Mar 18, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning.

Axios will be hosting a live virtual event Thursday, March 19, on the coronavirus and pandemic preparedness. Join us at 9am ET live for this in-depth discussion that will cover the impact of the crisis. 

Situational awareness: "Hospital workers in Washington state have been making protective medical gear out of office supplies and other run-of-the-mill materials," Bloomberg reports.

Today's word count is a record-setting 1,686, or a 6-minute read.

  • Read to the end for what I hope is a nice respite from the news.
1 big thing: Multiple medical shortages threaten coronavirus response

Illustration: Aïda Amer/Axios

Experts and lawmakers are beginning to call for extraordinary measures to alleviate medical shortages that could cripple the U.S. response to the coronavirus.

Why it matters: These shortages affect both testing and treatment, and if they persist, could also thin the ranks of health care workers able to help treat coronavirus patients. And the only solution may be for the federal government to get involved.

Driving the news: Invoking the Defense Production Act was on a list of options included in a 100-page federal government coronavirus response plan, dated from Friday, reported on by the New York Times last night.

  • The law, passed in 1950, gives the president enormous power to force American manufacturers to produce critical supplies.

What they're saying: Some lawmakers at the federal and local level had already called for the federal government to increase its manufacturing capacity.

  • Mark Levin, chair of the New York City Council's health committee, tweeted yesterday that he's "BEGGING, PLEADING that the fed gov't mobilize production and distribution of medical supplies and equipment."

Where it stands: The U.S. is likely to face several key shortages in even a moderate outbreak.

  • Labs will need more of some key ingredients for diagnostic tests, including RNA-extraction kits, reagents and swabs. Staying on top of testing is essential to ultimately controlling the outbreak.
  • States are already sounding the alarm over inadequate supplies of protective gear, such as masks, gloves and gowns, for health care workers.
  • "If we run out of those, we're hosed. Because then doctors and nurses are going to have a choice between not caring for a sick patient, and putting themselves at risk," said Ashish Jha, the director of Harvard's Global Health Institute.
  • Ventilators are also in short supply. We have about 62,000, and only a limited ability to tap other supplies.
2. The toll on our mental and emotional health
Data: Axios/Ipsos survey of 1,092 U.S. adults, conducted March 13-16, 2020. Margin of error of ±3.2 percentage points; Chart: Axios Visuals

The threat of a coronavirus outbreak started to weigh on Americans' mental and emotional health even before they began to embrace the most important preventive measures, according to a new polling partnership between Axios and Ipsos.

Why it matters: Several more weeks of social distancing, including school closures and widespread shutdowns of public spaces, while the outbreak itself continues to grow, will only make that existential toll grow larger, Axios' Sam Baker writes.

By the numbers: This national survey of 1,092 adults was conducted March 13–16 — a tipping-point period in which dire official warnings and tight new restrictions heightened awareness of just how bad the pandemic could be.

  • Just 8% of the people in our survey said their physical health had gotten worse over the preceding week, but 22% said their mental health had taken a hit and 29% said their emotional well-being had gotten worse.
  • Nearly 80% said they’re concerned about the coronavirus.

Between the lines: Public-health measures to slow the virus seemed to be gaining a foothold in this period, but were not yet universal.

  • 64% said they had stopped shaking hands in the past week, but 53% said they had not canceled or skipped large gatherings.

What's next: This is the first installment in a new project — the Axios-Ipsos Coronavirus Index. It will be a weekly barometer of how the pandemic is affecting Americans' health, finances, trust and quality of life. So stay tuned for more.

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

The Trump administration is slow to engage key agencies like the U.S. Army Corps of Engineers, other parts of the Defense Department, the Federal Emergency Management Agency and the Department of Veterans Affairs, NYT reports.

Treasury Secretary Steven Mnuchin said Tuesday that the administration is discussing sending checks to Americans "immediately" to help cushion the economic impact of the coronavirus outbreak.

Democratic National Committee chairman Tom Perez on Tuesday advised states to expand mail-in and early-voting options amid the novel coronavirus outbreak, The Hill reports.

The hotel industry is asking the federal government for $150 billion in emergency aid, mostly to keep employees on the payroll until the novel coronavirus threat subsides and travelers are ready to hit the road again.

New York City Mayor Bill de Blasio said Tuesday that a decision will be made within the next 48 hours on whether to order the city's more than 8 million citizens to shelter in place amid the ongoing coronavirus outbreak.

New York Gov. Andrew Cuomo and New York Attorney General Letitia James announced Tuesday that the state will freeze student, medical and other state-referred debt payments for at least 30 days to ease financial burdens caused by COVID-19.

The Trump administration is asking construction companies to donate their inventories of face masks to local hospitals and forgo ordering more due to a global shortage in response to the novel coronavirus.

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.

China's successful fight against the coronavirus has exacerbated a pre-existing crisis of confidence in Western democracies. But many of China's measures to combat the coronavirus aren't authoritarian; they are the kind of total social mobilization that happens during war, Axios' Bethany Allen-Ebrahimian writes.

Coronavirus isn't just wreaking havoc on our health, livelihoods and economies, it's now poised to feed Middle East unrest and, possibly, terrorism, Axios' Amy Harder reports.

The novel coronavirus stays viable in the air for several hours and can last on surfaces from hours to days, depending on the material, according to a study published Tuesday in the New England Journal of Medicine.

A startling new report from Imperial College London warns that 2.2 million Americans and 510,000 Britons could die from coronavirus if extreme action isn't taken to change the course of the outbreak. The report's dire warnings prompted a quick course correction from both the American and British governments on their strategies.

5. U.S. doesn't have enough hospital beds either

It's not just medical supplies that are in short supply: Every corner of the U.S. is at risk for a severe shortage of hospital beds as the coronavirus outbreak worsens, according to new simulations from Harvard, mapped out by ProPublica and the New York Times.

Why it matters: Total nationwide capacity for health care supplies doesn't always matter, because hospitals in one area can help out neighboring systems when they're overwhelmed by a crisis. But these projections indicate that won't be an option with the coronavirus — everybody will be hurting at the same time, Axios' Bob Herman writes.

By the numbers: Harvard's projections show if 50% of all currently occupied hospital beds were emptied and sizable percentages of Americans were infected, the country would need at least three times more beds to care for everyone.

  • "No market would be spared," Harvard's Jha wrote.

Those models line up with James Lawler, an infectious disease doctor at the University of Nebraska Medical Center who forecast in a recent presentation to hospital insiders that the U.S. may eventually have as many as 96 million cases, resulting in 4.8 million hospitalizations. He told Axios he stands by those projections.

  • The U.S. has 924,000 total hospital beds, or less than three beds for every 1,000 people. Roughly 5% of those beds are in standard intensive care units, where the sickest coronavirus patients would need to go.

Go deeper: The coronavirus crisis has to focus on "flattening the curve"

6. CMS issues new telehealth flexibility

Medicare said yesterday that it will temporarily pay providers for a much broader range of telehealth services.

Why it matters: This will allow seniors — who are particularly vulnerable to the coronavirus — to avoid going to hospitals or doctors offices for routine care that can be provided virtually. This in turn reduces their exposure to the virus.

What they're saying: "It's not clear how comfortable older adults are with telehealth, but if they are, and their doctors are on board, this seems like a smart way to keep patients connected to their doctors, without exposing themselves or others to greater risk," the Kaiser Family Foundation's Tricia Neuman said.

  • Yes, but: "There are obvious limits to telehealth for patients when more extensive work ups are needed for diagnosis, or for monitoring conditions, or when patients need in-office procedures, or surgery," Neuman added.
7. A coronavirus vaccine is still a long way away

Illustration: Sarah Grillo/Axios

Moderna has moved incredibly quickly to begin testing a potential vaccine for the new coronavirus in U.S. patients. The biotech company went from taking the genetic sequence of the new coronavirus to manufacturing its first batch of vials in less than a month, Bob writes.

Reality check: Best-case scenario, a vaccine could be ready for production by next year — but that's assuming the drug proves to be both safe and effective, which is completely unknown right now.

What they're saying: Bob and Axios' Dan Primack spoke with Moderna CEO Stéphane Bancel to understand the timing of this very fluid situation.

  • After this phase 1 trial and a potential phase 2 trial over the summer, Bancel believes the vaccine can begin a phase 3 trial by this fall.
  • A phase 3 trial would enroll at least 3,000 people, and if data shows the vaccine is safe and effective for that sample, the FDA could approve it.
  • Anthony Fauci of the NIH has said it's a possibility there could be a novel coronavirus vaccine in 2021, "and I would agree with that," Bancel said.

Yes, but: There's no data yet. It's a scientific feat to get to this stage so quickly, but that will matter a lot less if the vaccine doesn't work well or if people suffer serious side effects.

8. Vitals readers' silver linings

I don't think this newsletter has ever had an eighth item before, but your responses were all too good not to share. I've selected a few here that are hopefully relatable to a few different groups of people:

  • "After lunch I take my kids ... to our backyard for a soccer match. It is just the three of us .... So, when there is a tie, I am the ref. When a kid is up, I join the underdog’s team. We play to 10 .... It isn’t so bad if you ask me. Childhood is short."
  • "I know a number of people experiencing the return of their young adult children who have moved to other cities to take jobs, but are now returning home as their offices and schools close and they need to self-isolate somewhere comfortable and comforting ... these COVID refugees are being welcomed with open arms!"
  • In January, "I started a virtual 22 Week beginners running challenge .... As COVID-19 developed, my online group has been sharing what our lives are like ... Running is keeping us sane .... It is a social distancing victory that ironically is deepening social connection."
  • "When my 30-something children put their babies to bed for the night, we all go on zoom and play charades (have it show on your TV) which is even more hilarious done this way .... I read books to my granddaughters for 1/2 hour over Facetime (ages 3 and 1) to give their parents a moment of respite."

What's next: Keep sending these in, and I'll keep sharing some of them!

Caitlin Owens