by encouraging protesters to "liberate" themselves from their governors' rules.)

The bottom line: Trump has made clear to advisers that he doesn't want to give a daily platform to public health warnings that could discourage an economic reopening.

  • But when Birx picks a battle — as she did privately against Georgia's decision to open tattoo parlors and hair salons — Trump listens.

Read more.