May 1, 2020

Axios Vitals

Good morning.

Join Axios co-founder Mike Allen and health care business reporter Bob Herman on Monday, May 4, at 12:30pm ET for a live virtual event on gene therapy and the future of disease treatment.

  • Our conversation will be with Rep. Scott Peters (D-Calif.) and Dr. Jane F. Barlow, EVP and CCO of Real Endpoints and senior adviser of the MIT FoCUS Project.
  • Register here. 

Today's word count is 1,214, or a 4.5-minute read.

1 big thing: Good and bad news about asymptomatic coronavirus cases

Photo: Alexi Rosenfeld/Getty Images

We don’t yet know what proportion of people infected with the coronavirus are asymptomatic, but it’s becoming clear that there’s a large number of them.

Why it matters: The more people who have been asymptomatic carriers of the coronavirus, the lower its fatality rate. But asymptomatic carriers also present unique problems for stopping the virus’ spread, as they likely don't know they have it.

The big picture: Until we can do widespread, reliable antibody testing to determine how many people have had the virus, the best data we have to go off of are one-off studies — which have suggested widely varying rates of asymptomatic carriers.

  • Around half of the soldiers on the Theodore Roosevelt aircraft carrier who tested positive for the coronavirus were asymptomatic, per the L.A. Times. Another study found that about 18% of positive cases on the Diamond Princess cruise ship were asymptomatic.
  • “We don’t know the definitive answer, but it probably is a substantial proportion,” infectious disease expert Anthony Fauci told me.

Between the lines: If asymptomatic cases are common, that mathematically increases the likelihood (age and pre-existing conditions aside) that you or I could catch the virus and be completely fine.

  • In the darkest of plausible scenarios, where we fail to contain the virus and it spreads relatively unencumbered throughout the U.S., a high asymptomatic rate would translate into a lower death rate — a small comfort.

Yes, but: It also is hugely problematic for efforts to keep the coronavirus from spreading.

  • It could then spread undetected, and would be harder to track. “If you have so many asymptomatic people around, it’s going to be much more difficult to get your arms around contact tracing, because you’re going to have so many people who get exposed to someone who is asymptomatic,” Fauci said.

Go deeper.

2. The coronavirus death count may be even higher
Data: The Center for Systems Science and Engineering at Johns Hopkins, the CDC; Note: CDC provisional death data is partial and varies based on state submission of death certificates; Chart: Naema Ahmed/Axios

The number of deaths in states hit hardest by the coronavirus is well above the normal range, according to data from the Centers for Disease Control and Prevention.

Why it matters: In some of these states, the number of excess deaths this year — or deaths above the typical level — is greater than the number of reported coronavirus deaths, suggesting that the virus may have killed more people than we're aware of.

Between the lines: "These increases belie arguments that the virus is only killing people who would have died anyway from other causes. Instead, the virus has brought a pattern of deaths unlike anything seen in recent years," the New York Times writes.

  • The excess deaths may also account for non-coronavirus patients who are dying of causes that are usually treatable, as people avoid hospitals out of fear of catching the virus.
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.

As states try to mitigate the spread of the coronavirus while easing restrictions, unemployment filings in the U.S. topped 30 million in six weeks, with another 3.8 million Americans filing jobless claims last week.

American Airlines and Delta Airlines announced on Thursday that passengers will be required to wear face masks on their flights starting in early May, joining Jet Blue and Frontier Airlines.

Amazon's stock was down nearly 5% in after-hours trading Thursday after the tech giant said that shareholders should expect coronavirus-related costs to eat up all the $4 billion in profits it would expect for Q2.

Hundreds of Michigan residents demonstrated outside the state Capitol Thursday with signs, flags and guns protesting against Gov. Gretchen Whitmer's coronavirus restrictions. Some were successful in pushing inside the building.

Georgia Gov. Brian Kemp (R) has announced that he will lift the state's shelter-in-place order for most residents on Thursday at 11:59pm, though it will remain in place for the elderly and “medically fragile” through June 12.

Maryland Gov. Larry Hogan (R) told the Washington Post during a virtual event Thursday that coronavirus tests that arrived from South Korea are being guarded by members of the Maryland National Guard and state police.

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

Russian Prime Minister Mikhail Mishustin told President Vladimir Putin in a televised meeting on Thursday that he had tested positive for the novel coronavirus.

Returning to the podium Thursday for the first time since recovering from the coronavirus, Prime Minister Boris Johnson said he could confirm that the U.K. is "past the peak of this disease."

There are three truly existential threats to humanity: pandemics, climate change and nuclear weapons. COVID-19 has rightfully absorbed the world's attention and will for months to come. But the last treaty constraining the world’s largest nuclear arsenals is set to expire in nine months, Axios' Dave Lawler reports.

Over 4 million workers have applied to Italy's national welfare agency to get €600 payments (roughly $650) for wages lost due to the country's stay-at-home order, the agency tweeted on Wednesday.

5. Coronavirus success stories from around the world

South Korea and Hong Kong recorded no new local cases yesterday, and New Zealand and Australia also approached that milestone, Dave reports.

The big picture: Beyond those poster children of effective COVID-19 responses (Germany and Taiwan also qualify), there are a number of other success stories with lessons to offer the world.

Vietnam has now gone two weeks without any known community spread and has yet to record a death.

  • That success has been largely overlooked, per the Washington Post’s Adam Taylor. Researchers “have identified three key tactics used widely by the government: temperature screening and testing, targeted lockdowns and constant communication,” he writes.

Senegal “now boasts the third-highest recovery rate in the world,” according to a weekly report from Albright Stonebridge Group.

  • “The Dakar-based Institut Pasteur (IPD) has developed a rapid $1 COVID-19 test, and the country has repurposed facilities built for Ebola into COVID-19 testing centers, as well as spearheaded the production of 3D-printed ventilators,” the ASG report notes.

Ghana is now lifting its lockdown, with President Nana Akufo-Addo saying the country’s test-and-trace program is proving highly effective.

South Africa, haunted by its slow response to the AIDS epidemic, imposed a strict lockdown and sent testing teams into townships to catch outbreaks before they grew. It quickly flattened the curve.

Central European countries like Slovakia, Poland and the Czech Republic have also seen far fewer cases and deaths than Western European countries.

  • They had additional time, with outbreaks beginning weeks after Italy’s, but used it well, the FT notes.
6. Air travel will never be the same

Illustration: Sarah Grillo/Axios

Whenever you're ready to fly again, be prepared: Air travel after the coronavirus will look and feel a lot different from the last time you boarded a plane, Axios' Joann Muller writes.

In the meantime, pack your patience along with your face mask: Everything is going to take longer.

  • Expect new procedures for everything from luggage check-in to security clearance and boarding.
  • You might even need to have your blood tested to prove you're in good health before boarding.

Masks and social distancing are only the beginning. In a new report, "The Rise of Sanitised Travel," SimpliFlying anticipates dozens of ways air travel might change in the coming months and years. Some examples:

  1. Online check-in: Besides choosing their seat or paying for checked bags, passengers might also need to upload a document to confirm the presence of COVID-19 antibodies before they fly.
  2. Airport curbside: Passengers could be required to arrive at least four hours ahead of their flight, and pass through a "disinfection tunnel" or thermal scanner to check their temperature before being allowed to enter the airport.
  3. Health check: Passengers would undergo a health screening, and potentially even have their blood tested. In April, Emirates became the first airline to conduct rapid on-site COVID-19 testing of passengers before boarding.

The big question: How much hassle will people tolerate, or will they avoid flying altogether?

Go deeper.