With great relief, we welcome President Biden’s inauguration and his administration’s robust and rational Covid-19 recovery and economic stimulus plan. The $1.9 trillion plan includes positive steps that public health experts have been calling for since the beginning of the pandemic. While it is painfully overdue, the significant investment signals a new era of competent and responsive leadership who will work with and not against vulnerable communities. Yet with the death toll surpassing 400,000 and new cases surging across the country, the plan needs to go further.
Regular testing of all Americans is our best defense against Covid-19
Testing is our first and simplest line of defense against Covid-19. But throughout the pandemic, tests have not been readily available to all Americans. The $50 billion Biden has allocated in his plan to expanding testing infrastructure intends to solve this issue by increasing lab capacity and the availability of tests while developing consistent testing protocols for schools, long-term care facilities, and prisons.
This is a welcome start, but Biden needs to invoke the Defense Production Act to ensure the production and distribution of 150 million inexpensive, at-home, rapid antigen tests per day that are freely distributed to the public. This would allow every American to self-administer a rapid test at home twice a week and catch a majority of asymptomatic infections before they spread into the community. If the Defense Production Act can be used to rapidly produce personal protective equipment, we can surely use it to produce tests.
Treat vaccine rollout less like the flu and more like an act of bioterrorism
Biden should be commended for injecting $20 billion in a national vaccination program that partners with states, localities, tribes, and territories. The sluggish start to vaccination cannot continue if we want to swiftly reduce the death toll. Biden’s commitment to launching community vaccination centers around the country and deploying mobile vaccination units to remote areas will help the vaccine reach underserved communities. In terms of escalating the rollout, the Biden administration should look towards how the federal government stockpiled and planned to rapidly administer medicines and vaccines in the aftermath of 9/11 in case of a bioterrorist attack involving anthrax or smallpox.
Funding the creation of 100,000 public health jobs is also a creative solution to the simultaneous unemployment crisis. Senator Kirsten Gillibrand played a role in championing this legislation to train thousands of local community public health workers in vaccine outreach and contact tracing. These workers will relieve the burden on strained vaccination and testing sites and then transition into long-term community health roles that address the health disparities that have been exposed and amplified during the pandemic.
Incentivized quarantine will help regain control over the virus
Yet, with new highly contagious variants developing, vaccination alone will not eliminate the virus. Covid-19 will likely become an endemic human disease resembling the annual influenza. Biden’s proposal to increase funding for sequencing and surveillance of the virus mutations will be essential to controlling the pandemic in the long term.
Despite a robust approach towards medical control of the virus, Biden’s plan neglects to include vital public health measures to control the pandemic. A national mask mandate is a good start, but we need to get serious about isolation protocols for those exposed or infected and replicate the successful public health practices of countries like China, Australia, and New Zealand who have achieved zero or near zero infection rates.
The Biden Administration needs to go further and create a universal, incentivized home quarantine program in conjunction with self-administered testing at home. In such a program, those with verified infections would be paid to isolate at home for 14 days. Renewing the employer requirement to provide emergency paid sick leave allows some Americans the privilege of quarantine without financial burden. But some gig economy workers, such as delivery drivers who don’t receive sick leave, are avoiding getting tested. They can’t afford the loss of income if they test positive and subsequently need to quarantine. Only with an incentivized quarantine program can we ensure that Americans don’t have to choose between protecting their community and their paycheck.
An incentivized quarantine program may seem extreme to some, but it has become devastatingly clear throughout the pandemic that there is no other option to regain control over the virus. With each reopening in the U.S., the UK, France, or Israel, cases have eventually come roaring back to terrifying levels. In contrast, China’s mandatory 14-day quarantine policy for all who have been potentially exposed to the virus has meant the country, with a population of over 1.4 billion, has experienced just one Covid-related death in the past eight months. With the above-mentioned substantial investment in rapid testing, we can be more efficient and focus resources on quarantining those infected.
Some may argue that such a rigid approach would not work in the Western world. Yet, we have seen the Australian and New Zealand governments implement similar policies and have successfully returned to normal life without a vaccine. One of the great tragedies of the Covid-19 pandemic in the United States, Europe, and South America is that we have not learned from our neighbors and used the power of central government to enforce quarantines.
Extend economic relief and legislate worker safety
Biden’s proposed eviction and foreclosure moratorium will also help with quarantine efforts and allow individuals and their families to safely shelter in place. The moratorium should continue for as long as needed based on the status of infection rates. Economic relief needs to be tied to the progression of the crisis and not an arbitrary date. Free hotel isolation programs like that of New York City should also be established in all states and be widely promoted.
Nearly one year into the pandemic, employers have yet to receive regulations that would require them to protect their employees from Covid-19 exposure. Employers have been left to voluntarily develop their own Covid-19 safety protocols without public health experts’ guidance. Predictably this has left frontline workers vulnerable. The responsibility of enforcing standards has again been left to the states, with only 14 states adopting comprehensive worker safety Covid-19 protections as of December 2020.
By authorizing the Occupational Safety and Health Administration to issue a Covid-19 Protection Standard that covers a broad set of workers, Biden will take the first step to ensure workers’ safety. Additional funding for training and enforcement of OSHA standards will guarantee that businesses have the capacity, clarity and responsibility to carry out these protections.
Cast a global focus to fighting the pandemic and address associated health issues
Biden is also moving to restore U.S. leadership globally by joining the World Health Organization’s COVAX initiative and reinstituting humanitarian aid to address the pandemic’s global impact on health, food security, and gender-based violence. This international focus is an important shift from the previous administration as the pandemic will never truly end until it is addressed globally.
Finally, Biden’s plan crucially addresses other health issues associated with the pandemic. Mental and behavioral health issues have been steadily rising throughout the pandemic and will likely persist long after it ends. Enabling the Substance Abuse and Mental Health Services Administration to expand access to mental health services is a worthwhile investment of $4 billion. Notably, Biden intends to fund studies of the long-term health impacts of Covid-19 and potential therapies. While the focus has been rightfully on the death toll, many Covid-19 ‘long haulers’ are finding themselves unable to return to work or carry out personal responsibilities.
Subsidizing COBRA coverage and lowering or eliminating health premiums through the Premium Tax Credit is another long-overdue policy. Debt and financial burden must not deter Americans from seeking care for Covid-19 infections or other health conditions. The dual pandemic and unemployment crises provide the perfect argument to move towards universal health coverage and away from predominantly employer-sponsored coverage.
Biden’s multifaceted and detailed plan instills hope for an evidence-based approach to fighting the pandemic in the future. Yet we must not risk complacency and go further by enhancing quarantine protocols and invoking appropriate legislation to increase the supply of tests and vaccines dramatically. We must not be so distracted in fighting the current pandemic’s challenges that we neglect to plan and prepare for future epidemics and biological threats simultaneously.