What could Biden do to fight Covid-19?
President-elect Joe Biden won this year’s election against President Donald Trump while campaigning on taking swift, decisive action against Covid-19.
The question now, as election results trickle in, is how much Biden will be able to do on his own — potentially without Congress.
As it stands, it’s unclear if Democrats will be able to win enough seats to take Senate control. They would need two of three remaining races in Georgia and North Carolina to turn their way, and all three seats are currently held by Republican incumbents.
And without a Democratic-controlled Senate, Biden won’t be able to do everything he’s proposed to combat the pandemic. Senate Majority Leader Mitch McConnell gloated during former President Barack Obama’s years that he blocked the Democratic agenda — and he’ll likely try the same in the next few years under Biden.
The research backs several approaches to dealing with Covid-19: social distancing, aggressive testing and tracing, and widespread masking. Trump had rejected these approaches — demanding that states open up early and quickly, punting testing and tracing programs down to local and state governments, as well as mocking and questioning masks. But Biden promised to follow the science, and released plans outlining how he’d implement these evidence-backed approaches.
There are some big things that Biden and his administration will still be able to do. He could empower scientists to lead the federal response to Covid-19 — particularly the Centers for Disease Control and Prevention, which has been stifled and politicized under Trump — to standardize and improve guidance given to Americans, states, schools, businesses, and others about the virus. The Biden administration could coordinate nationwide efforts for testing, tracing, and protective equipment for health care workers. It could take steps to allow more testing — which Trump has actively resisted — by breaking down regulatory barriers. It could improve data tracking and reporting for Covid-19.
But implementing a robust Covid-19 response will likely be much harder if Republicans keep the Senate and choose to obstruct any legislation that could give Biden a political win. For one, the Senate will have to approve almost anything that requires more money for anti-coronavirus efforts.
That could limit a stimulus package, which could make social distancing more tolerable and more possible for many Americans. It could also rule out legislation pushing states to adopt mask mandates and enforce them with federal funds. And it could prevent expansions of access to health care more broadly, placing the costs of coronavirus-related treatment on Americans.
It’s possible, of course, that Republicans in the Senate work with Biden — something that Biden’s team told me they were optimistic about, given the former vice president’s history in Congress. “Joe Biden has spent his career uniting Republicans and Democrats across the aisle to pass critical legislation in times of crisis, from economic recovery during the Great Recession to the historic 21st Century Cures Act, and this pandemic is no different,” Jamal Brown, national press secretary for the Biden campaign, said in a statement.
But that would go against much of McConnell’s recent, obstructive history in Congress, too.
There’s also a stark reality: With Trump still having more than two months in office, and with Covid-19 already surging nationwide and expected to get worse this fall and winter, there’s going to be a lot of damage to the US that Biden can’t undo. More than 230,000 Americans are dead. Some measures will be much more difficult to implement if the coronavirus remains so widespread; for example, it’s simply harder to do effective contact tracing when there are a lot more infected people, with many more potential contacts, to track down to get them to self-isolate.
Still, Biden will likely be able to help slow spread of the virus and, perhaps most importantly, prepare America for the widespread distribution of a vaccine — setting the country up for a more lasting solution to the epidemic.
What Biden could still do to fight Covid-19
It remains possible, if unlikely, that Democrats take the Senate. That would certainly make Biden’s job much easier — and his plans would likely get passed more or less as proposed.
Short of that, there are some steps, experts say, that Biden could take to right America’s efforts against Covid-19.
Perhaps most importantly, Biden could, on day one, stop the constant stream of lies and misinformation that have come out of Trump and his White House daily. That begins with Biden’s promise to use his bully pulpit to empower scientists — put them at the head of the federal response, as well as in charge of regular briefings to the public about what’s going on.
To this end, Biden could move to rejuvenate the CDC. Under Trump, the agency — once considered the gold standard for public health in the world — has been diminished by attempts to politicize, corrupt, and overshadow it.
The country needs “a long campaign to get people to trust science again,” Cedric Dark, an emergency medicine physician at the Baylor College of Medicine, previously told me. “My colleagues don’t trust anything coming out of the CDC now, due to how politicized it’s been.”
As one example, Trump and his White House task force pushed the agency to briefly recommend less testing, particularly for asymptomatic people, because, in Trump’s view, testing made the US look bad by exposing more coronavirus cases. The CDC later reversed the guidance, reportedly after internal backlash, but the episode damaged the agency’s credibility among experts and segments of the public.
Biden could simply allow the CDC to lead the Covid-19 response, letting the agency act on what it believes to be the best science instead of the politics. That could not only lead to more consistent guidance from the agency — no back-and-forths on testing, for example — but empower the CDC to enact actual policies, such as mandating masks on public transit, that Trump has resisted or blocked.
All of this could also play into another crucial role for the Biden administration: rebuilding trust in a coronavirus vaccine. As Trump politicized the issue by pushing for a vaccine by Election Day, Americans’ stated willingness to get a vaccine, especially among Democrats, fell in public opinion polls. By potentially putting scientists in charge of the process, and transparently communicating developments about vaccine development and distribution, the Biden administration could help reverse that trend.
More broadly, the Biden administration could improve federal coordination against the coronavirus. It could bring back the White House pandemic response office, disbanded under Trump, to guide and oversee strategy among sprawling federal agencies. It could foster more testing, working with labs and companies across the US to fix bottlenecks that have strained the country’s testing capacity and scalability so far. It could set up a national contact tracing program, aiding lower levels of government to harmonize efforts spanning beyond local and state boundaries.
“More money is ultimately needed to ramp up,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me, “but from the organizing and planning side, there are things they can do [without] Congress.”
And, on the vaccine front, the Biden administration could leverage federal resources, from the CDC to the military, to develop the massive distribution network that will be necessary to get vaccines to hundreds of millions of Americans. According to experts, distributing the vaccine could take months — well into 2021 and possibly 2022. That will make it a big part of Biden’s job in the next couple years.
The Biden administration could also use its vast regulatory powers to improve the US’s ability to tackle Covid-19. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, pointed out that there are currently no home tests approved by the Food and Drug Administration for the coronavirus. “There are some regulatory roadblocks to doing that,” Adalja told me. “And I think they’re less likely to be solved when you have a president in office that says the more testing we do, the more cases we have, and it makes us look bad.”
The Biden administration could also, as the president-elect has promised, leverage the powers of the Defense Production Act to manufacture more protective equipment for health care workers. While shortfalls of this equipment were generally worse back in the spring, many hospitals still have to deal with, for example, reusing N95 respirators over and over due to low supplies, and they can face other constraints during large Covid-19 surges.
To the extent there are separate funds still available for Covid-19 efforts, the Biden administration could simply spend them. That may sound obvious, but reports in the summer indicated that the Trump administration still hadn’t spent money approved by Congress for testing and contact tracing. That’s an easily fixed problem.
There are more obscure, but potentially helpful, changes that a Biden administration could take. For example, the Trump administration shifted hospital data reporting from the CDC to the US Department of Health and Human Services. The transition has been a disaster — the data is so faulty that we at Vox had to stop using it for our state epidemic tracker. Reversing that could help better track the disease and its impact on hospitals.
Looking outside the US, the Biden administration could try to rebuild global coordination against the coronavirus. Trump tried to cut off ties from the World Health Organization, but Biden could undo that. Trump also took a more hostile stance toward Europe and China, which Biden could reverse to improve cooperation against Covid-19 around the world — and help keep the virus out of the US.
Some things will be impossible without a cooperative Senate
Parts of what Biden has promised, however, will require the approval of Congress. Maybe with the election over and Trump out of office, Republicans could take Covid-19 more seriously and pass major legislation that deals with the pandemic.
The Biden campaign, at least, remains optimistic that could happen, arguing that the president-elect has a history of working across the aisle. “He knows the leaders of the Republican Senate very well, and he knows the system,” former Defense Secretary Chuck Hagel, a Biden surrogate, told me. “He’s always been a legislator that reaches across the aisle to find compromise.”
It’s also possible, though, that Republicans in the Senate take the opposite approach. Rather than handing Biden anything that could be construed as a political victory, they could obstruct and block Biden’s proposals.
If that happens, it will severely limit anything that requires significantly more funding. The federal government does have some extra cash laying around at any moment, but budgets and laws dictate what the bulk of federal spending must cover. If Biden needs funds to scale up testing, tracing, or a vaccine, he may have a tough time getting that through a Republican Senate.
The possibility of a stimulus package and economic aid looms large. This is important not just to address the economic pain caused by the pandemic, but to actually slow the spread of the virus: Workers are more likely to stay home when they’re sick if they’re guaranteed paid leave. They’re more likely to get a test or vaccine if either is free or more affordable. Restaurants and bars are more likely to agree to stay closed down if a bailout makes them whole.
It’s just one of the many ways the economy and pandemic are inherently tied together. As Jade Pagkas-Bather, an infectious diseases expert and doctor at the University of Chicago, previously told me, “Dead people don’t shop. They don’t spend money. They don’t invest in things.” Similarly, Americans scared of the virus are more likely to stay home and not spend on the kinds of things and activities that keep the economy going.
A stimulus package could also contain funds that more directly address the pandemic. By some estimates, the US still needs to hire tens or even hundreds of thousands of contact tracers. That could cost a bit of money, which could be earmarked to states or the federal government by Congress.
“In order for our economy to recover, we really do need to resource our public health response more effectively,” Crystal Watson, a senior scholar at the Johns Hopkins Center for Health Security, previously told me.
More money could also be needed for a national mask mandate. Under one model for a national law, the federal government would incentivize states with federal funds to enact their own mandates and enforce them. That could encourage the 17 states without mandates to pass one. But if there’s no funds, Biden is effectively limited to begging cities, counties, and states to enact a mandate on their own.
Some Democrats were also hoping to use Covid-19 legislation to build on Obamacare and expand access to health care — since it’s a health issue, and coronavirus treatment can be expensive for both patients and providers. But that, too, would require federal funds.
One of the Senate’s other major roles is approving key positions in Biden’s Cabinet and administration. The people in these jobs are those charged with carrying out the president’s vision and plans. But the Senate could simply refuse to approve some or all of these jobs — limiting Biden’s ability to run his own government and, therefore, his response to Covid-19. (Although some notable jobs, including the head of the CDC or a new White House office, don’t need Senate approval.)
Combined, all these hurdles could severely hinder just how much Biden can do to contain the virus. That could leave it to local and state governments to pick up the slack, as they’ve done under Trump. But cities and states have much more limited resources, and less ability to coordinate a national effort, than the federal government. So they’ll likely produce a more constrained, fractured response — a partial repeat of what’s happened in the US so far.
Much of America’s Covid-19 problem is here to stay
Part of Biden’s problem will also come in the next two months, before he takes office on January 20, 2021. Although America already suffers the highest raw death total in the world, and the US has one of the top four highest rates of deaths per person among 36 developed countries, things could still get worse.
For one, experts widely expect the ongoing surge of Covid-19 to get worse through the fall and winter — as schools reopen, the cold pushes people back into poorly ventilated indoor spaces where the virus spreads more easily, holidays bring people together and lead to superspreading events, and a potential flu season hammers hospitals already struggling with coronavirus outbreaks.
Trump could, of course, take steps to prepare the country for all of this. But even as the virus has surged nationwide, Trump hasn’t stepped up. Even after he got sick with Covid-19, Trump has continued downplaying the virus — tweeting, “Don’t let it dominate your life.” There’s simply no indication that Trump will change his approach in the next few months.
If all that holds and the epidemic gets worse, Biden could come into office with the worst outbreak the country has seen so far. That’s not only a disaster on its own terms, but it will make his job more difficult: It will require more social distancing, masking, testing, and tracing to put down. Tracing is particularly tricky, with some experts saying that it’s already extremely difficult in the US — since there are so many cases to track down — and it could be virtually impossible in much of the country once cases skyrocket further.
“We really have to take other measures to bring down transmission in order for contact tracing to be effective,” Watson said.
That’s not to say the situation is hopeless. Even smaller actions to bring down infection can save a lot of lives — just reducing the Covid-19 death toll to date by 5 percent would have prevented more than 10,000 deaths in the US. And federal leadership will be as needed as ever for the months-long process of distributing vaccine doses to more than 300 million Americans.
But much of Trump’s damage is here to stay, and that damage will likely get worse in the coming months. It will be on Biden, with a potentially uncooperative Senate, to try to turn that around.