Joe Biden’s plan to beat back the Covid-19 pandemic in the United States is founded on a simple premise: leadership matters.
President Donald Trump has badly botched the response thus far, according to most experts, and the numbers tell the tale: 200,000 Americans are dead. He’s tried to discredit the scientific institutions tasked with managing the response. Millions of people are still out of work. Thousands of businesses have closed that will never reopen.
Biden’s campaign has spent the last six months coming up with its plan to fix it.
“What worries me now is we’ve been living with this pandemic for so long, we’re at risk of becoming numb to the toll it’s taken on us and our country,” Biden said last week. “There are 200,000 moms and dads, sons and daughters, grandmothers and grandfathers, aunts and uncles, friends and coworkers who are no longer with us. And so many of them didn’t have to lose their lives to this virus if only the president had acted sooner.”
If he’s elected president, Biden sees his role as, fundamentally, removing the obstacles set up by the Trump administration that hindered an effective Covid-19 response. The Trump White House has pressured states to reopen before they contained their outbreaks; Biden would encourage mask mandates and, if necessary, new lockdowns. The president has undermined the government’s top scientists; Biden is promising he will empower them. Congress has failed to appropriate any new funding for Covid-19 response since the spring; Biden and congressional Democrats want to make major new investments.
Biden believes the public needs to hear a new message from the government, one founded in good science. His top adviser and presumed chief-of-staff in waiting is Ron Klain, who oversaw the Obama administration’s Ebola response. He has convened an informal panel of experts, who have briefed him regularly on the state of the US outbreak and on the best strategies for containing it.
Taken together, the campaign is working toward what public health experts say is the most effective strategy for containing Covid-19: a test-trace-isolate program, making mask-wearing and social distancing mandatory, and, once the science supports it, an equitably distributed vaccine. Totally suppressing Covid-19 to the same level that South Korea or New Zealand have is likely a lost cause at this point. But the Biden campaign believes it can flatten cases and deaths until a vaccine is widely available, potentially saving thousands of lives in the process.
The Biden plan faces enormous challenges. As Vox reported at the beginning of the pandemic, local officials are largely tasked with executing these public safety measures, and it’s entirely possible Republican governors aren’t going to want to go along with Biden’s way of doing things. It could be difficult to restore public trust in the scientific process. And equitably distributing a scientifically sound vaccine to the general population is something the candidate himself has compared to a large-scale military operation.
Still, Biden says he is up for the challenge.
“We can, as we have so many times in our history, begin anew,” Biden said this week. “We can get control of this virus.”
Step 1: Fix America’s test-trace-isolate problem
America has never had a cohesive Covid-19 testing strategy. Since February, there have been regular supply shortages delaying test results. States have been fighting each other for precious resources. Contact tracing has not been a priority for the federal government, and most states have still not hired nearly enough people to perform that work. Without an effective test-trace-isolate program, the US has never had a realistic chance of stamping out the virus.
After talking with some of Biden’s Covid-19 advisers, it’s clear that his first priority as president would be to use the tools at the federal government’s disposal to improve US testing. The goal is more testing and faster testing that then allows for better contact tracing to identify which people need to be isolated, all in order to slow down Covid-19’s spread.
The core of Joe Biden’s Covid-19 response plan is ramping up and better coordinating testing across the United States.William Campbell/Getty Images
Biden wants to set up a pandemic testing board to oversee the allocation of testing materials around the country. That could help the kind of testing bottlenecks the US has periodically experienced throughout the year; tests in Florida during its summer spike were taking a week or more to come back, making them effectively useless for contact tracing and isolating, while people in a state like Connecticut, where cases had actually fallen off, could get results in a day or two.
The Trump administration has explicitly tried to limit testing to symptomatic individuals only, after the president has said both privately and publicly he wants less testing because more testing means more cases are identified. The FDA currently has a restriction in place that limits rapid-results antigen tests to symptomatic individuals, when the expert consensus says those tests should actually be used to screen asymptomatic people. Because people with Covid-19 can spread the virus before they show symptoms, that broader community-based testing would help identify infectious individuals early so they can isolate and avoid spreading it to others.
A Biden-led Centers for Disease Control and Prevention would likely issue new federal guidelines on Covid-19 testing, encouraging more testing of asymptomatic individuals and front-line workers as well as in nursing homes.
“I had thought for the first several months, this was an allocation problem, getting the tests where they need to be,” David Kessler, the former FDA chief who is advising the Biden campaign on Covid-19, told me. “But there is this artificial impediment to testing, by setting up this restrictive criteria.”
High-level coordination conducted by a centralized testing board, as Biden is proposing, would also be important for equitably distributing those new antigen tests, a process that will likely take months. Right now, NBA and NFL players can get tested all the time because their leagues can afford to buy the available antigen tests. But essential workers might not have the same opportunity.
That’s the kind of disparity a Biden administration would want to try to fix as tens of millions of antigen tests are shipped around the country in the coming months.
“This is turning into an equity problem, a world of haves and have-nots,” said Thomas Tsai, a Harvard health policy professor who has worked on testing issues.
Testing ultimately matters only if sick people isolate themselves and public health workers can contact the people they may have exposed so they can isolate, too.
Most US states have also still not hired enough contact tracing workers. Biden has said he wants to establish a new US public health job corps that would perform that contact tracing work, with federal money to hire at least 100,000 people and train them, a plan that would likely require new funding from Congress.
Polls have shown a lack of public comfort with smartphone contact tracing apps, and public health workers have anecdotally reported encountering skepticism from people they’ve interviewed, who are wary of sharing personal information with the government. Biden campaign advisers believe federal leadership that encourages trust could lead to more buy-in from the public for these public health efforts, though it will likely remain a challenge given the deep political polarization in the US.
The pandemic is not going to end without an adequate test-trace-isolate program; anything else, including eventual vaccine distribution, depends first on slowing Covid-19’s spread.
Step 2: Provide people, businesses, and states with more economic relief
Trump has presented the pandemic and the economic crisis as fundamentally at odds, saying the US cannot let the cure (lockdowns) be worse than the disease (Covid-19). But public health experts say the two are inevitably linked. The only way to fully restore the economy is to get the virus under control; people aren’t going to resume their normal lives if they are worried about getting sick at a restaurant or a store.
The Biden campaign and Democrats in Congress are planning another round of economic relief as millions remain out of work and businesses close.Noam Galai/Getty Images
Still, the economic pain is real, and that pain puts pressure on government leaders to allow some business activities to resume lest jobs and businesses be permanently lost. One way to alleviate that pressure and allow more time for better public health interventions to start suppressing Covid-19’s spread is to provide more economic relief.
The US economy has regained some of the jobs lost since March, but millions are still out of work. It’s clear by now that the V-shaped recovery hyped by the Trump administration is not going to happen. The unemployment and business relief provisions Congress passed earlier in the year have started to expire, and nobody in Washington seems optimistic that any new deal on extending that assistance will be reached by the end of the year.
Biden could take administrative actions that would provide Americans with some economic relief. But the most powerful tools will need to be approved by Congress — and the difference between President Biden negotiating with a Congress fully controlled by Democrats versus a Congress split between a Democratic House and a Republican Senate is substantial.
Democrats in Congress say their first order of business would be a new Covid-19 relief and response package. It would likely incorporate the necessary funding to improve testing and tracing, according to Senate Democratic aides, as well as specifications about how federal money should be spent.
It would also be expected to include economic provisions. Increased unemployment aid and new funding for state and local governments would be a given, based on the legislation already passed by House Democrats and interviews with aides. Democrats will likely want to extend the now-expired $600 additional unemployment benefit. Congress could also add funding specifically for state Medicaid programs, which have had enrollment swell during the economic downturn, aides say.
Democrats will have to decide whether their first big bill will focus narrowly on Covid-19 or whether to include bigger permanent reforms. On health care, they could either stick with more incremental improvements, such as covering treatment for the people with long-term Covid-19 complications, or go bigger by enhancing the Obamacare tax subsidies and even possibly establishing the public health insurance option Biden says he supports.
Senior Democrats acknowledge there will be enormous pressure from the more progressive members to go big. Nobody is ruling anything out, but as one health policy expert put it recently: “First, you have to stop the bleeding.”
Step 3: Fast and equitable use of an effective Covid-19 vaccine
More economic relief should lower the pressure on states and businesses to reopen, while more testing and tracing should help reduce Covid-19’s spread. But to actually put an end to the pandemic, we will need a vaccine.
And for all Trump’s antics around a Covid-19 vaccine, the bottom line is that an effective vaccine does seem likely to be developed in record time. Several candidates are already in phase 3 trials, and there is hope that within a matter of months, one or more will be approved.
Then comes the hard part, which is distributing the vaccine to people. That mission will require a tremendous amount of coordination: producing the doses, shipping them around the country, figuring out which populations will be prioritized, setting up vaccination sites, and getting the message out to the public about how to get their vaccine.
“Distributing a vaccine to the entire population is as complex and challenging as the most sensitive military operation,” Biden said in remarks earlier this month.
With clinical trials underway, there is optimism about a Covid-19 vaccine. But distributing it to 330 million Americans will be a challenge.Craig F. Walker/The Boston Globe via Getty Images
He promised to develop a more detailed plan for vaccine distribution before assuming office, but he did lay out what that plan would cover:
a detailed timeline for when people would get the vaccine
a clear delineation of which populations would be prioritized
the specific means for shipping and storing the vaccines at appropriate temperatures
which government agencies would be responsible for implementing that plan
The Trump administration, through its Operation Warp Speed, already placed orders for some of the most promising vaccine candidates and it has paid drug companies to start manufacturing doses even before they know whether the vaccine will be viable. It also, somewhat controversially, asked state and local health departments to develop distribution plans so they’d be ready to start vaccinating people as soon as October.
Some saw that as an example of Trump applying government pressure to get a vaccine sent out before the election. Practically speaking, however, that directive should still encourage health agencies to make preparations before Biden takes office. They won’t be starting from scratch.
Rather, Biden’s leadership role will be just as critical as his operational responsibilities. Public trust in an eventual Covid-19 vaccine is not very high right now, polls show, and it has been deteriorating over the last few months. If too few people take a vaccine because they don’t trust it, then it’s going to be harder to completely stamp out the virus.
So Biden will have a public health imperative to strengthen the American public’s faith in a vaccine. He has had to equivocate during the campaign, emphasizing that while he doesn’t trust Trump himself, he does trust vaccines and scientists as a rule.
“I trust vaccines. I trust the scientists,” he said recently. “But I don’t trust Donald Trump — and the American people can’t either.
If Biden is the president, then he can empower those scientists and even make them the face of a vaccine push. But even under the most optimistic scenarios, vaccinating some 60 percent of Americans will take months. Dr. Anthony Fauci, one of the government scientists Biden says he trusts, has said as much.
A President Biden couldn’t do everything to stop Covid-19. He couldn’t mandate a national stay-at-home order, and it would take a huge amount of political capital to get Republican governors on board with one. He couldn’t require masks nationwide, though he could urge states to issue their own. And he certainly can’t speed along the science that will, hopefully, eventually lead to a vaccine.
That’s why Biden’s Covid-19 plan starts with improving US testing and tracing. That’s how the country gets through those intervening months. It’s the first step toward the end.
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