Apr 10, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning.

Today's word count is 1,326, or a 5-minute read.

1 big thing: We can't just flip the switch on the coronavirus

Illustration: Sarah Grillo/Axios

It feels like some big, terrible switch got flipped when the coronavirus upended our lives — so it's natural to want to simply flip it back. But that is not how the return to normalcy will go, Axios' Sam Baker reports.

The big picture: Even as the number of illnesses and deaths in the U.S. start to fall and we start to think about leaving the house again, the way forward will likely be slow and uneven.

  • This may feel like it all happened suddenly, but it won't end that way.

What's next: Nationally, the number of coronavirus deaths in the U.S. is projected to hit its peak within the next few days. But many big cities will see their own peaks significantly later — for them, the worst is yet to come.

  • The White House is eyeing May 1 as the time to begin gradually reopening the economy. But that also will not be a single nationwide undertaking, and it will be a halting process even in the places where it can start to happen soon.
  • "In principle it sounds very nice, and everyone wants to return to normalcy. I think in reality it has to be incredibly carefully managed," said Claire Standley, an infectious-disease expert at Georgetown University.

The future will come in waves — waves of recovery, waves of more bad news, and waves of returning to some semblance of normal life.

  • "It's going to be a gradual evolution back to something that approximates our normal lives," former Food and Drug Administration commissioner Scott Gottlieb said.
  • And there will be more waves of infection, even in areas that have passed their peaks.

The real turning point won't come until there's a proven, widely available treatment or, even better, a widely available vaccine.

Read the story.

Go deeper: Automakers lay out back-to-work playbook for a pandemic

2. The coronavirus is pinching labs

Commercial labs are in a precarious financial position, as the overwhelming demand for coronavirus tests is not close to making up the revenue of other tests that aren't being ordered, Axios' Bob Herman reports.

Why it matters: Commercial labs are anchoring coronavirus testing, and testing remains paramount to mitigating the spread of the coronavirus.

By the numbers: The U.S. is testing about 150,000 people a day, but that testing capacity has barely expanded in April.

  • Hospitals have partially stymied the effort to increase capacity, Nature reported.
  • Large commercial labs, like Quest Diagnostics and LabCorp, also have major backlogs that have slowed test results.

What they're saying: The surging coronavirus demand is pinching them at a time when other revenue is drying up.

  • "During the last two weeks of March, volumes declined in excess of 40% inclusive of COVID-19 testing," Quest said in a financial filing.
  • The second quarter, which runs from April through June, will be "the worst quarter in lab history," analysts at Robert W. Baird said in an investor note.
  • Labs continue to call for their own bailout so they can ramp up testing. They didn't get one in the most recent stimulus package.

Yes, but: Labs won other sought-after policies, like deferred Medicare cuts, and billions of lab dollars have been squandered on stock buybacks.

  • Quest has repurchased $3.1 billion of its own stock since 2013, and LabCorp's stock buybacks have totaled $1.5 billion since 2015. Both companies also have a combined $2 billion remaining for stock buybacks.
3. The latest in the U.S.
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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios

Roughly 16 million Americans have filed for jobless benefits over the past three weeks due to the pandemic's growing economic repercussions.

  • 6.6 million Americans filed for unemployment last week, the Labor Department announced Thursday.

Hospitals, doctors' offices, suppliers and other health care facilities have now received $51 billion in "advance payments" from Medicare, the Centers for Medicare & Medicaid Services said Thursday.

Investors expect the earnings season that kicks off on Tuesday to be ugly, Axios' Courtenay Brown reports.

The U.S. has expelled more than 6,000 migrants using new powers enabling the federal government to almost immediately turn back border-crossers under the Centers for Disease Control and Prevention emergency public health order that went into effect on March 21, according to new Customs and Border Protection data.

799 people died from the coronavirus in New York over the past 24 hours, a record high for the third straight day that brings the state's total death toll to 7,067.

The Federal Reserve announced Thursday that it will support the coronavirus-hit economy with up to $2.3 trillion in loans to businesses, state and city governments — made possible in part by Treasury funds set aside in the government stimulus package.

Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told NBC's "Today" on Thursday that he's hopeful that social-distancing measures in place across the U.S. will reduce the total number of coronavirus deaths.

4. The latest worldwide
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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.

As the coronavirus spread beyond China, some of the earliest outbreaks were traced to religious services or pilgrimages, Axios' Dave Lawler reports.

OPEC+, led by mega-producers Saudi Arabia and Russia, reached a tentative agreement Thursday to impose large cuts in oil production as the coronavirus pandemic fuels an unprecedented collapse in demand, per Bloomberg and Reuters.

Europeans and Americans are desperate to move beyond the worst of the crisis and return to something approximating normality, but the World Health Organization is cautioning that moving too fast will undermine the sacrifices made so far.

U.K. Prime Minister Boris Johnson has been moved out of intensive care, but is continuing to be monitored at St. Thomas' Hospital in London, according to a Downing Street spokesperson.

Angela Merkel has managed to unify Germany during the coronavirus crisis, but her response is proving far more divisive at the EU level.

Coronavirus lockdowns have led to a decline in murders in some of the world's most violent countries, the Los Angeles Times reports.

5. The FDA's about-face on testing

In terms of regulatory flexibility, the Food and Drug Administration's approach to coronavirus antibody testing is a 180-degree turn from its approach to diagnostic testing.

The big picture: The antibody tests, also known as serological tests, essentially detect whether someone's immune system has reacted to the coronavirus, helping determine whether they have had it — regardless of whether they had symptoms.

  • The tests will help determine how widespread the coronavirus outbreak has been, something currently unknown because of diagnostic testing failures.

By the numbers: Only one test has received an emergency use authorization from the FDA , but more than 80 test developers have notified the agency that they have non-authorized tests available for use, which is allowed.

  • The agency eventually adopted a similarly flexible approach to diagnostic tests.
  • But the Trump administration has been widely criticized for its early decisions to rely on tests made by the Centers for Disease Control and Prevention, and for being slow to allow commercial and academic labs to participate.

Yes, but: The FDA's rationale for keeping a close hold on who was making coronavirus tests was that it was important for the tests to be accurate.

  • Scott Becker, executive director of the Association of Public Health Laboratories, has raised concerns about questionable serological tests that have appeared on the market, and has voiced these concerns about the "wild, wild West" environment to the administration, per the Washington Post.
6. Biden's new Medicare-for-more proposal

Former Vice President Joe Biden yesterday proposed lowering the Medicare eligibility age from 65 to 60.

  • Older Americans without employer-based coverage would be the biggest winners, because they often have to pay a lot on the individual market.
  • It's unclear how many people with employer coverage would opt into Medicare instead.

What they're saying: "This could be the start of a gradual expansion of Medicare, sort of 'Medicare for more' rather than Medicare for All," the Kaiser Family Foundation's Larry Levitt told me. "There is clear symbolic importance to this proposal, since it establishes Medicare as the mechanism for expanding coverage."

The big picture: Biden's health care plan would have already allowed Americans 60 and older to choose coverage from a public option.

  • While the updated policy is a nod to Sen. Bernie Sanders' Medicare for All push, it's still fundamentally coherent with Biden's position that people should still have the option of buying private insurance.
7. How the U.S. fell behind on the coronavirus

Illustration: Aïda Amer/Axios

Early missteps allowed the novel coronavirus to spread throughout the U.S for weeks before state and local officials implemented strict lockdowns designed to keep the pandemic from spinning further out of control.

Why it matters: The U.S. missed the boat on the kind of swift, early response that would have been most effective, and has been scrambling to catch up ever since.

  • Axios' Marisa Fernandez has compiled a timeline from official sources as well as media reports, which shows how that all-important time was lost.

Read the timeline.

Caitlin Owens