May 12, 2020

Axios Vitals

Caitlin Owens

Good morning.

  • I spent my mental health day/weekend caring for dogs. If there is a foolproof way to distract yourself from the news, it's hanging out with a puppy and a one-year-old dog.

Today's word count is 1,171, or a 4-minute read.

1 big thing: Why contact tracing may fall apart

Illustration: Sarah Grillo/Axios

Our contact tracing capabilities aren't where they need to be nationally, and some experts are questioning whether the old-timey public health tool will ever be successfully used to keep coronavirus outbreaks under control in the U.S.

Between the lines: One of the biggest vulnerabilities in the strategy is that, in the U.S. at least, it relies on public buy-in — something that is far from guaranteed.

  • "You need people to be willing to come forward and say, I'm symptomatic, I have this illness. I'm willing to be traced," bioethicist Jacob Appel told me in an interview for "Axios on HBO."

The big picture: The idea behind contact tracing is that public health officials will track everyone that confirmed coronavirus patients came into contact with while infected. Those contacts, once notified of their exposure, would then isolate themselves.

Yes, but: American nature could be a problem. On one hand, most Americans have taken social distancing seriously. On the other, they’re already tiring of it, and concerns about civil liberties have been raised.

  • "Testing programs depend on ... people being so compliant that they will stay home for 14 days because a health worker told them to. Meanwhile, in Detroit last week a grocery store security guard was shot in the head for asking someone to wear a mask," Keith Humphries, a professor at Stanford University, tweeted yesterday.

The other side: "I think it's reasonable to expect that while there may be some resistance to tracing and quarantine, the majority of people will accept it," Jeremy Konyndyk, a a senior policy fellow at the Center for Global Development, tweeted in response.

The bottom line: "The quarantine, social distancing contact tracing model most likely would work better if human nature were perfect — if we could get everybody to do what we hoped they would do," Appel said. "I think the verdict is out on whether people will socially distance to do that in the United States."

2. Americans hate contact tracing
Data: Ipsos/Axios survey, margin of error of ±3.4 percentage points; Chart: Andrew Witherspoon/Axios

Speaking of public buy-in, there doesn't seem to be much of it. In a best-case scenario, just half of Americans would participate in a voluntary coronavirus "contact tracing" program tracked with cell phones, according to the latest installment of the Axios-Ipsos Coronavirus Index.

  • The findings underscore deep resistance to turning over sensitive health information, and mistrust about how it could be used, Axios' Margaret Talev writes.
  • The only way to get even half of Americans to participate would be for public health officials to run the program, not the White House or tech or phone companies.

The big picture: Even as the death toll rises and infections breach the White House firewall, week nine of our national survey also finds more people itching to return to work as they used to know it — and bending guidelines to see family and friends.

  • 64% say returning to their pre-coronavirus lives would be a large or moderate risk. Just 30% say that's worth the risk right now.
  • But four in 10 say they think returning to their normal place of employment would post only a small risk or no risk.
  • 63% consider airplane travel or mass transit to be a large risk, down from 73% a month ago.
  • Nine in 10 say they're still practicing social distancing, but just 36% say they're self quarantining, down from a peak of 55% in Week 4.
  • 32% say they've visited family or friends in the past week, the highest share in seven weeks.

Go deeper.

3. The latest in the U.S.
Expand chart
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.

The U.S. death toll from the coronavirus surpassed 80,000 on Monday, as more states began taking steps to reopen parts of their economies.

More than a month after recommending Americans wear face masks in public, the White House is taking its own advice.

President Trump claimed at a press briefing Monday that any American who "wants" a coronavirus test can get one — contradicting his testing coordinator Adm. Brett Giroir, who just moments earlier said that tests are mostly reserved for people who "need" one because they present symptoms or are participating in contact tracing.

MLB owners approved a proposal to send to the league's players' union that would start this year's baseball season without fans around the Fourth of July, AP reports.

New York will ease some coronavirus-related restrictions and open "certain low risk businesses and recreational activities" statewide starting May 15, Gov. Andrew Cuomo announced Monday.

The FDA granted Monday an emergency use authorization for a new coronavirus antibody test by Abbott Laboratories.

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

A poll of five countries — the U.S., U.K., Germany, Sweden and Japan — finds that concerns around getting sick or losing jobs are fading slightly, but realization is setting in that lives will be different even after the crisis abates, Axios' Dave Lawler reports.

Belarus is now grappling with one of Europe's highest per capita coronavirus infection rates, even as President Alexander Lukashenko plays down the danger.

The U.K. government released Monday a 60-page plan to reopen its economy by easing the coronavirus lockdown restrictions that it has maintained since March.

5. The Swedish coronavirus approach results

Sweden, which did not go into lockdown, has suffered 15 times as many deaths as has Norway, which did lock down.

The other side: The scientist behind Sweden's approach, Anders Tegnell, says Sweden also appears to have far more immunity in its population (25% vs. 1–2% in Norway, according to initial tests), and will therefore be well positioned for a potential second wave, Lawler writes.

Between the lines: Tegnell anticipates that immunity will last for at least three to six months, though there's insufficient data to know for sure.

  • He contended in a Q&A with the International Center for Journalists on Friday that decisions to lock down across Europe weren't based on any established science. "The costs are enormous," he argues, and the benefits still unclear.

The big picture: Sweden's death toll stands at 3,256, according to Johns Hopkins.

  • Case counts had continued to trend upwards in recent weeks even as the virus was relatively well contained in neighboring countries, though Tegnell says the latest data suggests the situation is improving.
  • He says the reason for the high death toll is that many elder care homes in and around Stockholm were badly affected.

Worth noting: Despite its more lax approach, Sweden's economy has been hit hard, the FT notes.

6. A new push for hospital price transparency

The Trump administration is doubling down on its price transparency agenda, saying in a new proposal Monday that privately negotiated prices between hospitals and private health insurers may inform how Medicare pays for future health care services.

Yes, but: Hospitals are suing over the original price transparency regulation, so this proposal would get thrown in the trash if hospitals win in court, Axios' Bob Herman reports.

Details: Last year, Medicare finalized a rule that required all hospitals to publicize the prices they negotiated with insurance companies by 2021. 

  • Hospitals immediately sued, saying the rule was unconstitutional and federal overreach. They just asked a federal judge to throw out the rule.
  • However, Medicare is still moving forward with this new proposal, which builds on last year’s rule and would require hospitals to list the median commercial prices on federal reports.
  • By 2024, Medicare would then use those prices to "develop market-based" payments.

The bottom line: This entire proposal is a long way from happening, and more importantly hinges on whether the courts believe the federal government even has the authority to require hospitals to publish all of their prices.

Caitlin Owens

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