More masks, more tests, more scientists: Joe Biden’s victory in the presidential election will flip the United States’ coronavirus pandemic response to what doctors and scientists hope will be a long-overdue, full-throated, nationally coordinated effort that will save lives.
But the president-elect is being handed an unprecedented health crisis with no easy fixes. On his predecessor’s watch, the coronavirus infected upwards of 9 million Americans and killed more than 237,000. Access to a vaccine is likely months away. Public confidence in federal health agencies has eroded. Cases, hospitalizations, and deaths are surging across the country, more than two months before Biden will take office.
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And despite winning the election, Biden will need to persuade the 70 million-plus people who voted for Trump to accept his more aggressive strategy to combat the pandemic. Any COVID relief funding he’ll want to pass to boost the economy will depend on a deeply divided Congress, with control of the Senate resting in the hands of Georgia voters in a double runoff in January.
But with Biden in charge, the country at least has a chance of containing the outbreak, according to medical experts. They expect to see a night-and-day difference between him and President Donald Trump, who told the world not to fear the virus even when he was infected with it. The Trump administration’s strategy consisted mostly of banking on a vaccine while giving up on preventing or slowing infections, flouting the guidance of his own top federal health officials.
In contrast, Biden “respects scientists, he respects doctors,” Eric Topol, a cardiologist at the Scripps Translational Science Institute, told BuzzFeed News. “That’s something that will be refreshing, for sure.”
“Our work begins with getting COVID under control,” Biden said in his victory speech in Wilmington, Delaware, on Saturday night. He linked recovery of the US economy directly to stopping the spread of the virus, a contrast with Trump’s embrace of reopening businesses even as pandemic case numbers surged.
A nationally coordinated approach like the one Biden proposed during the campaign, “will make a world of difference,” said Amesh Adalja, an epidemiologist at the Johns Hopkins University Center for Health Security who spoke to reporters ahead of the election.
Biden’s seven-point plan essentially flips the US coronavirus response from Trump’s state-led one to a central federal effort. It calls for doubling drive-thru testing nationwide, using wartime powers to manufacture enough medical equipment for vulnerable people, and injecting another $25 billion into manufacturing and distributing vaccines. It also calls for implementing a nationwide mask mandate that could save about 70,000 lives and establishing a public health corps that would employ 100,000 Americans as contact tracers. He has said he’ll return the federal response to one driven by scientists — quickly naming cabinet officials for federal agencies central to the pandemic response as well as a 12-person coronavirus task force.
US cases by date reported
But with new cases now exceeding 100,000 a day, Biden will face a series of immense challenges following his inauguration.
"The country is behind the eight ball right now because everything has been so messed up," said Nicole Lurie, a former HHS official at the Coalition for Epidemic Preparedness Innovations. (Lurie has been a pandemic adviser to the Biden campaign but said that she does not speak on its behalf.) “The challenge in this whole tragedy will be helping people understand that their individual behavior helps coronavirus cases and with the economic recovery,” she added. “They go together.”
Esther Choo, an emergency physician and a professor at Oregon Health and Science University, said the administration’s goal should be “retooling conversations so that it is not a conversation about what one party believes or the other party believes, but is focused in the data in a way that it has always been in previous pandemics.”
As people head indoors for winter during the remaining two months of Trump’s tenure, the death toll in the US could reach 405,000 by Feb. 1, according to pandemic modeler Ali Mokdad of the Institute for Health Metrics and Evaluation at the University of Washington. “The public needs to be more vigilant to take care of our loved ones,” Mokdad said in a recent briefing held by the Infectious Diseases Society of America.
“The US is languishing in this pandemic because of a failed, and sometimes completely absent, federal response,” pediatrician Rhea Boyd said by email. “There is no escaping that fact, especially as we watch other nations, some with comparable resources to ours and some with less, successfully navigate their way through this international crisis with far fewer cases and deaths.”
Biden faces the enormous task of regaining the public’s trust after an election that spun basic medical questions, from the usefulness of masks to the dangers of prescribing unvetted drugs, into points of political tribalism. Abetted by advisers like neuroradiologist Scott Atlas, Trump flouted mask-wearing and social distancing, and expressed an openness to the controversial strategy of fully reopening society and letting the virus spread among healthy people.
“I hope that trust will come back from the general public — it’s going to be a really steep hill to climb,” said Angela Rasmussen, a virologist at Columbia University. “This is definitely not going to happen overnight even if the CDC, on night one, issues clear and consistent guidelines.”
Ideally, Topol said, a Biden administration would demonstrate a commitment to transparency by holding daily press briefings with the heads of the key health agencies and career scientists like Anthony Fauci, whom Trump sidelined and publicly berated. “On day one, we have the science and public health experts call all the shots,” Topol said.
The Trump administration made vaccines a central part of its strategy, overpromising on both their timing and efficacy. Now, a Biden administration faces the prospect of telling the public that vaccines will likely be, at best, 70% effective at blocking the disease. A vaccine is not expected to be available for the vast majority of Americans until the middle of next year. On Oct. 30, the CDC’s Amanda Cohn warned an agency advisory panel that a vaccine was “not a panacea.”
“The US is languishing in this pandemic because of a failed, and sometimes completely absent, federal response.”
And getting the vaccine to everyone who needs one will be an enormous challenge. When vaccines begin rolling out, they will need to conquer logistical hurdles, such as national distribution and low-temperature storage requirements.
During the campaign, Trump took shots at Biden for how he handled the 2009 H1N1 flu pandemic as vice president. Only around 23% of adults ended up getting an H1N1 flu vaccine, serving as a cautionary tale. As public trust in the coronavirus vaccine plummeted this summer, convincing people to get their shot — and, in the case of the two-shot vaccines, to come back for their second dose — will be difficult.
“There are some hardcore people who don’t want a vaccine,” said Ezekiel Emanuel, a health adviser to the Biden campaign and a former adviser to the Obama administration. “But the real target is people who are wavering and uncertain because of the way that the FDA has been pressurized, the politicization. I think once the public is convinced the Biden administration is not doing that, they'll have a very different response.” (Emanuel, who spoke to BuzzFeed News prior to the election, will reportedly be part of the president-elect’s coronavirus transition task force.)
Biden’s campaign promise for a national mask mandate will also face steep challenges. Americans are intensely divided by party in how they see the pandemic, with Republicans expressing 92% of the “skepticism or opposition” to masks reported by a recent Pew Research Center survey. Whether the president can even order a national mask mandate is an open question, the Congressional Research Service reported in a legal analysis in August. “Depending on the scope of a direct federal mask mandate,” it concluded, “there may not be an existing federal mechanism suitable to enforce it.”
Many of Biden’s coronavirus strategies are also contingent on funding that will require cooperation from Congress. If the Democrats fail to seize the Senate, Biden’s plan will likely face an uphill battle to receive full funding.
At stake is a $2 trillion sequel to 2020 coronavirus stimulus funding that Senate majority leader Mitch McConnell opposed in the run-up to the election, and then said he supported earlier this week while election results were up in the air. A decade ago, McConnell blocked expanding stimulus funding, despite a deep, painful recession, and health experts fear a repeat of this scenario.
“Sen. McConnell has no real interest in ending the pandemic, addressing the social and economic crisis that has come in the virus’ wake. He’s blocked any robust efforts coming out of the House for months now,” Gregg Gonsalves, an infectious diseases expert at Yale, told BuzzFeed News. “He is all about power, amassing it for his party at all costs.”
In the absence of more stimulus funding to support workers staying at home, more businesses will be forced to open and at-risk employees will have to choose between getting evicted and risking infection. Those conditions will make the virus more likely to spread.
“You can’t have public health agencies entrusted with asking so much of people, if they’re not going to have the support they need to get through that,” Rasmussen said.
Lurie said she expected the new administration to make bipartisan outreach efforts, based on Biden’s and Vice President–elect Kamala Harris’s histories in office. “I think you will see governors, mayors, all kinds of elected officials will welcome more federal help,” she said. “People everywhere are really tired of the pandemic.”
“I think you will see governors, mayors, all kinds of elected officials will welcome more federal help.”
Despite any post-election grievances, even red states could be encouraged to follow the Biden administration’s guidelines, according to Howard Koh, a former HHS official and professor at the Harvard T. H. Chan School of Public Health. A president could withhold coronavirus response funding vital to states if they don’t adhere to CDC recommendations on masks and business openings. “I can see the Biden administration following that sort of path,” said Koh.
The Biden team has also been urged to upend Operation Warp Speed, the secretive public–private partnership that has spent more than $10 billion on fast-tracking coronavirus vaccines and treatments. Sen. Elizabeth Warren has called for firing OWS chief Moncef Slaoui, a former pharmaceutical industry executive who held millions in stocks in companies participating in the race for a vaccine.
But Lurie doubted a Biden administration would disavow Operation Warp Speed, or any other effective current pandemic responses, in a knee-jerk fashion. “I think we've seen the consequences of throwing away effective efforts just because they belonged to a past administration — and they aren't good," she said. “Get a vaccine is the priority, I think."
Beyond the US, the global impact of a Biden win shouldn’t be underestimated, Koh added. The president-elect will likely have the country resume funding the World Health Organization and join the global COVAX effort to deliver 2 billion vaccine doses to more than 150 nations around the world by the end of next year.
“We really need a global response to the pandemic,” Koh said, “or the infections are going to just keep coming.” ●