April 15, 2020

Good morning.

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Today's word count is 1,371, or a 5-minute read.

1 big thing: America isn't prepared to reopen the economy

Illustration: Aïda Amer/Axios

The U.S. still can't perform many of the public health measures we'd need in order to keep coronavirus infections tightly contained in a reopened economy.

The big picture: Extreme social distancing has bought us some time, but much of the country still lacks some of the critical systems needed to handle waves of new infections once those restrictions begin to lift.

"We have to have something in place that is efficient and that we can rely on, and we’re not there yet," Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told the Associated Press yesterday.

  • "I'll guarantee you, once you start pulling back there will be infections. It's how you deal with the infections that's going count," he added.

We would need to be testing people who aren't exhibiting any symptoms — not limiting tests to the sickest patients.

  • The U.S. is now testing more than 100,000 people a day, but it's still not enough.

We would need thousands of health care workers across the country to track down, test and potentially isolate people who have interacted with confirmed coronavirus patients.

  • We have barely begun building up that workforce.

We would need a plan for how to transition recovering coronavirus patients from hospitals to post-acute care, raising the risk of the virus spreading through nursing homes, assisted living facilities and rehab centers.

The bottom line: Given how much it has cost to lock the U.S. down once, it's unlikely we'll get another chance to get this right.

Go deeper: We can't just flip the switch on the coronavirus

2. California's path toward reopening

California Gov. Gavin Newsom released a roadmap on Tuesday that will guide how he will make the decision to relax the stay-at-home policies his state implemented to combat the spread of the coronavirus, Axios' Fadel Allassan reports.

My thought bubble: These steps reflect what public health officials say needs to be done, but as I just told you, we still have a ways to go.

Details: Newsom said California would use six indicators to determine when to relax social distancing measures:

  1. "The ability to monitor and protect our communities through testing, contact tracing, isolating, and supporting those who are positive or exposed."
  2. "The ability to prevent infection in people who are at risk for more severe COVID-19."
  3. "The ability of the hospital and health systems to handle surges."
  4. "The ability to develop therapeutics to meet the demand."
  5. "The ability for businesses, schools, and child care facilities to support physical distancing."
  6. "The ability to determine when to reinstitute certain measures, such as the stay-at-home orders, if necessary."

Newsom's roadmap also notes that life will be different even after stay-at-home orders are eased. For example, restaurants will likely reopen with fewer tables and face coverings will be more common in public.

What he's saying: "There is no light switch here. Think of it as a dimmer. It will toggle between less restrictive and more restrictive," Newsom said.

3. The latest in the U.S.

Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios
Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios

The number of novel coronavirus cases in the U.S. now exceeds 600,000, per Johns Hopkins. More than 3.12 million tests have been conducted and nearly 50,000 Americans have recovered from the virus as of this morning.

More than 10,000 people have died in New York City due to the coronavirus in confirmed and probable cases, per newly released data from the city's health department.

Doctors, nurses and other health care personnel constitute up to 19% of confirmed coronavirus cases in the U.S., a new analysis from the Centers for Disease Control and Prevention shows.

U.S. mayors have banded together to ask Congress for $250 billion in direct funding to help cities deal with the enormous costs of fighting the coronavirus pandemic while also facing significant revenue loss from shutdowns of local economies, Axios' Kim Hart reports.

New York Gov. Andrew Cuomo took to MSNBC's "Morning Joe" Tuesday to push back on President Trump's assertion that he has the sole authority to end states' stay-at-home measures and move to reopen the economy from the coronavirus crisis.

While industry giants reassure shoppers there is enough food during the coronavirus pandemic, people continue to be met with empty supermarket shelves due to stresses on established supply chains, the Washington Post reports.

4. The latest worldwide: Trump vs. the WHO

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.
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.

President Trump announced Tuesday that the U.S. is placing a hold on funding to the World Health Organization for 60–90 days over its handling of the coronavirus pandemic, pending a review.

Driving the news: Trump accused the WHO of "severely mismanaging and covering up" the coronavirus crisis, adding that the U.S. "has a duty to insist on full accountability."

By the numbers: The WHO's 2018-2019 budget was about $6 billion, and the U.S. is by far the biggest donor of any country, contributing more than $400 million to the organization last year.

  • "American taxpayers provided between $400 million and $500 million per year to the WHO. In contrast, China contributes roughly $40 million a year, or even less," Trump said Tuesday.

Go deeper.

5. Medical supply scramble continues

The U.S. is still scrambling to get health care workers the personal protective equipment, ventilators and lab testing materials that they need.

Between the lines: President Trump has repeatedly said that governors are responsible for obtaining supplies for their states, but industry groups are asking the federal government to play a larger role.

  • The American Medical Association asked FEMA to create a national system to acquire and distribute personal protective equipment, in light of ongoing shortages.
  • David Skorton, president and CEO of the Association of American Medical Colleges, wrote a letter to coronavirus task force coordinator Deborah Birx asking for more federal help with diagnostic testing supply shortages.

Meanwhile, the private sector is shifting into gear on its own and in partnership with the government.

  • The Trump administration and 20 major health care systems launched a new ventilator loan program that will allow hospitals to ship unused machines to areas where they are needed most to fight the coronavirus pandemic, Axios' Joann Muller reports.
  • General Motors started manufacturing ventilators on Tuesday under a $489.4 million federal contract. But it will take until August to produce all 30,000 the government ordered under the Defense Production Act.
  • Space-focused organizations around the U.S. are now looking to manufacture ventilators and other much-needed health equipment to aid the pandemic relief effort, Axios' Miriam Kramer reports.

1 scary stat: Prescription drugs needed by patients on ventilators are being filled only 53% of the time so far in April, as demand has skyrocketed, according to Vizient, a health care purchasing group.

6. The latest on Gilead's coronavirus drug

What Gilead wants its remdesivir bottle to look like. Photo: U.S. Patent and Trademark Office

Gilead Sciences is still testing its potential coronavirus treatment, but here's a sign the company may be expecting good news: It has applied for a trademark for the drug's packaging, Axios' Bob Herman reports.

Why it matters: "The reason you make this trademark is because you think you're going to get a product out there soon," said Josh Gerben, a trademark lawyer who first noticed Gilead's application. "This is part of your brand protection."

The big picture: Gilead's drug, remdesivir, is seen as a promising candidate to treat the novel coronavirus, but is still undergoing clinical trials and hasn't been proven to work.

  • Gilead is slated to release new data on remdesivir data later this month, from randomized trials in China.
  • Filing for a packaging trademark indicates the company is seriously thinking about this drug's branding and mass distribution.

What they're saying: A Gilead spokesperson says the trademark application "is par for the course" and "entirely consistent with our stated responsibility to plan for a potential regulatory authorization should remdesivir be proven safe and effective."

Gilead has already trademarked the same blue-and-gray bottle top and white labeling in other federally approved drugs.

7. Newly uninsured can turn to stable ACA market

People losing their employer-based health insurance in the coronavirus economy would find a pretty stable Affordable Care Act market if they need it — not that the Trump administration is advertising that fact, Bob writes.

Why it matters: ACA plans will be an important backstop for some newly uninsured people, many of whom could likely find affordable coverage on the law's insurance marketplaces.

Where it stands: The average monthly premium for ACA coverage was down 3% in this year's enrollment period, compared with 2019, according to a federal report that was released earlier this month but not publicly promoted.

  • That average monthly premium is $595, but the overwhelming majority of enrollees get a subsidy to help cover those costs — and people who have just lost a job could be eligible for those.
  • Some people "could get paid to buy ACA plans" right now because of looming insurance company rebates, according to Duke University health insurance researcher David Anderson.

Yes, but: You won't hear much about those options from the Trump administration, which has been consistently hostile to the ACA and has declined to open up a special enrollment window that would let anyone who has been disrupted by the economic shutdown to buy coverage.

Go deeper: Why Medicaid will be an even bigger lifeline for people losing their jobs and health coverage