Feb 26, 2020

Axios Vitals

Good morning. I forgot to solicit your "Bachelor" opinions yesterday (yes, I am back to watching this season). Send me your best takes and predictions.

Today's word count is 836, or a 3-minute read.

1 big thing: Brace yourself for a coronavirus outbreak

Illustration: Aïda Amer/Axios

Public-health officials' warnings about the novel coronavirus are sounding increasingly urgent, with one top CDC official asking the public yesterday "to prepare for the expectation that this might be bad," Axios' Sam Baker reports.

Reality check: Other administration officials, including President Trump himself, were more subdued in their assessments. But underneath those tonal differences, the reality of the coronavirus is the same: It spreads quickly, and has already spread to many countries, making it likely to start spreading here, too.

Where it stands: There are now cases piling up across Asia and into the Middle East, where it's also spreading locally, even from people who weren't exposed in China. As the virus itself spreads and as American travelers encounter it in more places, the risk of a pandemic rises.

  • Financial markets are already braced for the worst; the S&P 500 fell by 3.4% yesterday as fears of the virus widened.
  • So far, though, there are only about 50 confirmed cases of coronavirus inside the U.S., and most of those people were exposed to the virus abroad.

Yes, but: There may already be more American cases than we know about. The CDC's diagnostic tests for the virus have malfunctioned, and only about a dozen state and local health agencies even have them.

  • The CDC is working on a new one, but in the meantime, the U.S. has only tested some 426 people for the virus.

What's next: The White House is asking Congress for $2.5 billion to combat the virus, though even some Republican senators were unhappy with a briefing yesterday about the federal response, per the Washington Post.

2. Democratic debate topics finally expand

Democrats finally debated health care subjects other than Medicare for All last night.

Details: The candidates were asked how they'd handle issues like rural health care and the coronavirus.

  • Sen. Amy Klobuchar talked about building up the health care workforce in rural areas, while Sen. Bernie Sanders talked up his role in increasing funding for community health centers through the Affordable Care Act.
  • Former Vice President Joe Biden talked about his experience dealing with Ebola and criticized Trump for cutting funding for the CDC.

Why it matters: We have a much wider range of health care problems than political debates usually suggest. Discussing rural Americans' lack of access to health care may not be as exciting as debating whether to do away with private insurance, but it's a subject that many voters struggle with every day.

  • And as the coronavirus is revealing, administrations don't always get to control what dominates their agenda.

Go deeper: Health care's imminent existential crises

3. Walmart's new health care venture

Photo: Joe Raedle/Getty Images

Walmart is looking to expand its role in health care delivery, Bloomberg reports.

Details: Walmart stores already frequently house pharmacies and vision centers, but its new health centers — there are two so far — would offer more comprehensive medical, vision and dental care, along with X-rays and lab tests.

  • Unlike traditional clinics, which are usually staffed by nurse practitioners, the health centers are run by doctors, and patients are seen in exam rooms.
  • Patients are told what their care will cost before they get it, and those prices are often half of what Walmart has estimated they cost elsewhere.

The big picture: If it's successful, the move sets Walmart up to compete against companies like Walgreens and CVS, which have moved into clinics, and could give patients in rural communities more access to care.

4. FDA weighs in on drug shortage risk

I reported over the weekend that the FDA had compiled a list of around 150 drugs that are at risk of shortage if the coronavirus outbreak worsens in China.

Food and Drug Administration commissioner Stephen Hahn tweeted yesterday that "reports referencing a list of 150 drugs susceptible to shortage as a result of #coronavirus" were "incorrect information."

I stand by my reporting, although there are many ways to analyze the data.

  • The FDA said in a statement that it "has identified about 20 drug products, which either solely source their active pharmaceutical ingredients or produce finished drug products from or in China."
  • But that doesn't include the many drugs that have some ingredients made in China, which could also be at risk.
  • No shortages have been reported so far.

What they're saying: "HHS and FDA are proactively modeling various shortage scenarios, including drugs that may not be sole source per se but have a large footprint in the impacted region, and thus could be associated with a future shortage. To plan responsibly, we have to cut the pie many ways," said a senior HHS official who has seen the list of around 150 drugs that I originally reported on.

Between the lines: There's a ton of public interest in the coronavirus, and there's a public health interest in quelling panic. But the fact remains that our drug supply chain is highly reliant on China.

5. Cannabis-based drug is going mainstream

Sales of the epilepsy drug Epidiolex hit almost $300 million in 2019, GW Pharmaceuticals reported Tuesday. Sales are expected to surpass a half-billion dollars this year as the drug gains more insurance coverage in Europe, Axios' Bob Herman writes.

Why it matters: Epidiolex is the first FDA-approved medication made from a substance in cannabis, and it's starting to take off.

Where things stand: Epidiolex got off the ground in 2018, and more doctors started to prescribe the medicine in 2019. Roughly 60% of patients taking Epidiolex are kids who suffer from rare diseases that cause seizures.

  • New launches in Germany, the U.K., France, Spain and Italy will help almost double Epidiolex sales this year, according to Wall Street analysts.
  • It also doesn't hurt that GW Pharmaceuticals raised the list price of Epidiolex by 6% this past January, from $1,235 per 100 milliliter bottle to $1,310 — even though nothing about the drug changed.

Go deeper: Pharma starting to see green with cannabis