August 21, 2020

Good morning. I am OFF next week, meaning that Sam Baker will be hitting your inboxes every morning. Send me your best staycation ideas, and also tips for how to regain sanity in one short week.

Today's word count is 1,190, or a 4-minute read.

1 big thing: Hospitals still suing patients in coronavirus hotspots

Illustration: Annelise Capossela/Axios

As millions of Americans lost their jobs and fell sick with the coronavirus this summer, hospitals in some of the hardest-hit states were getting back to the business of suing their patients.

Why it matters: The Americans least likely to be able to pay their medical bills are the same people who are vulnerable to the virus and its economic fallout.

The big picture: Almost all of the roughly two dozen Community Health Systems hospitals in Florida, Texas and Arizona have sued patients since the pandemic began. Many paused or slowed down in the spring, but then resumed business as usual over the summer — when these states were being hit hardest.

  • These hospitals have filed dozens — sometimes hundreds — of cases per county between Jan. 1 and Aug. 14, according to Axios' review of court records in the counties that make them available online.
  • A random sampling of those lawsuits show that hospitals have sued to collect medical bills ranging from less than $1,000 to, in one case, $125,999.53.

Where it stands: Hospitals' aggressive legal actions against former patients was already deeply controversial before the pandemic — before millions of people lost their jobs, and in many cases their health insurance at the same time, or had their wages cut.

The other side: "It is the strong preference of our affiliated hospitals to work directly with patients to resolve their bills, and financial assistance programs are available. Legal action is always the last avenue considered, and it is only considered after evaluating a patient’s ability to pay," CHS said in a statement.

The bottom line: The health system's pre-pandemic issues haven’t gone away, and in some ways, they’ve only gotten bigger.

2. The patients being sued

In June, the Western Arizona Regional Medical Center filed a lawsuit against Blair Smiley — for the third time in two years. She thought the hospital was only pursuing one lawsuit against her until she spoke with me on the phone.

  • Smiley isn't sure what medical care the latest lawsuit involves, or how much the hospital is suing for. She suspects it might stem from taking her daughter to the hospital twice last year when she was uninsured. Her daughter, who just turned 10, now uses a feeding tube.
  • Smiley works for a funeral home, and her husband is a disabled veteran. She said her hours have been reduced, partially because of pandemic-related limits on funerals, and she doesn't make enough to pay off her medical bills. She tried to figure out a payment plan with a debt collector, but couldn’t afford that rate, either.

In another case, Lake Granbury Medical Center, a hospital located near Fort Worth, Texas, is suing a patient, Richard Piper, for nearly $35,000, plus court fees, attorneys’ fees and interest.

  • "I am [writing] this response to inform you of my inability to [pay] this outstanding medical Debt, I only bring home a check of 525 dollars a week and [am] helping two daughters with my grandkids," Piper wrote earlier this month in a letter to the judge in the case.
  • He added that he was in the hospital for four or five days. "When I went to the hospital I told them I had no insurance and I could not afford it, every day I asked to leave and was told no .... When I was discharged, I asked for some kind of relief to help pay this and was not given an option."
  • Piper said in an interview that his daughter lost her job during the pandemic, and that his hours at work have been cut "way back."

Share this story.

3. The latest in the U.S.

Data: The COVID Tracking Project; Note: Does not include probable deaths from New York City; Map: Andrew Witherspoon/Axios

Florida's death toll from the coronavirus exceeded 10,000 on Thursday, according to the state's department of health.

The Department of Homeland Security formally declared teachers essential workers in guidance released this week, continuing the Trump administration's push to reopen schools amid the coronavirus pandemic.

A study published Thursday found that children may play a larger role in the spread of COVID-19 than previously realized, intensifying concerns as schools grapple with whether to reopen, Axios' Marisa Fernandez writes.

Sen. Bill Cassidy (R-La.) said Thursday that he tested positive for the coronavirus, and is "strictly following the direction of our medical experts" by quarantining, local ABC affiliate WBRZ reports.

American Federation of Teachers President Randi Weingarten and Microsoft President Brad Smith at an Axios event on Thursday called for expanding access to broadband in the U.S. in order to close the digital divide in education.

The Labor Department said new applications for unemployment bumped higher last week, after jobless filings steadily dropped in recent weeks.

4. The latest worldwide

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

As the global race for a COVID-19 vaccine heats up, China is in its own moment to demonstrate its scientific capabilities, Axios' Alison Snyder reports.

Russia's coronavirus death toll has surpassed 16,000, per JHU.

Mexico will be getting at least 2,000 doses of Russia's potential coronavirus vaccine to test among its population, Reuters reports.

The U.K. added Portugal to its safe travel list but removed Croatia, Austria and Trinidad and Tobago, BBC notes.

5. What's needed to prevent a COVID-flu nightmare

Illustration: Eniola Odetunde/Axios

With the flu season just around the corner, medical experts are worried about the likelihood of battling a COVID-19 pandemic and the influenza season at the same time, Axios' Eileen Drage O'Reilly reports.

The big picture: There are two main scenarios: a winter from hell with overwhelmed hospitals, unknown effects from virus co-infections, misdiagnoses resulting in wrong treatments, and a surge in deaths, or a flu season mitigated by COVID-19 measures and other steps people still have time to take.

  • It's possible that if most people practice social-distancing measures and hygiene measures taken for COVID-19, the flu season may be much lighter than normal, as seen in the Southern Hemisphere.

On the one hand: The nightmare scenario reflects multiple possible problems...

  • Hospitals could get completely overwhelmed as both flu and COVID-19 can require intensive care, including ventilator use. Some areas are already strained by the pandemic.
  • Co-infections of the viruses have unknown consequences, which is worrisome when COVID-19 already has a confounding range of symptoms.
  • Without better access to diagnostics, people may not know what type of respiratory illness they have. Both can have similar symptoms but require different treatment protocols.
  • COVID-19 and flu data could get conflated, as both fall under the influenza-like illnesses the CDC tracks nationwide during the flu season.

On the other hand: The flu season could be mitigated.

Go deeper.

6. Delta Airlines adds widespread virus testing

Illustration: Sarah Grillo/Axios

A widely available coronavirus vaccine would go a long way toward rebuilding public confidence in air travel, but until it arrives, Delta Airlines believes widespread, proactive COVID-19 testing for employees will help win passengers' trust, Axios' Joann Muller writes.

What's happening: In partnership with the Mayo Clinic and Quest Diagnostics, Delta plans to test all of its 75,000 employees for both active COVID-19 and antibodies by the end of the month.

  • It will then use those results as a baseline to help develop a re-testing strategy based on tailored risk assessments.
  • More than 60% of Delta employees have been tested so far this month.
  • Delta and CVS Health said this week they would accelerate testing of remaining flight crews with a 15-minute test administered in crew lounges at Delta hub airports.

Why it matters: Testing is another precaution by Delta — in addition to checking symptoms, requiring masks, cleaning planes frequently and limiting flight capacity to 60% — to try to woo back passengers during the pandemic.

  • Other airlines are doing many of the same things, but it's believed Delta is the only one attempting to test every employee.
  • Testing is "really one of our best tools right now in keeping workforces safe," William Morice of the Mayo Clinic tells Axios.

Go deeper.