Mar 13, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning.

😷 Heads-up: We have a special report about the coronavirus coming this weekend. As a subscriber to this newsletter, you'll see that in your inbox from Mike Allen on Saturday.

📺 This week on "Axios on HBO": Rep. James Clyburn, the Democratic "kingmaker" largely credited for Biden's surge, says he thinks President Trump is a racist and warns the U.S. "could very well go the way of Germany in the 1930s" (clip); DNC chair Tom Perez talks diversity, coronavirus and the future of the Democratic party; plus much more. Tune in Sunday 6pm ET/PT on all HBO platforms.

Today's word count is 1,212, or a 5-minute read.

1 big thing: Why the U.S. is so far behind on testing
Data: AEI; Table: Axios Visuals

Some of the nation's best academic laboratories wanted to begin developing their own coronavirus diagnostic tests early last month, but were blocked by federal rules about test development.

Why it matters: The U.S. is woefully behind in mass deployment of tests to detect the novel coronavirus, determine its spread and isolate hot spots. Once given the go-ahead to develop tests under more relaxed terms, some of these labs were able to get tests up and running in a matter of days.

Even though their testing capacity is usually limited, academic labs are particularly crucial to coronavirus testing because they're attached to hospitals. That means that providers treating patients at these hospitals can receive tests results much more quickly than those who have to send samples to commercial, state or CDC labs.

  • Part of the overall problem with testing right now isn't just that there aren't enough tests available, but also that there can be long delays in determining whether patients are infected or not.

"They followed the standard process, but what needed to be in vision was that this was a once in a generation pathogen — a once in a generation epidemic," former FDA commissioner Scott Gottlieb told me.

The approval process for the academic labs highlights the clash between bureaucracy — which is in place for a reason — and the need to move quickly in the face of an emerging pandemic.

  • "I do understand the FDA's viewpoint, which is there's really a need to standardize testing and make sure test results are accurate," said Charles Chiu, associate director of the University of California at San Francisco Clinical Microbiology Laboratory.
  • But "this is something that probably should have been discussed from the get go when we first knew about the outbreak in China."

Read the story.

2. What we can learn from Italy

The coronavirus outbreak in Italy has gotten so bad so quickly that some doctors are now forced to practice "catastrophe medicine" — determining which severely ill patients should, and should not, get care based on the resources available.

Between the lines: The U.S. is not at that point — but a week ago, neither was Italy, Axios' Bob Herman reports.

  • The rapid deterioration there underlines the importance of taking preventive measures seriously, and the need for political and health leaders to start thinking about hard ethical questions.

Where it stands: The rapid spread has forced Italian leaders to quarantine the entire country and close all shops except for pharmacies and grocery stores. The Italian health care system, which many experts hold in high regard, is overworked.

What's next: There are several theories as to why cases exploded so dramatically in Italy, but the answers aren't clear right now. In the meantime, experts say the biggest lesson for Americans is that trying to limit the virus' spread — mainly by limiting contact with potentially infected people — really is important.

Yes, but: The U.S. has no national plan for how to ration care if intensive care units and ventilators are all in use.

The bottom line: Shutting down schools, closing cultural spots, suspending sports and staying at home will upend people's lives in the short term, and hypothesizing who should get lifesaving care is an ethical nightmare.

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

Governors and businesses in the U.S. decided to lessen community spread and exposure of the novel coronavirus by shutting down mass gatherings.

Stocks plunged more than 9% on Thursday, with the S&P 500 26% below its February all-time high.

Some hospital systems are temporarily pausing bills for any patients who receive care related to the new coronavirus.

New York Gov. Andrew Cuomo said the state's hospitals may need to halt all elective surgeries and recall former doctors and nurses, which would add 25% to 30% to the system's capacity, he said.

In California, Gov. Gavin Newsom released a sweeping executive order, allowing the state to take over hotels and medical facilities for coronavirus treatments.

President Trump came in contact with Brazilian President Jair Bolsonaro's press secretary at Mar-a-Lago, who later tested positive for coronavirus.

  • The White House has said neither Trump nor Vice President Mike Pence are going to get tested.
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.

Sophie Grégoire Trudeau, wife of Canadian Prime Minister Justin Trudeau, is in isolation after testing positive for the novel coronavirus on Thursday.

EU leaders said Thursday that President Trump's sweeping decision to impose travel restrictions on the continent in response to the coronavirus pandemic was "taken unilaterally and without consultation."

U.K. Prime Minister Boris Johnson gave a sober address Thursday on his country's response to the coronavirus, saying "many more families are going to lose loved ones before their time."

The world was not prepared for a pandemic. When one struck, international coordination broke down rather than ramping up, Axios' Dave Lawler reports.

  • The lack of preparedness has left countries, including the U.S., scrambling to craft a response once the novel coronavirus had already reached their shores. The dearth of global coordination could both exacerbate the crisis and make it more difficult to recover from.
5. Remote everything

Illustration: Aïda Amer/Axios

As cases of the coronavirus multiply across the U.S., every office, school, restaurant and store shutdown is stress-testing the country’s ability to live life without leaving home, Axios' Erica Pandey writes.

Why it matters: The coronavirus is triggering a grand experiment: Remote work and remote learning have long been buzzwords, but the sudden switch to telecommuting en masse has the potential to accelerate shifts in how work is conducted and the way we think about it.

The big picture: Telework isn’t a new concept. It can be a great way to bring new types of workers — including stay-at-home parents or people living in rural areas — into the fold, and it can save companies millions in real estate costs.

But it's still relatively uncommon in the U.S. — and there's ongoing debate over whether remote employees are as happy and productive as onsite ones.

  • Less than 4% of Americans work from home full time.
  • Remote learning is more prevalent, with just under 16% of U.S. students taking all of their courses online, per a recent study from the Department of Education.

Now that almost every office and school is abruptly asking (or forcing) people to work at home, the disruption in habits and procedures could have lasting effects — even after people go back to business as usual.

Go deeper.

6. Health hiring boom may not help virus
Data: BLS; Chart: Danielle Alberti/Axios

Health care hiring has surged over the past few years, but the influx of bodies won't necessarily alleviate an impending wave of coronavirus cases, Bob writes.

The big picture: Most new health care jobs are on the administrative side — not doctors, nurses or other clinical staff who are needed to help triage and care for patients.

Where things stand: The health care industry has added roughly 914,000 jobs over the past three years — more than the population of San Francisco — and a large chunk of those jobs came in outpatient settings like physician offices.

  • However, more granular federal data show a majority of the hires have been for administrative and clerical jobs, like hospital billing, collections, IT, marketing and insurance contracting.
  • Many home health jobs have been created, which could help older adults who have chronic illnesses and need to stay at home during the outbreak, but the biggest need will be in hospital intensive care units.

The bottom line: "We have a lot of fat in our health care system," said Bob Kocher, a doctor and partner at Venrock. "But we don't have any fat on the clinical workforce side."

Go deeper: A longer coronavirus outbreak is the best outcome for the health care system

Caitlin Owens