Axios Vitals

You might have thought a global pandemic, with its delays in elective care, declines in visits to doctors and big drops in vaccination rates, might be bad for the health care industry's bottom line.

• You'd have been wrong, Axios' Bob Herman reports.

Driving the news: Even after excluding one-time deals, the industry is posting profits that are above historic norms.

Pharmaceutical companies: Drug sales fell across many companies, but cutting administrative and research costs kept earnings at industry highs.

• Nine of the 10 biggest profit margins recorded as of July 31 belonged to drug companies.

Hospitals: HCA Healthcare, Universal Health Services and Community Health Systems all posted profits well above expectations — which surprised Wall Street, considering hospitals halted elective procedures for more than a month.

• Baptist Health, a not-for-profit hospital system headquartered in Kentucky, "does not foresee a need for additional forms of liquidity" because it has 241 days of cash on hand, the eight-hospital system told bondholders last week.

Health insurers: UnitedHealth Group had a record-breaking quarter. Anthem, Cigna and others similarly posted significantly higher earnings than last year.

• This was entirely expected. Insurance premiums were still rolling in, but people didn't go to their doctor or hospital as often because of stay-at-home orders.

The losers: Medical device manufacturers like Boston Scientific, Stryker and Edwards Lifesciences all lost money in the second quarter.

• But those companies' stock prices have risen anyway, because surgeries that involve their devices have picked back up.

The bottom line: Just like Big Tech, the pandemic has not significantly stunted the economic and political strength of the health care industry.

Go deeper: Follow our health care earnings tracker

"What we are seeing today is different from March and April. It is extraordinarily widespread. It's into the rural as equal urban areas," Deborah Birx, the White House coronavirus task force coordinator, said on CNN yesterday.

"The dominoes are falling now," David Rubin, of Children’s Hospital of Philadelphia, told the Washington Post.

Driving the news: The virus is everywhere now, and the U.S. has no real plan to contain it — the New York and New England regions are the only sustained bright spots in the country, and deaths from the June spike in Sun Belt hotspots are still mounting.

• "To everybody who lives in a rural area, you are not immune or protected from this virus," Birx said on CNN. "This epidemic right now is different and it's more widespread and it's both rural and urban."
• She also said multi-generational households may need to consider wearing masks at home.

My thought bubble: There is very little reason right now to suspect that things will get substantially or sustainably better here over the next few months.

Go deeper: Nine states set single-day coronavirus records last week

Almost every minute of the school day will have to be reimagined to safely accommodate in-person instruction in the middle of the pandemic, my Axios colleagues reported this weekend.

"I can't walk around and kneel next to a student to see how they're doing. That's where the teaching and learning magic happens, but now it's all going to be antiseptic. And it's gotta be," said Larry Ferlazzo, a high school teacher in Sacramento.

Instruction will have to change dramatically, as teachers try to make it work in classrooms that were never designed for social distancing.

• Meals may have to be in classrooms, which raises new questions about cleanliness and extra work for teachers — but social distancing in lunch rooms is probably impossible.
• Most schools no longer have a full-time nurse on site, which makes monitoring student and staff health impossible for some areas.

Even the best-laid plans may crumble, simply because we have not gotten the virus itself under control and this is not a scenario schools have ever planned for.

That will have its own ripple effects, as Axios' Courtney Brown reports this morning: Virtual school will only worsen the retail apocalypse.

• Back-to-school season is the second-biggest revenue generating period for the retail sector, after the holidays.
• But a ton of analysts foresee a sharp drop in that kind of shopping this year, because school will be at home, many parents' finances are tight or unpredictable, and the need just doesn't seem that great.

The bottom line: The way to avoid all of these bad consequences is to get the virus' spread under control — as long as we're not doing that, we're left with all bad options.

The coronavirus pandemic is leading Americans toward a more favorable view of doctors, Kaiser Family Foundation president Drew Altman writes in his latest Axios column.

By the numbers: Back in 2005, just 17% of Americans said physicians were mostly interested in working for the public good, while 31% said they were mostly interested in making money.

• This month, 36% of Americans say doctors are mostly interested in the public good, and just 10% say they are mainly about making money.

Between the lines: The profession isn't seen as completely altruistic: Most of the country — 54% — say doctors care equally about money and the public good.

• And doctors are still far behind nurses; 60% of people see nurses as mostly motivated by caring for the public good.
• Doctors are still doing a lot better than pharmaceutical companies and insurers; only 4% of the public say they care primarily about the public good.
• The many knowledgeable physician-scientists on national and local TV every day talking about the pandemic may also be enhancing the image of doctors with the public.

Yes, but: Doctors are earning a lot of goodwill right now, but don't expect the public to cut them too much slack.

• People are struggling with medical bills and frustrated by their experiences with the health care system, and the pandemic has only heightened cost anxieties.

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• Some scientists are afraid the White House will put political pressure on regulators to speed a vaccine to market before it's fully proven to be safe and effective, the New York Times reports.

• "At this point in time, there's been five randomized-controlled, placebo-controlled trials that do not show any benefit to hydroxychloroquine. So, at this point in time, we don't recommend that as a treatment," Adm. Brett Giroir told NBC's "Meet the Press" on Sunday.
• More athletes, across all sports, are opting out of resumed play because they're afraid of catching the coronavirus.