Essential workers have borne the brunt of the coronavirus pandemic for months, but the U.S. is still doing relatively little to protect them.

Why it matters: With no end to the pandemic in sight, America's front-line workers still must choose between risking their health and losing their source of income.

Driving the news: The Trump administration said this week that health insurers aren't required to cover coronavirus diagnostic tests performed as part of workplace safety or public health surveillance efforts.

• It didn't say who is supposed to pay for these tests. If employers are stuck footing the bill, that makes the testing less likely to happen.

The big picture: There's been no national effort or initiative to protect essential workers, and America is still failing to implement basic public health measures as new cases skyrocket.

• Masks have become a political flashpoint and aren't required in many of the states that are emerging coronavirus hotspots.
• That means essential workers go to work each day without any guarantee that the people they're interacting with will take one of the most basic and effective steps to prevent transmission of the virus.
• No one is even talking about mass distribution of personal protective equipment beyond health care workers. And even some health care workers — particularly those who work in nursing homes — don't have the protective gear that they need.

More broadly, the financial incentives for frontline workers, particularly those who are low-income, to keep working make it nearly impossible for them to avoid health risks.

What we're watching: The line between essential workers and those who are required to return to the office by their employer has become blurry, and millions more Americans are facing dilemmas similar to those faced by grocers and bus drivers.

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The real number of U.S. coronavirus cases could be as high as 23 million — 10 times the 2.3 million currently confirmed cases — the Centers for Disease Control and Prevention told reporters yesterday, Axios' Marisa Fernandez reports.

Between the lines: The new estimate is based on antibody testing, which indicates whether someone has previously been infected by the virus regardless of whether they had symptoms.

• "This virus causes so much asymptomatic infection. The traditional approach of looking for symptomatic illness and diagnosing it obviously underestimates the total amount of infections," CDC director Robert Redfield said.

The agency also expanded its warnings of which demographic groups are at risk, which now include younger people who are obese and who have underlying health problems.

• The shift reflects what states and hospitals have been seeing since the pandemic began, which is that young people can get seriously ill from COVID-19.

The new guidance also categorizes medical conditions that can affect the severity of illness:

• Conditions that increase risk: Chronic kidney disease; chronic obstructive pulmonary disease; obesity; weakened immune system from solid organ transplant; serious heart conditions, such as heart failure, coronary artery disease or cardiomyopathies; sickle cell disease; Type 2 diabetes.
• Conditions that may increase risk: Chronic lung diseases, including moderate to severe asthma and cystic fibrosis; high blood pressure; a weakened immune system; neurologic conditions, such as dementia or history of stroke; liver disease; pregnancy.

America's great economic reopening is hitting a major snag, just like the public health experts warned. Confirmed case counts are soaring to the point where Texas Gov. Greg Abbott is pausing the state's reopening and canceling elective surgeries to stockpile PPE.

The Kentucky Derby has been rescheduled for Sept. 4–5, and is expected to allow spectators on site, but will impose COVID-19 precautions including limited occupancies and barn access, as well as encouraging guests to wear face masks, per a Thursday announcement.

Major infrastructure projects have been put on ice, economic development programs are getting the ax, and workers are losing their jobs, Axios' Kim Hart writes.

Another 1.5 million Americans filed for unemployment benefits last week, the Labor Department announced Thursday.

Africa is reeling from the economic ravages of the coronavirus. Now the disease itself is accelerating across the continent, Axios' Dave Lawler reports.

Why it matters: "The question we've been asking is, 'Is it that we will not see widespread outbreaks or that we haven't seen them yet?'" says Tom Frieden, former CDC director.

• The outbreaks are now growing, the WHO warns, and COVID-19 is spreading from cities into rural areas where they will be even harder to track and treat.

By the numbers: Home to 17% of the global population, Africa accounts for just 3.5% of the global case count and 1.8% of deaths.

• But while Africa (population 1.3 billion) has roughly as many confirmed cases as the U.K. (population 67 million), limited testing means the numbers tell only part of the story.

That's not to say we have no idea what's happening on the continent. Frieden says enough strategic testing is being done to ensure massive outbreaks aren't going undetected.

• But based on the data we do have, he says, "it is likely that Africa is on the brink of a large outbreak."
• Frieden points to high test positivity rates in countries like Sudan as a sign many cases are going undetected. However, he expects mortality rates to remain relatively low given Africa's young population.

The big picture: Many people who are never infected by COVID-19 will nonetheless die as a result of the pandemic.

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A fair price for Gilead's coronavirus drug, remdesivir, likely should not exceed $2,800 for a course of treatment, according to updated estimates from experts at the Institute for Clinical and Economic Review.

The bottom line: Gilead hasn't released a final price for remdesivir yet, and it could set the bar for other coronavirus treatments that come after it, Axios' Bob Herman writes.

Details: ICER — which conducts cost-effectiveness analyses on drugs and other medical treatments — originally released remdesivir price estimates in May, but revised its figures as more information has come out:

• $10 per treatment: Same low-end estimate assumes recovery of basic costs plus a small margin.
• $310 per treatment: This price reflects the drug's current clinical benefit, which reduces hospitalization time but not the chance of death. (If the drug shows a mortality benefit later, this could go up to $5,000.)
• $600 per treatment: Roughly what generic drug companies are charging for remdesivir overseas.
• $1,600 per treatment: If Gilead tried to recoup new research costs.
• $2,800 per treatment: This assumes dexamethasone becomes the new standard for hospitalized coronavirus patients, and "therefore the overall lives and life years saved with remdesivir are lower," ICER said.

The number of people who lost jobs and related health coverage and then signed up for Affordable Care Act health plans on the federal website was up 46% this year compared with 2019, representing an increase of 154,000 people, the federal government said in a new report.

The bottom line: The government said the rush of people going to HealthCare.gov was tied to "job losses due to COVID-19," Bob writes.

Yes, but: Medicaid enrollment due to coronavirus-related job losses appears to be growing even faster than enrollment in ACA plans, according to the Georgetown University Health Policy Institute.

Go deeper: Medicaid will be a coronavirus lifeline