Mar 30, 2020

Axios Vitals

Good morning. I hope you had a restful weekend, and took some time away from the news. Today's is bleak.

Today's word count is 1,277, or a 5-minute read.

1 big thing: America's grimmest month

Preisdent Trump gives a press briefing in the Rose Garden. Photo: Tasos Katopodis/Getty Images

President Trump asked Americans to continue social distancing until April 30, officials warned that tens or even hundreds of thousands of Americans could die — and that's the least depressing scenario.

Why it matters: April is going to be very hard. But public health officials are in agreement that hunkering down — in our own homes — and weathering one of the darkest months in American history is the only way to prevent millions of American deaths.

The big picture: Because of early missteps by the Trump administration, the virus has already spread widely throughout the U.S., undetected, and the number of cases in most major U.S. cities has skyrocketed.

  • We now must wait for the virus to run its course among those who are already sick, or have recently been exposed and fall ill in the next few days.

By the numbers: Estimates now being echoed by the Trump administration have found that the U.S. coronavirus outbreak will peak in two weeks.

  • Deborah Birx, who's coordinating the White House coronavirus response, mentioned by name a model by the University of Washington's Institute for Health Metrics and Evaluation that predicts the demand for hospital beds and supplies — including ventilators — will far exceed supply on April 14.

The alternative is worse. Without social distancing, as many as 2.2 million Americans could die, Trump said yesterday — the number of deaths predicted by a report released earlier this month.

The bottom line: We should all expect the same harrowing stories from hospitals in Italy and China to be replicated here. At the same time, we'll be wading into uncharted economic territory.

  • And yet, we've never all had such an important role to play, as individuals, in mitigating a national crisis: staying home, and stopping the spread.
2. Why the U.S. doesn't have more hospital beds
Adapted from OECD; Chart: Naema Ahmed/Axios

The shortage of hospital beds in the U.S. didn't happen by accident. It's a result of both market pressures and public policy, the Kaiser Family Foundation's Drew Altman writes in today's column.

Why it matters: The bed shortage is one of many factors complicating America's response to the new coronavirus. But if we want to have more beds and critical equipment on hand for the next pandemic, the government will need to make it happen — and pay for it.

By the numbers: The U.S. has 2.8 hospital beds per 1,000 people, far fewer than other developed countries.

How it happened: Health care resources, including hospital beds, are allocated mainly by market dynamics, not public-health blueprints. 

  • Over the last 50 years, a great deal of care has shifted away from inpatient hospital settings and into outpatient services. 
  • The motivation was to help control costs and improve the quality of care, while making it more convenient for patients.

Government also worked to directly cut the number of U.S. hospital beds, believing in a rule called Roemer's Law, which said that "a hospital bed built would be a hospital bed filled," driving up costs.

The bottom line: If we want to have surge capacity of hospital beds and equipment in place for the next crisis, and if we don't want to push health care costs higher, hospitals will need to acquire extra beds and then leave that surge capacity largely unused until the next crisis.

3. The latest in the U.S.
Expand chart
Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios

Abbott Laboratories says it has received emergency authorization from the FDA to produce portable novel coronavirus tests, which the company indicates can detect the virus within five minutes and will be available starting next week.

A 47-year-old inmate at a federal prison in Louisiana died Saturday from the coronavirus, marking the first virus-related inmate death in the federal prison system, a Bureau of Prisons spokesperson told NBC News.

An infant less than one year old died in Chicago after testing positive for the novel coronavirus, the state health department said on Saturday.

President Trump on Friday ordered General Motors to make ventilators to help coronavirus patients — something the automaker was already on track to do, Axios' Joann Muller writes.

Louisiana Gov. John Bel Edwards said on CBS News' "Face the Nation" on Sunday that his state is at risk of exceeding its ventilator capacity by April 4, stating that he has placed orders for "about 12,000 ventilators" but has thus far only received 192.

The senior U.S. Navy officer now in charge of fixing America's coronavirus supply chain is trying to fill the most urgent needs: ventilators and personal protective gear. But barely a week into his role at the Federal Emergency Management Agency, he's still trying to establish what's in the pipeline and where it is, Joann writes with Axios' Jonathan Swan.

Gilead Sciences CEO Daniel O'Day said in an open letter Saturday that the company is expanding access to its experimental anti-coronavirus drug remdesivir to include severely ill COVID-19 patients.

4. The latest worldwide
Data: The Center for Systems Science and Engineering at Johns Hopkins, the CDC, and China's Health Ministry. Note: China numbers are for the mainland only and U.S. numbers include repatriated citizens and confirmed plus presumptive cases from the CDC.

The countries that have most successfully fended off the novel coronavirus have mainly done it with a combination of new technology and old-school principles, Axios' Sam Baker reports.

The biggest pandemic in decades serves as a reminder of just how big a role infectious disease has played in human history — and will continue to play in the future, Axios' Bryan Walsh writes.

U.K. Prime Minister Boris Johnson announced Friday that he has tested positive for the coronavirus and will be self-isolating while leading the nation's response to the outbreak.

5. Coronavirus exposing holes in employer insurance

Illustration: Sarah Grillo/Axios

A record 3.3 million people filed for unemployment in one week, in the wake of the coronavirus outbreak, but people didn't just lose their jobs. Many also lost the health insurance that came with the job, Axios' Bob Herman reports.

Why it matters: U.S. workers, even those who feel relatively secure in their health benefits, are a pandemic away from falling into the ranks of the uninsured.

Many of the people losing their jobs right now may not have had coverage to begin with — which would make the coronavirus-related disruption smaller, but still highlights the very large holes in this system.

  • The concern: People who get the virus but don't have insurance are susceptible to high medical bills, or even death if they avoid or are denied treatment.

The big picture: People who lose their jobs have some options.

  • COBRA: This option allows people to keep their employer coverage for up to 18 months. However, people have to pay the full insurance premium — an average of $1,700 a month for a family plan.
  • Medicaid: State Medicaid agencies determine eligibility on current income, so this may be the easiest, lowest-cost way for people to get health coverage.
  • Affordable Care Act plans: The health care law created marketplaces for coverage, and people who lose their jobs can sign up outside the standard enrollment window.
  • Short-term plans: These stopgap plans, promoted by the Trump administration, provide some coverage but often don't cover major hospitalizations.
6. The calm before the coronavirus storm

Several parts of the country have not been overwhelmed by coronavirus cases yet, but hospitals are sitting in what they view as the calm before the storm, Bob reports.

The bottom line: Health care workers in these relatively quiet areas are urging people to stay home for the foreseeable future so they don't become the next coronavirus hotspot.

What we're hearing: Workers in areas that haven't tallied large numbers of coronavirus cases know more are coming, and they want their communities to take social distancing seriously.

  • Ohio was among the first states to shut down businesses and urge people to stay at home, which has helped keep cases manageable, said Robert Wyllie, the head of medical operations at Cleveland Clinic.
  • Michael Ring, a cardiologist at Providence Sacred Heart Medical Center in Spokane, Washington, sits on the opposite end of the state from Seattle. Their staff are delaying almost all procedures because they "don't want patients to come to the office," he said on a conference call last week.
  • The Montana Hospital Association asked for a shelter-in-place declaration last week, and Gov. Steve Bullock issued it a day later.

The big picture: The Trump administration has not issued a national order for people to stay at home, but providers think it's time to do so.

Go deeper: Doctors and nurses urge public to stay home