Apr 1, 2020

Axios Vitals

Good morning.

Axios will be hosting a live virtual event on how the private sector can contribute to social good in the midst of a global pandemic. Join us Friday, April 3, at 12:30pm ET live for this in-depth discussion featuring Dallas Mavericks owner Mark Cuban, Michigan Gov. Gretchen Whitmer, and Edelman U.S. CEO Richard Edelman.

Today's word count is 1,339, or a 5-minute read.

1 big thing: Medicaid will be a coronavirus lifeline

Illustration: Sarah Grillo/Axios

Medicaid will be a lifeline for droves of Americans affected by the coronavirus pandemic, Axios' Bob Herman reports.

Why it matters: Medicaid has long been the safety net that catches people during hard times, but a crisis of this magnitude will call upon the program — and strain states' budgets — like never before.

The big picture: Millions of people have already filed for unemployment amid the coronavirus-induced economic shutdown, and many of them will end up on Medicaid.

  • The program will pick up many people who lost their income and their health insurance together, as well as people who lost jobs that didn't provide health insurance, and potentially some people who are still working and need medical care but aren't insured.
  • Medicaid is not the only option, but it's the biggest one.

The intrigue: Partially due to the ACA, hospitals and health centers can sign up uninsured patients for Medicaid on the spot if they think those patients are likely to be eligible.

  • As medical providers start to see influxes of coronavirus patients, some percentage of those patients may get added to the Medicaid rolls.

Yes, but: This surge in Medicaid enrollment could create big financial problems for states.

  • The federal government pays most of the costs, but states are obligated to balance their budgets.
  • States fund their share of the program through tax revenues that are disappearing as the economy shutters — and at the same time, Medicaid spending will increase as more people enroll.
  • Congress has already chipped in to cover more of the program's costs during this crisis, but experts agree states will need a lot more federal help.

A gut punch: Medicaid won't be much help to most people in the 14 states that did not expand the program under the ACA.

2. The socioeconomics of mental health
Data: Axios/Ipsos survey, margin of error of ±9 percentage points; Chart: Naema Ahmed/Axios

The Americans who are weathering the coronavirus storm with the most stability are the ones who say it's taking the greatest toll on their mental and emotional health, according to the latest installment of the Axios-Ipsos Coronavirus Index.

Between the lines: We’ve been asking people each week whether their physical, mental or emotional health has deteriorated over the past week — a real-time measure of how the virus and the national lockdown are affecting the public the longer they go on, Axios' Sam Baker writes.

  • Wealthier and more educated respondents are more likely to say their mental health is getting worse than lower-income people.
  • These well-situated people are far more likely to be working from home, while lower- and middle-income people are either going to work as usual or, in some cases, to have seen their companies close.
  • People with lower socioeconomic status are, however, more worried about getting the coronavirus and about their ability to pay their bills.

Our thought bubble: The more tenuous your situation already was, the harder you've been hit by the coronavirus lockdown. Lower-wage workers who are going to work as usual really are at a greater risk of getting sick, losing their jobs and being unable to pay their bills. 

  • But that uncertainty was already a fact of life for many low-income families. 
  • That may help explain why people working from home are experiencing a greater psychic burden — we're not used to the future feeling so precarious.

Read 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 captain of a nuclear aircraft carrier docked in Guam asked the U.S. Navy for more resources after 100+ members of his crew became infected with the coronavirus, saying, "[t]he spread of the disease is ongoing and accelerating," per a letter obtained and confirmed by the San Francisco Chronicle.

For many people who've lost jobs or income because of the coronavirus pandemic, today presents a stressful decision: Do you pay your rent or mortgage?

More than 400 long-term care facilities across the U.S. are now combating cases of the novel coronavirus, the Centers for Disease Control told Axios on Tuesday.

The Food and Drug Administration issued an emergency approval Tuesday for a serological testing kit produced by Bodysphere Inc. that can detect a positive or negative result for COVID-19 in two minutes.

Nearly 6% of reported U.S. patients who tested positive for the novel coronavirus also had underlying health conditions, which typically led to more hospitalizations and the need for intensive care, according to new data out Tuesday from the Centers for Disease Control and Prevention.

CNN anchor Chris Cuomo announced Tuesday that he tested positive for the coronavirus.

A federal judge on Tuesday ordered U.S. Immigration and Customs Enforcement to release 10 detained immigrants who are at risk of contracting the novel coronavirus while in confinement.

Inmates in all U.S. federal prisons "will be secured in their assigned cells/quarters" for 14 days beginning on April 1 to slow the spread of the novel coronavirus, the Bureau of Prisons announced on Tuesday.

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.

Official statistics out of China suggest it is bouncing back from the coronavirus outbreak that shuttered the country for much of the first quarter, but there is growing speculation that data is being massaged to paper over a bevy of nagging issues, Axios' Dion Rabouin writes.

Asia's strict new coronavirus containment measures should worry places like Europe and the U.S., per the New York Times.

The novel coronavirus pandemic is the "greatest test" the world has faced together since the formation of the United Nations just after World War II ended in 1945, UN Secretary-General António Guterres said Tuesday.

5. Beacons of hope from the West Coast

Washington state and California, which originally appeared to be epicenters of the coronavirus outbreak in the U.S., have slowed their surges of new cases, although it can't be ruled out that California is just behind on testing.

Why it matters: These states were early adopters of stringent social distancing measures, and these policies appear to making a difference. That should offer us all fresh encouragement to keep staying home and practicing good hygiene.

Yes, but: As Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, warned yesterday during a White House coronavirus briefing, the numbers nationwide will likely get worse before they get better.

  • The U.S. is still adopting social distancing policies state-by-state, and there's a lag between when these measures are implemented and when people who have already been exposed begin to experience symptoms.
  • It then takes a few days for some of these people to need to be hospitalized, and then a few more days for deaths to rise.
  • This pattern will keep repeating until the virus stops spreading, which will continue as long as sick Americans continue to interact with healthy ones. But if we all stay home, that spread can't happen.

The bottom line: "In the next several days to a week or so, we're going to continue to see things go up. We cannot be discouraged by that, because the mitigation is working and will work," Fauci said.

  • Remember that things looked really bad in Washington and California a few weeks ago, too.
6. How the pandemic will reshape cities

Illustration: Eniola Odetunde/Axios

The coronavirus pandemic will leave its mark on urban centers long after the outbreak itself recedes, Axios' Kim Hart reports.

Why it matters: The most densely populated cities are ground zero for the virus' rapid spread and highest death tolls — and they're also likely to be pioneers in making lasting changes to help prevent the same level of devastation in the future.

The big picture: The combination of urbanization, climate change and a hyper-connected society means infectious disease epidemics are likely to become more common, the World Economic Forum warns.

Here are predictions from urban experts on how cities might change:

  • Buildings: We spend 90% of our time indoors. "Buildings, if managed poorly, can spread disease. But if we get it right, we can enlist our schools, offices and homes in this fight," said Whitney Austin Gray, senior vice president of the International Well Building Institute.
  • Streets and sidewalks: "When we start to think about social distancing, we may see a rapid transition to broader sidewalks and closing streets and giving people more space to get around in cities," said Brooks Rainwater, director of the National League of Cities' Center for City Solutions.
  • Airports: Temperature checks and other health screenings will likely become more common, Richard Florida and Steven Pedigo write in a piece published by the Brookings Institution.
  • Remote work: This prolonged period of working from home is expected to accelerate corporate America's acceptance of remote work as a more permanent part of workplace culture.

Go deeper.