Jun 29, 2020

Axios Vitals

Good morning. I do not know who needs to hear this, but I am a reasonably social 20-something and so can speak to this with some authority: Y'all, the bars aren't worth it.

Today's word count is 1,002, or a 4-minute read.

1 big thing: New hotspots failed to build up public health tools
Data: Nephron Research and JHU; Table: Axios Visuals

Most of the states facing large coronavirus outbreaks today didn't build up their public health systems enough ahead of time.

Why it matters: States like Arizona, Florida and Texas had months to learn from the mistakes of New York and other early hotspots, yet find themselves now in similar situations.

The big picture: The U.S. has rapidly scaled up its testing and contact tracing capabilities, but they're still not nearly enough.

  • States should have at least 30 contact tracers per 100,000 people during the pandemic, according to the National Association of County and City Health Officials. Most states' workforce falls far short of that metric, according to a Nephron Research analysis.
  • The World Health Organization has said 5% or less of diagnostic tests should come back positive for at least 14 days before governments allow reopening, but many states are now well above this threshold, per Johns Hopkins University.
  • In some hotspots, people are having a hard time getting tested, leading to long lines and crowding, NYT reports. Overall, the U.S. still isn't doing the number of tests that many experts say it needs to be.

Between the lines: Part of the reason the U.S. economy shut down was to buy states time to build up their public health infrastructure. Many states failed to do so before reopening, leading to today's predictable results.

The bottom line: There's no reason why any city or state in the U.S. can't eventually become a coronavirus hotspot.

  • Arizona, Texas and Florida are learning this the hard way, but there are plenty of places that still have more time to build up their testing, tracing and isolation capabilities.

Go deeper: Bigger, wealthier cities lead on coronavirus recovery

2. Contact tracing's other big problems

Illustration: Aïda Amer/Axios

It's not just that we don't have enough contact tracers. Understaffed public health agencies, privacy concerns, disappointing technology, and the sheer size of the pandemic are limiting the technique's effectiveness, Axios' Bryan Walsh writes.

Driving the news: Government virus expert Anthony Fauci told reporters in a press briefing on Friday that contact tracing efforts to contain the coronavirus are "not working."

Even those states that have sufficiently beefed up their contact tracing systems are struggling to get people who have tested positive to report whom they were in contact with — or, in some cases, to even pick up the phone.

  • New York state currently has nearly 50 tracers per 100,000 people, the most in the U.S. But in New York City, long the epicenter of the pandemic, contact tracers were only able to successfully complete an interview with about half of all positive cases June 1–20.

Unlike tracing the spread of STDs, where contacts can be narrowed down to sexual partners, COVID-19 requires tracers to quiz a positive case for everyone they may have come into contact with, even for a relatively short period of time.

  • Early hopes that app-based smartphone contact tracing might help have largely gone unfulfilled.
  • Black Americans are being infected and dying of COVID-19 at higher rates, but a long history of discrimination — including by doctors — has made them "less willing to line up and trust a public agency right now, public health included," writes Johns Hopkins' Katelyn Esmonde.

Go deeper.

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.

The Biden campaign plans to focus its messages this week on "the difference between what Joe Biden called for and what Donald Trump did at crucial inflection points" since the pandemic arrived in America, according to a Biden adviser, Axios' Jonathan Swan reports.

The coronavirus is spreading at more than double the rate of the rest of the U.S. in counties that are at least a quarter Hispanic, a New York Times analysis out Friday indicates.

Health and Human Services Secretary Alex Azar warned on CNN's "State of the Union" Sunday that the "window is closing" for the U.S. to take action and get the coronavirus under control, calling the current state of the outbreak a "very, very serious situation."

Former FDA commissioner Scott Gottlieb told CBS News' "Face the Nation" on Sunday that surging coronavirus cases across the Sun Belt are a result of "community spread that's been underway for some time" and that even if states take aggressive action to curb the spread now — which they're not — cases will continue to grow for weeks.

A new report shows that the COVID-19 pandemic has led a third of U.S. women surveyed to report that they want to delay childbearing or have fewer children, Bryan writes.

A choir of more than 100 people performed without masks at an event featuring Vice President Mike Pence at First Baptist Church in Texas on Sunday, CNN reports.

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

Sunday saw the world hit two grim global coronavirus milestones — 10 million confirmed cases and 500,000 deaths, according to data from Johns Hopkins.

Schools across Italy are scheduled to reopen starting Sept. 14, Prime Minister Giuseppe Conte and Education Minister Lucia Azzolina announced on Friday.

Brazil reported on Saturday 38,693 new novel coronavirus cases in 24 hours and 1,109 additional deaths.

Officials in the Australian state of Victoria said Sunday they would require returned travelers to undergo mandatory testing before they're allowed to leave hotel quarantine amid a surge in cases.

5. Pandemic hasn't stopped drug price increases

Pharmaceutical companies raised the price of 245 drugs between January 20 and June 20, according to a new analysis by Patients for Affordable Drugs.

Between the lines: Some of these drugs are directly related to the pandemic. And the hikes occurred against the backdrop of economic calamity hitting many American families.

  • The average price increase was 23.8%.

By the numbers: 61 of the drugs with price hikes were being used to treat the coronavirus, while another 30 were undergoing clinical trials for use against it.

  • Some of the drugs — like those used to sedate ventilated patients — saw both a surge in demand and an increase in price.
  • "Although some price hikes may be attributable to interruptions in global manufacturing supply chains, others can be attributed to opportunistic hikes in the face of steep increases in demand," the authors write.

Another 118 drugs that saw price increases are used to manage chronic conditions.

  • These patients are generally more vulnerable to severe coronavirus infections, and thus may be facing harder decisions about returning to work.

Read the report.