Oct 21, 2020

Axios Vitals

Good morning.

Today's word count is 888, or a 3-minute read.

1 big thing: The overwhelming aftershocks of the pandemic

Illustration: Eniola Odetunde/Axios

The coronavirus pandemic will wreak havoc on the U.S. health care system long after it ends — whenever that may be.

Why it matters: The pre-pandemic health care system was already full of holes, many of which have been exposed and exacerbated over the past several months, and many Americans will be stuck with that system as they grapple with the long-term consequences of the pandemic.

The big picture: The pandemic has caused a crushing wave of mental health problems, exposed longstanding racial disparities, caused people to delay care for other conditions, and likely created new long-term health problems for many coronavirus survivors.

Mental and behavioral health issues are especially concerning, experts say.

  • The number of people looking for help with anxiety or depression has dramatically increased since last year, according to a new report from the advocacy group Mental Health America.
  • "Severe depression, severe anxiety, psychosis that's already emerged — they aren't going to go away just because one of the precipitating factors goes away, like the pandemic," MHA president and CEO Paul Gionfriddo said.
  • Tens of thousands of Americans were overdosing on opioids every year, and the epidemic appears to have gotten worse during the pandemic, WSJ recently reported.

Between the lines: The pandemic has painfully exposed deep racial disparities within the health care system and beyond, which will only continue to hurt people of color.

What's next: While the government and private insurers have tried to pick up all or most of the costs of coronavirus treatment, patients with long-term side effects will have to navigate the same patchwork system that has made chronic conditions so expensive for years.

  • Meanwhile, there could be a spike in demand for care for unrelated health conditions that went undiagnosed or untreated during the pandemic.
2. CDC: Two-thirds of excess deaths from COVID-19

About 285,000 more people have died in the U.S. than anticipated, and 66% of those fatalities were due to COVID-19, a report out Tuesday from the Centers for Disease Control and Prevention shows.

By the numbers: The deaths, recorded between Feb. 1 and Sept. 16, disproportionately affect Latino and Black Americans. The "excess death" rate among 25-to-44 year-olds is also up about 27% from previous years, Axios' Marisa Fernandez writes.

The big picture: The coronavirus is on track to be the third-leading cause of death in the U.S. by the end of the year, behind heart disease and cancer. At least 219,000 people have died of COVID-19 so far.

Go deeper: Which states have seen the most excess deaths because of the coronavirus

3. Studies show drop in COVID death rate

Here's some better news: There's been a sharp drop in mortality rates among hospitalized coronavirus patients, including older patients and those with pre-existing health conditions, per two new peer-reviewed studies.

By the numbers: One study that looked at a single health system found that hospitalized patients had a 25.6% chance of dying at the start of the pandemic, but now have only a 7.6% chance, NPR reports.

  • Researchers found that the mortality rate had dropped for all groups, when controlling for factors like age and health status.
  • A second study of 21,000 hospitalized cases in England found a similarly large drop in the death rate.

What's happening: Doctors have developed standardized treatments for the virus, and have gotten better at identifying when patients are at risk of blood clots or a severe immune system reaction.

  • Mask wearing could also be helping, as it reduces the amount of the virus a person receives and thus reduces the severity of that person's illness.
  • And keeping hospitals below their maximum capacity — one of the byproducts of social distancing — also helps patients survive by ensuring they receive better care.

Yes, but: None of this means that the virus is low-risk — at least not compared to the flu. A CDC study released yesterday found that hospitalized coronavirus patients are five times more likely to die than hospitalized flu patients, and are also at higher risk for 17 complications.

4. Joe Biden's big lead on health care issues
Reproduced from a Kaiser Family Foundation Health Tracking Poll; Chart: Axios Visuals

Health care has fragmented into multiple issues in this campaign cycle, and Joe Biden leads President Trump on almost all of them, according to Kaiser Family Foundation polling.

The big picture: Biden's commanding leads on protecting people with pre-existing conditions and managing the coronavirus outbreak suggest that Trump's record and rhetoric on those issues, while popular with his base, may have backfired with the electorate generally, KFF's Drew Altman writes in today's column.

By the numbers: Biden has a 20-point lead over Trump when voters are asked who they think has a better approach to the future of the ACA, and an identical 20-point edge on protections for pre-existing conditions.

  • Biden has a 16-point lead on dealing with coronavirus and a nine-point advantage on overseeing the development and distribution of a vaccine.
  • He has a nine-point lead on dealing with surprise medical bills and a seven-point lead on drug costs — an issue where Trump used to have the edge.

Yes, but: Democrats traditionally have a lead on health care, and opposition to the Affordable Care Act is still a big motivator for the GOP base — 76% of Republicans support overturning the law.

5. Catch up quick

Illustration: Aïda Amer/Axios

Senate Majority Leader Mitch McConnell (R-Ky.) has urged White House negotiators not to cut a deal with Democrats on new coronavirus stimulus before the election, Axios' Alayna Treene reports.

Several Republican senators defended Anthony Fauci after a string of attacks in recent days from President Trump, who has called the government's top infectious-disease expert "a disaster" and claimed without evidence that he's a Democrat.

California health officials on Tuesday told theme parks like Disneyland and Universal Studios Hollywood that they can reopen once daily coronavirus cases in their respective counties drop below one per 100,000 people.

University of Michigan students must shelter-in-place for 14 days due to an uptick in COVID-19 cases on campus, the school's president Mark Schlissel wrote in a letter on Tuesday.