Sep 30, 2020

Axios Vitals

Well, the first debate between President Trump and Joe Biden is over, and it was painful.

  • The big picture: I didn't learn anything new about either candidate's health care positions, and I doubt most Vitals readers did either. I am not going to waste your time by rehashing it here.

Today's word count: 987, or a 4-minute read.

1 big thing: The coronavirus' alarming impact on the body

Illustration: Eniola Odetunde/Axios

Scientists are racing to learn more about the damage the novel coronavirus can do to the heart, lungs and brain.

Why it matters: It's becoming increasingly clear that some patients struggle with its health consequences — and costs — far longer than a few weeks.

The big picture: The virus can have a severe impact on the lungs, as you might expect. Pneumonia associated with the disease can damage air sacs in the lungs, and the resulting scar tissue can cause long-term breathing problems.

  • But researchers conducting autopsies have also found evidence of the virus in parts of the brain, kidneys, gastrointestinal tract and in the cells that line blood vessels, the Washington Post has reported. They've also found clotting in many organs.

One of the most attention-grabbing effects of the virus is its link to myocarditis, particularly because of concerns about the dangers the heart disease poses to athletes.

  • One particularly alarming study, conducted in Germany, found that 78% of people who had recovered from the coronavirus had heart abnormalities that could be detected on an MRI two months later, including many who hadn’t been hospitalized. Around 60% had signs of myocarditis.
  • But it's hard to attach meaning to these findings yet, as The Atlantic's Ed Yong recently reported. Many people have myocarditis and are fine; others can have severe complications, including health failure and death.

Coronavirus patients frequently report neurological symptoms — including scary ones like stroke, brain hemorrhage and memory loss — and a recent study found evidence that the virus can invade brain cells, the New York Times writes. The study hadn't yet been peer-reviewed.

Between the lines: It's unclear whether the virus itself causes organ damage, or whether it's a result of the body's immune response — or both.

Go deeper.

2. CDC director overruled on cruise ship ban

Robert Redfield, the director of the Centers for Disease Control and Prevention, was overruled when he pushed to extend a "no-sail order" on passenger cruises into next year, according to two sources with direct knowledge of the conversation yesterday in the White House Situation Room, Axios' Jonathan Swan reports.

Why it matters: Cruise ships were the sites of some of the most severe early coronavirus outbreaks, before the industry shut down in March. And their future is just the latest disagreement between Redfield and members of President Trump's team.

The undermining of Redfield has been the source of much consternation among public health officials inside the administration, who argue that a politically motivated White House is ignoring the science and pushing too aggressively to reopen the economy and encourage large gatherings.

  • Public health officials have privately complained that the thwarting of Redfield on the cruise ship ban is politically motivated because the industry is a major economic presence in Florida — a key battleground state where the polls are statistically tied.

The other side: White House deputy press secretary Brian Morgenstern rejected the officials' complaints that election year politics influenced the cruise ship decision.

  • "The president, the vice president and the task force follow the science and data to implement policies that protect the public health and also facilitate the safe reopening of our country," he said. "It is not about politics. It is about saving lives."
  • The CDC did not respond to requests for comment.

Go deeper.

3. Drugs aren't driving U.S. health spending
Reproduced from Kaiser Family Foundation; Chart: Axios Visuals

Voters care a lot about drug prices, but they're not the main reason the U.S. spends so much on health care, the Kaiser Family Foundation's Drew Altman writes in today's column.

The big picture: The U.S. spends twice as much per person as other wealthy nations, according to a new Peterson-Kaiser Tracker analysis — and hospitals and outpatient care are the primary culprits.

By the numbers: The U.S. spent $10,637 per capita on health care in 2018. Comparable countries spent $5,527.

  • The overwhelming majority of the difference — 76% of it — came from spending on inpatient and outpatient care — not drugs, which get more attention but represent just 10% of the difference.

Why it matters: Cutting hospital spending is hard to do without causing real pain, and that has made it politically risky, as well.

  • A public option, like that proposed by Joe Biden, would put pressure on hospital prices. The intensity of that pressure would depend on the plan's payment level and how many people it covers, which would affect its purchasing power.
  • A single-payer health plan would have even more leverage, though universal coverage — not price controls — is usually its supporters' primary focus.

What we're watching: President Trump has set out new price transparency rules for hospitals, though its likely impact on costs is unclear and the industry has challenged it in court.

4. We're drinking more alcohol than in 2019

Illustration: Sarah Grillo/Axios

Americans reported drinking alcohol more frequently and in higher quantities since last year, according to a study published in JAMA.

Why it matters: Excessive alcohol consumption may cause or worsen mental health problems, such as anxiety or depression. Experts have also warned the stress of the pandemic has fomented alcohol and drug abuse, Axios' Marisa Fernandez writes.

By the numbers: The greatest changes were among women and people 30 to 59 years old.

  • On average, alcohol was consumed one day more per month by three of four adults.
  • Frequency of alcohol consumption for women increased by 17%. Heavy drinking among women — four or more drinks within a few hours — spiked 41% since 2019.
  • Adults aged 30 to 59 years increased their drinking by 19% since last year.
5. Catch up quick

Illustration: Aïda Amer/Axios

Seven former FDA commissioners accused the Trump administration of "undermining the credibility" of the agency in a Washington Post op-ed published Tuesday.

All people traveling through the Tampa International Airport will be able to get a coronavirus test on the premises starting Oct. 1, TPA and BayCare Health System representatives announced Tuesday.

Postponed vacations, holidays in isolation and back-to-back virtual meetings are taking a toll on millions of American workers. As we head into the fall, workers are feeling the burnout, Axios' Erica Pandey reports.

The U.K. reached a new high for total positive coronavirus cases this last week, per the country's Health Ministry, and reported a record number of COVID-19 infections in the last 24 hours, per the BBC.

The NFL announced Tuesday that three players and five staffers from the Tennessee Titans tested positive for coronavirus, forcing the temporary closure of the team's facility, ESPN reports.

New York City's coronavirus positivity rate has ticked up to 3.25%, its highest since June, Mayor Bill de Blasio said at a news conference on Tuesday.