The situation is bleak in the United States now, but it could be exponentially worse come the fall and winter. “Twindemics” of influenza and covid-19 could result in the deadliest winter in living memory. Hospitals, already stretched to capacity by the flu, could exceed their ability to treat the critically ill. Death rates could escalate, the economy could worsen, and schools could all be closed with no path to reopening. As millions more become infected, covid-19 “long-haulers” could grow in number, with potentially hundreds of thousands of people living with long-term effects such as lung damage, kidney failure and debilitating fatigue.
All this is a worst-case scenario, but it is far from implausible. Biden’s campaign website presents a thoughtful and detailed response to covid-19 that is incomparably better than President Trump’s actions to date. I still have some unanswered questions. Most important: How would Biden describe the national strategy? Would the new president call for a full, six-week lockdown to suppress covid-19 infections? Or does he think that a targeted approach — closing indoor bars and restaurants and requiring masks — is more realistic?
With either strategy, there’s the question of how he will get people behind him, given the polarization that will surely be worse after a bruising election. Let’s say he calls for a national lockdown. Given our federal system, he can’t carry one out on his own. Perhaps the country is in such dire straits that people would follow his lead. More likely, some governors wouldn’t agree. They may even resist instructions to shutter certain businesses. And there’s the real question of whether Americans will comply with directives from a new president, after nearly a year of hearing mixed messages from their leaders.
Biden has called for restoring the public’s trust by having scientists and doctors lead the public health response. In March, Americans could well have abided by a European-style shutdown and achieved similar results. But, now, that trust has been eroded, it will be difficult to reestablish.
There’s also the matter of the private sector. Biden has talked about activating the Defense Production Act to secure needed reagents and supplies for tests. Doing that early on in the pandemic is one thing. But in the absence of a national testing strategy, there are now many different companies, supported by a variety of philanthropies and investors, working to ramp up their own products. Biden has proposed a national board to oversee testing. Will this board expand on what’s already in place or would it ask various groups to stop piecemeal efforts and aim for one coordinated “moonshot”?
Similarly, as a new administration examines where the United States is on vaccine development, it might well find efficiencies that can come from nationalizing production and distribution. To what extent would the federal government take over this work and ask pharmaceutical companies to pivot to a new national plan?
I’d also like to hear more about the help that will be needed for those who survive covid-19. Biden has said that patients seeking care for the novel coronavirus shouldn’t have to pay. Does this extend to those suffering long-term health consequences — will they receive health care with no co-pays in perpetuity? What is his plan to pay for this, and for the potentially large increase in individuals who will be seeking disability assistance?
Let’s not forget about mental health. I’m looking to hear an acknowledgment of how covid-19 has already worsened existing mental health disparities. Addiction, too, is a disease of isolation. A recent study found that a shocking 40 percent of American adults are experiencing a mental health or substance-use condition. One in 10 seriously considered suicide in the preceding 30 days. By January, it won’t be enough to say that we need to have more behavioral health treatment, as important as that is. How will a new president treat a sickness on top of a sickness — one that could, by then, affect more than half the country?
Last week, Biden made headlines when he announced that he’d impose a three-month mask mandate. If that were implemented today, it would make a big difference in curbing the spread of the coronavirus. By January, such a mandate will probably be nowhere near sufficient. A President Biden would be leading a nation in profound health, economic and social crisis. He needs to rally the American people with a plan that anticipates the extraordinary challenges in the months and years ahead.
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