Mar 20, 2020

Axios Vitals

Good morning. Thanks to all of you who joined us yesterday for Axios' first virtual event!

ūüďļ In this week's must see "Axios on HBO", we dive into how the coronavirus pandemic is upending politics, business and global affairs. Don't miss:

  • A rare in-depth interview, where China's ambassador to the U.S. discusses the spread of COVID-19 and so much more
  • CEO of Carnival defends its response to the Diamond Princess outbreak and addresses whether this could sink the multi-billion dollar cruise industry
  • Microsoft's CEO on the remote work surge¬†
  • Sen. Ted Cruz talks about his time in self-quarantine
  • Plus, a candid conversation with Supreme Court Justice Stephen Breyer

Tune in Sunday 6pm ET/PT on all HBO platforms.

Today's word count is 1,340, or a 5-minute read.

1 big thing: America's medical mask crisis

Illustration: A√Įda Amer/Axios

Hospitals around the country are running out of medical masks and other protective gear, and health care workers are taking desperate steps to protect themselves from exposure to the novel coronavirus.

Why it matters: Keeping doctors, nurses and other providers healthy and able to work is central to America's ability to manage the crush of patients expected to flood hospitals in coming days.

  • "If you can't protect your health care workforce, you're not going to have a health care workforce, and you're not going to have a health care system," Harvard's Ashish Jha told me.

What's new: We've been sounding the alarm about medical masks for awhile, but this disaster scenario is becoming reality in some places, especially New York and Washington state.

  • Hospitals are considering shutting their doors, doctors are seeing patients while wearing dangerously inadequate protective gear, and volunteers are cobbling together makeshift face shields, the New York Times reports.
  • The Centers for Disease Control and Prevention has posted strategies for what to do without masks, including using bandanas and scarves ‚ÄĒ¬†which have unknown utility.

What we're watching: President Trump has invoked the Defense Protection Act, which gives the federal government extraordinary manufacturing powers, but has yet to use it.

The bottom line: We're only at the beginning of our fight against the coronavirus, and our most important line of defense ‚ÄĒ¬†health care workers ‚ÄĒ¬†increasingly don't have the tools they need. That's not good.

2. Old anti-malarial drug takes the spotlight

The Trump administration is taking a very public interest in an old, cheap anti-malarial drug as a potential coronavirus treatment, although it's way too soon to put much stock in its effectiveness.

What they're saying: The Food and Drug Administration is investigating whether the drug can reduce the duration of patients' symptoms in mild to moderate cases, or to reduce "viral shedding," which helps prevent disease spread.

As I reported earlier this week, pharma company Bayer is donating a large quantity of its version of the drug, Resochin, to the U.S. government. Bayer confirmed the donation of 3 million tablets yesterday.

  • "Currently not approved for use in the United States, Bayer is working with appropriate agencies on an Emergency Use Authorization for the drug's use in the U.S.," the company said in a statement.

Yes, but: Awareness of the drug's potential has bolstered demand. Chloroquine and its variant hydroxychloroquine have gone into shortage, Business Insider reports.

  • The drug is also used to treat arthritis or lupus, and the shortages could threaten the health of patients who rely on it.

My thought bubble: Remember that this is an unproven treatment; there's absolutely no guarantee that it will help treat coronavirus.

3. The latest in the U.S.
Expand chart
Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios

California Gov. Gavin Newsom issued a statewide stay-at-home order last night, requiring nearly 40 million people to stay at home.

Senate Majority Leader Mitch McConnell's proposal for a "Phase 3" stimulus package in response to the coronavirus outbreak includes cash payments to many Americans and billions for small and large businesses. Details.

The State Department Thursday issued a Level 4 travel advisory for all international travel, warning Americans not to fly abroad due to the novel coronavirus pandemic.

More than half of U.S. small business owners say their business will not be able to continue operating more than three months due to economic strain caused by the coronavirus pandemic, according to a Goldman Sachs survey.

Sixteen senators have asked the nation's largest health insurance companies to "suspend all cost-sharing requirements connected with treatments for COVID-19 and associated health complications."

Connecticut rescheduled its 2020 primary to June 2 in response to the novel coronavirus outbreak, Gov. Ned Lamont said on Thursday. There are at least 68 confirmed cases of the virus in the state.

U.S. unemployment filings surged to 281,000 in the week ended March 14 ‚ÄĒ¬†a two-year high and an increase of 70,000 from the week prior ‚ÄĒ¬†according to Labor Department data released Thursday.

The health care industry, led by the American Hospital Association, asked Congress on Thursday for $100 billion to offset the expenses related to coronavirus testing and treatment.

4. The latest worldwide
Data: The Center for Systems Science and Engineering at Johns Hopkins, the CDC, and China's Health Ministry. Note: China numbers are for the mainland only and U.S. numbers include repatriated citizens and confirmed plus presumptive cases from the CDC.

Several African countries recorded their first coronavirus cases this week, and case numbers accelerated in countries including South Africa, escalating fears that Africa could be the pandemic's next frontier.

Haiti reported its first two cases of the novel coronavirus on Thursday, President Jovenel Mo√Įse announced in a press conference, per multiple reports.

Italy's coronavirus death toll topped nearly 3,500 ‚ÄĒ now the highest in the world.

Prince Albert II of Monaco has tested positive for COVID-19, the palace announced Thursday.

5. Bad news for the ventilator shortage crisis

Automakers and their parts suppliers are offering to produce desperately needed ventilators to keep coronavirus patients alive, but quickly retooling industrial factories to make precision medical equipment might not be feasible, despite the good intentions.

Why it matters: The U.S. faces a critical shortage of medical equipment beyond protective gear, including ventilators that help patients breathe, Axios' Joann Muller writes.

Driving the news: In a call Wednesday to inform the Trump administration of the shutdown, GM CEO Mary Barra told White House economic adviser Larry Kudlow that GM wanted to help and was studying how it could potentially support production of medical equipment like ventilators.

  • That news prompted a similar statement from Ford, and later, Tesla CEO Elon Musk tweeted, "We will make ventilators if there is a shortage."

Yes, but: Pivoting to wartime footing for ventilators is not like churning out tanks, planes and ships for World War II, says Sandy Munro, CEO of Munro & Associates, an expert in lean manufacturing who has intimate knowledge of both the auto and medical device industries.

  • Production of medical devices requires sterile rooms with much higher standards than those required in a "clean room" at an automotive paint shop, for example, he says.
  • The Food and Drug Administration would have to validate any new facilities, a process that can take up to 180 days, explains the Huffington Post.
  • The technicians who manufacture ventilators also require eight to nine months' training, says Munro.

Go deeper.

6. Potential coronavirus surprise medical bills

A loophole in the new coronavirus response legislation that President Trump signed into law this week exposes some patients to being billed for coronavirus tests ‚ÄĒ despite lawmakers' claims that the tests are free for everyone.

Details: The law says tests that have received FDA authorization must be free, but seems to leave out those tests that are awaiting or don't need such emergency approval.

  • The FDA has allowed labs to run tests while their authorization is pending, creating a window in which coverage may not be required under law.
  • The agency also recently issued new guidance allowing states to review tests themselves.
  • The exception "leaves patients open to surprise billing for tests administered under current policy," the Infectious Diseases Society of America wrote in a statement earlier this week.

Yes, but: Many insurers have pledged to fully cover the tests, so just because a patient receives one of these exempted tests doesn't mean they'll necessarily be billed.

  • And the Senate GOP proposal for the third round of coronavirus-related legislation includes a provision that would fix the problem.
  • "If not remedied it will leave patients holding the bag for high testing bills and ultimately limit the number of tests being covered during this public health crisis," the American Medical Association wrote in an email to lawmakers acquired by Axios.
7. The risks of coronavirus in Trump country

Illustration: A√Įda Amer/Axios

The demographics, work patterns and media habits of President Trump's base are putting many of his supporters at elevated risk for the health and economic impacts of coronavirus, Axios' Stef Kight and Sara Fischer report.

Why it matters: National surveys, including the Axios-Ipsos Coronavirus Index, found that Republicans and Midwesterners have been more likely to respond with less urgency than Americans who identify as Democrats or live in coastal centers.

  • Trump's response to the crisis and his messaging about its seriousness are important ‚ÄĒ especially after his early suggestions that the virus wasn't that bad and multiple statements that it's "under control."

The big picture: Senior citizens face higher risks from the virus than younger people.

  • U.S. counties with the highest percentage of people 65 years and older tend to be very Republican areas that voted for Trump in 2016, according to the Brookings Institution's William Frey, who analyzed Census Bureau data for Axios.

When it comes to work, people in blue collar jobs that are often difficult to do remotely ‚ÄĒ in fields such as transportation, construction, maintenance and installation ‚ÄĒ were far more likely to vote for Trump than for Hillary Clinton in 2016, according to a CityLab study.

Between the lines: Disinformation and distrust in the media could be putting elderly people and some Republicans at greater risk as well.

Go deeper.

I don't have any silver linings for you today because they stopped coming in! Maybe a prompt will help ‚ÄĒ parents, how are you handling the new normal with your kids?