Mar 9, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. News is breaking fast on the coronavirus, but you can catch up quickly in the Axios stream, which is constantly kept up to date.

Today's word count is 751, or a 3-minute read.

1 big thing: Inside a coronavirus drug delay

White House coronavirus response coordinator Debbie Birx, Vice President Mike Pence and HHS Secretary Alex Azar. Photo: Drew Angerer/Getty Images

Crossed lines and poor communication between the U.S. government and a leading pharmaceutical company appear to have complicated the breakneck search for a coronavirus treatment, my colleague Jonathan Swan and I reported this weekend.

Why it matters: Pharmaceutical giant Gilead, in its a rush to begin clinical trials on a potential treatment, may have violated federal law instead of waiting for slow-to-come federal approvals on drug exports.

The big picture: The rules and protocols for these trials aren't mere bureaucracy — they exist to make sure clinical trials are rigorous, controlled and scientifically sound enough to form the basis of what can be life-or-death decisions.

  • At the same time, some officials argue, the federal government needs to be prepared to move especially quickly during emergencies like this outbreak.

Details: Gilead shipped a batch of its investigational drug, called Remdesivir, to China after requesting — but not receiving — federal approval from the Department of Health and Human Services, which is required by law.

  • Gilead's unilateral decision to ship the coronavirus drug without approval caused consternation within the senior ranks of the Trump administration, according to administration officials with direct knowledge of the events that unfolded behind the scenes.

The other side: Some officials within the administration think that HHS should have approached the situation with more urgency and coordination, although HHS provided Axios with a timeline that includes three separate instances of the Food and Drug Administration communicating with Gilead.

  • The company also reached out to senior HHS officials outside of the FDA.
  • "The timeline normally might be fine, but in a global public health challenge, people need to move, which apparently Gilead was doing and the HHS bureaucracy was not," said an administration official.

Go deeper.

2. Trump immigration policies could hinder care

Democrats and public health experts are concerned that the Trump administration's immigration policies could scare immigrants away from getting medical help as the novel coronavirus spreads, Axios' Stef Kight reports.

What we're watching: Ken Cuccinelli, the acting director of U.S. Citizenship and Immigration Services, told senators last week that health care facilities are already "sensitive locations" where immigration enforcement isn't carried out, except in "exigent circumstances."

Why it matters: To slow the deadly coronavirus, Americans need to be able to get tested and see doctors. For immigrants, though, that can involve trusting the federal agencies that have made it harder for them to stay in the country.

  • "This administration has given immigrants very little reason to believe them," Migration Policy Institute's Sarah Pierce told Axios.

What they're saying: "It's potentially a really large public health problem," said Wake Forest's Christine Coughlin, who has written about unauthorized immigrants' compliance with quarantines. "I believe there is a perception that if you were to go and seek treatment or seek testing, you could be potentially reported and then potentially deported."

  • The higher uninsured rate among non-citizens is "likely to be especially dangerous during a pandemic," Wendy Parmet, director of the Center for Health Policy and Law at the Northeastern University School of Law, wrote in an op-ed Wednesday.

Go deeper.

3. Paul Farmer on the coronavirus

Photo Illustration: Sarah Grillo/Axios. Photo: Ramin Talaie/Corbis via Getty Images

Paul Farmer, co-founder of Partners in Health, has spent decades treating infectious diseases in impoverished countries like Haiti and Sierra Leone.

What he's saying: The U.S. has lagged in its response to the coronavirus, but Farmer still has confidence in the country's public health agencies as well as the treatments that are available to infected patients, Axios' Bob Herman writes.

A sample from Bob's interview, which has been edited for brevity and clarity:

Q: What's your sense for where we stand, globally, on the coronavirus right now?

PF: I've been struck by the [JAMA report] on 138 patients in Wuhan: 26% of that cohort required intensive care. Is that similar to other cohorts even if we don't know the number in the denominator? If it's a substantial fraction of patients who require intensive care, there are a lot of places in the world where I've worked that don't have an intensive care unit. With the Ebola epidemic, we lacked [intensive care beds] then, and we lack them now.

Read the whole interview.

4. Nursing homes prepare for the coronavirus

Nursing homes are uniquely vulnerable to the coronavirus, and they — along with other elderly care facilities — are taking action to protect their residents, AP reports.

Between the lines: Older people and those who have other health complications are particularly susceptible to the virus, early evidence suggests, and the majority of U.S. deaths so far have been linked to a Seattle-area nursing home.

The big picture: About 2.5 million Americans live in long-term care facilities.

  • These facilities are stockpiling medical supplies, preparing for staff shortages and screening visitors, while the federal government is focusing all of its nursing home inspections on infection control.

Go deeper: Hospitals have been preparing for coronavirus uptick

5. While you were weekending...
  • If the growing novel coronavirus outbreak becomes a lasting pandemic, it could accelerate fundamental changes in the economy, politics and the workplace, Axios' Bryan Walsh writes.
  • Health officials have begun warning the sick and elderly to avoid traveling and crowds, representing a change in tone from the administration, Politico reports.
  • Misinformation about the coronavirus is still proliferating on social media platforms, despite the companies' aggressive efforts to remove it, the New York Times reports.
Caitlin Owens