Nov 5, 2020

Axios Vitals

Good morning. I am thrilled to announce that we can all get back to the REAL drama tonight, when Clare may finally get the boot on "The Bachelorette."

  • I am going to set a personal record for how much television I can watch in one week.

Today's word count is 1,416, or a 5-minute read.

1 big thing: Coronavirus cases are rising in 35 states
Expand chart
Data: The COVID Tracking Project, state health departments; Map: Andrew Witherspoon, Sara Wise/Axios

New coronavirus infections surged by roughly 20% over the past week as cases continued to climb in every region of the country, Axios' Sam Baker and Andrew Witherspoon report.

Why it matters: All signs indicate that the pandemic will keep getting worse throughout the winter, making it harder and harder to eventually control — even if there's a new president, and even with a vaccine.

By the numbers: Over the past seven days, the U.S. averaged about 85,000 new cases per day. That's a 20% increase from the week before, and it's the highest caseload of the entire pandemic.

  • Cases rose in 35 states, held steady in 10 and declined in just five.
  • The pandemic continued to get worse in almost every critical swing state as Election Day approached. The number of new infections rose over the past week by 14% in Wisconsin, 16% in Florida, 21% in Pennsylvania, 37% in Ohio and 56% in Michigan.

Testing improved over the same period. The U.S. is now conducting over 1.2 million tests per day. That's a 5% increase over the week before — hardly enough to explain the much larger surge in cases.

What we're watching: Hospitalizations are also on the rise nationwide, prompting renewed fears in some pockets of the country that local hospital capacity won't be able to handle the rising tide of the pandemic.

  • Most experts believe the virus will continue to gain a bigger and bigger foothold over the winter, killing thousands of people.

What's next: Joe Biden has vowed to change America's course in the pandemic, if he wins the presidency.

  • But the outbreak will likely be so much worse by Inauguration Day, and politically motivated resistance to public health measures is already so deeply entrenched, that a vaccine may be the only real way to accomplish that.
2. We're stuck in pandemic limbo
Data: Covid Tracking Project; Chart: Axios Visuals

I wrote yesterday about what Biden could do about the pandemic if elected president. But if he pulls off a win, that's still two and a half months from now, and the virus is raging.

  • The U.S. reported 103,087 new daily coronavirus infections yesterday — a new single-day record for cases, according to data from the COVID Tracking Project.

What they're saying: "The question now is whether leaders in hard hit areas who have favored a light touch will implement more aggressive covid control measures now that Election Day has passed," Johns Hopkins' Caitlin Rivers tweeted yesterday.

  • For now, President Trump is insisting that the country is "rounding the corner" on the pandemic and ignoring the advice of most scientists and public health experts.
  • "Trump is not in charge. He's given up, he has basically implied, 'I don't care about this' and he has turned it over to the governors," Carlos del Rio, an infectious disease expert at Emory University, told NYT.

What we're watching: How bad things can get before something has to change, especially in the parts of the country most resistant to mask wearing and social distancing measures.

3. Europe's grim lesson about lockdowns

European leaders are learning that the longer you wait to address the coronavirus, the harsher the mitigation measures to address an exponentially growing caseload must be.

Driving the news: Much of Italy will be placed under a strict lockdown as of Friday in the most drastic steps the country has taken to fight the coronavirus since it led the world into lockdown nearly eight months ago, Axios' Dave Lawler reports.

  • Italy managed to keep the spread of the virus largely under control for months after a brutal first wave. But like much of Europe, it's currently recording unprecedented daily case counts and scrambling to avoid a return to overcrowded hospitals and climbing death tolls in the coming weeks.
  • Prime Minister Giuseppe Conte announced that the strictest policies would be implemented in four regions rather than nationwide.

England's second lockdown begins today, which Prime Minister Boris Johnson told Parliament was the only option for avoiding a "medical and moral disaster."

  • Johnson had previously resisted taking such drastic action, "rejecting calls from scientists who advise the government, and from the opposition Labour Party, for an earlier but shorter lockdown," per the NYT.

The bottom line: "Europe is a great cautionary tale" for the month ahead in the U.S., Brown's Ashish Jha told me earlier this week.

  • An outbreak can't be controlled overnight, and the longer it's left alone, the more intense the policy responses are that would be required to control it.
4. Health care still loves a divided Congress
Data:; Chart: Andrew Witherspoon/Axios

Health care stocks skyrocketed after Tuesday's election results indicated Republicans likely will maintain control of the Senate, all but assuring continued gridlock in both chambers of Congress, Axios' Bob Herman reports.

The big picture: A Republican Senate means "the public option and direct government negotiation on drug prices are dead for at least the next two years," Spencer Perlman, an analyst at Veda Partners, wrote to investors Wednesday.

The winners: Health insurance companies, pharmaceutical companies and medical device firms scored the biggest stock gains.

  • The status quo has been lucrative for pretty much every sector of the health care industry, and the prospect of no major federal reform under Biden or President Trump would insulate employer coverage, which is the ultimate pot of gold.

Yes, but: The Supreme Court is about to hear a case that could invalidate the Affordable Care Act. If the conservative majority strikes down the entire law, the industry would face considerable upheaval after spending the past decade incorporating the law into their businesses.

  • Hospitals would be most affected by the Supreme Court invalidating the ACA: Millions of people would lose Medicaid and individual health coverage, resulting in more uncompensated care. Stocks of hospital companies like HCA Healthcare and Tenet Healthcare were down Wednesday.

Flashback: This same health care stock surge happened after the 2018 midterms guaranteed congressional gridlock.

5. New challenges for those who are homeless

Illustration: Eniola Odetunde/Axios

The challenge of helping people experiencing homelessness during the pandemic has spurred some cities to action and prompted bitter divisions in others, as shelters struggle with the new challenges of adhering to the CDC's social distancing, PPE and sanitary guidelines.

Why it matters: Some cities have tried new ways to help, such as buying up vacant hotels, apartments and other buildings to use as housing. Some feel grief as outdoor homeless encampments grow, Axios' Jennifer Kingson reports.

  • And a triple threat — the advent of cold weather, new spikes in coronavirus cases, and the lifting of evictions moratoriums — is looming.

The backstory: Nobody knows whether the national homeless population is rising or falling in 2020, since the annual point-in-time count is conducted by HUD on a single night in January and thus doesn't capture what's happened during the pandemic.

  • The current situation differs vastly from one place to another.
  • Early in the pandemic, people feared that COVID-19 would travel rapidly through homeless populations. But that hasn't played out as feared, in part because communities have implemented the CDC's guidelines and tried to move people experiencing homelessness from shelters to hotels or other dwellings.

The bottom line: The dynamics will shift again this winter.

  • "There's a tidal wave of evictions coming at us, and it's going to produce some homelessness for sure," Linda Gibbs, a principal at Bloomberg Associates and former deputy mayor for health and human services in New York City, tells Axios.

Go deeper.

6. Air pollution connected to higher death rates

A new study of more than 3,000 counties in the U.S. finds a correlation between higher levels of particulate air pollution and higher death rates from COVID-19, Axios' Bryan Walsh reports.

Why it matters: COVID-19 may be caused by the novel coronavirus, but the outcome of an infection is influenced by everything from age to race to the environment. Understanding the connection between disease and pollution can help us address those risks going forward.

By the numbers: In a study published yesterday in Science Advances, researchers from the Harvard T.H. Chan School of Public Health found every increase of one microgram of fine-particle air pollutants at the county level was associated with an 11% increase in that county's COVID-19 mortality rate.

  • That result echoes earlier preprint research by the same team from the earliest weeks of the pandemic showing that air pollution was connected to worse outcomes from COVID-19.

The catch: The researchers caution that because individual-level data on COVID-19 outcomes for large, representative populations doesn't yet exist, it's difficult to be certain that air pollution is connected to coronavirus deaths.

  • People who live in areas with high levels of air pollution are also more likely to be poor and Black — two factors also associated with higher levels of COVID-19 death rates.

The bottom line: We now understand the novel coronavirus can be airborne, and so are the air pollutants that appear to make the disease that much worse.

Don't forget to submit your dogs!