Mar 23, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. I hope you got some rest this weekend.

Situational awareness: Former Vice President Joe Biden has asked President Trump to drop legal challenges to the ACA, in light of the novel coronavirus pandemic.

Today's word count is 1,685, or a 6-minute read.

1 big thing: The gaping holes in our testing strategy

Sen. Rand Paul. Photo: Win McNamee/Getty Images

The Trump administration is urging commercial labs to prioritize testing inpatients for the novel coronavirus, Vice President Mike Pence said yesterday, a reflection of how we're prioritizing America's woefully inadequate supply of diagnostic tests.

Why it matters: A high-profile example of the pitfalls of this strategy — which essentially means that only the sickest patients get tested — is Sen. Rand Paul's positive diagnosis, announced yesterday. Paul is asymptomatic, but recently was in close contact with other senators, leading them to self-quarantine.

  • That's how this is supposed to work; it cuts off the virus's line of transmission by keeping everyone who has been exposed quarantined at home. But it's impossible to do this across the population when we don't know who is infected.
  • Our next-best option is for everyone to stay home and assume that they have the virus. But plenty of people have been ignoring social distancing guidance.

The big picture: As researchers learn more about the virus, it's becoming more apparent that asymptomatic carriers are likely important to its spread.

The latest: Our testing issues are no longer about a lack of labs making them. The latest problem is that even as our testing capability ramps up, we face shortages of the supplies used to make and conduct the tests.

  • There are also concerns that people seeking tests who aren't severely ill will waste resources beyond the tests themselves, like personal protective equipment, and expose non-infected people.

What they're saying: "We are in a new phase of this fight. Only one thing matters now: treatment of the gravely ill," tweeted Mark Levin, chair of New York City Council health committee.

2. Who the coronavirus economy hurts the most

Illustration: Aïda Amer/Axios

Tens of millions of people are trying to stave off the coronavirus without reliable access to basic needs like shelter, food or health care, Axios' Kim Hart reports.

Why it matters: The people who were already vulnerable in a strong economy are facing severe hardship as jobs evaporate overnight and safety net services are strained to the max.

Here's a look at who's hurting the most:

People experiencing homelessness: You can't "socially distance" or shelter in place if you don't have shelter in the first place.

Low-income workers: Hourly-wage workers in retail, food service, janitorial jobs, and even preschool teachers often live paycheck to paycheck — and their incredibly slim margins are about to be obliterated.

Older residents of rural areas: Rural residents tend to be older and less likely to have paid sick leave or access to health care services.

Single parents: They're shouldering the burden of work (if they still have it) and childcare on their own.

Poor families: Children are at the mercy of their circumstances and, without school to offer routine and reliable meals, can take on the anxiety they see in the adults around them.

The mentally ill and immunocompromised: This group of patients has a host of complicated pre-existing conditions that often go untreated due to lack of access to care or social stigma.

Inmates: Social distancing is hard to achieve in overcrowded jails without putting everyone on lockdown or solitary confinement, Axios' Stef Kight reports.

Go deeper.

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

President Trump told a news conference Sunday that he's activated the federal National Guard to assist Washington state, California and New York to combat the spread of the novel coronavirus.

After days of intense negotiations, talks between Capitol Hill leaders and the White House over a "Phase 3" stimulus package to fight the coronavirus broke down on Sunday, leading to a failed cloture vote meant to move the bill forward.

Ohio, Louisiana and Delaware on Sunday mandated that all citizens stay at home — with some exceptions — to help stop the spread of the coronavirus.

Apple, GM and Tesla are among the U.S. firms diversifying from their specialist areas to help deliver essential medical supplies like masks and ventilators to assist in the fight against the novel coronavirus, Axios' Ina Fried and Joann Muller report.

Illinois Gov. J.B. Pritzker said on CNN's "State of the Union" Sunday that inaction by the federal government has forced state governments to compete "against each other" for coronavirus supplies.

President Trump should use the Defense Production Act to ramp up the country's domestic production of medical masks, gowns and other items crucial for health care workers to fight the novel coronavirus, the American Hospital Association, American Medical Association and American Nurses Association wrote in a letter on Saturday.

The Food and Drug Administration has approved a "point-of-service" coronavirus test, made by Cepheid, that will be rolled out March 30.

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.

In a rare interview, China's ambassador to the U.S., Cui Tiankai, told "Axios on HBO" that he stands by his belief that it's "crazy" to spread rumors about the coronavirus originating from a military laboratory in the U.S.

Syria reported its first case of the novel coronavirus on Sunday, according to state media.

The German government is banning public gatherings of more than two people to help prevent the spread of the coronavirus outbreak, stopping just short of confining people to their homes Bloomberg reports.

Classified Chinese government data suggests that one-third of coronavirus cases in the country were asymptomatic "silent carriers," according to the South China Morning Post, the English-language paper in Hong Kong.

The government of Singapore is tracing the coronavirus in ways that are simultaneously impressive and terrifying for those who worry about high-tech dictatorship.

Rwanda, Uganda, Burkina Faso and other African countries are making new efforts to pause international travel and institute stay-at-home orders to combat the spread of the novel coronavirus, AP reports.

5. We may need retired doctors and nurses

Illustration: Aïda Amer/Axios

Hospitals are asking retired doctors and nurses to come back and help with operations as they prepare for a rush of severe coronavirus cases, Axios' Bob Herman reports.

The bottom line: Retired clinicians likely won't be placed in intensive care units or coronavirus testing stations, because older adults are at higher risk of falling ill and dying from the virus. But they could help stabilize hospitals that will need as many hands on deck as possible over the coming months.

Where it stands: The Association of American Medical Colleges floated this idea last week with hospitals and federal agencies.

  • "The question is: How can we bring people up to speed and bring them in?" said Janis Orlowski, a physician and executive at the AAMC. "They will ... [likely] backfill in areas where it's not direct patient care."

What they're saying: Some retired clinicians are willing to take on other necessary care, while residents and other doctors funnel into coronavirus cases.

By the numbers: 41% of doctors are 55 or older, according to American Medical Association data provided to Axios, and 38% of nurses are 55 or older.

6. Photo du jour

Photo: Nicholas Christakis' Twitter

Communities across the country are preparing for an influx of coronavirus patients, which is expected to greatly exceed the number of hospital beds available.

Go deeper: No part of the U.S. has enough hospital beds for a coronavirus crisis

7. How the coronavirus differs from the flu
Data: WHO, NEJM and CDC; Chart: Naema Ahmed/Axios

The coronavirus pandemic is caused by a virus humans haven't encountered before — meaning our bodies have no built-in immunity to it and researchers are frantically working to learn more about it, Axios' Eileen Drage O'Reilly reports.

Why it matters: While there are important lessons to be learned from other pandemic flus and even seasonal flu outbreaks, the coronavirus pandemic is new and not exactly comparable, making predictions, policies and treatments all the more difficult.

While both seasonal flu and COVID-19 cause similar respiratory illnesses, there are key differences between the viruses.

  • Influenza has an incubation period of roughly 2–3 days, whereas the coronavirus incubates longer (5–6 days on average) before symptoms appear, possibly allowing more people to unknowingly spread the virus.
  • On average, 1.3 people catch the flu from an infected person versus 2–3 for the coronavirus.
  • There's a flu vaccine and multiple effective treatments, so many exposed to the flu will have lessened symptoms. There's no vaccine or treatment yet approved for COVID-19.
  • Children appear to be more susceptible to severe complications from this seasonal flu than from COVID-19, with the CDC reporting the highest number of influenza-associated deaths (149) at this point in the season, with the exception of the 2009 flu pandemic.
  • But, the overall mortality rate for COVID-19 is between 10 and 40 times higher than the average 0.1% mortality rate for the seasonal flu.

Go deeper.

8. U.S. counties expect to spend billions

County officials are urging Congress to make their governments eligible to directly receive coronavirus relief funds to offset the ballooning costs of responding to the crisis, Kim reports.

Why it matters: The country's 1,900 public health departments are run by counties, which also manage roughly 1,000 U.S. hospitals. More than 500 counties have already declared a state of emergency to trigger additional funding and resources.

By the numbers: Los Angeles County, the most populous in the country, is estimating $290 million in costs over six months, and 50 of the 88 cities in the county will face additional expenses of $145 million.

  • Harris County, Texas, which includes Houston, has already spent almost $43 million in coronavirus response costs and expects to spend an additional $11 million every month.
  • Contra Costa County, California, estimates its health department alone will have incurred $46 million through May.
  • San Diego County, California, is spending about $7 million each month for emergency response, including temporary housing for people who need to be quarantined.

Between the lines: Costs are only part of the picture. Adding to the budgetary pressure is the anticipated lost tax revenue due to businesses shutting down for weeks if not months, which makes it even more challenging to absorb the extra costs.

Go deeper.

9. Vitals readers' silver livings

Keep 'em coming!

  • My husband and "I have different strengths and we are using them in tandem. We are keeping to a routine and enjoying exercising at home, walks on the beach, online socializing, cooking, baking and eating (!). But the biggest surprise, and gift, is we are not squabbling! We are grateful for each day of health."
  • "In learning to keep my kids doing math while entertaining them, I've gotten to exercise some creativity (good for my brain and mood!). My first-grader and I have done 'animal math' with a bucket of plastic animals that hadn't been opened for years and 'soft math,' which includes tossing stuffed animals back and forth to create addition and subtraction problems."
  • "I was supposed to go to Italy in one week with my long-distance boyfriend and his family, but we obviously had to cancel that trip. Instead, we met up at his parent's house to work from home, and have been eating pasta, going on walks in the woods, and drinking Italian wine all week. It's been absolutely lovely to see him and spend time with his family!"
Caitlin Owens