President-elect Joe Biden, as one of the first official acts of his transition, appointed a COVID-19 Advisory Board to shape his incoming administration's efforts to handle the coronavirus pandemic. The board will be led by co-chairs former Food and Drug Administration commissioner David Kessler, former U.S. Surgeon General Vivek Murthy, and Yale University public health professor Marcella Nunez-Smith. By choosing Kessler and Murthy, Biden is recycling a couple of enthusiastic over-regulators and drug warriors who have variously sought to outlaw nutritional supplements, cigarettes, vaping, and guns, and to justify imposing taxes on sodas and fast food on public health grounds.
Beyond these inauspicious advisory board appointments, let take a look at Biden's broader plan to address the accelerating COVID-19 pandemic. The first and most important part of Biden's plan is to "fix Trump's test-and-tracing fiasco." Instead of complaining that more testing finds more cases, Biden wants to enable Americans to find those cases. To do so he promises to "invest in next-generation testing, including at home tests and instant tests, so we can scale up our testing capacity by orders of magnitude."
According to the COVID Tracking Project, coronavirus testing has now reached around 1.5 million per day. That's not nearly enough. Back in April, researchers at Harvard outlined a testing and tracing plan aiming at safely reopening the U.S. economy by revving up testing to 5–20 million people per day. The Harvard plan also recommended hiring and training 100,000 contact tracers, a recommendation Biden has said he would follow. (About half of Americans say they would be comfortable sharing information with COVID-19 tracers, according to a recent finding from the Pew Research Center.)
Economics Nobelist Paul Romer and his colleagues argued that "population-scale testing can suppress the spread of COVID-19" through providing 330 million Americans with at-home test kits costing $1 each for weekly use would cost $20 billion. Ultimately, rapid home COVID-19 tests are the best path to a new normal in which individual Americans can easily find out if they are infected and then voluntarily self-isolate so that they do not transmit the illness to their fellow citizens.
More worryingly, Biden would invoke the Defense Production Act to ramp up production of masks, face shields, and other personal protective equipment (PPE). It is true that some public health officials are already warning of possible PPE shortages as the number of COVID-19 cases increases this winter. However, the would-be pandemic central planners in a Biden administration should keep in mind missteps such as the Trump administration's use of the DPA to force manufacturers to produce ventilators, which has resulted in a glut of the machines.
Biden sensibly promises to make sure that public health authorities provide clear, consistent, evidence-based guidance on how communities can navigate the pandemic. Noting that social distancing functions more like a dial than a light switch, guidance on the extent of social distancing practices would be based on the risks and degree of viral spread in each community. Biden promises more federal spending to help schools, small businesses, and families make it through the pandemic. What's currently on the legislative table is a pandemic stimulus bill proposed by the Speaker of the House Nancy Pelosi (D–Calif.) for $2.2 trillion. In the heat of the presidential campaign, Trump declared that he wanted an even bigger stimulus than that.
Today, vaccine makers Pfizer and BioNTech announced the good news that the preliminary results of their clinical trial suggest that their vaccine is 90 percent effective in preventing coronavirus infections. Biden plans to spend $25 billion on a COVID-19 vaccine manufacturing and distribution plan that will guarantee it gets to every American, cost-free. The Trump administration deserves credit for launching Operation Warp Speed in May, which aimed to incentivize the development and subsequent production hundreds of millions of doses of COVID-19 vaccines in under a year. But Trump's shenanigans have also alarmed a significant proportion of the American public about the safety of COVID-19 vaccines. For his part, Biden aims to allay vaccine safety fears by making the vaccine approval process exceptionally transparent.
Today the president-elect urged his fellow Americans to wear masks as a way to help blunt the rise of COVID-19 cases this winter. On his website Biden points to studies that suggest near-universal masking could prevent millions of cases and tens of thousands of deaths in the U.S. through February. Another analysis in a July preprint reviewing the literature on the efficacy of facial coverings to prevent disease transmission notes that "the preponderance of evidence indicates that mask wearing reduces the transmissibility per contact by reducing transmission of infected droplets." They calculate that near-universal masking could spare as much as one trillion dollars in losses from the U.S. economy, if that masking is a partial substitute for lockdowns.
Donning masks in situations where social distancing is difficult is a good idea. Wearing masks is largely about "source control"—that is, preventing already infected people from transmitting their microbes to non-consenting others. It is now pretty well established that presymptomatic and asymptomatic individuals shed enough virus to infect other people. That is, they cannot know in advance that they are harming other people by transmitting the coronavirus to them.
Biden reluctantly recognizes that the president has no constitutional authority to impose a national mask mandate. Consequently, he plans to work with governors and mayors to implement essentially a nationwide face mask mandate. One tool Biden could use to force states to impose mask mandates would be the threat of withholding federal funds. Such mandates would entail more law enforcement which would understandably provoke a public backlash against over-policing. Ultimately, why does Biden think government-enforced mask mandates are even necessary since most data suggest that the vast majority of Americans have been wearing masks for months now?
Biden is correct that the previous administration made numerous fatal blunders in its handling of the pandemic, and that more clarity and transparency at all levels is an important step in rectifying those mistakes. That will be a welcome change from his predecessor's failure to roll out sufficient testing, devise an effective reopening strategy for the country, and his numerous inane assertions that the end of the pandemic was nigh, including claims like the virus will disappear "like a miracle" and "this is going to go away without a vaccine" and "the China plague will fade" and "we're rounding the corner and it's going away." Nevertheless the makeup of Biden's advisory board and his mixed messages on mask mandates give cause for concern, and will be worth keeping an eye on.