Overnight Health Care: US passes 4 million COVID infections | Coronavirus surges show worst is yet to come | Trump likely to sign executive orders on drug pricing Friday

Overnight Health Care: US passes 4 million COVID infections | Coronavirus surges show worst is yet to come | Trump likely to sign executive orders on drug pricing Friday
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Welcome to Thursday's Overnight Health Care.

The U.S. surpassed 4 million coronavirus infections, while California and Texas are reporting record-high deaths. President TrumpDonald John TrumpLincoln Project ad dubs Jared Kushner the 'Secretary of Failure' Pence: Chief Justice Roberts 'has been a disappointment to conservatives' Twitter bans Trump campaign until it deletes tweet with COVID-19 misinformation MORE is likely to sign drug pricing executive orders on Friday, and there's yet another study showing no benefit from hydroxychloroquine.  

We'll start with infections:

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US passes 4 million coronavirus infections

The United States surpassed 4 million confirmed coronavirus infections on Thursday, according to data from Johns Hopkins University, a grim milestone that shows just how badly the country is losing the fight against the virus.

The climb to 4 million took just 15 days, just about half the time it took to reach 3 million cases, showcasing just how quickly the virus is spreading. Despite the efforts of President Trump and members of his administration to paint a positive picture several months into the crisis, the U.S. is struggling to contain a virus that is now spreading almost uncontrolled across large swaths of the country.

Hospitalizations are spiking, the positivity rate is rising and multiple states are reporting daily records on the number of cases and deaths. The U.S. reported more than 1,000 deaths three days in a row this week, the highest since late May, and more than 143,000 people have died nationwide, according to Johns Hopkins figures.

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Coronavirus surges show worst is yet to come

It's not getting better anytime soon.

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Surging coronavirus cases across the country are threatening to explode into new epicenters as the hard-won progress earned by months of painful lockdowns unravels into a summer of lost opportunity.

More than 4 million people in the United States have tested positive for COVID-19, and more than 140,000 have died. 

After wrestling the virus down to as few as 17,000 new cases a day in the first days of June, the daily case count has surged to heights even greater than those reached in the worst days of March, April and May. The United States has averaged 66,000 cases a day in the last week, its highest seven-day average and twice as high as the average in late June.

Slightly better outcomes: There are signs that physicians are getting better at treating the novel pathogen, and that more widespread testing is identifying cases that earlier would have gone overlooked. The share of people who test positive and die has fallen.

But: The number of daily dead and the number of people who require hospitalization for treatment are lagging indicators, and both threaten to rise as case counts multiply. The number of hospitalizations and deaths will not plateau or begin to decline until weeks after the number of cases begins to drop. 

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Related: California, Florida report record numbers of daily deaths

Trump likely to sign executive orders on drug pricing Friday

Mark your calendars for 3 p.m. tomorrow.

While the plans could shift at the last minute, some GOP lawmakers have been invited to a presidential event on drug pricing Friday at 3 p.m. at the White House in the South Court Auditorium to make the announcement, according to an invitation obtained by The Hill. 

The exact details of the orders remain unclear, but sources say one order is likely to include a version of a proposal to reduce some U.S. drug prices by tying them to the lower prices paid in other countries. 

An idea that had been in the mix earlier in the week to eliminate the rebates drugmakers pay to negotiators known as pharmacy benefit managers (PBMs), is now unlikely to be included, sources say. 

The moves on drug prices come as the election nears and Democrats have been hammering Republicans on the issue of health care, particularly a Trump-backed lawsuit to overturn the Affordable Care Act.  

Big caveat: It remains unclear when any of the actions can actually take effect. The power to implement drug pricing policy through executive order is limited, meaning it will likely take time for the formal regulatory process to play out after Trump signs the orders. 

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Birx warns of disturbing rise of coronavirus cases in 12 cities

White House coronavirus task force coordinator Deborah Birx said in a private meeting with local and state health officials that the task force is tracking increases in the virus in 12 U.S. cities.

"There are cities that are lagging behind and we have new increases in Miami, New Orleans, Las Vegas, San Jose, St. Louis, Indianapolis, Minneapolis, Cleveland, Nashville, Pittsburgh, Columbus and Baltimore, so we're tracking this very closely,” Birx said in the audio, first obtained by the nonprofit Center for Public Integrity.

“We're working with the state officials to make sure we're responding together, but when you first see that increased test positivity, that is when to start the mitigation efforts."

"I know it may look small, and you may say that only went from 5 to 5.5 [percent], and we're going to wait and see what happens," she added. "If you wait another three to four, even five, days, you'll start to see a dramatic increase in cases. So finding and tracing those very early individuals is really critical."

Local officials in cities with rising rates of test positivity, Birx said in the Wednesday call, should practice aggressive mitigation.

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New study finds hydroxychloroquine ineffective at treating COVID-19

Another study has found that an antimalarial drug touted by President Trump and his top advisers is not effective at treating COVID-19, and may cause adverse effects.

The "controversy" should be long dead by now, but some Trump allies and White House officials still haven't quite let it go. 

The study, published Thursday in the New England Journal of Medicine, found that hydroxychloroquine did not improve outcomes for the 667 COVID-19 patients participating in a randomized trial at 55 Brazilian hospitals.

In the study, patients with mild to moderate COVID-19 illness were split into three groups, in which one group received hydroxychloroquine, another group received the drug along with azithromycin — an antibiotic — and the last group received neither.

All groups received standard care for COVID-19.

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The study found a 7-day course of hydroxychloroquine, with or without the antibiotic, did not result in better recovery outcomes.

Read more here.

Trump administration recommends against universities requiring COVID-19 tests before students return

The Trump administration said Thursday it is not recommending universities require students be tested for COVID-19 before they head back to campus this fall.

“In general, testing people before going back to the university … is not a strategy that we recommend, nor does the CDC recommend, because you're only negative for that one moment,” Adm. Brett Giroir, assistant secretary at the Department of Health and Human Services who is in charge of COVID-19 testing strategy, told reporters.

Universities across the country are taking various approaches to coronavirus testing. Some are requiring tests for students before they arrive on campus, while others plan to test students after their arrival. Some schools say they plan to regularly test students and staff.

Giroir said schools should use surveillance testing that would only test a random percentage of students. That could be done through pool testing, Giroir said, in which samples from several people are combined and then tested together instead of individually.

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What we’re reading: 

Can you get Covid again? It’s very unlikely, experts say (The New York Times)

Ever heard of a surgical assistant? Meet a new boost to your medical bills (Kaiser Health News

Trump’s end run around CDC brings threat of fewer drugs for hospitals (Politico

State by state: 

States search for ways to deal with Covid-19 testing backlogs (Kaiser Health News

To expand or not to expand Medicaid: Missouri voters to decide in August (NPR)

Infectious disease experts warn against reopening schools in Florida, Texas and other states where coronavirus cases are surging (CNBC)

Op-eds in The Hill 

Publicly funded vaccines must be priced fairly and available for all 

The integrity of science is vital — politics cannot interfere