A new set of leaders could be running the US’ coronavirus response come January.
After presumptive Democratic presidential nominee Joe Biden announced California Sen. Kamala Harris as his running mate on Tuesday, they hinted at their plans to tackle the US coronavirus outbreak during a speech in Wilmington, Delaware. Their strategy would include reinforcing the use of face masks, ramping up testing, and delivering more resources to states so that schools and businesses could safely reopen.
Some of those are longer-term goals, but public-health experts say there are things a new administration could do on day one to alter the course of the pandemic.
We asked six experts — including scholars from Vanderbilt, Harvard, and Johns Hopkins University — to set an agenda for Biden and Harris’ first day in office, should they win. Here’s what they came up with.
1. Give the CDC its authority back
Almost every expert mentioned the same priority: restoring the authority of the Centers for Disease Control and Prevention, which is headquartered in Atlanta.
“Get it the heck out of Washington, for Pete’s sake,” Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, told Business Insider. “Washington is politics. Atlanta CDC is nonpartisan public health.”
Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, said the CDC should be able to develop plans of action that aren’t clouded by fears of how things will be perceived by the White House.
“The first course of action is to restore the CDC to its place leading this response and to remove politics from the response completely,” he told Business Insider. “We have the structure to deal with this. It’s just that that structure has been sidelined from the very beginning.”
In May, a CDC official told the Associated Press that the White House had ignored the agency’s guidelines for reopening public places in favor of a more aggressive reopening strategy. Then in July, the White House directed hospitals to report coronavirus data to the Department of Health and Human Services via a private technology firm, TeleTracking Technologies, instead of straight to the CDC.
Under a new administration, Adalja said, the CDC should only have one question in mind: “Is this true?” rather than “Does the president approve of this?”
2. Institute daily press briefings
If elected, Biden has said, he intends to place one of his first calls to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. Multiple experts said a Biden-Harris administration should put Fauci in front of the public on day one.
“They need to get the public-health leadership — Tony Fauci, Deborah Birx, and Robert Redfield — up on a podium and say that they are going to put the public-health people in charge,” Schaffner said. (Birx is the current coordinator of the White House coronavirus task force. Redfield directs the CDC.)
During past infectious-disease emergencies — Zika, Ebola, and H1N1 — the CDC held regular press conferences to inform people about changes to the public-health response. But CDC coronavirus briefings were abruptly discontinued in March after Dr. Nancy Messonnier, director of the agency’s National Center for Immunization and Respiratory Diseases, warned that the virus would inevitably spread throughout the US.
The CDC resumed holding briefings at the end of May after a nearly three-month hiatus. But experts say they’d still prefer these briefings to happen more often: at least once a day.
“This is a public-health crisis that needs to be led by public-health experts,” Dr. Leana Wen, a public-health professor at George Washington University who previously served as Baltimore’s Health Commissioner, said. “They need to stop muzzling scientists and start daily briefings to the public about what is going on.”
“You really have to view the pandemic as a problem that you’re willing to talk about,” Gates said. “Willing to admit we’ve made some mistakes, and that we’re going to keep learning, and let the voice of the CDC and experts like Dr. Fauci not be restricted, in terms of allowing them to speak to the public, and not be drowned out by whatever treatments you have a personal thought about.”
In a July editorial published in the Journal of the American Medical Association, Redfield suggested that the universal adoption of face masks could bring the US’s outbreak under control in as little as four weeks based on case numbers and transmission rates at that time. A model from the University of Washington, meanwhile, predicts that the US could prevent nearly 67,000 coronavirus deaths by December if 95% of the population were to wear face masks in public.
The CDC currently recommends face masks for the public, but mask mandates aren’t consistent across states or counties. In the absence of a unified national policy, masks have turned into a political statement instead of an effective public-health tool.
“This also goes back to this attack on expertise,” Adalja said. “I would suspect that this could be handled better by any administration than the one currently.”
Experts say there are ways to get the entire country on board with masks.
“You would get some religious leaders backing it, some major business corporation leaders all up on the podium, all singing the same song,” Schaffner said. “They need to address the fact that this is not politics. This is real and coronavirus is not disappearing.”
4. Ramp up testing
The US is already testing more people per capita than almost any other nation: around 204 daily tests for every 100,000 people. But it also represents a quarter of the world’s coronavirus cases — meaning its testing capacity is still relatively limited. The weekly average of daily tests is now 13% lower than it was at the end of July, according to data from The COVID Tracking Project.
“We need robust testing with rapid turnaround to allow contact tracing to work better,” Marissa Levine, a public health professor at the University of South Florida, said.
A lack of testing makes it hard to identify new cases in time to contain an outbreak. So many experts say a Biden-Harris administration should accelerate the development of at-home diagnostic tests with the same speed as vaccine research.
“We have dozens of companies that have developed diagnostic tests and many of their applications for approval are sitting at the FDA for weeks and sometimes months,” Dr. Ashish Jha, faculty director of the Harvard Global Health Institute, said. “That’s unacceptable.”
5. Use the Defense Production Act
Experts also hope Biden will more fully utilize the Defense Production Act, which allows the president to require businesses to prioritize the federal government’s supply-chain needs. The law also restricts companies from hoarding or price gouging critical supplies.
Trump invoked the Defense Production Act for ventilators and N95 masks in April. But experts have called on his administration to use the law far more to ensure there’s a steady stream of medical supplies being manufactured, including testing swabs, personal protective gear, and vaccine equipment.
“We need to secure the supply chain because it’s not the vaccine that’s going to save lives, it’s the vaccination,” Wen said. “We cannot be running out of vials and syringes.”
Invoking the act could also help diagnostic-testing companies ramp up production.
“What I would like to see is the federal government actually sit down with these companies and say: ‘What do you need to go faster than you think you can go?'” Jha said. “They might need help with supply chain. They may need help with capital. The whole point of the Defense Production Act is to do exactly those things.”
6. Appoint Ron Klain as testing czar
One of Biden’s first priorities should be to appoint strong leaders, Gates said.
“There are lots of people who are involved in the global response to Ebola and smallpox and polio, who would love to help out the US bring this thing to a close,” he said.
A few experts suggested appointing Ron Klain, Biden’s chief of staff from 2009 to 2011, as the new White House coronavirus testing czar. Klain coordinated the White House response to the Ebola outbreak in 2014 and 2015.
“What America needs is an effective federal response — and there is nobody better than Ron at making that happen,” Jha said.
In July, the current testing czar, Admiral Brett Giroir, told CNN that the government was doing all it could to test people. But he also acknowledged that turnaround times for test results still lagged. Experts hope a new czar could more proactively scale up production and processing.
“You really need a prominent, nonpartisan national leader who’s going to orchestrate this, who will then reach out to testing companies and make sure that their tests become more widely available,” Schaffner said.
7. Develop a federal dashboard with live data
In January, researchers at Johns Hopkins University developed a live dashboard to track coronavirus cases. For a while, the tool was one of the sole resources for measuring the scope of the US outbreak. It’s still one of the most prominent and widely used.
But Wen said the federal government should be publishing its own data — including test positivity rates, contact tracing efforts, and racial demographics — in real time.
So far, a lack of federal oversight has led to inconsistencies in how states measure their outbreaks. Some states include positive results from antigen tests (which detect the spiky proteins on the virus’ surface) in their case tallies, while others rely solely on standard PCR tests (which detect the virus’ genetic material). Different hospitals may also have varying definitions of COVID-19 recoveries and deaths.
“The Johns Hopkins folks do their best and individual states have varying levels of data collection, but we need a central source that’s within the federal government, where they pull in the data that comes from local jurisdictions and states,” Wen said.
8. Convene scientific experts to come up with a new response plan
Finally, experts called for a new national strategy led by a panel of scientific experts.
“The key will be to rely on scientific understanding, not wishful thinking,” Dr. Joshua Sharfstein, a vice dean at the Johns Hopkins Bloomberg School of Public Health, said.
Levine said it would be very possible for a Biden-Harris administration to find a way to suppress the virus and boost the economy at the same time.
“Our big challenge has been that we’ve pitted the economy against health,” Levine added. “That administration, if it were to be elected, needs to bring those two together.”