Jul 17, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning.

Today's word count is 1,020, or a 4-minute read.

1 big thing: Doctors better at treating coronavirus patients

Illustration: Sarah Grillo/Axios

Doctors and hospitals have learned a lot about how best to treat people infected with the coronavirus in the months since the pandemic began.

Why it matters: Better treatment means fewer deaths and less pain for people who are infected, and research into pharmaceutical treatments is advancing at the same time as hospital care.

The big picture: Some of the simplest changes have been the most effective. For example, doctors have learned that flipping patients onto their stomachs instead of their backs can help increase airflow to the lungs.

  • Providers also now prefer high-flow oxygen over ventilators, despite the early focus on ventilator supply.

Researchers have also discovered new utility in old drugs.

  • Dexamethasone, a cheap steroid used to treat inflammation, has been found to reduce deaths by one-third among patients on ventilators and one-fifth among those on oxygen.
  • Preliminary data has shown that remdesivir, an antiviral, probably doesn't save seriously ill patients' lives, but can help others get out of the hospital a few days earlier.

Between the lines: Hospitals are also able to provide better care when they're not overwhelmed with patients.

  • New York's hospitals were so overwhelmed in the spring that they brought in employees to work well outside of their specialties. In some hospitals' emergency rooms, patient-to-nurse ratios rose to more than 20-to-1, NYT reports — five times the recommended ratio.

What we're watching: These advances in treatment protocols will only go so far, especially if hospitals in states like Florida, Arizona and Texas become too full to put them into practice.

  • In states with rising case counts, "I think you're going to see mortality rates increase there because of that phenomenon of hospitals being unable to deliver optimal care, because they don’t have the staffing," said James Lawler, an infectious disease specialist at the University of Nebraska Medical Center.

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2. The risk of loneliness, trauma from COVID-19

Illustration: Sarah Grillo/Axios

The coronavirus that's packing people in hospitals as they grapple with sometimes life-threatening complications is leading to another problem for some survivors: mental health issues, Axios' Eileen Drage O'Reilly reports.

What's happening: Many hospitals require adult patients to enter without family. Their stress, loneliness and fear, sometimes magnified by invasive treatment procedures, place them at a high risk for disorders such as PTSD, some medical experts say.

Loneliness can affect all of us during a pandemic, as many people stay physically distant from each other and more than 36 million Americans live by themselves.

  • But the situation is different for COVID-19 patients. With the exception of giving birth, many hospitals don't allow adults to bring a support person due to fears of infection and a limited supply of personal protective equipment.
  • Not only is it stressful to be diagnosed with a new disease with minimal treatment options, but the virus itself can affect the brain, including psychiatric and neurological complications.

Some COVID-19 survivors may experience PTSD, which can last for years without treatment.

  • Most people feel anxiety with the uncertainty of COVID-19, but some experience PTSD due to trauma and a "threat to life or threat to physical integrity," says Anthony King, professor of psychiatry and psychology at the University of Michigan.

The big picture: Research has shown many ICU survivors experience trauma, particularly with procedures like intubation.

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

Georgia Gov. Brian Kemp's (R) office filed a lawsuit Thursday in an effort to block Atlanta Mayor Keisha Lance Bottoms from enforcing a citywide mask mandate.

Sen. Dianne Feinstein (D-Calif.) said in a statement Thursday that she will introduce an amendment to the Senate's next coronavirus stimulus bill that would withhold federal relief funds from states that do not require people to wear masks in public.

Florida on Thursday reported 13,965 new coronavirus cases and 156 deaths — breaking the state's previous record for highest single-day death toll since the start of the pandemic.

Arkansas Gov. Asa Hutchinson (R) and Colorado Gov. Jared Polis (D) issued orders on Thursday requiring people statewide to wear masks in public.

Hackers associated with Russian intelligence services are trying to steal information from researchers involved in coronavirus vaccine development, according to a joint advisory by U.K., U.S. and Canadian authorities published Thursday.

4. The latest worldwide
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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

Nearly one-quarter of all coronavirus cases recorded to date came in the first 15 days of July, when 3.1 million were tallied worldwide, Axios' Dave Lawler reports.

Breaking it down: Compare that to 2.4 million over the prior 15 days, or 1.8 million in the 15 days before that.

  • Two-thirds of the cases recorded worldwide yesterday came in the U.S. (60,711), Brazil (41,857), India (32,695) and South Africa (12,757).
  • Testing rates are increasing in some countries, but still vary incredibly widely.

The flipside: While case counts continue to rise, the global death rate has been relatively flat in recent weeks and is still well below April's peak.

  • At that time, the U.S. and a number of European countries were recording far more deaths than they are now.
  • While India is approaching 1 million cases — four times the number recorded in Spain — its 24,915 deaths are actually below Spain's total.

What to watch: Ashish Jha, director of the Harvard Institute of Public Health, told the BBC World Service he expects single-day tallies of over 1 million cases before the pandemic is over.

5. How cities can come back stronger

Illustration: Annelise Capossela/Axios

Cities ravaged by the coronavirus pandemic have a chance to come back stronger — and more equitable — than they were before, if they're willing to get creative in the way they think about budgeting, public services and infrastructure, Axios' Kim Hart reports.

Why it matters: Making smart decisions now can help build more equitable, livable cities that will also be better equipped to weather public health crises. But if local leaders simply default to old habits, they'll entrench inequities that the pandemic has exploited and made worse.

The big picture: Building the right priorities into local recovery efforts can help even cash-strapped cities empower vulnerable residents and build more resilient economies — but they need to move quickly. Here's what the experts recommend.

  1. Jump-start projects with diverse benefits that do several things at once, according to a roadmap by HR&A, an urban and community development consulting firm.
  2. Green investments create both jobs and more resilient infrastructure. Among the recommendations in a C40 Cities report from mayors of many of the world's biggest cities.
  3. Removing real estate restrictions would make it easier to repurpose vacant buildings and storefronts, per a report by the Manhattan Institute detailing recommendations for revamping New York City's obsolete zoning practices.

Go deeper.

Caitlin Owens