On January 20, 2021—exactly one year after the first case of COVID-19 was confirmed in the United States—Joe Biden will be inaugurated as the 46th U.S. President. Once he takes office, he will be able to institute the impressive “Biden-Harris plan to beat COVID-19,” which includes universal free testing, massive scale-up of personal protective equipment (PPE), and implementation of mask mandates nationwide.
But the inauguration is an awfully long time to wait for aggressive federal action to tackle the worst pandemic in a century, one that is spiraling out of control day by day. On November 28, 2020, the U.S. recorded over 200,000 new cases for the first time ever. Daily hospitalizations and deaths are rising to the kinds of numbers seen during the spring and summer surges. The lame duck period will be the darkest weeks of the pandemic, fueled by the colder weather driving people indoors and by holiday travel that promotes viral spread.
There are many aspects of governance and global health collaboration that the incoming administration cannot undertake until after the inauguration. But what can the Biden team do now to help the pandemic response?
First, the most critical action it can take immediately is to build a common public vision of both the threat of the pandemic and the actions needed to control it. One of the most devastating legacies of Trump during this crisis is that he deliberately misled the American people, downplaying the deadliness of the virus and undermining public health messaging, leading to widespread confusion and suspicion. Biden and his COVID transition team have already embarked on the Herculean task of reversing this damage by sending clear consistent messaging soon after the election on critical issues such as the importance of masks and of curbing holiday travel.
Another simple but critically important message that Biden should promote is the importance of avoiding the “three Cs”—closed spaces (especially if they are poorly ventilated), crowds, and close contact—as these all make viral transmission more likely. The team could go further by organizing more formal briefings for the public about the state of the pandemic, including being honest with the American people that this pandemic will last well into 2021 and possibly beyond.
Second, since Trump seems to have lost all interest in the pandemic, it is now largely up to the state governors to slow the spread of the virus. The Biden camp should analyze the daily detailed data on healthcare utilization from Health and Human Services and then provide targeted scientific advice to those governors in “hot zone” states that are running out of beds and health workers.
An enormous failing of the Trump administration right now is that it has provided no agreed upon national playbook of how to respond to the current surge in cases. The Trump White House did release reopening guidelines back in the spring—though many states, like Florida and Arizona, ignored them and reopened even with astronomical case numbers. But this time around there has been no coherent federal guidance to states on which triggers to use to roll back and then reopen society. The result has been a patchwork of actions across America, with some governors, like Michigan governor Gretchen Whitmer, putting in place a “circuit breaker” (a set of limited restrictions aimed at curtailing rising infection rates), but other governors largely failing to act.
This type of “choose your own adventure” governance at the state level has worsened public confusion. The Biden team should work to build national consensus on common triggers for public health policies, such as restrictions on indoor gatherings and interstate travel.
Third, with the transition planning now well underway, the Biden team is already likely evaluating the national stockpile of medical supplies and equipment to assess the readiness of our country to face at least another a year of this healthcare crisis. Aside from PPE, hospitals are also reporting shortages in commonly used medications as well as equipment and products for disinfection and sterilization. President-elect Biden has said that he will invoke the Defense Production Act on “day one” to ramp up PPE manufacture. He could use the lame duck period to identify both the remaining needs and also potential manufacturing partners who could take on the critical production tasks after the change in administration. Additionally, the Biden team should consider expanding manufacturing plans to include better quality masks for the public. This could be accomplished by either manufacturing more medical masks for the additional demand or to at least standardize and improve the quality of masks the general population uses through regulatory input from National Institute for Occupational Safety and Health and Food and Drug Association.
Fourth, over the course of this pandemic, schools, businesses, and religious organizations have faced common challenges on decreasing the risk posed by having any size group of people spending time indoor. As a country, we have been so consumed by a pandemic that posed an existential threat that we have made no space to identify and celebrate small successes that show how we can better balance pandemic mitigation and living our lives. There is a wealth of best practices and public health innovations that Biden’s team should identify and amplify. There are health departments that conducted successful contact tracing while preserving community trust and privacy, universities that kept campus infections rates low, manufacturers that made high quality face masks for public use, and businesses that protected their workers. The Biden transition team could consider working with states to host a virtual “marketplace of ideas” to identify best practices that could be widely adopted to help Americans continue to safely live and conduct business until we achieve vaccine herd immunity.
Finally, the Biden camp should consider working with scientists both within and outside the government to identify key remaining scientific questions with major public health and national policy implications. There are many scientific unknowns that need urgent research, which the Biden team should start planning for right now. Although the scientific community is already working on these topics, what is missing is forethought and planning about the policy implications—that is, about how the evidence will be turned into action. For example, we need to know how long those infected with COVID-19 are truly infectious—this question could have a profound impact on everything from the time that infected patients need to isolate (and miss work or other activities) to what type of testing we suggest to those exposed, and how we invest in that capacity. We need a comprehensive research program on the prevalence, impact, and treatment of long covid to help us prepare our health systems for ongoing health problems faced by COVID-19 survivors and we need planning for our healthcare system prepares for this increased demand. Overall, by cataloguing remaining scientific questions, our government can build proactive policy plans rather than being reactive.
Effective vaccines are on the horizon, and Biden has promised a $25 billion investment in “a vaccine manufacturing and distribution plan that will guarantee it gets to every American, cost-free.” To put this amount into perspective, CDC director Robert Redfield estimates that states need about $6 billion to distribute the vaccine, the National Association of City and County Health Officers puts the figure at $8.4 billion, and the stalled House COVID-19 relief bill (the Heroes act) included $7 billion for vaccine distribution.
But a vaccine won’t be like a light switch that goes on and the virus suddenly disappears. It will take many months—perhaps a year—to roll out and distribute enough doses of vaccine across America to reach vaccine herd immunity. So, we will continue to be living with constraints for some time. Biden should be acting ambitiously right now in anticipation of the long-term challenges that are still ahead.