Apr 7, 2020

Axios Vitals

Good morning.

Today's word count is 1,472, or a 5-minute read.

1 big thing: We're still behind on coronavirus testing

Illustration: Sarah Grillo/Axios

Coronavirus testing capacity is still lagging far enough behind demand that the U.S. continues to only test the sickest patients — a bad omen for future efforts to return to normal life.

Why it matters: Diagnostic testing is the cornerstone of any containment strategy. To even begin talking about resuming social and economic activity, we would have to get testing right first.

Driving the news: The Trump administration said yesterday that at least 1.79 million tests have been completed.

  • More than 665,500 samples were tested last week, according to an HHS spokesperson.
  • But tests are still generally being saved for those who need them the most, namely the sickest patients and health care workers — indicating a shortage.
  • People who do get tested often wait several days for their results.

Between the lines: The problem boils down to overwhelming demand and testing supply shortages, the New York Times reports.

What's next: The goal of social distancing is to drastically reduce the number of confirmed cases, by limiting people's interaction with one another. But once we've done that, testing is crucial for identifying new outbreaks and determining who has already been infected before they spread the virus further.

  • To successfully transition our national strategy into this case-based intervention phase, we need to be able to complete at least 750,000 tests per week, according to a report by former FDA commissioners Scott Gottlieb and Mark McClellan, John Hopkins' Caitlin Rivers and Crystal Watson, and Tempus' Lauren Silvis.
  • Global demand for testing supplies isn't likely to decrease anytime soon.

The bottom line: It's hard to see the country being able to shut down twice. That means we only have one more shot at getting this right, and the clock is ticking.

2. The virus hits home
Data: Ipsos/Axios poll; Chart: Danielle Alberti/Axios

The share of Americans who know someone who's tested positive has more than tripled in just a few weeks, to 14%, according to the latest installment of our Axios-Ipsos Coronavirus Index.

  • It's still highest in the Northeast, but last week alone it doubled in the South — and it's becoming most pronounced among people who still must leave home to work, Axios' Margaret Talev writes.

Why it matters: As the U.S. braces for infection rates to peak at different times in different cities and states, Week 4 of our national survey shows how the pandemic is pervading all of society, but unevenly.

Between the lines: The way the outbreak is touching the lives of different groups gives us a deeper understanding about the waves in which the virus spreads.

  • Among those still reporting to work as they normally would, the share of people who knew someone with the virus grew by 15 percentage points since our initial March 13–16 survey, from 3% to 18%. (It jumped from 10% to 18% in just the last week.)
  • That compares with a gain of 11 percentage points among those working from home, from 5% to 16%. (The increases are smaller among those who already weren't working, or who got furloughed.)

"People are literally knowing more people that have the virus," said Cliff Young, president of Ipsos U.S. Public Affairs. "I think that's significant, because it becomes more real."

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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

Recorded deaths from the novel coronavirus surpassed 10,000 in the U.S. on Monday, per Johns Hopkins data. More than 1,000 people in the U.S. have died of coronavirus-related conditions each day since April 1.

In late January, President Trump's economic adviser Peter Navarro warned his White House colleagues the novel coronavirus could take more than half a million American lives and cost close to $6 trillion, according to memos obtained by Axios.

Wisconsin's Supreme Court on Monday blocked an executive order by Gov. Tony Evers (D) that attempted to delay in-person voting for the state's primary election — currently scheduled for Tuesday — until June 9.

Compared to adults, children with the coronavirus are less likely to be hospitalized or show symptoms like a fever, cough or shortness of breath, new U.S. data from the Centers for Disease Control and Prevention show.

The total number of new hospitalizations, ICU admissions and daily intubations in New York have decreased each of the past three days — an indication that social distancing may be working, New York Gov. Andrew Cuomo said Monday.

Washington, Oregon and California are all sending ventilators to New York and other states experiencing a more immediate need for the potentially life-saving machines amid the coronavirus outbreak.

The Masters has been rescheduled for Nov. 9–15, which will include all professionals and amateurs who qualified for the original April date and all existing ticket holders.

Former Federal Reserve Chair Janet Yellen said Monday on CNBC that U.S. unemployment, driven by the coronavirus pandemic, could already be as high as 13% "and moving higher."

4. The latest worldwide
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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.

U.K. Prime Minister Boris Johnson has been taken to the intensive care unit of St. Thomas' Hospital in London due to increasingly severe coronavirus symptoms.

The G20 is emerging as a venue for cooperative efforts to try and calm the oil market, and Bloomberg and others report that a potential meeting of G20 energy ministers could be Friday.

Austrian Chancellor Sebastian Kurz said Monday that his country plans to take steps to begin lifting its coronavirus lockdown next week, Reuters reports.

5. Who the public wants in charge
Data: KFF Health Tracking Poll, March 25-30, 2020; Chart: Axios Visuals

President Trump has repeatedly said that he sees the federal government's role as "backup" to the states on the response to coronavirus. But Americans want the federal government — not states — to take the lead, according to the latest KFF tracking poll, the Kaiser Family Foundation's Drew Altman writes in today's column.

Why it matters: States have so far been the ones issuing specific directives about social distancing, and are also trying to source health care supplies.

By the numbers: 60% of the people KFF surveyed said the federal government should be primarily responsible for the coronavirus response, almost double the 32% who say their own state should be primarily responsible.

Yes, but: More than half — 52% — say their state is actually leading the response, not the federal government.

  • There's a big partisan breakdown in these perceptions.
  • Nearly seven in 10 Democrats say their state is leading the response, while 53% of Republicans say it's the federal government.
  • People in states with stay-at-home orders are more likely to say their state government is leading the response.

The bottom line: The public seems to believe that in a health crisis of this magnitude, with a virus that doesn’t stop at state or international borders and the death toll mounting, a more uniform and aggressive national response is needed.

6. Feds relax Medicare Advantage regulations

Federal payments to Medicare Advantage companies will increase by 1.66% in 2021, and several of the insurance program's policies are being waived or changed due to the coronavirus outbreak, the Centers for Medicare & Medicaid Services said Monday.

The bottom line: Medicare Advantage continues to grow at a lofty rate, and the Trump administration is protecting those health insurers through the pandemic and into next year, Axios' Bob Herman reports.

By the numbers: The 1.66% payment rate hike for 2021 plans was higher than the proposed rate, but lower than what the industry got for 2020.

  • Depending on how many medical codes Medicare Advantage insurers attach to their elderly and disabled members, the average rate increase could be as high as 3.6% next year.

Between the lines: New regulatory changes, issued due to the coronavirus, are arguably more important than the payment increase.

  • CMS is "reprioritizing" audits of Medicare Advantage plans that looked for exaggerated coding — a move that will temporarily give a reprieve to the industry that feared the audits would would claw back billions of dollars.
  • Companies can expand telehealth options and waive copays this year for people who are affected by the outbreak.
  • The coronavirus is making it difficult for health plans and doctors to collect quality data; therefore, the federal government will be more lenient on data requirements for 2021 and 2022, which likely will protect bonus payments that plans receive.
7. Funeral homes buckle under the coronavirus

Illustration: Aïda Amer/Axios

Morgues, funeral homes and cemeteries in hot spots across America cannot keep up with the staggering death toll of the coronavirus pandemic, Axios' Erica Pandey reports.

Why it matters: The U.S. has seen more than 10,000 deaths from the virus, and at least tens of thousands more lives are projected to be lost. The numbers are creating unprecedented bottlenecks in the funeral industry — and social distancing is changing the way the families say goodbye to their loved ones.

  • "This feels like three years of funerals condensed into a month," says Patrick Kearns, a funeral director in Queens. "So many of us were worried about the front end of this virus. Unfortunately, the back end of it is something people hadn't thought about."

What's happening: Morgues and funeral parlors in cities hit hardest by the pandemic are overwhelmed, with three or four times as many bodies as they're built to hold. While experts tell us the availability of burial plots at cemeteries is not scarce, burials and cremations are being delayed.

  • FEMA has asked the Pentagon for 100,000 military-style body bags to prepare for the surging death counts across the U.S.
  • States like New York and Massachusetts are setting up temporary morgues at college campuses and outside hospitals and nursing homes as existing facilities overflow.

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