Oct 5, 2020

Axios Vitals

Good morning. I'm filling in today while Caitlin takes a mental health break. There will be no dogs in today's newsletter.

  • Today's word count: 841, or a 3-minute read.
1 big thing: The virus is in control

Illustration: Sarah Grillo/Axios

The coronavirus is an unaware little pathogen hurtling aimlessly through the air. We are much smarter than the coronavirus and should be able to control it — and in many parts of the world, we have.

  • But not in America. Not even in the West Wing — the most secure part of America. Here, the virus is in control.

The big picture: The U.S., and the Trump administration specifically, have refused to acknowledge that the virus gets to set the rules for this conflict. It travels how it travels. It infects whoever it can. Yes, we can beat it, but we have to fight it on its terms.

  • "We can't will the virus to be different than it is. You can't intimidate the virus, you can't tweet at the virus, you can't bully the virus. You can't be like, 'I'm just going to ignore the virus and it will go away,'" said Ashish Jha, the dean of Brown University's school of public health.

Time and time again, the U.S. has tried to stand on principle or fend off the virus with the kind of show of strength you’d use to deter a strategic, thinking enemy.

  • We saw it in the early reopening debate and the political and legal battles over whether churches should be exempt from bans on large indoor gatherings. The virus doesn't know it's spreading through a church. It doesn't know what religion is.
  • The political rush to open the economy before controlling the virus itself caused cases and hospitalizations to soar. The virus isn't cowed by economic growth.
  • If you don't take it seriously and don't do much to protect yourself, the virus is likely to find you, no matter who you are. It doesn't know it's infecting the president.

When large groups of people gather without masks or social distancing — whether that's on a college campus, at a motorcycle rally, at a wedding, or at the White House — the coronavirus gets a foothold.

2. Testing can't do it alone

Illustration: Sarah Grillo/Axios

Testing is just about the only coronavirus intervention the White House embraced. And though testing is essential, it's not enough, on its own, to contain the virus.

Testing basically worked, in this particular outbreak — it identified multiple infected people, including the president, who can now isolate and avoid infecting others.

  • But testing is just information: It tells you who has the virus. If you don't do anything with that information, then testing won't help you control the virus. Sen. Ron Johnson, for example, tested positive and then went to a public event anyway.

And it has gaps. Testing will tell you whether you've come into contact with someone who has the virus, and can help you avoid doing so.

  • But that's just not enough, without also using the tools — like masks and social distancing — that can help reduce your risk of infection if you do come into contact with someone who hasn't tested positive yet.
  • "It's not sensitive enough. It's not going to find enough cases. You're going to miss too many, and then when you don't have many other layers of protection, you're hosed," Jha said.
3. Trump's health: What we know

President Trump waves to supporters while taking a ride outside Walter Reed hospital last night. Photo: Alex Edelman/AFP via Getty Images

It is very difficult to get a comprehensive, trustworthy read on the severity of President Trump's infection.

What they're saying: Sean Conley, Trump's lead doctor, said all weekend that Trump is doing well and experiencing only relatively minor symptoms. And with its many photo ops, the White House is clearly trying to send the same message.

Yes, but: The details we have about Trump's treatment regimen could call that optimism into question.

  • Trump is now taking the steroid dexamethasone, Conley said Sunday. That drug may help save the lives of seriously ill patients, especially those on ventilators. But it's less effective for patients who are only on supplemental oxygen, and has shown no benefit in the mildest cases.
  • Trump is also receiving two other treatments: remdesivir, which has been shown to reduce hospitalization but not to save seriously ill patients' lives, and an experimental antibody treatment from Regeneron Pharmaceuticals.

Between the lines: The fact that Trump's doctors added dexamethasone to his treatment regimen likely means that they were concerned about his condition deteriorating, possibly because of a drop in his oxygen levels, doctors uninvolved in Trump's treatment told Bloomberg.

"It feels like a whole lot of Kremlinology and I'd just be happier if they’d tell us the truth," University of California, San Francisco medical professor Robert Wachter, told STAT.

4. Insurers roll back telehealth discounts

Spine surgeon Melvin Makhni conducts a virtual appointment. Photo: Jessica Rinaldi/The Boston Globe via Getty Images

Anthem and UnitedHealthcare have begun to roll back policies that waived cost-sharing for virtual doctors' appointments, the New York Times reports.

Why it matters: The pandemic led to a big increase in the use of telehealth, as the entire industry tried to keep patients out of the emergency room. And many experts have said it's a shift that could be here to stay.

  • But that will only happen if the reimbursement structure makes it happen.
  • No one should have expected co-pays to stay waived forever, and virtual visits will still likely be significantly cheaper than a visit to the ER.
  • Still, it's not clear yet just how thoroughly the public has adapted to a world of more virtual visits. especially in the absence of obvious financial incentives.
5. Catch up quick

Illustration: Sarah Grillo/Axios

  • New York City will close schools and businesses in parts of Brooklyn and Queens that have seen a spike in cases. (WSJ)
  • Officials in New Jersey are trying to track down the people who might have gotten infected from Trump during a fundraiser. But, like almost all U.S. contact tracing efforts, it's not going so great. (Politico)
  • New Zealand "beat the virus again."
  • Joe Biden tested negative on Sunday, his third negative test since the debate. (WashPost)