Editor’s Note: Kent Sepkowitz is a CNN medical analyst and a physician and infection control expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion at CNN.
The latest surge of Covid-19 infections in the US could not be occurring at a worse time – not just because the winter and influenza seasons are approaching or because the entire country is already worn down by the pandemic, but rather because we have entered into the lame-duck period between Election Day and the inauguration of President-elect Joe Biden on January 20, 2021. This interval is a non-trivial 5% of the entire Donald Trump presidency.
That means almost 11 weeks of very uncertain leadership in the battle to control the raging pandemic. The current Covid-19 statistics are shocking: in the US, new cases recently have exceeded 100,000 a day, with deaths nearing an average of a thousand a day.
This deepening crisis requires immediate, thoughtful, informed, evidence-based and decisive attention by the President and his advisers. Otherwise, the pandemic will worsen, the economy will worsen and the morale of the American people will worsen.
With President-elect Biden announcing his coronavirus task force on Monday, there is sure to be a tug of war between the outgoing Trump administration and the incoming Biden administration on whose guidance the nation should follow during these lame-duck months. In addition, the news this week that a vaccine trial sponsored by BioNTech in collaboration with Pfizer has shown promise in preventing clinical disease will likely add even more confusion about just who is in charge of making the next round of crucial decisions to control the pandemic.
For example, the most important first decision for any vaccine that reaches the point of public distribution will be how best to determine which groups receive it first. Healthcare workers? Police officers? Military personnel? The BioNTech-product will initially have at most a 50 million dose supply for worldwide (not just US) use, demonstrating the need – soon, hopefully – for this type of decision.
Prior to the vaccine announcement, the Trump administration had not laid out a clear public health plan. The current approach (or lack thereof) has increasingly appeared to be a laissez-faire, herd immunity-lite strategy as articulated by Trump’s lead advisor on Covid-19, the neuroradiologist, Dr. Scott Atlas.
The administration is prickly about calling it “herd immunity.” But the approach is focused on protecting high risk populations for whom the basics of masks and distancing and testing would be embraced, while allowing the infection to spread unfettered through “normal risk” populations. Thought the administration has touted the merits of such a plan, it does not seem that any new policies have been enacted to concretely segregate the vulnerable and healthy populations.
Leaving aside the obvious point that there is ongoing mixing of the low-risk and high-risk populations, such as in hospitals and nursing homes, making this desired segregation very difficult to achieve – and leaving aside the fact that many people at high risk for severe outcomes are not aware that they indeed are at risk – this “herd immunity for us, high-end protection for thee” approach is a particularly peculiar strategy for this administration.
Waiting for a population to develop herd immunity is very much a delayed reward, long game approach, something that would reap benefit only after a year or two (or three or four) of implementation. This means that the Biden administration would profit by decisions made by the Trump team. But short-term, it would inevitably lead to countless deaths all easily traced to the (wrong-headed) herd embrace.
Plus, hospitals would remain overwhelmed, possibly compromising the care of other acute medical conditions such as heart attack and stroke, medical resources would again be stretched to capacity and beyond, and makeshift morgues would once more be filled with pandemic victims.
Of course, the possibility of an effective vaccine in the near future changes some of the possible long-term scenarios. It also makes the decisions right now even more important since an adequate supply of vaccine will take some time to develop. And then we must consider that there will be those who will decline taking the vaccine, which, according to September data from Pew Research Center, may be as high as half of the US population.
Either way, unless the President changes course, we will have 11 weeks of worsening pandemic, herd or no herd, vaccine or no vaccine.
Alternatively, Trump may realize that these 11 weeks will be quite busy as he prepares himself for life as an ordinary citizen. In addition to being president, he has lawsuits pending, debts coming due, and his core business of luxury hospitality has been sharply affected by the pandemic. So he will have plenty of non-governmental work to do along with his day job.
It is conceivable therefore that he might leave the ever-more complex business of managing the pandemic to the scientists trained in public health or to Vice President Mike Pence and his committee. After all, the strategy is straight forward: masks, distancing, hand hygiene, avoidance of indoor crowds, and lots and lots of testing and tracking.
No longer pressed to appear fearless in front of science-doubting voter base, he might opt to try to undo some reputational damage by making a late run at contagion control. Maybe. And such an approach might pay political dividends – it will make it all the easier to blame the new president for the inevitable many months of pandemic chaos that will characterize the first months of 2021.
But no matter which route Trump takes, President-elect Biden is in for a very bumpy ride. The pandemic is out of control not just in the US but across much of Europe. And – quite relevant to Biden’s challenges – many European countries have large groups of mask refuseniks, those who believe that it is their inalienable right to go bare-faced, consequences be damned.
The US refuseniks seem to be larger in number and perhaps more accustomed to governmental support, given that the President has often sided with them. They may come to view bare-faced living lifestyle as an act not just of pandemic denialism but a way to thumb their noses at the incoming President whose election some may not accept as legitimate.
Plus, let’s be honest, even those who embrace the tenets of public health and good-guy citizenship are really tired of the pandemic. This is cabin fever on a national scale. People miss hanging out with their friends and families. All of the societal niceties that once seemed so dumb, contrived and phony – dinner party, anyone? – now seem like the promised land.
Worst of all though is the problem of Covid-19 itself. It is really contagious; we have mediocre treatments at best; there are thousands of survivors with ongoing symptoms who may take months and months to fully recover; the healthcare system is exhausted and financially stretched thin; and we have yet to understand what protective effect the initial vaccine will have on the population – and what unexpected side effects it may bring about.
But there is actual hope. Paradoxically, it is easier to show progress against a runaway pandemic than one with tortoise-like spread. The speed that the BioNTech-Pfizer vaccine showed possible benefit is – ironically – only because of runaway infection in so many areas. The planners had planned to wait for 62 cases of proven Covid-19 to be diagnosed in the trial before they examined the data. By the time they got around to analysis, 94 cases had accumulated, demonstrating just how much virus was circulating in the communities where the trial was conducted.
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Plus, we know what works: testing and testing and testing, masks, distancing, rapid response to new small outbreaks, adequate supplies for hospitals and nursing homes, appropriate attention to prison populations and meatpacking workers and schools and credible national voices updating the country on a regular basis.
The path is not easy, but it is very straightforward. And showing some success engenders more enthusiasm which in turn created even more success.
To be sure, even with best pandemic protection practices in place, life will not immediately be easy or rock-around-the-clock by the holiday season. But adopting such protective measures nationwide would save lives and show us a light at the end of the tunnel that we desperately, desperately, need to see.