Jul 15, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. Thanks to everyone who joined us for yesterday's telehealth event.

Today's word count is 1,417, or a 5-minute read.

1 big thing: Florida's coronavirus outbreak is getting worse
Reproduced from The COVID Tracking Project; Chart: Axios Visuals

Florida is the new domestic epicenter of the coronavirus pandemic, and it's on track to keep getting worse.

By the numbers: Of the 20 U.S. metro areas with the highest daily case growth, nine are in Florida, according to Nephron Research.

Driving the news: The state health department announced 132 new deaths yesterday, the most the state has seen since the pandemic began.

Between the lines: Deaths lag several weeks behind new cases, and cases are skyrocketing.

  • The state on Sunday announced more than 15,000 new cases, shattering the single-day case records in New York and California.
  • Florida now has more confirmed cases, adjusted for population, than New York ever had — although New York's true caseload was almost certainly multiple times higher than its official one.

Zoom in: "Miami is now the epicenter of the pandemic. What we were seeing in Wuhan five or six months ago, now we are there," said Lilian Abbo, an infectious disease specialist at the University of Miami, earlier this week.

  • Orlando, Fort Lauderdale, Fort Myers-Cape Coral, Tampa-St. Petersburg-Clearwater, West Palm Beach-Boca Raton, Sarasota-Bradenton, Jacksonville and Pensacola are also in the top 20 metro areas, as of July 12.

What we're watching: Hospitals are filling up, Disney World is open and the state is imposing minimal social distancing requirements.

  • Democratic Rep. Donna Shalala told Bloomberg that the state should consider a three-week shutdown. "We're in a very difficult situation at the moment, and unless we step back and reset our strategy, a lot more people are going to die."
2. White House tells hospitals to bypass CDC

The Trump administration is cutting the Centers for Disease Control and Prevention out of the process of collecting coronavirus data, the New York Times reports.

Why it matters: The new database will not be open to the public, according to the Times, and comes amid repeated efforts by the Trump administration to sideline the CDC, Axios' Sam Baker writes.

Details: The White House told hospitals to stop reporting key data about their patients to the CDC, and to instead feed it into a new system that will flow directly to the Health and Human Services Department, which oversees the CDC.

  • The change was designed to help the White House's coronavirus task force allocate resources, officials told the Times.
  • But experts said they're worried that the new system will make it harder for people outside the White House to track the pandemic.

Between the lines: Experts told NYT that the CDC's data collection systems are flawed, but some questioned whether the administration's new system would be significantly more efficient, on top of their questions about its transparency.

  • The CDC "will certainly participate" in the new process, but "will simply no longer control it," HHS spokesperson Michael Caputo told the Times.

Context: The CDC is increasingly under fire from the White House and its Republican allies.

3. The latest in the U.S.
Expand chart
Data: The COVID Tracking Project; Map: Andrew Witherspoon/Axios

Healthy volunteers who took Moderna's coronavirus vaccine candidate appeared to generate an immune system response to the virus, and there were "no trial-limiting safety concerns," according to a new study published in the New England Journal of Medicine.

If everyone in the U.S. wore a mask, the coronavirus pandemic could be "under control" within four to eight weeks, Centers for the Disease Control and Prevention director Robert Redfield said in a discussion led by medical journal JAMA on Tuesday.

When asked on Tuesday who the public can trust during the coronavirus pandemic, top infectious disease expert Anthony Fauci said that people "can trust respected medical authorities ... who have a track record of giving information and policy and recommendations based on scientific evidence and good data."

Four former directors of the Centers for Disease Control and Prevention blasted the Trump administration's "repeated efforts to subvert" agency guidelines related to reopening schools, accusing the White House in a scathing Washington Post op-ed of undermining science with "partisan potshots."

The Trump administration announced Tuesday it will be ramping up testing at nursing homes in coronavirus hotspots using rapid point-of-care diagnostic test instruments.

4. The U.K.'s big pandemic flop
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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

One country was easily the best-prepared in the world to respond quickly to and mitigate the spread of an epidemic, according to the 2019 Global Health Security Index: Great Britain.

Reality check: When the coronavirus struck, the U.K. had arguably one of the least effective responses among rich countries, despite decades of preparation for just such an event. Its death toll ranks behind only the U.S. and Brazil, Axios' Dave Lawler writes.

The big picture: Prime Minister Boris Johnson has been heavily criticized for failing to prioritize the virus early on, and his scientific advisers came under fire for initially advising against lockdown.

  • Since then, the government has been criticized for not ramping up testing capacity quickly enough and for its struggles on contact tracing.

Between the lines: The U.K. had years of preparation to call upon, but it could have also looked around the world and learned from best practices elsewhere.

Worth noting: The U.S. was second in the 2019 rankings on rapid response to an epidemic, while Brazil was also in the "most prepared" category.

  • Some countries much farther down the rankings — Uruguay (81), Vietnam (73) — have fared much better.
5. What to do about coronavirus "dumpster fire"

"There's no point in sugar-coating this. The U.S. response to the Covid-19 pandemic is a raging dumpster fire," STAT's Helen Branswell writes.

Why it matters: Not only is it cathartic to copy and paste those words into this newsletter, but Branswell also compiled a list of leading public health experts' suggestions for how to turn things around in the U.S.

What they're saying: The experts agreed that a widespread return to lockdown should be a last resort, and may not be possible. "It would be really a morale breaker," Fauci said.

But in lieu of lockdowns, the experts' suggestions included:

  • Go back to phase 1 of the reopening process, and exercise much more caution. "If we do that, particularly closing the bars, avoiding anything that has a congregation of a large number of people, wearing masks outside essentially all the time, keep distancing ... I would almost guarantee that we would see a turnaround of the resurgence that we're seeing now," Fauci said.
  • Ban indoor activities
  • Give better, more useful information about risks and safety precautions
  • Put infection data to better use
  • Cut out politics
  • Provide more help to vulnerable people
  • Set up more mobile testing sites
  • Beef up contact tracing, with federal support

My thought bubble: None of this sounds prohibitively hard. That doesn't mean we'll do any of it.

6. Coronavirus testing is again overwhelmed
Data: The COVID Tracking Project; Chart: Andrew Witherspoon/Axios

The U.S. is doing almost as much testing as experts had predicted we'd need, and it's still far from enough given our enormous caseload — which the experts hadn't accounted for.

Driving the news: "In light of the ongoing spread of COVID-19 in states across the country, many labs are now receiving more test orders than they are able to process in a single day. We have urged ordering providers to prioritize testing for those most in need, especially hospitalized and symptomatic patients," Julie Khani, president of the American Clinical Laboratory Association, said in a statement yesterday.

The bottom line: That means we're nearly back to where we started in March, when tests were limited to the sickest patients.

  • The point of building up testing capacity wasn't so that we could keep track of how many times states set new caseload records. It was so that we'd have information about the spread of the virus, and then act accordingly to stop it.
  • As cases began to rise last month, we failed to act accordingly.
7. Health care's "COVID quarter" is here

Health care companies will start reporting second-quarter financials in earnest this week, showing how the coronavirus lockdowns and subsequent reopenings affected their businesses, Axios' Bob Herman writes.

The big picture: Revenues almost certainly will be down for most companies, as the virus forced people to stay at home and led to fewer people getting surgeries and going to pharmacies.

  • But that doesn't mean profits were eliminated, and Wall Street has already pumped health care stock prices back to where they were pre-pandemic.

Between the lines: Health insurers stand to profit the most in the quarter because people deferred a lot of care that wasn't related to COVID-19.

  • Insurance companies still collected premiums, but paid out fewer medical claims — which inevitably will lead to higher earnings.
  • However, some insurers have issued premium rebates back to employers and consumers.

What to watch: Whether more companies continue to get large tax breaks that stemmed from federal coronavirus legislation.

  • Tax-exempt, not-for-profit hospitals also were battered in the first quarter by the market's downturn, so it's worth watching how much their sizable investment holdings rebounded.

Go deeper: Follow our health care earnings tracker

Caitlin Owens