Axios Vitals

The U.S. reached a grim new milestone yesterday: The coronavirus death count officially passed 100,000, although experts say the true number of deaths is likely higher.

My thought bubble: It's difficult to even conceptualize 100,000 deaths.

• We've already reached a place that was previously unfathomable for most of us, and we don't know what other terrible milestones await us in the future.

The big picture: A couple of months ago, we began to hear horrible stories about Italian hospitals being overrun by coronavirus patients to the point where doctors had to make harrowing decisions about who received treatment, and who didn't.

• That never happened here. These 100,000 people didn't die because our health system ran out of capacity to help them. They died because, absent a treatment, there was nothing else that could be done for them.
• These people were disproportionately minorities, older Americans and people with pre-existing medical conditions.

That doesn't mean these deaths were inevitable. More robust testing and contact tracing earlier on could have led to earlier interventions or prevented new infections.

The bottom line: We don't know the death rate of the coronavirus, because we don't know how many people have had it, due to a lack of testing. But we can reasonably assume that only a small percentage of Americans have been infected so far.

• That means that even though most people haven't had the virus, and even though most of the country adopted stringent social distancing measures for at least a little while, and even though our health care system wasn't overwhelmed, 100,000 Americans still died.
• That's a sober warning as every state begins to reopen.

The enormous devastation caused by the coronavirus thus far has taught us some things that could help prevent more lives lost going forward, per ProPublica's Caroline Chen.

• "Though we’ve long known about infection control problems in nursing homes, COVID-19 got in and ran roughshod," she writes.

• "Racial disparities in health care are pervasive in medicine, as they have been in COVID-19 deaths."
• "Essential workers had little choice but to work during COVID-19, but adequate safeguards weren’t put in place to protect them."
• "Frontline health care workers were not given adequate PPE and were sometimes fired for speaking up about it."

Why it matters: These lessons don't come with easy solutions as the pandemic rages on, but there are a lot of ways that the U.S. can do better and learn from its mistakes. Better public health measures will translate into less sickness and death.

The Centers for Disease Control and Prevention issued new guidelines on Wednesday detailing how office buildings can reopen following months of social distancing amid the novel coronavirus outbreak.

Small community hospitals in Southern California have been overwhelmed with U.S. citizens and residents crossing the border from Mexico back into the states for COVID-19 treatment, the Washington Post reports.

MGM Resorts International plans to reopen four major Las Vegas resorts on June 4, the company announced Wednesday.

From predicting outbreaks to devising treatments, doctors are turning to AI in an effort to combat the COVID-19 pandemic, Axios' Bryan Walsh reports.

Anthony Fauci told CNN Wednesday that the scientific data "is really quite evident now about the lack of efficacy" of hydroxychloroquine as a coronavirus treatment.

Ford has developed software that literally bakes the interior of police cars to kill traces of the coronavirus that other cleaning methods might have missed, Axios' Joann Muller writes.

The EUis considering an $826 billion coronavirus rescue package to fund recovery efforts in response to the bloc's coronavirus-fueled economic strain, European Commission President Ursula von der Leyen said Wednesday.

France's health ministry advised doctors on Wednesday that hydroxychloroquine "should not be prescribed" to coronavirus patients, citing a lack of evidence as to the drug's benefits.

The U.K. has confirmed over 37,500 deaths from the virus — the most fatalities outside the U.S. Brazil has the most cases beyond the U.S. (over 411,200).

New Zealand has only eight active novel coronavirus cases and no COVID-19 patients in hospital after reporting another day of zero new infections. However, the death toll rose to 22.

Overall, new coronavirus infections in the U.S. are on the decline. But a small handful of states, mainly clustered in the South, aren't seeing any improvement, Axios' Andrew Witherspoon and Sam Baker report.

The big picture: Our progress, nationwide, is of course good news. But it's fragile progress, and it’s not universal. Stubborn pockets of infection put lives at risk, and they can spread, especially as state lockdowns continue to ease.

Ten states have not seen a single week of significant improvement — their caseloads have either gotten worse or have held steady all month.

• Most of them are in the South: Alabama, Mississippi, North Carolina, South Carolina and Virginia.
• But a handful of other, more populous states — California, Minnesota and Wisconsin — also stand out for their consistently lagging progress. Maine and Utah also have not reported a single week of significant improvement.
• Neither has Puerto Rico.

Between the lines: The number of total cases is a flawed but important metric.

• The number of confirmed cases will go up as testing improves, so spikes in some areas may simply reflect a more accurate handle on the situation, and not a situation that's getting worse.
• Even so, to get this pandemic under control and safely continue getting back out into the world, we still need the total number of new cases to decline.

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A new type of a Medicare prescription drug plan will cap insulin costs at $35 per month for people who have diabetes. The Trump administration and industry groups were quick to hype the model as a win for everyone, Axios' Bob Herman reports.

Reality check: Medicare's new model will bring some financial relief next year to patients who are struggling to afford their insulin. But experts say it doesn't change actual prices and gives cover to avoid more serious drug pricing reforms during the coronavirus pandemic.

The basics: Companies that sell Medicare drug plans can offer "enhanced" benefits that reduce how much people have to pay at the pharmacy.

• However, based on complex rules within Medicare's drug coverage gap, these enhanced plans don't receive the full 70% discount paid by insulin manufacturers.
• As a result, these plans don't offer enhanced benefits in the coverage gap, and that forces some seniors to pay high out-of-pocket sums for their drugs.

Driving the news: A new project through the Affordable Care Act's Innovation Center will allow these types of plans to receive the 70% discount if they cap monthly insulin costs, starting in 2021.

Yes, but: This only applies to insulin. The model also doesn't affect the list or net price of any insulin.

• An out-of-pocket cap means higher premiums for other beneficiaries and taxpayers, which Medicare chief Seema Verma acknowledged.

The big picture: The health care industry wouldn't have endorsed this idea if companies didn't think there would be some payoff.

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