Big progress is possible if the nation cooperates

Robert Roy Britt

Jan 18·7 min read

Hopes are high that Joe Biden as president will confront the pandemic with science-driven actions and words to slow the spread of both the coronavirus and misinformation, reverse the heartbreaking trend of rising deaths and eventually squash the bug. He inherits a tall task. The virus is spreading uncontrolled across America, just as a more infectious coronavirus strain is expected to take over soon, and the country is already a largely determined course to surpass 500,000 deaths in a few weeks.

“Could Covid kill a million Americans? Quite possibly, especially if a more transmissible strain spreads widely, says Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention. “Our actions in the weeks ahead matter a lot.”

Given the known science and Biden’s plans and comments to date, here are key changes to the pandemic response we can and should expect of the new president immediately, in no particular order, from governing style to strategy and tactics.

Speak truth

Americans need an unvarnished and accurate account of all aspects of the pandemic — a set of facts agreed upon by scientists and health officials and policymakers from the top down, communicated clearly and consistently to the public — about everything from the infectiousness of the virus to vaccination plans and any missteps and struggles. The president can’t control what everyone might believe, but he and his team can make a dramatic improvement in presenting facts about the pandemic rather than ignoring its severity and spreading dangerous lies and pseudoscience.

Respect science

The №1 promise of the Biden-Harris Covid-19 response plan is to “always listen to science.” This does not mean ignoring political realities or the economic consequences of lockdowns or other measures. Rather it recognizes that a healthy economy requires a healthy population of workers and consumers, plus science-informed policies and advice, even when knowledge evolves based on ongoing research.

“Our guidance evolves with the data and science, which is at a rapid pace during a pandemic of a novel disease,” says epidemiologist Saskia Popescu, PhD, an assistant professor at the Schar School of Policy and Government at George Mason University. Effective pandemic response “means leaning into these evolutions,” she says. Hence yes, advice on masks changed as the science of coronavirus transmission became clear.

“Science is discovery, not fiction,” as Biden put it in a January 16 speech. “It’s also about hope. And that’s America. It’s in the DNA of this country.”

So far, Biden’s appointments to key health and science posts are getting high marks from other health experts. By surrounding himself with well-respected scientists and experienced health experts — including elevating science to a cabinet-level position for the first time — Biden has sent a clear signal he intends to inject the pandemic response with a heavy dose of science, not politics.

“These world-renowned scientists and experts reflect the very best of our nation,” says Biden’s partner in science respect, veep-to-be Kamala Harris. “We are sending a clear message by naming them to these important roles: In our administration, decisions will be informed by the best available science and evidence.”

Lead by example

We can and should expect consistent mask-wearing throughout the new administration and in the federal government more broadly, along with consistent displays of social distancing and a total lack of any crowded rallies. As a start, Biden has promised an executive order requiring masks on federal property.

Rebuild trust

Every president faces the fact that roughly half the country voted for the other guy. But the best presidents understand that all citizens need clear, consistent, fact-based leadership, especially in crisis, and words and actions must speak to the entire populace, lifting spirits and fostering unity, not division, in the fight against a common enemy.

The №2 promise of the Biden response plan is to “ensure public health decisions are informed by public health professionals.”

By allowing the new leader of the CDC, the next Surgeon General and other key federal health officials to lead in their areas of expertise, to cooperate amongst themselves to sort through the science, and then speak openly and directly to the people, the new administration can begin to restore their credibility — imperative to gaining political and public acceptance of existing and new health measures.

Repair the nation’s soul

Throughout history, Americans have come together in crises. Covid-19 has instead ripped us apart, pitting friends and families against each other on everything from basic truths about the virus to whether mask mandates are an infringement on personal liberty or a common decency that saves lives. Through the actions above and below, and an outpouring of empathy from our nation’s leader, maybe, just maybe.

Fix the vaccine rollout

Despite promises of 20 million vaccinations by the end of 2020, as of January 17, only 14 million shots have been given. Nobody expected the rollout to be easy, but health experts and state officials describe a rudderless federal effort plagued by false promises. Few initiatives will matter more or benefit more from federal coordination and support than a fast, efficient and predictable vaccination program.

“We’re deploying vaccines like we do annual flu shots rather than the mass vaccinations done in Africa and Asia where millions are vaccinated in weeks,” says Ranu Dhillon, MD, a Harvard Medical School researcher who studies community-based health systems. “Instead of passively waiting for people to come get vaccinated, we need to search them out and go to where they are and keep following up until they opt out or are vaccinated. We should be rolling out the vaccine like we do the Census, even going door-to-door.”

Biden plans to mobilize FEMA and the National Guard to ramp up distribution and help administer shots at government- and community-run inoculation centers, while also working closely with pharmacies to get shots in arms more quickly. His goal: 50 million two-shot inoculations (100 million doses) in his first 100 days in office. His pandemic relief legislation, subject to congressional approval, seeks $400 billion to improve the vaccine rollout.

“Vaccines won’t change the overall pandemic curve for months, but scaling up vaccinations will greatly reduce deaths,” Frieden says. “No time to waste.”

Get rapid tests in every home

While Biden aims to make reliable physician-based testing free and expand testing sites, at least as important is his pledge to invest in rapid at-home tests, should Congress approve funds. These tests are less sensitive than the familiar PCR tests at sensing low-level infections, but they promise to be more effective at preventing widespread transmission, because they’re efficient at revealing more serious infections, and everyone in the country could test themselves frequently, getting results in minutes and then isolating promptly as needed. Critically, at-home tests can be relatively inexpensive — as little as a few dollars per test.

Solve the PPE shortage

Ongoing shortages of personal protection equipment (PPE), among health care workers and essential employees who have no options to work from home, have long pointed to the need for federal dollars and coordination. Biden vows to employ the Defense Production Act to ramp up PPE production. It’s the least we can do for the exhausted people on the front lines.

Soften the financial blow

Providing federal help to those who have lost jobs or seen income slashed can do more than help keep the economy from worsening. Deaths of despair — including from suicide, opioid overdoses and excess alcohol consumption — were already lowering U.S. life expectancy before the pandemic struck, and Covid-19 has only added to the downward trend and the pain, especially for people of color, women and those already struggling financially. Biden’s plan would provide direct financial relief to struggling families and businesses and offer emergency paid sick leave and support child care centers.

Create health jobs

In addition to asking Congress for additional direct economic relief to Americans and more dollars for federal and state mitigation efforts, Biden plans to create a U.S. Public Health Jobs Corps “to mobilize at least 100,000 Americans across the country with support from trusted local organizations in communities most at risk to perform culturally competent approaches to contact tracing and protecting at-risk populations.” At a time of historic unemployment, creating jobs specifically to help fight the pandemic would be a one-two punch of effectiveness.

Encourage universal mask use and better distancing

With the virus evolving to be more contagious, individual measures to prevent infections are more important than ever, while we wait for the months of vaccinating efforts needed to achieve herd immunity and recognize that even a small percentage of vaccinated people will still catch the disease, and it’s as-yet unknown if others who've gotten their shots might still transmit the coronavirus, even if they don’t get sick.

Biden and his team must get the nation on board with such simple basic health measures as masking up, avoiding crowds (indoor gatherings, especially), ventilating and filtering the air in homes and businesses, and keeping distance (six feet is not always enough).

How to accomplish this? See the 10 points above.