with Paulina Firozi

President Trump has seized on a bit of positive news as coronavirus cases surge in new hot spots across the country: The country's deaths are still going down. 

It's true that even as cases spike in western and southern states, deaths haven’t followed the same steep, upward curve at least so far. Deaths are still on a downward trajectory; while as many as 3,000 people died daily from the illness in April, that figure has fallen to around 550 deaths per day.

“Deaths and the all important Mortality Rate goes down,” he pronounced in a pair of otherwise misleading tweets over the weekend:

But coronavirus deaths are almost certain to rise. The key question is how quickly. 

“I do expect to see an increase in deaths in the coming weeks,” Lauren Ancel Meyers, a professor of biology at the University of Texas, told me. “Exactly how many more is uncertain, but unfortunately that is what we expect at this point.” 

President Trump's former Food and Drug Administration chief Scott Gottlieb said on CBS’s “Face the Nation” that “the total number of deaths is going to start going up again as the number of hospitalizations starts to spike again.” 

“You’re going to have more deaths, tragically," he said.

Epidemiologists say there are several potential reasons for why the death rate is trailing infections. 

Infections appear to be spreading fastest among younger people as they start mingling more.

Younger Americans are far less prone to serious illness or death than elderly Americans, so it’s feasible that as the virus burns through this population, it may cause proportionally fewer hospitalizations and fatalities.

In Arizona, around 40 percent of known cases were among people younger than 44 at the beginning of May but that’s now up to 60 percent of all cases. Florida officials have said people ages 18 to 44 are primarily responsible for the state’s recent spike in cases. And in Texas, more than half of new cases in the counties that encompass Austin, Dallas, Houston and San Antonio are among the young. 

And as testing becomes even more widespread — between 600,000 and 700,000 tests are now being conducted in the United States every day — more people with only mild cases of covid-19 or no symptoms at all are being included in the testing tallies.

Deaths also lag behind infections by three or four weeks.

Patients seriously ill with covid-19 generally don’t die until weeks into their illness. So, as infections and hospitalizations surge in states including Arizona, California, Texas and Florida, deaths will follow.

“We know death is a lagging indicator,” said Abraar Karan, a physician at Brigham and Women’s Hospital. “You have cases show up first, hospitalizations next and deaths show up after that.” 

It’s been clear for more than a month that infections are rising rapidly. Hospitalizations in most of these states are also climbing; over the weekend, coronavirus-related hospitalizations rose to their highest levels to date in Arizona and Nevada.

There are emerging signs that deaths are already trending upward in some states.

Compared to two weeks ago, the seven-day average of daily deaths is up nearly 50 percent in Florida and 54 percent in Arizona, according to the tracking website 91-DIVOC, which pulls data from Johns Hopkins University. The statewide death rate in both California and Texas is still holding steady, but some hospitals in both states have reported they’re nearing capacity in intensive care units.

“After Texas reported another single-day record for new coronavirus cases over the weekend, Austin Mayor Steve Adler (D) told CNN’s ‘State of the Union’ that there won’t be enough medical personnel to keep up with the spike in cases if the rate of increase continues unabated in his city,” Robert Barnes and Derek Hawkins report.

“If we don’t change this trajectory, then I am within two weeks of having our hospitals overrun,” Adler said, noting that the city's intensive care units could be overflowing within 10 days.

There's some good news: Doctors have figured out better ways of treating covid-19 patients.

Experts say this could be a small factor in lower death rates.

Physicians have come a long way in developing a standardized way of caring for covid-19 patients, compared to the pandemic’s outset. They’ve learned — and research has confirmed — that dexamethasone cuts the risk of death for patients on a ventilator by a third and reduces the risk of death for patients on oxygen by a fifth.

Another drug, remdesivir, has been shown to speed up hospital recoveries by four days, but didn’t have a statistically significant impact on survival rates. Doctors have also discovered that putting severely ill patients in a prone position improves the flow of oxygen to their lungs. 

And then there’s plasma transfusion, where patients are given blood plasma from people who recovered. Those who have recovered from an infection have virus-fighting antibodies floating in their blood that can help the immune systems of recipients fight off an infection.

Former and current government officials issued dire warnings yesterday.

Gottlieb also had this dire prediction about the country's political leadership, per a “Face the Nation” producer:

Tom Bossert, former homeland security advisor to Trump, had this to say:

By the time deaths go up again, it could be too late to turn the trend around with more drastic restrictions. 

New coronavirus infections in Florida, for instance, exceeded 10,000 in a day for the third time in the past week, after the state posted a record of 11,458 the previous day. “The new infections pushed the state’s total caseload past 200,000, a mark passed by just two other states, New York and California,” Robert and Derek write.

“Frustration about the pandemic response has mounted among local leaders, who say they have had to grapple with conflicting orders and frequently changing guidelines from governors and the White House as they try to curb sharply rising infections,” Derek and Marisa Iati report.

“We don’t have room to experiment; we don’t have room for incrementalism when we’re seeing these kinds of numbers,” said Judge Lina Hidalgo (D), the top elected official in Harris County, Tex., which encompasses the sprawling Houston metro area. “Nor should we wait for all the hospital beds to fill and all these people to die before we take drastic action.”

Ahh, oof and ouch

AHH: Scientists are using a new method of vaccine development based on deploying RNA to trigger the immune system. 

This cutting-edge approach, not previously used in vaccine development, is showing promise. Developers in Britain, Germany, China and the United States plan to have tens of millions of doses ready by the end of the year,” William Booth and Carolyn Y. Johnson report

“Elegant in theory, efficacious in the laboratory but untested in the real world, the possible RNA vaccines are especially attractive because they might be cheaper, easier and faster to manufacture on a massive scale — at least one team boasts it could partner with producers in developing countries to provide millions of vials for as little as $5 a pop.” 

RNA vaccines could mean smaller, more potent doses. But questions do remain about the safety and long-term efficacy of RNA technology.

Drugmakers, academic groups and government labs are working on more than 150 vaccine candidates, most using traditional vaccine approaches. But out of 17 teams that have moved into the human testing phase of their potential vaccines, at least five are working toward RNA vaccines. 

“The RNA vaccines under study come from a small laboratory at Imperial College London, from the People’s Liberation Army Academy of Military Sciences in China, from three large pharmaceutical companies — Pfizer, Moderna and CureVac — and their partners,” Will and Carolyn write. 

“Though never deployed in humans outside of clinical trials, the RNA research is being backed by hundreds of millions of dollars in investment, fueled by the urgency to crack the covid code,” they add. "Each team is seeking the prize of being first to a vaccine, while guaranteeing their own populations will get early access.” 

OOF: Officials and public health experts disputed Trump's assertion that 99 percent of coronavirus cases are “totally harmless.” 

“Now we have tested almost 40 million people … by so doing, we show cases 99 percent of which are totally harmless,” Trump said during his Saturday remarks at the White House. 

Asked during an interview on CBS’s “Face the Nation” about the president’s remarks, Gottlieb said he wasn’t “really sure what he’s referring to,” and suggested Trump could be referring to the number of infected people who need to be hospitalized.

“But certainly more than 1 percent of people get serious illness from this,” Gottlieb said. “About 60 percent of people who get infected become symptomatic, about 10 to 15 percent of them will develop some form of covid pneumonia and somewhere around 2 to 5 percent of them will become hospitalized, depending on what the age mix is of the people who are getting infected. So this is still a pretty bad virus.” 

On numerous shows, FDA Commissioner Stephen Hahn dodged questions about the president’s comments. “Well, let’s talk about where we are right now. We’re seeing cases around the Sun Belt,” Hahn said when asked about the accuracy of the president’s remarks on ABC’s “This Week.” "We are certainly concerned, at the White House corona task force, about this … We’ve sent teams into those states to actually help with taking care of the patients who are now with Covid-19.”

Asked again, he said: “You know, any case, we don’t want to have in this country. This is a very rapidly moving epidemic, rapidly moving pandemic. And any death, any case is tragic.” 

Asked on CNN’s “State of the Union” about Trump’s remarks, Hahn said: “I’m not going to get into who is right and who is wrong… We have seen the surge in cases. We must do something to stem the tide.”

OUCH: There is growing evidence the virus can spread through the air.

More than 200 scientists from more than 30 countries will publish a paper outlining growing evidence of the potential that the coronavirus can spread via airborne transmission. The Post's James McAuley and Emily Rauhala report. The signatories want the World Health Organization to take the possibility seriously, 

“Until recently, most public health guidelines have focused on social distancing measures, regular hand-washing and precautions to avoid droplets. But the signatories to the paper say the potential of the virus to spread via airborne transmission has not been fully appreciated even by public health institutions such as the WHO,” they write. “The fact that scientists resorted to a paper to pressure the WHO is unusual, analysts said, and is likely to renew questions about the WHO’s messaging.”

“The paper, which was shared with The Washington Post ahead of publication this week in the journal Clinical Infectious Diseases, comes as the WHO faces criticism over its coronavirus response, calls for reform and a U.S. threat to cut funding and withdraw completely,” they add.

In the states

Most U.S. states haven’t publicized details of whether their contact tracing efforts are working.

Contact tracing, the process of contacting individuals who have potentially been exposed to the coronavirus and persuading them to quarantine, has been touted by experts as a key to controlling the pandemic. 

“But most places across the United States aren’t making public how fast or well they’re running it, leaving Americans in the dark about how their governments are mitigating the risk,” Steve Thompson reports. 

D.C. has published contact tracing efforts on an online dashboard. The city built up a staff of several hundred contact tracers and officials say they are seeking to contact those who test positive within 24 hours of a positive test in about 98 percent of cases. Oregon also posts regular data about contact tracing, and New York officials say they plan to do the same soon. 

The District’s dashboard also indicates it will soon publish metrics on the percentage of new cases that are people who tracers have already contacted and who have quarantined because they were in contact with an infected person. That would be a sign of success for a contact-tracing program.

As states see a spike in coronavirus cases, the surges will hinder contact tracing efforts. That will be true in places including Texas, Arizona, Nevada, South Carolina, West Virginia, Georgia and California, Steve writes.

“But even states seeing declines are finding it hard to measure their success in contact tracing, in part because the effort is often spearheaded by local and county health departments,” he adds. “…The Centers for Disease Control and Prevention posted guidance in April that included various recommended contact-tracing metrics — none of which are being publicly reported by most states.” 

The Trump administration's efforts

Vice President Pence has been zigzagging the country, visiting various hot spots where coronavirus cases are spiking. 

It’s an effort to signal that the administration is taking the resurgences seriously, even as the president appears to play down the ongoing pandemic, the Wall Street Journal’s Andrew Restuccia reports. 

Pence spent three hours in Florida on Thursday where he met the governor and local health experts, following similar visits to Arizona and Texas.

“As cases surge around the country, the Trump administration has also once again put members of the White House’s coronavirus task force in the spotlight after several weeks in which the panel was largely out of public view,” Andrew writes. "Three members of the task force—White House coronavirus coordinator Dr. Deborah Birx, Food and Drug Administration Commissioner Stephen Hahn and Health and Human Services Secretary Alex Azar—accompanied Mr. Pence on the trip.” 

Pence wore a mask during most of his visit late last week, a contrast with Trump, who has been reticent to wear one in public. Pence's mask-waring is a “response to concerns among some in the administration that the White House was sending mixed messages about the importance of wearing a mask, advisers said,” Andrew adds. Pence has pushed back against calls to mandate masks nationwide.

The industry impact

Low-skilled but essential health workers have been left out of the spotlight as people applaud doctors and nurses. 

The Brookings Institution points to the millions of essential but undervalued and low-paid workers, such as orderlies, pharmacy aides, nursing assistants, as well as janitors and food preparation and serving workers who work in health-care settings. They often face the same risk as their higher-profile colleagues, “but sometimes with less access to protective gear, pay that can fall below a living wage and only a modicum of recognition,” Justin Jouvenal reports

“With a median wage of $13.58 an hour, some of the largely female and minority cadre of nearly 7 million across the country worry they are a serious case of covid-19 away from financial ruin," he writes.

Lisa Brown, executive vice president of SEIU Local 1199 for the District and Maryland, said the union is not always informed when the workers fall ill. Brown said early in the pandemic, many workers who were not nurses or doctors were not a priority to get essential products, such as masks. 

Justin adds: “She said most receive basic gear now, but there are still problems. At one Washington-area medical facility, she said, workers are sharing smocks from shift to shift. Other workers are forced to buy their own equipment if employers don’t provide it.” 

Coronavirus latest

And here are a few more stories to catch up on after the weekend: 

The hardest hit: 
  • The covid-19 death of a black man who was disabled underlines questions surrounding disability and race, and provides a glimpse into the fraught end-of-life decisions many are making during the pandemic, Ariana Eunjung Cha reports.
  • Black and Latino residents across the country have been three times as likely to become infected as white residents, according to new CDC data obtained by the New York Times. Black and Latino people have also been nearly twice as likely to die of covid-19, compared with white people, according to the data. 
More on the administration’s response: 
  • Two working papers point to ways the pandemic will lead to deep psychological scars long term in the United States, including a distrust of government institutions, Christopher Ingraham reports.
More from the states: 
  • After beginning June with no active coronavirus cases, the city of Joplin, Mo., is at the heart of one of the fastest-growing coronavirus hot spots in the country, Griff Witte reports. “And like many places that skipped the springtime surge only to be walloped this summer, it’s fighting back with a much-diminished arsenal,” he adds, noting Missouri’s lifted stay-at-home order is not likely to be restored.
Curbing the pandemic: 
  • Temperature checks are being deployed to identify people who may be infected with the coronavirus. But it’s an imperfect system, since many contagious people have no symptoms. Some experts are suggesting that adding on smell tests could work well to better identify infected people, because the loss of sense of smell has been identified as an earlier symptom of the coronavirus, Stat News’s Sharon Begley reports.
Good to know:
  • More covid-19 patients are surviving after being placed on ventilators. After reports early in the pandemic indicated that a majority of patients who required ventilators eventually died, since the pandemic has continued U.S. hospitals are “reporting much lower mortality rates, results on par with death rates for patients with similar severe lung problems caused by other diseases,” Lenny Bernstein reports.

Sugar rush