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Good morning.

Join me and my Axios colleagues at 9am ET this morning live for an in-depth discussion on the latest coronavirus coverage. 

Today's word count is 1,552, or a 6-minute read.

1 big thing: Labs scrambling to stay ahead of test supply shortages

A health care worker screens a patient for COVID-19 at a drive-through testing site on March 18 in Arlington, Virginia. Photo: Drew Angerer/Getty Images

Some academic labs are continuously reworking their coronavirus tests, or trying to make new tests altogether, in an effort to stay ahead of shortages in the supplies they need to make those tests.

The big picture: The testing capacity of the U.S. has expanded, as large commercial labs pledge to make tests, but we'll be back at square one if we run out of the necessary ingredients.

Labs have been sounding the alarm about dwindling supplies of test ingredients like reagents, RNA-extraction kits and the swabs used to take samples from patients.

Driving the news: Stanford's clinical virology lab is in the process of validating its fourth RNA extraction method, medical director Benjamin Pinsky told me.

  • It's not as simple as just swapping one material for another. With each change, the lab has to make sure the test is still accurate.
  • "We have not had to do this, this rapidly with this many components of a particular test, in my time in the laboratory," Pinsky said.

The University of California at San Francisco's clinical virology lab is working on five assays — which are essentially test recipes — as a response to supply shortages, medical director Charles Chiu told me, even though it already validated one earlier this month.

Other labs are developing tests with the potential for shortages in mind.

  • "There is a concern that some item might become out of stock and so as soon as we are live with our test, we will start validating other modifications," Harvard's Michael Mina said.

Reworking existing tests isn't the only desperate attempt being made to ramp testing up. At-home kits are being developed and sold without FDA approval, the Washington Post reported last night, and testing sites are limiting who can be tested to conserve resources.

2. Patients will bear burden of coronavirus prep

Illustration: Eniola Odetunde/Axios

The Trump administration is urging hospitals to postpone elective surgeries to make room for coronavirus patients. And hospitals do need to free up more beds.

  • But still, it's worth remembering that "elective" is a broad term, and these decisions — even if they're the right ones — will have real consequences for real patients.

Case in point: NBC News published a heart-wrenching story last night about a patient who needs a liver transplant, but whose transplant surgery — scheduled for later this month — was canceled amid concerns about the coronavirus.

  • To preserve beds in their intensive care units, some hospitals are only performing transplant surgeries for the patients most at risk of death, NBC reports.
  • Prolonging even more routine procedures — like knee replacements or dental procedures — may be difficult for some patients, even if it's ultimately safer for them and the community as a whole.

What they're saying: This plan "will not only preserve equipment, but it also allows doctors and nurses to help those that are on the front lines, and it will protect patients from unnecessary exposure to the virus," CMS administrator Seema Verma said yesterday.

3. The latest in the U.S.
Expand chart
Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios

Over the past week, American attitudes towards the coronavirus have become dramatically more serious, as the U.S. has seen an uptick in positive cases and precautionary measures, according to a new survey provided exclusively to Axios by Harris Poll.

General Motors, Ford and Fiat Chrysler have agreed to close all of their North American factories through at least March 30 to allow the companies to thoroughly clean and sanitize their plants, after which plans to reopen will be evaluated "week-to-week," Axios' Joann Muller writes.

Stocks closed down more than 5% on Wednesday after a volatile day that saw trading halt for the fourth time this month amid novel coronavirus concerns.

The State Department is suspending "routine visa services in most countries worldwide" for immigrants and nonimmigrants in response to the coronavirus pandemic, the agency said Wednesday.

Ford and General Motors are looking into making medical equipment including ventilators that could help combat the coronavirus outbreak.

Rep. Ben McAdams (D-Utah) tweeted Wednesday night that he has tested positive for the novel coronavirus — hours after Rep. Mario Díaz-Balart (R-Fla.) made a similar announcement.

President Trump signed into law an emergency coronavirus relief package on Wednesday evening, as Americans face a pandemic that could catalyze a recession.

New York Gov. Andrew Cuomo announced Wednesday that President Trump has agreed to deploy a floating hospital called the USNS Comfort to New York Harbor to assist the state with the novel coronavirus outbreak.

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.

Russia is already spreading misinformation about the coronavirus throughout the West, according to digital forensics experts and government officials, Axios' Sara Fischer reports.

There were no cases of the novel coronavirus in Hubei Province, China, including the city of Wuhan, China, where the outbreak is believed to have begun, in the past 24 hours, per the local health department's website.

In a national address with no precedent in her 14 years as chancellor, Angela Merkel said Germany now faces the gravest challenge since World War II.

Two aspects make the COVID-19 pandemic unlike any disaster we've experienced in memory: its global nature and its unknown duration, Axios' Bryan Walsh writes.

The top Republican on the House Foreign Affairs Committee has accused China of carrying out "one of the worst cover-ups in human history" over the novel coronavirus outbreak and inflicting a pandemic and economic calamity on the world.

5. Phase 2 of the coronavirus crisis is here

Illustration: Aïda Amer/Axios

The U.S. is scrambling to prepare for the second phase of the coronavirus outbreak, and we're not ready yet, Axios' Sam Baker, Jennifer Kingson and Bob Herman write.

The big picture: Phase 1 was mainly about testing. This outbreak seemed largely theoretical as long as we didn't even know the number of U.S. cases. Phase 2 will be about the actual response.

  • It's no longer that this could be bad for the economy; the layoffs are starting. It's no longer that the health care system may be overmatched; hospitals are now racing to free up beds.
  • Partly because we were behind the eight ball on testing, taking too long to wrap our minds around what was coming, now we're scrambling into Phase 2, as well.

What's next: The Senate signed off on a coronavirus relief bill yesterday just as the White House formally proposed a separate $1 trillion relief and stimulus plan, with half the money going to cash payments to needy Americans.

Go deeper.

6. It may be time to waive treatment costs

Illustration: Sarah Grillo/Axios

It may soon be time for the U.S. to take an unprecedented step and waive the costs of treatment for the new coronavirus, for everyone, the Kaiser Family Foundation's Drew Altman writes in today's column.

Where it stands: Insurers have already waived the cost of testing for many patients. But if hospitals are deluged with coronavirus cases, as expected, it may also be time to look at the substantially higher cost of treatment.

By the numbers: The average hospitalization for COVID-19 will likely cost more than $20,000, and patients will be on the hook for an average of about $1,300 of that total.

  • Those estimates are conservative. They're based on an analysis of the cost to treat pneumonia, among people with employer-based insurance.

Not everyone who contracts the coronavirus will require hospitalization; many will be able to recover at home. But those who do require more intensive treatment will be at risk for big hospital bills — which could also scare people away from getting treated or even tested.

  • Almost 6 million uninsured people are at high risk for serious COVID-19-related illness; they would likely experience the greatest economic hardship.
  • Many people will be shouldering these costs at the same time they've been laid off, had their hours cut, or are experiencing other economic shocks from the epidemic.

Between the lines: Insurers could face significant challenges if they had to absorb these costs, so some federal help might be warranted.

7. NewYork-Presbyterian expects financial hit

NewYork-Presbyterian, one of the largest hospital systems in New York City, is anticipating the coronavirus outbreak will trigger anywhere from $350 million to $700 million in losses, according to a new financial disclosure.

The big picture: NewYork-Presbyterian is in one of the hardest-hit states and was forced to delay all elective surgeries and procedures, which will ding its revenue and profit. But even with a nine-figure negative swing, the system is not in danger of going under, Axios' Bob Herman reports.

Details: NewYork-Presbyterian's coronavirus estimates made several assumptions.

  • It assumed the crisis will last four months, the disease will progress here as it has elsewhere and that the system will have to allocate money for extra personnel.
  • NewYork-Presbyterian budgeted for a $246 million operating profit this year, but with its estimates, it now expects to lose anywhere from $104 million to $454 million.

Yes, but: The system has 311 days of cash on hand, plus its hospitals will be paid for COVID-19 patients, meaning there is no immediate financial peril.

  • NewYork-Presbyterian — like many other large, tax-exempt hospital systems across the country — has built a regional medical empire by garnering lucrative commercial insurance rates on elective surgeries and other procedures. The pandemic is putting that entire business model on hold.

What to watch: Hospitals are asking Congress for at least $1 billion in additional funds as well as payroll tax breaks to offset coronavirus costs.

8. Vitals readers' silver linings

Thanks again for everyone who sends these in!

  • "I'm reaching out to friends from previous eras of my life more than I ever have before (by phone, video chat, text, etc). I have two separate groups doing book clubs that we're going to hold by video chat. I hadn't realized how much I'd missed reading!"
  • "I sent [my mother] half of a Battleship game, so we can play over the phone.  It requires some level of trust and honesty, of course … ;-)"
  • "Taking the time and using this as a staycation. Just finished painting a peace pole .... Next will tackle ironing, emails, finish knitting a scarf started past winter, and will tackle covering a pillow next with fabric I purchased last winter. Plan to do some touch up painting inside, plant flowers in pots and tackle my decades worth of recipes that interest me, clean out the garage, and take my dog for more frequent walks."