May 21, 2020

Axios Vitals

Good morning.

Today's word count is 1,059, or a 4-minute read.

1 big thing: Isolating coronavirus patients isn't always easy

Illustration: Aïda Amer/Axios

States and cities are trying to fill in the gaps that could prevent many vulnerable people from successfully isolating themselves — an important part of tracing coronavirus infections and reducing the virus' spread.

Between the lines: People who don't have a home, who live in communal settings, or who don't have a way to meet their basic needs without leaving the home pose complicated challenges to the U.S. containment effort.

The big picture: Testing and contact tracing is the only way to contain the virus until there's a treatment, and isolating infected or potentially infected people is part of making that process work.

  • For people who can work from home, order groceries online and avoid interacting with vulnerable family members, self-isolation is very doable.

Yes, but: People experiencing homelessness, by definition, do not have a place to quarantine.

  • Those living in communal settings, like nursing homes and prisons, will also struggle to isolate — part of the reason these facilities have been so prone to outbreaks.
  • Millions of Americans live with someone who's vulnerable to the virus, whether because of their age or pre-existing health conditions, or are caregivers for elderly relatives.
  • Congress has mandated paid sick leave for certain workers, but the benefit is limited.

What they're doing: Some communities are trying to remove these barriers.

  • Colorado is requiring long-term care facilities to create isolation plans.
  • Massachusetts created five state-operated isolation and recovery sites for homeless residents who have tested positive for the coronavirus.
  • Nebraska is partnering with the University of Nebraska to provide quarantine housing.
  • New York City is offering hotel rooms to mildly symptomatic patients who need to isolate away from family, WashPost reports.

The bottom line: Successfully containing the coronavirus relies on sick or potentially sick people opting to isolate themselves. That isn't going to happen on its own.

2. Coronavirus cases are on the rise in the South
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Data: The COVID Tracking Project; Map: Andrew Witherspoon/Axios

Several Southern states are seeing a rise in new coronavirus cases, moving them further away from an important target for safely reopening parts of their economies, Axios' Andrew Witherspoon and Sam Baker report.

Why it matters: The Trump administration's reopening guidelines call for a consistent decline in new cases before proceeding with the process — and some states are proceeding even without clearing that threshold.

Between the lines: The total number of cases is an important piece of the puzzle — but it's only one piece.

  • The number of new cases will rise as a state performs more testing, so looking at this metric in isolation can give the false impression of a worsening outbreak.

Yes, but: Some of the states whose new cases are increasing in this analysis — including Arkansas, North Carolina and North Dakota — also fare poorly in a more holistic analysis that also accounts for other metrics.

Where it stands: South Dakota has made the most progress over the past week, cutting its new cases by over half.

  • North Carolina and North Dakota bring up the rear, with spikes in new cases of around 40%.

The bottom line: No one measurement tells the whole story, and there are signs that most of the country is moving in the right direction.

  • But there's a big difference between moving in the right direction and being out of the woods, and there will be no victory over the coronavirus without a sustained, documented decline in the number of new cases.
3. The latest in the U.S.
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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.

President Trump said on Wednesday that he plans to stop taking hydroxychloroquine as a defense against the novel coronavirus when his regimen finishes "in a day or two."

The Department of Homeland Security's watchdog has launched a new investigation into how FEMA coordinated with federal agencies to prepare for — and respond to — the coronavirus pandemic.

The CDC recently released a 60-page roadmap for states, restaurants, schools, child care programs, mass transit systems and other businesses to navigate reopening during the pandemic.

Apple and Google said on Wednesday that they have finished the initial version of their exposure notification technology and are making it available to health authorities to build their apps, Axios' Ina Fried reports.

Nearly half of U.S. households have lost income since mid-March — but the suffering varies widely by state, according to survey data released Wednesday by the Census Bureau.

Health and Human Services principal deputy inspector general Christi Grimm will testify before the House Oversight Committee on Tuesday about an April report that found "severe shortages" in coronavirus testing kits and personal protective equipment in U.S. hospitals, a committee spokesperson confirmed to Axios.

42 times as many mail-in ballots were cast in Tuesday's Virginia municipal elections than in 2016, according to new data from the Virginia Public Access Project.

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

The number of newly confirmed coronavirus cases globally jumped to a daily record this week, with more than 100,000 reported cases over the past 24 hours, the World Health Organization said Wednesday.

The COVID-19 pandemic is rolling back the tide of globalization, both economically and politically, Axios' Bryan Walsh reports.

Coronavirus deaths in São Paulo, the largest city in Brazil and the Western Hemisphere, have increased by over 485% since the city's health department began keeping track in April.

5. The coronavirus is slowing health care spending

The coronavirus pandemic will likely reduce total U.S. health care spending — at least for a while, Axios' Bob Herman reports.

The big picture: The pandemic is a health care crisis, but it's costing less than the other, routine care that's been postponed because of it.

By the numbers: Before the pandemic hit, the U.S. was projected to spend $4 trillion this year on health care, due in large part to the continued rise of prices.

  • A new Kaiser Family Foundation report and a new Health Affairs blog post by Richard Kronick, a former federal health policy researcher, indicate the pandemic may not increase spending and could lower spending below the $4 trillion projection.

Between the lines: Far fewer people went to their doctors and hospitals in March and April, according to KFF.

  • Health insurance companies have confirmed they are sitting on a lot of cash because medical providers aren't billing for as many services, drugs and equipment.
  • COVID-19 hospitalizations are so far tracking below expectations, but that could change "if we are individually and collectively extremely stupid" about reopening the economy, Kronick wrote.

The wild card: How quickly patients come back.

  • J.P. Morgan's May Proprietary Hospital Survey of 316 hospitals showed "significant improvement" in hospital revenues during the first two weeks of May, indicating some services are rebounding.
  • Congress also has subsidized the health care industry with $175 billion, or 5% of health care spending, in a bid to keep things normal.