May 29, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning.

  • I am taking my monthly mental health day today, which means that Sam Baker will be bringing you Monday's Vitals.

Today's word count is 1,374, or a 5-minute read.

1 big thing: How the U.S. might distribute a coronavirus vaccine

Illustration: Annelise Capossela/Axios

Now that there are glimmers of hope for a coronavirus vaccine, governments, NGOs and others are hashing out plans for how vaccines could be distributed once they are available — and deciding who will get them first, Axios' Eileen Drage O'Reilly reports.

Why it matters: Potential game-changer vaccines will be sought after by everyone from global powers to local providers.

  • After securing supplies, part of America's plan is to tap into its military know-how to distribute those COVID-19 vaccines.

How it works: In his May 15 announcement of Operation Warp Speed (OWS) — the official effort to accelerate the fight against the pandemic President Trump said that "when a vaccine is ready, the U.S. government will deploy every plane, truck, and soldier required to help distribute it to the American people as quickly as possible."

  • "The military are, in essence ... a hyper-planning institution and they're logistics. And they have a reach and a capacity unlike other institutions," says Stephen Morrison, senior vice president at the Center for Strategic and International Studies.

Who gets the first vaccines will need to be prioritized under a rolling immunization protocol, which may initially target front-line health workers and high-risk groups.

  • Ensuring equitable access is also key.

The big picture: All nations — including developing nations with few funds — will need access to vaccines to build herd immunity.

The bottom line: "We've never faced anything of this scale, and urgency and complexity before. ... The pressures to get the vaccine out are simply going to be extraordinary," Morrison says.

Go deeper.

2. The eye of the storm shifts to Latin America
Data: The Center for Systems Science and Engineering at Johns Hopkins; Chart: Naema Ahmed/Axios

The epicenter of the COVID-19 pandemic has moved from China to Europe to the U.S. and now to Latin America, Axios' Dave Lawler reports.

Why it matters: Up until now, the pandemic has struck hardest in relatively affluent countries. But it's now spreading fastest in countries where it will be even harder to track, treat and contain.

Driving the news: Brazil is now recording more deaths each day than any other country, surpassing the U.S. for the first time over the past three days.

  • Outbreaks are also growing fast in Mexico, Peru and Chile, with those countries recording more new cases than any country in Europe, excluding Russia. The World Health Organization is also worried about rising caseloads in El Salvador, Guatemala and Nicaragua.
  • As cases surge, poorly equipped health care systems throughout the region will struggle to cope. In Mexico, at least 11,000 health care workers have themselves become sick, per NYT.
  • A University of Washington study forecasts a sharp rise in fatalities in the region by early August — including 125,000 in Brazil, up from 24,512 now, per Reuters.
  • President Jair Bolsonaro, who has repeatedly dismissed the threat from the virus, is battling with local officials to reopen the economy even as the situation grows increasingly grave.

Go deeper.

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.

A Tyson pork processing plant in Iowa is experiencing a coronavirus outbreak with 555 confirmed positive cases among more than 2,500 employees, the state Health Department confirmed on Thursday to the Des Moines Register.

San Francisco officials unveiled reopening plans Thursday mandating residents wear face masks or coverings in essentially all public places and stand at least six feet away from one another.

New York Gov. Andrew Cuomo signed an executive order giving power to private businesses to deny service to people without masks.

House Speaker Nancy Pelosi lambasted Senate Majority Leader Mitch McConnell Thursday for delaying moving forward on the next coronavirus relief package.

Sen. Tim Kaine (D-Va.), Hillary Clinton's vice presidential pick in 2016, announced Thursday that both he and his wife, Anne Holton, tested positive for coronavirus antibodies after suffering from flu-like symptoms in March and April.

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

Greek Prime Minister Kyriakos Mitsotakis, when asked this week how his country had avoided a major COVID-19 outbreak, said: "It was obvious to me after talking to our public health experts that we would be moving into some sort of lockdown. I chose to do it earlier rather than later."

Twitter slapped a fact-check label on a pair of months-old tweets from a Chinese government spokesperson that falsely suggested that the coronavirus originated in the U.S. and was brought to Wuhan by the U.S. military, directing users to "get the facts about COVID-19."

New Zealand has a single novel coronavirus case after reporting a week of no new infections, the Ministry of Health confirmed on Friday local time.

Turkey will lift restrictions on intercity travel and allow several public places to reopen June 1, President Tayyip Erdogan said on Thursday, per Reuters.

5. Hydroxychloroquine fills exploded in March
Reproduced from Vaduganathan et al., 2020, "Prescription Fill Patterns for Commonly Used Drugs During the COVID-19 Pandemic in the United States"; Chart: Axios Visuals

Prescription fills of chloroquine and hydroxychloroquine soared in March, after they were put in the political spotlight by President Trump, according to a new study in JAMA.

Why it matters: The evidence suggests that the drug is not an effective treatment for the coronavirus, and is even dangerous for some patients.

Between the lines: The drug's notoriety exploded in mid-March, when the administration secured millions of donated doses of the drug and President Trump publicly touted it.

  • The administration's actions surrounding chloroquine have since been criticized by Rick Bright, a former senior HHS official who has filed a whistleblower complaint.

By the numbers: During the week of March 15–21, hydroxychloroquine and chloroquine fills increased from 2019 levels by 1,977% for short-term prescriptions, by 179% for medium-term prescriptions, and by 182% for long-term prescriptions.

  • By the end of April, prescription fills for less than 60 tablets were still significantly higher than historical amounts. But those for more than 60 tablets had decreased compared to 2019, "which could indicate decreased availability for patients with systemic lupus erythematosus and rheumatoid arthritis," the authors write.
  • Overall, there were 483,425 excess fills of the drug in the 10 weeks examined by the study, compared with 2019.

Go deeper: Trump says he's taking hydroxychloroquine despite FDA warnings

6. The mystery of coronavirus superspreaders

Illustration: Sarah Grillo/Axios

A small percentage of people — called superspreaders — may be responsible for a large number of COVID-19 infections, research is starting to indicate, Eileen reports.

Why it matters: While there's no method to detect who these people are before they infect others, there are ways to control behaviors that cause superspreading events — a key issue as states start to reopen and debate what types of events are OK.

The latest: Three recent studies by the London School of Hygiene & Tropical Medicine, Tel Aviv University and the Institute for Disease Modeling in Washington, which have not yet been peer-reviewed, came to similar conclusions: Roughly 10% of COVID-19 cases appear to have caused around 80% of new infections.

It reflects the law of the "vital few," where a small number (between 5% and 20%) are responsible for the majority of cases, says Eric Topol, executive vice president of Scripps Research, who's also tweeted about it.

  • Indoor congregations — such as at churches, prisons, meatpacking plants and nursing homes — offer the highest risk, he says.

What's happening: Why some people are superspreaders remains unknown. The person's genetics, immune system, how much virus they shed, and their behavior (such as how they speak, if they wash their hands often, if they socialize with large groups) likely play a role.

The bottom line: Understanding how superspreading works could help to fine-tune responses to the coronavirus pandemic — and curb it.

Go deeper.

7. Coronavirus' unequal economic toll
Reproduced from Kaiser Family Foundation; Chart: Axios Visuals

As the coronavirus pandemic wears on, almost half of all African American, Latino, and low-income Americans are having trouble paying their bills, including medical bills, the Kaiser Family Foundation's Drew Altman writes in today's column.

Why it matters: The findings from the latest KFF polling suggest that even if Congress’ relief efforts are helping, they’re not nearly enough.

By the numbers: Almost a third (31%) of the American people say they've experienced problems paying the rent or mortgage, or for food, utilities, credit card bills or medical costs as a result of the coronavirus.

  • Among African-Americans, that number climbs to 48%. Among Latinos, it's 46%.
  • And 47% of households with an annual income below $40,000 say they've had trouble paying their bills because of the pandemic.
  • 45% of black adults and 39% of Latinos say they've either skipped meals or relied on charity or government food programs such as SNAP since February — compared with just 18% of white adults. Most of those people said their experiences were a direct result of the coronavirus’ financial impact.

Drew's thought bubble: This pain would surely be worse without Washington's relief efforts. Even so, the hardship is real, and that strengthens the case for more aid and better targeting to the families that need it most.

Caitlin Owens