Letters to the Editor • Opinion
The coronavirus might not be the worst of it
The Washington PostDemocracy Dies in Darkness

A year ago, Biden unveiled a 200-page plan to defeat covid. He has struggled to deliver on some key promises.

The U.S. would have been better prepared for virus curveballs if the administration had moved more quickly to boost testing, acquire real-time data on the virus and convey risks more clearly, say some co-authors, advisers

President Biden signs a series of executive orders on the pandemic response hours after being sworn into office on Jan. 20, 2021. (Jabin Botsford/The Washington Post)
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President Biden entered office a year ago this week, staking his presidency on defeating the coronavirus pandemic with a battle plan hailed for its scope and specificity.

“Our nation continues to experience the darkest days of the pandemic,” the White House declared in its national pandemic strategy, released Jan. 21, 2021, Biden’s first full day as president. “Businesses are closing, hospitals are full, and families are saying goodbye to their loved ones remotely.”

Yet after a period when Biden’s vaccination focus appeared to be paying off, many of those problems have roared back as the delta variant, and then omicron, tore across the country. Once again, doctors and nurses are pleading for relief, as hospitalizations set new daily records and more facilities move to ration care. Many Americans say they’re confused by government pronouncements and losing faith in the agencies handling the response. Essential workers in packing plants, food service and emergency response say they still feel endangered by a virus that Biden had vowed to control.

“He promised he would take care of health workers, but it doesn’t feel that way,” said Cathy Kennedy, a neonatal nurse who helps lead the California Nurses Association. Kennedy said she worried that infected colleagues are being rushed back to work by short-staffed hospitals and blamed the White House for failing to enact permanent workplace safety standards to protect them.

As he prepared to take office, Biden oversaw a 200-page pandemic plan that promised to restore trust in the federal government, protect essential workers and slow the coronavirus’s spread. But, as president, he has struggled to execute key parts of it.

Page 59 promised “predictable and robust” federal purchasing of coronavirus tests — a pledge that industry leaders say fell far short, as Americans continue to line up to get tested while complaining they can’t find home test kits.

Page 81 pledged to “support schools in implementing COVID-19 screening testing,” but many parents, teachers and staff say that schools have largely been left to fend for themselves.

And Page 103 vowed “to ensure patient safety” in nursing homes by boosting staffing and vaccinations, yet worker shortages persist and elderly residents lag behind on getting booster shots.

On Jan. 13, the Supreme Court blocked the Biden administration from enforcing a vaccination-or-testing requirement for large employers. Here’s what to know. (Video: Julie Yoon/The Washington Post)

Some of Biden’s biggest challenges on executing that plan have been beyond his control, including courts that delayed and then blocked his vaccination-or-test mandates; Republicans who fought calls for masking and promoted vaccine disinformation; and, most significantly, an unpredictable virus that has evolved to evade some protections conferred by vaccines even as it became more transmissible.

“This is a good plan overcome by events,” said Andy Slavitt, who served as a senior adviser on the White House covid response last year. “Everyone had a failure to anticipate delta and omicron, the administration included.”

But many say the United States would have been better prepared to deal with the virus’s curveballs if the administration had more quickly delivered on promises to improve testing and real-time virus surveillance and encouraged masking nationwide, rather than focusing so heavily on vaccines. The nation’s struggles to ramp up access to rapid coronavirus tests this winter could have been avoided, for instance, had the White House stuck to pledges to boost test supply last year and explain to Americans when to use them, said outside advisers and co-authors of Biden’s plan.

“We’d be in a better place to deal with omicron, because we’d have more tools to fight it,” said a person who helped craft Biden’s plan and spoke on the condition of anonymity to discuss their work.

About 49 percent of Americans said that Biden was doing a good job handling the covid outbreak, down from 67 percent who approved of his response last March, a period when the virus was receding, according to a CBS News/YouGov poll released this week. Thirty-six percent of Americans said that U.S. efforts to contain the virus were currently going well.

Even some of Biden’s allies are demanding answers about why long-standing issues remain unresolved.

“I’m frustrated we’re still behind on issues as important to families as testing and supporting schools,” said Sen. Patty Murray (D-Wash.), who grilled Biden officials at a Senate Health, Education, Labor and Pensions hearing last week. “That’s not to say we have not made progress. It’s just clear we haven’t made enough.”

White House officials insist they have carried out virtually all of the promises in Biden’s plan, a list of seven broad goals that contain more than 180 discrete pledges that include addressing “disinformation and misinformation” and vaccinating Americans, as well as rejoining the World Health Organization and launching a national epidemic forecasting hub at the Centers for Disease Control and Prevention.

Officials say they have used the pandemic plan as their compass and have worked around-the-clock to implement it.

“The team sort of teases me that it’s my security blanket,” said Jeff Zients, the president’s coronavirus strategy coordinator, who keeps a blanket in his office that is emblazoned on one side with the image of the plan’s cover. (The other side reads “execution, execution, execution,” a not-so-subtle exhortation to his staff who sometimes borrow the blanket when they get cold.)

“If you look across the seven areas, I think we’ve made a lot of progress across all of them,” Zients added, touting metrics about expanding access to tests, reopening schools and immunizing millions of Americans. “It’s the execution that’s led to 210 million people now fully vaccinated and 80 million boosted,” he said.

Zients acknowledged one area, however, in which “we underestimated in that original strategy … the amount of disinformation and the fact that people would actually stand in the way of the pandemic response for political or other motivations.”

Asked by The Washington Post to grade Biden’s progress, 17 outside public health experts credit the administration with achieving some of its most important priorities. They note that about 63 percent of Americans are now fully vaccinated, helping to protect them from the worst consequences of the virus. Health disparities that Biden inherited, linked to higher covid death rates among communities of color, were dramatically reduced. Global health alliances needed to coordinate a worldwide pandemic response were restored.

But each of the outside experts characterized key parts of Biden’s plan as unfinished, saying that much work remains to fulfill the president’s promises to protect essential workers, curb the virus’s spread and restore Americans’ trust in the federal government, among other goals.

“All of the items here, you could credibly say, have been addressed in some way, most of them substantively,” said Krishna Udayakumar, director of the Duke Global Health Innovation Center, referring to Biden’s global strategy promises such as supporting the WHO, joining a vaccine-sharing alliance and resuming global leadership after the Trump administration retreated from those roles. “The administration can and does credibly say they are doing more than almost every other country. … And it is also true that none of it is even close to being enough to end the pandemic.”

‘Marching orders’

The “National Strategy for the Covid-19 Response and Pandemic Preparedness,” unveiled by the president on his first full day in office, took shape in transition-team meetings in September 2020. Drawing on contributions from more than 100 people, the plan was conceived as a path to lead the United States out of this pandemic while preparing for the next one. Vaccines were a central plank but far from the sole priority — in part, because the shots were still months away from being authorized by regulators.

The plan was also envisioned as a rebuttal to former president Donald Trump. Biden said Trump had ignored a pandemic playbook left by the Obama-Biden administration and then failed to develop one of his own as covid ravaged the country — an issue Biden and his allies had hammered throughout the campaign.

Joe Biden & Barack Obama: The Pandemic Playbook

Our administration literally left this White House a playbook that would have shown them how to respond before COVID-19 reached our shores. I'm not sure what they did with it—maybe used it to prop up a wobbly table somewhere—but they certainly didn't take it to heart. Eight months into this pandemic, cases are rising again across the country. Donald Trump isn't suddenly going to protect all of us. Joe will get this pandemic under control with a plan to make testing free and widely available, to get a vaccine to every American cost-free, and to make sure our frontline heroes never have to ask other countries for the equipment they need. His plan will guarantee paid sick leave for workers and parents affected by the pandemic, and he’ll make sure that the small businesses that hold our communities together and employ millions of Americans can reopen safely. We revisited our administration's pandemic playbook recently. Take a look—and then get out and vote for a leader who will get this virus under control. That’s Joe Biden.

Posted by Barack Obama on Monday, November 2, 2020

“Our national strategy is comprehensive. It’s based on science, not politics. It’s based on truth, not denial,” Biden said as he unveiled the plan on Jan. 21, 2021. “It’s complete detail on what we’re going to do. … This is the plan. This is the plan.”

In the weeks to come, more than a dozen current and former members of the administration said they looked to Biden’s plan for their marching orders on how to fight covid, with senior officials carrying a copy into meetings and checking collective progress against its goals.

“It was a combination roadmap-marching orders, ‘this is what we’re going to do,’ ” said Gayle Smith, who led the State Department’s covid response last year. “I think it mattered. And I think it still matters.”

The plan also was widely applauded outside of the administration, with public health and policy experts praising it as clear and comprehensive — and overdue, after Trump’s failure to articulate a strategy.

“I think they earned our trust with a good pandemic plan,” said Julia Raifman, an assistant professor of health policy at Boston University. “And then they did not follow through on it.”

Experts broadly agree that the Biden administration achieved its goal to widely vaccinate Americans, carrying out more than 40 promises to get more shots in people’s arms.

As surgeon general, Vivek H. Murthy, who helped write the plan, led an array of efforts to combat misinformation and activate local “community corps” to serve as trusted messengers. The federal government set up dozens of vaccination centers for Americans to get shots, a move hailed even by some Trump officials, and enlisted public service communications experts like the Ad Council to craft pro-vaccine messaging campaigns, a step the Trump administration never took.

White House officials and allies say the proof they succeeded is that about 250 million Americans have received at least one dose, up from about 15 million when Biden took office, according to The Post’s tracking. Some of those were skeptics who were won over by those campaigns.

And yet, despite the president’s insistence that the virus’s recent casualties are the result of “a pandemic of the unvaccinated,” some Americans, especially rural Republicans, remain strongly resistant. About a quarter of adults have declined to get the shots, and many parents remain uncertain about vaccinating their children. Even fully vaccinated Americans appear to be tuning out health officials’ exhortations, with 38 percent heeding calls to get booster shots. Public health agencies also have struggled to communicate why so many vaccinated people have gotten breakthrough infections, after Biden officials assured Americans last year that vaccinations would largely prevent them.

Over and over, the administration’s messaging has been undercut by a shapeshifting virus — with corrosive effects on public trust. By November, less than half of Americans said they were “optimistic” about the state of coronavirus vaccinations, down from two-thirds the prior January, the Kaiser Family Foundation found.

The administration has been less successful fulfilling 33 pledges intended to curb viral spread by expanding access to tests, improving data surveillance and issuing clear messages to the public, among an array of other measures.

“It was a lofty goal that, in retrospect, is not something that could be achieved by a single government over a period of one year,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and among the former Biden advisers who urged him in recent journal articles to reorient his strategies around “living with the virus.”

Biden pledged to improve real-time data analysis, for instance, so policymakers could make decisions more effectively, and the public, better understand its risks. But his former advisers said that U.S. leaders still rely on data from overseas when judging vaccines’ durability and their effectiveness against variants, slowing down decisions like recommending booster shots and shifting policies to fight omicron.

Messy, incomplete U.S. data hobbles pandemic response

As the White House focused heavily on vaccinations, some of its other priorities seemed less urgent as infections declined through last spring and early summer, prompting many in and out of the administration to think the pandemic was on its way out.

One promise was to “effectively distribute tests” so Americans wouldn’t need to wait in lines again to find out whether they were infected — an unfulfilled vow for the thousands of Americans in long testing queues before the holidays.

Another promise was to give Americans clear guidance to help them decide whether and when to wear masks, get booster shots or gather with others. But health officials struggled to explain their changing recommendations, leaving many people confused and frustrated. The CDC only Friday updated its long-standing mask guidance, saying N95 and KN95 masks offer better protection than cloth coverings against omicron.

The White House had “no plan” to explain to Americans why and when they needed to be tested for the virus, said Scott Becker, head of the Association of Public Health Laboratories, which helps provide coronavirus testing. “U.S. leaders didn’t really educate the consumer who’s never used these things before. … Now, we’re playing catch-up.”

Officials also neglected a core promise to make “predictable” test supply purchases, industry leaders said. Manufacturers who had shut down plants as demand for their products dropped precipitously last spring scrambled to ramp up this winter. Rather than prioritize large orders of tests last year, which could have equipped the nation to deal with a new surge, Biden officials focused on a vaccination campaign that seemed to be succeeding at driving down case numbers.

“I think there’s more that can be done there to ensure predictability,” said Scott Whitaker, head of AdvaMed, an association that represents manufacturers of coronavirus tests and other medical devices.

Several industry leaders referenced how Abbott Laboratories, a maker of coronavirus rapid tests, last year destroyed testing components because the market had dried up as case numbers fell, as the New York Times first reported. “That was a hugely unfortunate situation,” Becker said. Abbott has denied that it destroyed any finished BinaxNOW tests or “usable test components.”

Recently, as omicron surged, the Biden administration took steps to shore up testing capacity, including committing to buy 1 billion additional at-home tests, launching a website where Americans could order them free, and requiring insurers to cover the cost of rapid tests purchased online or in retail stores. The administration also has helped set up testing sites around the nation, harking back to last year’s vaccination centers, and touted its moves in a memo to Congress.

Many deemed those steps too little, too late.

“This Administration either knew or should have known that testing shortages were occurring across the country over the past several months,” Sens. Joe Manchin III (D-W.Va), Kyrsten Sinema (D-Ariz.) and Jacky Rosen (D-Nev.), and other moderates wrote Zients on Friday.

Biden’s plan also laid out measures to address health-care staff shortages, including offering surge assistance to hospitals and helping states boost their workforces. Experts praised the White House announcement last spring to invest more than $7 billion to recruit and hire public health workers but said it should have been more aggressive with short-term fixes.

“If they’d approached me a year ago and said, ‘what’s the one problem we should be working on outside of vaccinations?’ I would have said, ‘staff, staff, staff,’ ” said David Grabowski, a Harvard University specialist on long-term care, noting nursing homes have lost more than 400,000 workers since the pandemic began.

Grabowski and others called on the government to finance a $5 an hour pay increase for certified nurse assistants, arguing that additional compensation for the low-paid workers would help stabilize staffing. “This was a crisis that, now with omicron, has become a staffing apocalypse,” he said.

A Biden-backed relief package disbursed billions of dollars in bonus payments to nurse aides and other essential workers last year, but local leaders had broad latitude on how to structure the payments, and many workers say the payments were inconsistently applied.

Meanwhile, Biden’s plan vowed to “protect workers and issue stronger worker safety guidance,” instructing the Occupational Safety and Health Administration to consider protections. After a review, OSHA in June 2021 issued a temporary standard that required health-care employers to provide protective equipment, adequate ventilation and other safety measures to reduce workers’ risk of contracting covid.

But the administration shelved a separate standard that would have applied to other industries, said David Michaels, a George Washington University professor who previously led OSHA and advised Biden’s transition team on covid.

“I think a lot of people in public health were displeased that that standard was never issued. And, in retrospect, it was really a very significant mistake,” Michaels said.

OSHA announced last month that it would let the health-care safety standards lapse, saying it wasn’t ready to issue permanent protections by a December deadline, even though it believed “the danger faced by healthcare workers continues to be of the highest concern.”

The decision alarmed Democratic senators and health workers, who say that permanent workplace safety measures are overdue.

Kennedy, the California nurse, also blamed the exodus of some of her colleagues on the lack of protections. “It’s like a war zone” in her hospital right now, Kennedy said. “We need these protections. And they need to be permanent, because we don’t know what the next pandemic is going to be.”

In an interview, White House officials said the administration had prioritized the safety of “heroic” health-care workers. “We’ve made sure that there’s plenty of availability of PPE [personal protective equipment] and N95 masks,” Zients said.

Officials added they were navigating a fraught political environment in which regulations are consistently challenged, and they faulted the Supreme Court for striking down a separate OSHA rule last week that compelled most large businesses to mandate vaccinate-or-test rules.

“After this, workers are less safe,” said Natalie Quillian, deputy White House coronavirus coordinator. “And that’s not good for workers, that’s not good for customers, and that’s not good for our economy.”

Meanwhile, global health experts say that the White House is still doing too little to prevent another variant from emerging overseas and disrupting life in America again.

Duke’s Udayakumar credits the administration for donating more than 365 million vaccine doses abroad — far more than all other nations combined. But he said developing nations are still waiting on U.S. aid that could help prevent infections now and lower the risk of new variants developing. Less than 10 percent of people in low-income nations have received a single dose of coronavirus vaccine, according to Oxford University’s Our World in Data tracking project.

“The fundamental reality is we’ve got a huge task ahead of us that looks as daunting now as it did a year ago on the global front,” Udayakumar added.

Outside experts and some administration officials said Biden has sought to avoid the perception of prioritizing the international response over a still-surging U.S. outbreak. “It’s been difficult to get the White House to focus on improving vaccinations in Malawi, when the president is getting calls about overflowing hospitals in Missouri,” said one official who spoke on the condition of anonymity because of the issue’s sensitivity.

The White House and its allies say the administration has addressed every aspect of its global-strategy list, which included reviving government teams and diplomatic efforts that were wound down under Trump’s “America First” approach.

“I think President Biden came into a situation where the house was on fire at home and abroad,” said Smith, who led the State Department’s covid response last year. “Heads of state had not met and convened on [coronavirus policy] until President Biden brought them together. That’s crazy.”

But Smith, while praising the “tremendous progress” last year, acknowledged that more work is needed to achieve global targets. “The road ahead is tough,” she said.

Stay the course or seek ‘new normal’?

Asked what they’ve learned from year one, Biden officials said they’ll largely stick to the same game plan in Year Two.

“The tools that we’re using to fight omicron are the tools that we emphasized in the strategic plan: namely vaccination, therapeutics, testing, appropriate masking, and other public health standards,” Zients said.

He also emphasized the commitment to keeping schools open — “we have the tools and know how to do it,” Zients said — and stressed that the White House was focused on rolling out booster shots to protect vulnerable Americans.

Zients touted the administration’s efforts to speed development as well as supplies of Pfizer’s Paxlovid, an antiviral pill authorized just before Christmas and described as a potential game changer because it can be taken at home to prevent infections from advancing to severe disease. “As soon as it became clear that it was as effective as it is — 90 percent effective against severe disease — we made the purchase of 20 million doses, the most in the world,” Zients said.

Biden will further detail how he sees the path ahead in a news conference Wednesday, officials said. It’s a critical moment, with the public increasingly exhausted and looking for clear, simple messages on how to navigate what’s next.

Some hope he will use the opportunity to reframe how he talks about covid to communicate to Americans that it won’t quickly or easily be eradicated.

“ 'Living with covid’ isn’t raising a white flag,” said Celine Gounder, a New York University infectious-disease expert who was among the former Biden advisers calling for a “new normal” in the nation’s approach to the virus. “It’s focusing our efforts to curb hospitalizations and deaths from covid, especially among the most vulnerable.”

Former Biden advisers call for ‘new’ covid strategy

Gounder added the White House needs to continue to encourage mask-wearing, better deploy tests and improve data systems to track the virus — many of the measures in Biden’s plan that remain unfinished.

“There is no such thing as one silver bullet” to fight the virus, she said, especially when so many people aren’t getting vaccinated.