21 hours ago

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. I hope you enjoyed the weekend.

Today's word count is 1,138, or a 4-minute read.

1 big thing: How to do smarter coronavirus testing

Illustration: Eniola Odetunde/Axios

With testing once again a huge vulnerability to America's coronavirus response, public health officials are calling for a revamped strategy that features the use of more tests, even if they're imperfect.

Why it matters: The system is overwhelmed by the demand for tests, and yet prolific testing is key to identifying asymptomatic or pre-symptomatic coronavirus cases. Experts say the solution is smarter testing — which doesn't require perfect accuracy.

The big picture: Most coronavirus diagnostic tests right now are PCR tests, which are highly accurate, but relatively slow and expensive. But other kinds of tests exist; they just carry the risk of more false negatives.

  • Some experts argue that, when doing mass testing, the tests don't need to be 100% accurate. Catching, for example, even 50% of unidentified cases is better than the much-lower percentage that we're catching today.

Between the lines: Strategy is key, and who gets which test matters.

  • In a white paper calling for a national testing strategy, former FDA Commissioner Mark McClellan, Johns Hopkins' Caitlin Rivers and Duke's Christina Silcox last week wrote that symptomatic patients and people who are close contacts of known cases should still receive PCR or other highly-accurate diagnostic tests.
  • But "for people without symptoms, we also need broad availability of more rapid but sometimes less accurate screening tests ... to detect outbreaks sooner and give people more confidence in their workplaces and schools," they write.

Details: There are several alternative testing options. Antigen tests are faster and cheaper than PCR tests, but less accurate. The FDA has already authorized two companies to sell antigen tests, per Science, and others are in the pipeline.

  • Pool testing is another way to stretch limited resources.

Yes, but: Many insurers don't pay for tests that aren't "medically necessary," which generally includes screening or surveillance testing.

  • The absence of a guaranteed demand could be depressing the creation and mass production of these alternative tests.

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2. Indoor air is the next coronavirus frontline

Illustration: Eniola Odetunde/Axios

A growing body of research has made it clear that airborne transmission of the coronavirus is possible, Axios' Bryan Walsh reports.

Why it matters: That fact means indoor spaces can become hot spots. Those spaces also happen to be where most business and schooling takes place, so any hope for a return to normality will require better ways of filtering indoor air.

What's happening: After a concerted campaign by scientists, the World Health Organization last month updated its guidelines on COVID-19 to include the possibility that the coronavirus could be airborne.

  • That marked a shift from initial assumptions that the virus was mostly transmitted via contaminated surfaces and respiratory droplets emitted at close range.

Context: If coronavirus-contaminated aerosols can indeed hang in the air, perhaps for hours, then "mitigating airborne transmission should be at the front of our disease-control strategies for COVID-19," Joseph Allen of Harvard's Healthy Building program wrote in the Washington Post.

  • Schools in particular "definitely present a challenge," says Barry Po, president of connected solutions for mCloud Technologies.

The good news is there are existing technologies that can filter out or destroy coronavirus trapped in indoor air.

  • The easiest way is simply opening windows whenever possible, which dilutes the amount of virus in the air.
  • Portable HEPA filters, which can cost as little as a few hundred dollars, are capable of capturing particles as small as the novel coronavirus and could be used to clean individual classrooms.

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3. The latest in the U.S.
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Data: The COVID Tracking Project; Note: Does not include probable deaths from New York City; Map: Andrew Witherspoon/Axios

President Trump on Saturday signed four executive actions to provide relief from economic damage sustained during the coronavirus pandemic after talks between the White House and Democratic leadership collapsed Friday afternoon.

Some Republicans joined Democrats in criticizing President Trump Saturday night for taking executive action on coronavirus aid, with Democratic leaders demanding the GOP return to negotiations after stimulus package talks broke down a day earlier.

Former FDA commissioner Scott Gottlieb said on CBS News' "Face the Nation" that the coronavirus death toll in the U.S. will be "definitely" somewhere between 200,000 and 300,000 by the end of 2020.

Ohio Gov. Mike DeWine (R) said on CNN's "State of the Union" Sunday that Americans shouldn't think testing for the coronavirus is "not reliable or doesn't work," after he received a false positive result from an antigen test last week.

Major League Baseball announced in a statement Sunday that it has postponed the St. Louis Cardinals' three-game series against the Pittsburgh Pirates, set to start Monday, because of a coronavirus outbreak.

Six students and three staff members have tested positive for COVID-19 at North Paulding High School in Georgia, where a photo showing a hallway packed with maskless students went viral last week, the Atlanta-Journal Constitution reports.

35% of Americans say they would refuse a coronavirus vaccine, even if it was free, approved by the Food and Drug Administration and available immediately, according to a Gallup poll released Friday.

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

Australian officials in the state of Victoria announced another 19 deaths from COVID-19 on Monday morning local time, breaking the state and national record set the previous day of 17. Victoria also reported 322 new cases — the lowest in 13 days.

New Zealand has now gone 100 days with no detected community spread of COVID-19, the Ministry of Health confirmed on Sunday. It comes as Kiwis prepare to go to the polls on Sept. 19 for what Prime Minister Jacinda Ardern is calling the "COVID election."

Brazilian President Jair Bolsonaro posted a photo of himself to Facebook congratulating his soccer team, Palmeiras, for winning the state title Saturday, moments after the health ministry confirmed the national COVID-19 death toll had surpassed 100,000.

African countries collectively surpassed 1 million confirmed coronavirus cases this week.

The Bill and Melinda Gates Foundation is putting $150 million into an effort to distribute coronavirus vaccines to low-income countries in 2021, global vaccination alliance Gavi announced on Friday.

5. The cost of kids losing gym class

Illustration: Aïda Amer/Axios

With a growing number of schools opting for online-only classes this fall to limit the spread of COVID-19, physical education will be severely limited, if not suspended altogether, Axios' Kendall Baker writes.

Why it matters: While classroom-based learning can be done virtually, it's nearly impossible to replicate physical education — which plays a crucial role in kids' physical and mental health — through a screen. And with sports on hold in most states, PE is the only physical activity outlet some kids have.

  • Even schools offering in-person instruction this fall must re-imagine what gym class looks like amid a pandemic, with kids unable to share balls or equipment and with strict social distancing and sanitation guidelines in place.

The backdrop: Youth sports organizations helped ensure that kids got their daily 60 minutes of exercise this summer by hosting Zoom workouts, offering virtual training and providing parents with tips and ideas.

  • Some organizations will continue in that role once school resumes, but with youth sports participation on the decline — particularly among lower-income families — the majority of students will rely solely on PE.

The big picture: Physical activity has been linked to higher academic achievement, elevated self-esteem and reduced stress and anxiety, according to the CDC.

  • Whether that's still true when students are participating virtually, rather than running around with classmates, remains to be seen.

Go deeper.

Caitlin Owens