ALMOST 300,000 people have died of covid-19 in the US, and 200,000 more are expected to succumb to the disease by April. Coronavirus cases are spiking across the nation and hospitals are聽at or near capacity in many communities.
US president-elect Joe Biden has outlined a science-based approach to combating coronavirus that is a striking contrast to the actions of his predecessor. President Donald Trump downplayed the severity of聽the virus and flouted public health recommendations such as聽wearing a face covering and avoiding large gatherings.
Biden has already assembled a聽covid-19 advisory board and named a new health secretary, surgeon-general and covid-19 czar. He has also asked Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and current member of the White House Coronavirus Task Force, to聽stay on and become his chief medical adviser. That is a relief to聽Ali Mokdad at the University of聽Washington in Seattle. These are 鈥渟mart people who know what聽they are doing鈥�, he says.
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Quelling the latest surge of covid-19 won鈥檛 be easy for Biden鈥檚 administration, however. 鈥淭hey鈥檙e聽going to walk into a raging epidemic, where there鈥檚 distrust,鈥� says Georges Benjamin at the American Public Health Association in Washington DC. 鈥淭here are still people that don鈥檛 believe the disease exists.鈥�
狈别飞听厂肠颈别苍迟颈蝉迟 spoke with public health experts, epidemiologists, physicians and social scientists to see how Biden might turn the tide.
Win hearts and minds
Biden鈥檚 toughest challenge might be persuading the people who didn鈥檛 vote for him to adopt behaviours that curb the virus鈥檚 spread, such as wearing masks.
The most basic public health recommendations have become political flashpoints under the Trump administration. 鈥淚t鈥檚 not just that they鈥檙e being silent on the guidelines, it鈥檚 that they鈥檙e actively advocating for citizens to violate public health guidelines,鈥� says Jay Van Bavel at New York University. His research suggests . 鈥淭hat, to me, is the hardest part of聽it to overcome,鈥� he says.
During the 2020 campaign, Biden and his advisers adopted public health tactics that they are advocating, but role models won鈥檛 be enough to convince sceptics. 鈥淲inning this war against covid-19 is going to happen [鈥 one block at a time, one conversation between a trusted school nurse and a parent at a time,鈥� says Lindsey Leininger at Dartmouth College in聽New Hampshire.
Mandates on masks
One of the best tools to slow the聽spread of covid-19 has been promoted since fairly early in the聽pandemic: wearing a face covering. 鈥淚t is really a pillar of pandemic control,鈥� says Monica Gandhi at the University of California, San Francisco. Models developed by researchers at the University of Washington, which project 200,000 extra deaths by 1聽April 2020, predict that if 95聽per cent of people in the US wore a face covering, it could save 66,000 lives by the same date.
Biden has said he will require masks in federal buildings but won鈥檛 issue a national mandate on聽face coverings. Even if he did, it聽isn鈥檛 clear if a federal mandate could withstand a legal challenge. Instead he has pledged to persuade leaders in states that don鈥檛 require masks to enact mandates. And if聽the governors won鈥檛 listen? 鈥淭hen I go to every mayor. I go聽to every councilman,鈥� said Biden in a televised interview on 15 October. 鈥淎nd I go to every local official and聽say 鈥榤andate the mask鈥�.鈥�
Convincing some people in the聽US to comply will be a tough sell. The decision to wear a face covering has become linked to people鈥檚 political identities, says Monica Schoch-Spana at Johns Hopkins University in Maryland. Some Trump supporters see requirements to wear masks as infringing their individual rights.
Ramp up testing
Trump has falsely claimed that rising case numbers are only due to more testing. Public health experts argue that expanded testing is key to bringing the pandemic under control, because if people know they are infected, they are more likely to isolate and聽limit the spread of the virus.
The US is currently testing more than 1.5 million people a day. But in many places, tests are still hard to come by and people often have to wait days to get their results. Public health officials recommend that people with symptoms of covid-19, or who have had close contact with someone who has the聽virus, stay at home, but the longer the wait for results, the more difficult that becomes.
Biden has pledged to double the number of drive-through testing sites 鈥� the country currently has about 800. He has also promised to invest in rapid tests. The slower tests, which are the most widely available type in the US, detect even tiny quantities of viral RNA and must be processed in a lab. Most rapid tests detect pieces of viral protein and are less sensitive but offer near immediate results.
Michael Mina at Harvard University has been a vocal advocate for rapid, at-home testing, which is rare in the US. The聽only covid-19 test approved for home use that gives fast results requires a prescription and costs about $50. If half the population screened for covid-19 every four days, the pandemic would fizzle out because most contagious individuals would stop spreading the virus unknowingly, Mina argued in Time on 17 November.
Mass testing would also allow for more tactical application of lockdowns and other restrictions, says Ana Bento at Indiana University. Critics have argued that rapid antigen tests aren鈥檛 sensitive enough to catch every case and come with a risk of false positives, but Gandhi says they could still have an enormous impact. 鈥淲e鈥檙e making perfect the聽enemy of the good,鈥� she says.
Bolster the supply chain
The pandemic response in the US has been hampered by persistent supply-chain issues. A November report by the US Government Accountability Office (GAO) revealed that as many as half of US聽states have shortages of rapid point-of-care tests, reagents and testing instruments. Shortages of聽personal protective equipment haven鈥檛 been as severe as they were in spring, but some states still have little confidence in their ability to procure nitrile gloves and boot covers. A third of states said in a survey that they were concerned about supplies needed to administer covid-19 vaccines, especially syringes.
Addressing those shortages may require greater use of the Defense Production Act of 1950, says Benjamin. The law gives the president authority to compel companies to produce supplies in an emergency. Trump employed the act to beef up production of medical masks and ventilators in聽March, but Biden has pledged to聽use it more aggressively.
Support vaccine roll-out
The Pfizer/BioNTech covid-19 vaccine has been granted US emergency use approval, and Moderna has applied for this for its own vaccine. Vaccination of healthcare workers began on 14 December. Those shots seem to be 鈥渆ffective beyond our wildest dreams鈥�, says Gandhi.
But efficacy is only part of the story. 鈥淭he real driver of whether a聽vaccination programme really leads to large reductions in the number of cases is the speed at which it鈥檚 rolled out,鈥� says Jason Schwartz at Yale University. How fast the virus is spreading also matters. 鈥淚f you鈥檝e got a virus just spreading like wildfire throughout a community, it makes it that much harder for a vaccine to help聽us turn the page,鈥� he says.
It could take months before enough people are vaccinated to meaningfully affect transmission, says Mokdad. Both vaccines require two doses spaced three to聽four weeks apart, and some worry that people won鈥檛 return for聽their second dose.
Although states will be in charge of delivering the vaccine, the federal government has a crucial role. Schwartz says many local and state health departments don鈥檛 have the financial resources for a huge vaccination campaign. 鈥淚t鈥檚 an incredible responsibility that is complicated and costly,鈥� he says.
Massage the Message
Nine months into the pandemic, many people are experiencing serious fatigue. 鈥淗umans are a social species more than any other primate. It鈥檚 our natural way of being,鈥� Van Bavel says. 鈥淭his whole pandemic requires us to go against all these elements of human nature that give us joy, connection, mental and physical health.鈥�
Controlling the virus requires not just smart policies but widespread behaviour change. That factor is often overlooked, says Schoch-Spana. 鈥淲hen it comes to epidemic management, the last scientists to the table are the social behavioral scientists.鈥� She urges Biden to seek out 鈥渢he best minds of psychology and anthropology and sociology and geography.鈥�
Ensuring that people adopt or continue to adhere to health officials鈥� recommendations will require clear and consistent messaging, but also messages tailored to appeal to different groups. 鈥淚 think public health has to frame epidemic management in non-scientific terms that are meaningful to a wide variety of people,鈥� Schoch-Spana says. 鈥淔or some, it鈥檚 about economics, plain and simple.鈥� For others, it might be about returning to a more familiar way life or being able to worship with their congregation.
Gandhi says that the messaging also needs to be more sympathetic. She would like to see an attempt 鈥渢o truly understand what is the opposition to masking and to meet people where they are.鈥�
Biden鈥檚 team will also have to combat vaccine hesitancy. The latest Gallup polls shows that 63 per cent of people in the US would be willing to get vaccinated against covid-19. Leininger hopes that number will climb as the public sees healthcare workers lining up to get the vaccine. 鈥淲hen we look at who holds trust right now in this country in terms of being purveyors of medicine and science, it鈥檚 nurses,鈥� she says.
Mokdad is optimistic that the change of administration will have an impact on the spread of coronavirus. 鈥淭he fact that somebody is willing to listen to science and is willing to wear a mask publicly will make a big difference,鈥� he says. But given the significant obstacles Biden faces and the rampant spread of the virus, it鈥檚 not yet clear how quickly the new administration can curb the outbreak.
鈥淲e will get through this historical happening one way or another,鈥� Schoch-Spana says. 鈥淏ut it may take a lot of human pain.鈥�
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