The election of Joe Biden as the forty-sixth president of the United States heralds a massive change in the U.S. approach to controlling the coronavirus pandemic—a shift from a president who has consistently downplayed it to one who has vowed to make the coronavirus response a top priority, starting Inauguration Day. But Inauguration Day is still nearly three months away. Even as analysts and the American public anxiously waited for the final battleground states to be “called,” U.S. coronavirus cases hit record highs—more than 132,000 new cases on Friday alone. The next three months have the potential to turn almost unthinkably bleak: If no action is taken to curb the pandemic in the interim, deaths could total 400,000 in the United States alone by February.
International media, this past week, divided their attention between the American nail-biter and the rolling waves of Covid-19 cases and shutdowns in Europe and elsewhere, as the northern hemisphere proceeds toward winter. While some countries, like New Zealand and Australia, have successfully prevented or deflated ballooning outbreaks, it will be difficult to maintain those successes as the virus spreads rapidly across the globe. The entire world is headed into a tense season.
“I’m very worried,” Dr. Georges Benjamin, executive director of the American Public Health Association, told me. “We have a new confirmed infection every second and a death every 107 seconds. This disease is a wildfire going through the community,” he said, and it will “continue to explode over the next few months before it gets better.” But a stronger response from the U.S. government, now and in the future, could turn these trends around, experts say. And even without strong national leadership for a few more months, there are important actions states, cities, counties, and agencies can take.
New York City, for instance, was hit early and hard by the pandemic. While the Trump administration was still denying the spread of the virus on American soil, New York cases began skyrocketing, and officials realized they needed to work quickly—and that they might not be able to depend on a coordinated federal response. They were largely on their own.
“Cities are where the rubber meets the road. We have to address the coronavirus regardless of what the federal administration is, regardless of any changes in resources that are available to us,” Dr. Dave Chokshi, the commissioner of the New York City Department of Health and Mental Hygiene, told me. While New York’s response may not have been perfect, it focused on data and scientific evidence, working closely with communities and neighborhoods to tailor their responses to New York’s cultural and ethnic diversity in order to produce more equitable policy.
Municipal governments can be very effective at pinpointing exactly where infections are taking place and taking swift action to prevent further spread. “By sharing what’s happening at the neighborhood level or at the zip-code level, it actually helps to get people on the same page and to motivate them to take action, whether it’s faith leaders, or elected officials, or the heads of community-based organizations,” Chokshi said. “It helps to galvanize everyone to say, Look, something is happening in our communities, we need to take steps quickly before things get worse. And if there’s one thing that we’ve learned about this virus, which is such a formidable foe, it’s that swift action is necessary.” Local officials can also help communities and neighborhoods send messages about ways to protect yourself and others, from preventative measures to getting tested and treated.
States can also be powerful players in addressing the pandemic—in some cases, more effectively than the national government. While the U.S. might not legally be able to mandate mask-wearing, for instance, states can. This year, 33 states and the District of Columbia required people to wear masks in most public situations. Other states have developed contract-tracing apps, including apps for visitors to check into every day with potential symptoms. Some states instituted restrictions on travel from certain regions and testing regimes for those who had been in Covid-19 hot zones. Still others have cut down on how many people can be in restaurants or stores at a time. And at the height of spread, some states implemented stay-at-home orders.
U.S. agencies will also have the opportunity to change tack. Although officials at the Centers for Disease Control and Prevention, Food and Drug Administration, Health and Human Services, and elsewhere have often come under sharp criticism for kowtowing to the Trump administration, they may soon be given freer rein to begin implementing more effective strategies. And even if they continue keeping a low profile as the pandemic rages on, they will still begin the transition process of working with Biden’s team. That can include shifting certain approaches to line up with the incoming administration’s plans, as long as it doesn’t directly conflict with existing orders from the current administration. “These folks are professionals,” Benjamin told me. “This is not a new process for them.”
The transition period usually starts soon after an election, but this year, swift action will be more important than ever. “A new administration is going to have to spend this time ramping up and getting their plans together so they can hit the ground running,” Benjamin said. “It starts with who you appoint, and how they approach the public, and how transparent are those folks?” There’s a lot experts are still learning about the virus, even several months in. Being honest about what we do and don’t know will be an important part of regaining trust. “If you make a mistake, and people will, you own up to it quickly, apologize, and move on.”
Chokshi also emphasized the need for openness and transparency. The public needs to understand why guidelines like wearing a mask, keeping a distance, and avoiding crowds and indoor gatherings matter. And when a vaccine arrives, trust in public officials and the quality of the research will be paramount. “Trust is an essential ingredient for turning a vaccine into a vaccination,” he said.
Although New York managed to find ways to address the pandemic, national assistance would have been a huge help. “There are certain things that require an effective and coordinated federal response,” Chokshi said, including rapid and effective testing and contact tracing. “All of these things would be better and could be done at an even larger scale if we had the real commitment of federal resources and an ability to more effectively coordinate with the federal government.”
That goes for national paid and sick leave programs, protective gear for essential workers, and economic relief to keep small businesses afloat, as well. “Every time we talk about the virus and the pandemic, we should also hold in our minds all of the parallel pandemics that come along with the direct effects of Covid-19,” Chokshi added, pointing to national economic upheaval. “So many people, but particularly low-income people, have been caught between these really tough situations”—such as needing to work at a potentially risky job versus following stay-at-home orders—“and on both counts, it has health effects.” Mental health and routine health care have also suffered, while substance use, domestic violence, and inequality have worsened.
“This is a once-in-a-generation, I hope once-in-a-lifetime, crisis, in terms of the scale of this pandemic,” Chokshi said. And ultimately, “we need to have federal leaders thinking about this and thinking about what a historic moment it is, and bringing to bear all of the powers of the federal government to meet the historic moment for the country as a whole.”
Political analysts may be celebrating the end of a sleepless week. But health experts are just ramping up, overwhelmingly agreeing that even with a Biden win, the country is facing its greatest challenge in the months to come. As the rest of Twitter focused on the election last weekend, doctors were tweeting out horror over the latest case numbers.
“This is just petrifying,” Dr. Gregg Gonsalves, an assistant professor in epidemiology at Yale School of Medicine, said recently in response to a 42 percent rise in cases. “It is the worst we’ve ever been and not getting better.… We cannot wait to tackle this catastrophe.” Dr. Craig A. Spencer, an emergency doctor in New York, agreed. “Many of us are focused on Tuesday, but I think people might not fully recognize that the next few months are going to be really bad with Covid-19, regardless who wins the election,” Spencer said last week.
As of Friday morning, the U.S. had more than 9.7 million Covid-19 cases. A week ago, Dr. Alexandra Phelan, assistant professor at Georgetown’s Center for Global Health Science and Security, lamented crossing the nine-million case mark in the U.S.: “This is a shocking dereliction of duty to protect public health by U.S. governments. I deeply worry what a contentious or petty lame duck period could bring.”