At long last, the United States has a president who appears to understand the threats posed by Covid-19. The incoming administration also has the popular mandate and legislative power to address the crisis. As Americans, we are relieved and, for the first time in many months, cautiously optimistic.
But as epidemiologists, we are concerned that President Joe Biden’s current pandemic strategy will not be enough to avert further disaster. To prevent unnecessary deaths and give the vaccine a chance to succeed, Biden must encourage states to enact four- to six-week shutdowns by offering generous economic support to people and businesses.
The Biden team has inherited an incredibly difficult situation. The coronavirus is circulating at uncontrolled levels in almost every US community. More transmissible variants, such as the B.1.1.7 strain first identified in the UK, are here and could become the dominant strains sometime in March. To date, some 440,000 people have died from Covid-19 in the United States, with the heaviest death tolls borne by people of color. By mid-February, we may reach half a million deaths.
Even under Biden’s vaccination plan, only a small fraction of Americans—perhaps one in eight—would receive both vaccine doses by May. It is risky to allow high levels of viral transmission before vaccinations are widely administered. First, hundreds of thousands more people could die as the virus spreads unabated. Second, gradual vaccination places selective pressure on the virus, increasing the likelihood that new mutations could weaken the vaccines’ effectiveness. Suppressing transmission is the best way to reduce opportunities for the coronavirus to mutate during vaccine rollout, and the best way to suppress transmission is to implement policies that make it possible for large numbers of people to avoid face-to-face contact with other people.
The White House’s 200-page strategic plan for the pandemic response doesn’t go far enough. It includes mask mandates, testing programs, and targeted restrictions. But an emphasis on masking, for instance, will yield limited returns, since a large share of Americans—73 percent according to a recent poll—already wear masks whenever they leave the home. The directive to issue new workplace safety regulations is important, but must be contextualized: The Occupational Safety and Health Administration has limited enforcement powers and fewer than 900 inspectors to cover the entire country.
As written, the strategic plan will not enable what it calls a “safe reopening” of businesses, schools, and travel. A premature, large-scale return to shared indoor spaces, with only piecemeal mitigation measures, runs the risk of worsening the pandemic and further pushing our buckling health systems past the point of collapse. For example, New York Governor Andrew Cuomo plans to permit resumption of indoor dining at 25 percent capacity on Valentine’s Day. This poses a reckless and unnecessary risk to restaurant workers, diners, and the vaccine rollout. Similarly, California Governor Gavin Newsom lifted stay-at-home advisories on January 24. Closing nonessential businesses to bring transmission under control is a prerequisite for being able to open schools safely; these governors’ moves represent steps in the wrong direction. Strong federal guidance is needed not only to reduce transmission but also to guide prioritization of permitted in-person activities during vaccine rollout.
Earlier this winter, many countries had hoped to control the pandemic through targeted measures of the sort that the Biden administration is proposing. But country after country—the United Kingdom, Germany, Australia, Israel—has found that curbing the virus requires stay-at-home orders combined with broad closures of nonessential businesses and other institutions. These public health measures are not only effective; they also poll well with the public: Sixty-one percent of Americans support closing nonessential businesses, while only 32 percent oppose closures. Stay-at-home orders enjoy similarly high support.
Despite public support, President Biden has backed away from the broad public health measures he initially supported. In August, then–presidential candidate Biden responded to an interviewer’s question about whether he would support a national shutdown if scientists supported it by saying, “I would shut it down. I would listen to the scientists.”
But in November, a member of the president-elect’s coronavirus task force, Michael Osterholm, proposed a national shutdown of four to six weeks to bring transmission under control, while covering losses to workers, businesses, and state and local governments. President-elect Biden was quick to distance himself from Osterholm’s views, saying, “I’m not going to shut down the economy, period. I’m going to shut down the virus.”
Osterholm’s proposal was correct in November, and it’s even more correct now. While candidate Biden stated he was “prepared to do whatever it takes to save lives,” President Biden’s rejection of shutdowns could kill hundreds of thousands of Americans.
While federalism prevents Biden and Congress from ordering sweeping, national public health measures by decree, the White House is far from powerless. The president can make the case for statewide and regional shutdowns. The Democratic-controlled Congress can provide generous economic and logistical support that allows nonessential workers to stay home and keeps businesses afloat during temporary closures. Congress can also pass federal legislation to pay workers at nonessential businesses to stay home during a public health emergency, even if some governors choose not to cooperate.
Biden’s proposed $1.9 trillion pandemic bill offers much-needed aid, but it is primarily intended as an economic stimulus, not as a tool for enabling public health measures. Moreover, Biden has reportedly decided to work with Republicans rather than pass the bill through reconciliation, a process that would not require bipartisan support. These negotiations may delay the bill, narrow its scope, and reduce its funding. This unnecessary, preemptive compromise will lead to many more needless deaths.
It has been a year since the first confirmed Covid-19 death in the United States. With Trump out of office and a new Democratic-majority Congress, there is no excuse for tolerating upward of 4,000 Covid deaths per day. Americans don’t actually want to risk exposure and death, and wouldn’t if their incomes and health care didn’t force them to. The science is clear: A short-term shutdown of nonessential activity, with generous economic support, can curtail the pandemic. Biden’s Covid-19 plan and relaxed restrictions at the state level will cause death and devastation, just when we’re so close to being safe again.