May 11, 2020

Axios Vitals

Sam Baker

Good morning ... I'm filling today while Caitlin takes a well-deserved mental health break.

  • If you, too, could use a little break, how about some penguins enjoying a walk in the woods? Or maybe this guy, who's really feeling himself after sticking the landing jumping over a puddle?

🎬 "Axios on HBO" returns tonight with interviews with Vice President Mike Pence (clip), Sen. Marco Rubio and Salesforce CEO Marc Benioff. Plus we explore the bioethics of contact tracing.

  • Catch the show tonight at 11pm ET/PT on all HBO platforms. 

All right, on to the depressing stuff. Today's smart brevity count: 974, or a 4-minute read.

1 big thing: Staring failure in the face

Illustration: Aïda Amer/Axios

South Korea — a model for how to handle the coronavirus well — has had to re-tighten some of its commercial restrictions amid a new outbreak. On Sunday, South Korea reported the biggest-single day increase in cases it has seen in over a month.

That number: 34 new cases.

  • The U.S., by contrast, is seeing roughly 25,000 new cases per day — a discrepancy that far outstrips the differences in population between the two countries.

What happened in South Korea is pretty much what you'd expect: An infected person went to several clubs in one night. He is believed to have infected 43 fellow clubgoers, who in turn infected another 11 people, per NPR.

We will almost certainly see much bigger subsequent waves of infection here in the U.S., where the focus is on reopening — even in nursing homes. We're already seeing full flights again, and our adherence to social distancing has never been uniform.

  • There's even a risk of an outbreak within the White House — close quarters where many people are still showing up to work and few are wearing masks.
  • Two West Wing workers have tested positive, prompting a slew of senior officials to self-quarantine — including, per the New York Times, CDC director Robert Redfield, FDA commissioner Stephen Hahn, and the NIH's Anthony Fauci.
  • Eleven Secret Service employees also have the coronavirus, Yahoo News reports.

Between the lines: The White House is a model of what it would look like to go back to work with ample testing and ample protections, which most of the country will not have.

My thought bubble: The coronavirus can gain a foothold even in the most highly guarded workplace in the country. We've seen in South Korea that a return to normal life can open the door to a new outbreak, even after things seemed under control. We know they're not under control here.

  • We know this is a highly contagious virus, and we know that distance from other people is the only real protection at this point.
  • In other words, we know what awaits us as we reopen.
2. Even health care jobs aren't safe
Data: Bureau of Labor Statistics; Chart: Naema Ahmed/Axios

The coronavirus pandemic is a health care crisis, but health care still isn't immune from the rampant job losses the pandemic has wrought, Axios' Bob Herman reports.

By the numbers: The health care industry lost more than 1.4 million jobs in April.

The reason: These jobs have gone away because outpatient care has dried up, as providers postponed elective procedures.

  • More than four out of five of those lost jobs were at dentists, doctors' offices, chiropractors and other outpatient settings.
  • Technicians, billing clerks and medical assistants who work in outpatient settings — many of whom are not highly paid — have felt the brunt of the job losses.

What's next: Don't expect a quick return, even as elective procedures are able to come back online.

  • Patients who have lost their insurance or are worried about catching the coronavirus in a waiting room will likely stay away even from outpatient facilities.
  • "Of all the places people want to come back to quickly, a health care setting is probably not at the top of the list," said Ani Turner, a health economist at Altarum.

What we're watching: All of these delays in elective care a boon to insurers, who are saving a lot of money while outpatient procedures are on ice.

  • Some insurers will likely have to pay big rebates to their customers as a result. UnitedHealth Group is getting a jump start on that process, announcing $1.5 billion worth of voluntary premium credits and waived fees.
3. We're delaying important care

Illustration: Sarah Grillo/Axios

The evaporation of outpatient care also has real-world health impacts, my colleague Eileen Drage O'Reilly notes.

Vaccination campaigns have been disrupted globally.

  • That could lead to an explosion of other infectious diseases like measles and polio once people start moving around again, says Julie Fischer, professor of microbiology and immunology at Georgetown University.

Cancer screenings are slowing down, too.

  • Data from the Epic Health Research Center indicates a drop of 86%–94% in the number of screenings for cervical cancer, colon cancer, and breast cancer — all of which typically demonstrate better rates of survival when caught early.

Non-coronavirus emergencies may also be taking a backseat, though it's hard to say for sure.

  • "There are a lot of anecdotal reports that people are afraid to go to hospitals for emergencies. I think that it's going to be difficult to assess what the total impact is until the pandemic starts to ease up enough that we get good data," Fischer says.
4. It's more dangerous than we thought

Photo: Win McNamee/Getty Images

This Washington Post story does a very good job explaining an important part of the coronavirus — the scary and surprising symptoms that doctors keep learning about as they go.

The respiratory harm, as we all know, is very bad. But that's also what doctors and scientists were expecting to see when COVID-19 first emerged. They've also been taken aback by a raft of unexpected, harder-to-explain health effects.

  • In addition to coughing and a fever, potential symptoms are now believed to include, for some patients, a loss of smell, purple toes, pinkeye, vomiting and diarrhea.
  • And in addition to attacking patients' lungs, doctors now believe COVID-19 can cause strokes, kidney damage and problems with the immune system, and can weaken the muscles in the heart.
  • It also seems to be infecting more children than expected.

Between the lines: The virus appears to do major damage to blood cells, which likely helps explain why it's able to attack so many of the body's systems, and its damage to the heart in particular, the Post reports.

Related: Many doctors are now second-guessing the use of ventilators, because some coronavirus patients are able to function just fine even with oxygen levels so low that they should be unconscious, the Wall Street Journal reports.

Go deeper: The coronavirus is a moving target — and that has implications for a vaccine

5. Catch up quick
Expand chart
Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios.
  • The White House will try to push themes of: "preparedness and confidence" this week in an effort to persuade a skeptical public that it's time to go back to work.
  • The FDA gave its first emergency use authorization for a coronavirus antigen test.
  • Brazil is rapidly becoming a coronavirus hotspot, but President Jair Bolsonaro is criticizing local lockdown orders.
Sam Baker