Former Biden transition advisors call for change in COVID-19 strategy

Several health advisers to President Biden’s transition team are calling on the administration to revamp its COVID-19 pandemic strategy and set clear goals for what the “new normal” of living with the virus will look like.

In three separate op-eds published in the Journal of the American Medical Association, the authors recommended dozens of strategies that go above and beyond what the Biden administration is currently doing. 

The authors include Luciana Borio, a former acting chief scientist at the Food and Drug Administration; Ezekiel Emanuel, an oncologist and University of Pennsylvania professor; Michael Osterholm of the University of Minnesota; and Rick Bright of the Rockefeller Foundation. 

The authors made clear that COVID-19 is not endemic yet, and that the U.S. is far from that point. But they said the administration needs to clearly communicate the current goals and strategies, instead of shifting from one crisis to another.

For instance, they said it was shortsighted for Biden to declare last summer that the U.S. has “gained the upper hand against this virus.”

“By September 2021, the Delta variant proved these steps to be premature, and by late November, the Omicron variant created concern about a perpetual state of emergency,” they wrote. “In delineating a national strategy, humility is essential.”

Neither COVID-19 vaccination nor infection appear to confer lifelong immunity, and the current vaccines do not offer protection against infection either. The goal for the “new normal” with COVID-19 does not include eradication or elimination, they wrote.

The appropriate risk threshold should reflect peak weekly deaths, hospitalizations, and community prevalence of viral respiratory illnesses during high-severity years, such as 2017-2018. That year had approximately 41 million symptomatic cases of influenza, 710,000 hospitalizations and 52,000 deaths

“Today, the U.S. is far from these thresholds,” they said, and getting to that point will take effort. 

For instance, they said the U.S. needs to invest in a public health data infrastructure 

“As Omicron has reemphasized, the US is operating with imprecise estimates of disease spread, limited genomic surveillance, projections based on select reporting sites, and data from other countries that may not be generalizable. These shortcomings are threatening lives and societal function,” the authors wrote.

They also called for better investment in testing.

“Every person in the US should have access to low-cost testing to determine if they are infected and infectious. The Biden administration’s plan to distribute 500 million at-home rapid tests and ramp up production using the Defense Production Act is an important step in the right direction but many more are needed,” they wrote.

The authors also said that vaccine mandates should be imposed more broadly, including for children in schools, and that the government should make high quality masks like N95 available for free for all Americans.

“It appears that SARS-CoV-2 will persist, and the COVID-19 pandemic will continue for some time. Consequently, to achieve a sustainable ‘new normal’ with substantially lower virus transmission and mortality from COVID-19, testing, surveillance, masking, and ventilation all need significant improvement,” the authors wrote.