May 4, 2020

Axios Vitals

Good morning.

Axios is hosting a live virtual event on gene therapy and the future of disease treatment.

  • Join Axios co-founder Mike Allen and Axios health care business reporter Bob Herman today at 12:30pm ET for a conversation with Rep. Scott Peters (D-Calif.), EVP and CCO of Real Endpoints and senior adviser of the MIT FoCUS Project Dr. Jane F. Barlow and FDA Director of the Center for Biologics Evaluation and Research Dr. Peter Marks.
  • Register here

Today's word count is 1,327, or a 5-minute read.

1 big thing: U.S. coronavirus caseload has held steady
Data: The Center for Systems Science and Engineering at Johns Hopkins; Chart: Andrew Witherspoon/Axios

The number of new coronavirus cases nationally hovered around 30,000 a day during the entire month of April, meaning that the virus has managed to spread in spite of stringent social distancing measures.

Why it matters: Many states have already started to lift these measures, which will enable the virus to spread even faster.

Between the lines: Many Americans — like health care workers, grocery workers and emergency personnel — haven't been able to stay home, as their jobs are considered essential. That's enabled the virus to spread among these populations.

  • It has also been able to spread among people who live close together, like nursing home residents.

The big picture: The fewer people who have the virus once society reopens, the easier it will be to control. That's part of why we shut down — the caseload had already outgrown our public health infrastructure's ability to respond to it.

  • We've built up our testing capacity over the last several weeks and are starting to do the same with contact tracing, but these tools can only do so much against exponential spread — even when fully developed, which they're not yet.
  • Even if we're able to keep the caseload at current levels, that's still an enormously challenging reality to live with.

What they're saying: "Continuing spread at something near current levels may become the cruel 'new normal.' Hospitals and public-health systems will have to contend with persistent disease and death," former FDA commissioner Scott Gottlieb wrote in a Wall Street Journal op-ed yesterday.

The bottom line: April was tough, but as states begin to reopen, we don't yet know what lies ahead of us.

  • Things could get worse, or today's status quo could be in place for a long time.
  • What happens will look different from one community to another.
2. Reopening is a risk for Republican governors
Reproduced from Kaiser Family Foundation; Data from The Center for Systems Science and Engineering at Johns Hopkins, U.S. Census Bureau; Chart: Axios Visuals

Republican governors run a big risk — both to public health and their own political fortunes — if they open up their economies too soon, without adequate safeguards.

The big picture: The hardest-hit areas so far have mostly been in states with Democratic governors. But the number of coronavirus cases is now increasing more quickly in states with Republican governors, the Kaiser Family Foundation's Drew Altman writes in today's column.

By the numbers: Coronavirus cases and deaths are both higher in Democratic states than in Republican ones, even after adjusting for population. 

  • However, over the last two weeks, reported infections have increased 91% in red states versus 63% in blue states. 

Driving the news: Texas has begun easing its lockdown measures, and other red states are also moving quickly. Florida has reopened some beaches, and some southern states in particular never locked down as tightly as the Northeast and West Coast.

Between the lines: The core of the Republican base in white, rural areas is at risk. 

  • 20% of people living in non-metro areas are older than 65, compared with 15% in metro areas.
  • And rural residents under 65 are more likely to have pre-existing health conditions (26%), compared to their urban counterparts (20%).

The bottom line: Polls show that Republicans are far more likely than Democrats to think that the worst is behind us when it comes to COVID-19. 

  • That may be partly because they, and the Republican governors, think this is largely someone else’s problem. It isn’t.
3. The latest in the U.S.
Expand chart
Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios. This graphic includes "probable deaths" that New York City began reporting on April 14.

COVID-19 has killed over 67,000 Americans and infected over 1.1 million others in less than three months since the first known death in the U.S., Johns Hopkins data shows.

President Trump asserted during a Fox News town hall Sunday night that he's "very confident" the U.S. will produce a coronavirus vaccine by the end of the year, a timeline much more optimistic than what most public health officials have predicted.

Pete Gaynor, who runs the Federal Emergency Management Agency, is drafting a document whose title sounds like the stuff of horror movies: "COVID-19 Pandemic Operational Guidance for the 2020 Hurricane Season," Axios' Jonathan Swan reports.

Don't expect fast action on the next coronavirus stimulus package, known on Capitol Hill as "phase 4." Senior sources in the Republican Senate conference say most GOP senators want to wait a bit before passing another big aid bill, Swan writes.

New York Gov. Andrew Cuomo announced Sunday that New York, New Jersey, Massachusetts, Connecticut, Pennsylvania, Rhode Island and Delaware are forming a regional consortium to reduce competition when purchasing personal protective equipment (PPE).

Gilead Sciences CEO Daniel O'Day said on CBS' "Face the Nation" Sunday that the company has donated its entire supply of the antiviral medication remdesivir to the federal government, which will determine which U.S. cities will receive the drug based on "urgent" need.

White House coronavirus coordinator Deborah Birx said on "Fox News Sunday" that from a public health standpoint, it is "devastatingly worrisome" that protesters in Michigan and around the country are gathering in close quarters and not wearing masks while demonstrating against stay-at-home orders.

Medical schools around the country are fast-tracking soon-to-be graduates so they can join the fight against the coronavirus, Axios' Fadel Allassan reports.

12.3% of New York state has tested positive for novel coronavirus antibodies, Gov. Andrew Cuomo said at a briefing on Saturday.

4. The latest worldwide
Expand chart
Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

Oxford University scientist John Bell, who is leading one of the efforts to develop a coronavirus vaccine, said on NBC's "Meet the Press" Sunday that his research group will likely get evidence on whether the vaccine has efficacy by early June.

Secretary of State Mike Pompeo said on ABC's "This Week" Sunday that there's "enormous evidence" to support the theory that the coronavirus originated in the Wuhan Institute of Virology, not a nearby market.

The Italian government announced that confirmed coronavirus deaths in the country increased by 174 on Sunday, the smallest daily increase in fatalities the country has seen since March 9.

Russia reported 10,633 new coronavirus cases on Sunday, increasing its confirmed case total to 134,687. It marks the fourth consecutive day that the country announced record single-day increases, according to Johns Hopkins University data.

U.K. Prime Minister Boris Johnson said in an interview with The Sun on Sunday that the rapid deterioration of his condition while suffering from the coronavirus had doctors preparing how to announce his death.

5. Testing has leveled off again
Data: The COVID Tracking Project; Chart: Andrew Witherspoon/Axios

The number of coronavirus tests completed daily has plateaued again, after steadily rising for about a week.

Why it matters: This is about half of what some experts say we need to be doing every day to safely return to normal life, with others saying the target is even higher.

  • The more testing we do, the more likely we are to catch outbreaks before they get out of control.
6. Coronavirus patients are most infectious early on

Coronavirus patients are most likely to infect other people in the early stages of the disease, even before they start showing symptoms, according to a new study in JAMA Internal Medicine.

Why it matters: This can help inform public health officials' efforts to trace and isolate a confirmed patients' known contacts.

  • It also means that stopping the spread of the virus will be challenging, as people are most contagious before they may even know they have the virus.

Details: The study, which focused on confirmed coronavirus patients in Taiwan and their contacts, found that the novel coronavirus has a relatively short infectious period.

  • The risk of transmission is highest around the time a patient becomes symptomatic, and decreases with time.
  • "Because the onset of overt clinical symptoms, such as fever, dyspnea, and signs of pneumonia, usually occurred 5 to 7 days after initial symptom onset, the infection might well have been transmitted at or before the time of detection," the authors write.

Go deeper: The good and bad news about asymptomatic coronavirus cases

7. Updated hospital bailout tracker

Axios' Bob Herman has now identified $2.2 billion of the initial $100 billion in bailout money that the federal government has doled out to hospitals and health systems.

Some of the newest funds to be disclosed are:

  • Community Health Systems: $245 million
  • Banner Health: $200 million
  • Universal Health Services: $195 million
  • UnityPoint Health: $74.5 million

What we're watching: The hospital lobby is asking for more money and urging the federal government to convert the $100 billion in Medicare loans into straight grants.

Go deeper: The hospital bailout tracker