As infectious disease experts had warned over the summer, the fall brought another rise in COVID-19 cases in the United States. It is a third surge in what is still the first wave as the number of daily new cases only flattened slightly in the spring before rising again in June. As of the writing of this article, the number of daily new cases is averaging 177,000 and close to 2,000 people are dying each day.
The COVID-19 pandemic has reached a crisis level in multiple states. In El Paso, Texas, hospitals have run out of beds even though the city’s convention center was converted into a hospital, and some patients are being transported nearly 600 miles away to Austin. States are also running out of medical staff to care for the influx of patients. The governor of North Dakota is allowing nurses who have tested positive for COVID-19 to work in coronavirus wards. In Iowa, one school district is asking school staff to volunteer at the local hospital where workers are “overwhelmed,” and paramedics report COVID-19 patients who would have been hospitalized before this surge are being sent home.
The Trump administration has failed to take appropriate steps since the beginning of the pandemic to stop the spread of the virus. It politicized the virus by threatening to withhold funding to Democratic-led states. President Trump refused to take COVID-19 seriously and even mocked people for wearing masks. He pushed businesses to reopen and sided with the employers over the needs of workers to be protected, clearly putting profits over people.
Harvard epidemiologist Robert Hahn tried to quantify the impact of President Trump’s rejection of public health measures on people’s behavior and estimates it contributed to thousands of deaths between April and July. Public health officials at the University of Washington in Seattle predict more than 500,000 people will die from COVID-19 by the end of February if we do not change course. They report that over 100,000 lives could be saved if more people simply wore masks.
There is a lot of hope that the incoming Biden administration will take more effective actions to mitigate the spread of the virus. Joe Biden has already appointed a COVID-19 task force of public health experts and the first bullet point in the updated Biden-Harris COVID-19 plan is “Listen to science.” But will the Biden administration really listen to science if that requires putting people’s needs above corporate profits?
Throughout his campaign, Joe Biden made it clear that his focus was on reopening businesses and schools. This was also Trump’s focus, so it remains to be seen if the Biden approach will be substantively different.
Perhaps the first warning sign came in the form of Biden’s response when COVID-19 Task Force member Michael Osterholm told the media that a national shutdown of four to six weeks with financial support for workers, businesses, and local and state governments was needed to slow the spread. Osterholm cited the examples of Australia and New Zealand, two countries that have been effective in controlling the pandemic, and that both used national shutdowns. The European Union, which is also experiencing a large surge in COVID-19 cases, is using national shutdowns to slow the spread, with positive effect.
In response to Osterholm’s statement, Celine Gounder, another task force member, said: “A national lockdown or shutdown is not on the table. The President-elect has no intention of implementing a national lockdown.” And in a recent press conference, President-elect Biden said, “I am not going to shut down the economy, period.”
It is also concerning that the updated Biden-Harris COVID-19 plan does not mention providing economic relief to families and workers. While it prioritizes testing, personal protective equipment and funds to make businesses safer, it says nothing about stopping evictions, providing monthly support checks or covering health care costs for people.
What Demands Should We Make of the Biden Administration?
Three infectious disease epidemiology professors at the Johns Hopkins Bloomberg School of Public Health — Emily Gurley, Stefan Baral and David Celentano — all agree that a big impediment to controlling the pandemic to date is the lack of a national strategy.
Celentano told Truthout that the Centers for Disease Control and Prevention (CDC) would normally coordinate that strategy, but it “has been sidelined and muzzled. Thus, it devolved to the states with no federal response.”
Baral said the CDC needs to develop a clear national strategy with actions the states must take, sign off on state plans, and provide technical and financial support to implement them.
Gurley lamented the widespread lack of agreement about what the goals at a national level should be — something that needs to happen in order for the CDC to be able to develop an effective national strategy. “We all agree that if there aren’t hospital beds, that’s bad,” she said. “We can agree about what is bad but not on what the goals should be.”
As far as Osterholm’s proposal for a national shutdown with financial support, all agreed that shutdowns are effective at reducing the number of cases but expressed doubt that it could be done in the United States because adequate financial support would not be provided and people would not comply. Celentano wrote, “Yes, a total shut down of 4-6 weeks would be highly effective, even now, but it is probably not politically possible, with a focus on the economic impact that would ensue.”
Gurley said people must have an incentive to stay at home and that means paying them to do so. (Alameda County in the California Bay Area is doing this.) Baral said the uneven implementation of shutdowns has created vast inequities because governments have failed to make sure people have a safe place to quarantine, paid leave and the ability to meet their basic necessities. Each of the epidemiologists stressed the importance of protecting essential workers and their families.
Last August, in an op-ed in The New York Times titled, “Here’s How to Crush the Virus Until Vaccines Arrive,” Osterholm and Neel Kashkari, president of the Federal Reserve Bank of Minneapolis, argued the United States has the savings to safely take on more debt to finance the COVID-19 relief necessary to support the public during a shutdown. They warn, “History will judge us harshly if we miss this life- and economy-saving opportunity to get it right this time.”
Congress has missed this opportunity in a major way by failing to provide support to the people who need it the most. As we experience this exponential rise in COVID-19 cases, we are also in a period where the meager protections provided in the CARES Act are disappearing. The Center for Budget and Policy Priorities reports the economy is weakening and poverty is rising, especially for Black and Latinx people.
The major winners of the CARES Act were the millionaires and billionaires. The Institute for Policy Studies found that billionaires have gained nearly $1 trillion in wealth since March while their workers risk their lives each day without improvements in pay or working conditions.
Sadly, all signs point to the Biden administration making the same mistake in not prioritizing the basic needs of the people. This is going to continue to contribute to preventable hardship and deaths and prolong the recession. Seventy percent of the national gross domestic product relies on consumer spending, so the most effective way to stimulate economic recovery is from the bottom up. When people who have unmet needs are given money, they immediately spend it on food and other goods. Even the “free market” economist Milton Friedman understood that giving people money directly, “helicopter money,” is a powerful tool to stabilize economies.
So, what do we do now, given the current situation? Baral outlined a partial plan with three components. First, make testing more available and “align it with people’s lived realities.” One reason there is such widespread community transmission of the virus is that people are not aware they are COVID-19 positive. People, particularly in low-income communities, still face barriers to being tested, such as not having a car to use for the drive-through testing centers or not being able to get a doctor’s order. Others are not getting tested for fear of losing their job if they are positive.
The second component would be providing isolation units where people can quarantine if they test positive and don’t have a place to stay. These units, which could be hotel rooms or vacant dorms or apartments, would provide food, bathrooms, internet and television for people while they stay there, as well as medical supervision.
Baral pointed to the massive outbreaks that are occurring at homeless shelters and said he receives many calls from people who are underhoused. This pandemic is defined by inequity, he emphasized. The best predictor of how a person will fare is the square footage per person per household, a measure of affluence. Those with more space are less affected.
And the third component is paid leave to quarantine. Instead of blaming and shaming people, everyone needs to feel secure in not working if that is what they require. This includes both people who have been exposed to COVID-19 and those who test positive. People who are at high risk for severe disease because of their health status and who don’t have access to a low-risk job environment should also receive support so they can quarantine.
These three steps would make a big difference in mitigating the spread of the virus as we wait for an effective vaccine, but an essential factor that will determine our overall success is trust. People need to trust the system has their best interests in mind before they will comply with restrictions on their lives, cooperate with contact tracing and get vaccinated.
Baral warns that police should not be employed to implement public health polices because that destroys trust. Instead of a punitive approach, we need an empowering approach that gives people what they need to protect themselves. In Spain, for example, masks must be worn on all public transportation, so they make free masks available if passengers need them.
Our privatized health care system, which puts profits first, has eroded trust in the system. Transitioning quickly to a national public system, such as Medicare for All, would start to change that.
Another benefit of a national health care system is that public health is integrated into the system as it is in some of the counties that have handled the pandemic well. Gurley, who focuses on contact tracing, explained that here a person will be notified of their test result by one part of the health care system and then the public health department may or may not follow up with them. “We are always fighting an uphill battle every time someone is diagnosed,” she said.
One can only imagine how difficult it must be for epidemiologists to watch the current crisis and know there are straightforward public health measures that could contain it and save lives. Gurley ended our conversation with these words: “We have to have some drastic measures to even change course a bit.”
Will a Biden administration do that? Given the power of the medical-industrial complex over the government and other corporate interests that oppose shutting businesses down, we are unlikely to see strong measures unless we organize and mobilize to demand them. The pandemic will be with us for the foreseeable future. Even when an effective vaccine is approved, it will take time to manufacture and administer enough doses to reduce viral transmission.
For now, we need to continue to take measures to prevent transmission of the virus and demand that beyond the Biden-Harris COVID-19 plan, Congress and the White House must also meet the economic, housing and health care needs of everyone. Access to tests, places to quarantine, paid sick leave and rebuilding trust through a health care system that puts people’s health over corporate profits will put us on the best path to containing this pandemic.