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Good morning. Happy Friday. I hope you all take some time this weekend to get away from the news and connect (virtually) with friends and family.

  • And for those of you who'd like to share your creative ways to enjoy the weekend during this strange time, I'd love to feature in Monday's Vitals!

Today's word count is 1,447, or a 5-minute read.

1 big thing: What a coronavirus exit ramp looks like

Illustration: Sarah Grillo/Axios

Americans are looking for an exit ramp away from the extreme social distancing brought on by the coronavirus, but that will require steps we're not yet prepared for, my colleague Bryan Walsh and I report.

The big picture: Responsibly easing off of social distancing will only be possible as the number of new cases levels off, and will depend on extensive testing to avoid another surge in infections.

Where it stands: If we're going to back off of aggressive measures like school and business closures, the next phase of the response would involve doing a lot of the things we should have done from the beginning.

  • That includes quickly identifying and isolating newly infected patients, and identifying others they may have infected.
  • Places that house vulnerable people, like nursing homes, would still need strong oversight.

Yes, but: All of that requires fast, widespread testing, which the U.S. still can't do.

  • We’re still facing shortages of some supplies needed to make and conduct tests, and it still takes several days to receive test results.

What's next: Syndromic surveillance — testing a random portion of the community — might help the U.S. get a better handle on the true prevalence of COVID-19.

  • Seattle has launched an effort to do just that, adapting an existing program that checks for influenza prevalence.
  • And the FDA recently signed off on a test that can deliver results within 45 minutes, though it's only available to help diagnose very sick patients, not to catch cases before they become severe.

Life won't go back to normal for a long time. Normalcy will return in doses, and at different paces in different parts of the country.

2. The next coronavirus hotspots
Data: The Center for Systems Science and Engineering at Johns Hopkins, Census Bureau; Note: The metros used are OMB's Combined Statistical Areas, which include surrounding communities; Chart: Andrew Witherspoon/Axios

A second wave of cities, including Boston, Detroit, New Orleans and Philadelphia are seeing increases in confirmed coronavirus cases, and could become epicenters for the outbreak if they're not able to bring those cases under control soon.

Why it matters: Whether these cities can prevent their outbreaks from spiraling out of control will be a major test for America's ability to contain the virus.

New Orleans in particular is nearing a crisis, with hospitals already becoming overwhelmed and supplies of medical safety gear running low, per the New York Times.

  • Orleans Parish has experienced the highest number of deaths per capita of any county in the U.S.

What we're watching: Other cities may have even higher numbers of cases, but just haven't tested enough people to know it.

Between the lines: The U.S. has finite medical resources, including personnel as well as medical supplies like ventilators. The more hotspots we have at one time, the higher the demand for these resources.

The bottom line: State or city borders will not contain the virus. It moved from a market in Wuhan, China, to all 5o U.S. states within three months.

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

The U.S. on Thursday reported the most coronavirus cases in the world for the first time, over China and Italy with at least 82,404 infections and more than 1,000 deaths, according to data from Johns Hopkins.

The Trump administration is developing a plan to label counties across the country as "high-risk, medium-risk, or low-risk" areas for the spread of the coronavirus, President Trump said in a letter to the nation's governors on Thursday.

A record 3.3 million people filed for unemployment insurance last week, a sign that the coronavirus is causing joblessness like never before.

The White House canceled an announcement planned for Wednesday on a proposed venture between General Motors and Ventec Life Systems to build necessary ventilators amid the coronavirus outbreak, the New York Times first reported and Axios confirmed.

Three immigrant minors in government custody who had crossed into the U.S. without their parents are confirmed to have the novel coronavirus, according to a statement by Health and Human Service's Office of Refuge Resettlement.

Sen. Amy Klobuchar (D-Minn.) announced Monday that her husband, John Bessler, has been released from the hospital after testing positive for the coronavirus.

One of the biggest silver linings of the current crisis is the fact that the U.S. has the deepest capital markets in the world, Axios' Felix Salmon writes.

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.

China will temporarily suspend entry for foreign nationals with visas or residence permits beginning at midnight on March 28 in an effort to stop the spread of the coronavirus, the Ministry of Foreign Affairs announced Thursday.

In a dramatic reversal, Israeli Prime Minister Benjamin Netanyahu's chief rival, Benny Gantz, has agreed to join forces in an "emergency government" to deal with the coronavirus crisis.

The good news is, climate change is not directly at play with the coronavirus. The bad news: we humans are still root drivers in pandemics like this one, Axios' Amy Harder reports.

5. Small hospitals' bailout concerns

Congress is about to provide $100 billion for hospitals and other health care providers to cope with the fallout from the coronavirus, but small hospitals have no idea how to access those funds — and many need the money immediately, Axios' Bob Herman reports.

What they're saying: "A lot of rural hospitals out there need a cash infusion today," Alan Morgan, CEO of the National Rural Health Association, told Axios. "How is it going to happen? What is the process? There are way more questions than answers."

Details: The stimulus bill says "the Secretary of Health and Human Services shall, on a rolling basis, review applications and make payments" to hospitals and other providers, out of a $100 billion fund.

  • HHS did not respond to questions about how that process would work.

Between the lines: Many hospitals are part of large, profitable systems that benefit from their area's demographics. The coronavirus will cause them financial distress, but they are not in danger of going under.

  • Rural and safety net hospitals, which treat disproportionate amounts of older and low-income patients, have a lot less wiggle room to call off elective procedures as they wait for a coronavirus surge.
  • Many small hospitals can't get new loans from banks and could miss payroll as soon as next week.

The bottom line: Bob asked Morgan how this process was supposed to work. "I don't know," he said, "and we are greatly concerned."

6. Remdesivir's orphan designation surprise

When an experimental coronavirus treatment received a special designation from the Food and Drug Administration on Monday, it came as a surprise to the government's top health care officials — including the FDA commissioner.

Why it matters: Top officials aren't normally involved in everyday regulatory decisions. But this particular designation was particularly controversial, as critics quickly questioned whether it was giving an unfair financial advantage to one drugmaker in the midst of a pandemic.

Background: Pharmaceutical company Gilead Sciences is running clinical trials to test whether one of its drugs, called remdesivir, is an effective treatment against the novel coronavirus.

  • On Monday, the FDA granted remdesivir status as an "orphan" drug.
  • Orphan status is reserved for drugs that treat rare diseases. It gives their developers lucrative perks, such as an extended monopoly and tax credits.
  • At the time of the designation, fewer than 200,000 people had been diagnosed with the coronavirus in the U.S., which is the legal threshold for an orphan drug. But the virus is obviously spreading fast, and experts say it could eventually afflict a huge percentage of Americans.

The intrigue: Health and Human Services Secretary Alex Azar, FDA commissioner Stephen Hahn and Janet Woodcock, who leads the FDA office in charge of new drugs, weren't aware ahead of time that remdesivir was receiving orphan status, according to multiple sources familiar with the situation.

Gilead said yesterday that it was asking the FDA to rescind the orphan designation.

7. The coronavirus problems posed by parks

Closed businesses, home offices and schools amid the coronavirus pandemic has translated into an influx of outdoor recreation in parks, despite states' advice for people to stay home, Axios' Kim Hart and Marisa Fernandez report.

Why it matters: So many people are visiting city parks to escape the stuck-at-home monotony that the public spaces have become crowded. Some people are exercising in groups or playing contact sports, undermining social distancing recommendations.

Driving the news: New York Gov. Andrew Cuomo launched a pilot program to open up a New York City street in each borough for residents to walk at a safe distance from each other.

  • The big picture: The decision comes as a potential solution for the state to keep dense clusters of people at bay when the warmer weather entices outdoor exercise or socializing, a huge problem especially with young people, Cuomo said.

Yes, but: Some cities and states have had to close off areas or parks because the risk of illness spreading in mass crowds was believed to be too high.

Go deeper.

8. Justice Department sues Anthem

The Justice Department has sued Anthem, alleging that the health insurance company knowingly submitted inaccurate medical codes to the federal government from 2014 to 2018 as a way to get higher payments for its Medicare Advantage plans and turned "a blind eye" to coding problems.

Why it matters: This is one of the largest Medicare Advantage fraud lawsuits to date, and federal prosecutors believe they have more than enough to evidence to claim that Anthem bilked millions of dollars from taxpayers, Bob reports.

Background: DOJ has been probing the "risk adjustment" practices of all the major Medicare Advantage insurers for years, but hadn't pulled the trigger on a lawsuit against a major player.

The Department of Justice is alleging that Anthem reviewed medical records, but only focused on finding "all possible new revenue-generating codes" while purposefully ignoring all erroneous diagnoses.

The other side: Anthem said in a statement that it intends "to vigorously defend our Medicare risk adjustment practices."

Go deeper.