“We let this fire spread across much of this county and we didn’t have testing,” said Ashish Jha, dean of Brown University’s public health school. “And then in March we said, ‘Oh My God, things are really bad.’ And we had to shut down.” To change the trajectory right now, he said, “we need to go big” on genomic surveillance.
The country has begun to ramp up genetic sequencing. But there’s no time to waste. Experts say the U.S. needs to sequence between 5 and 10 percent of all positive samples from Covid-19 testing to get a clear picture of which variants are spreading where. Currently, the sequencing rate is about one-half of one percent.
“The variants are the biggest challenge we’re facing right now,” said Marcus Plescia, who works closely with officials nationwide as chief medical officer of the Association of State and Territorial Health Officers.
Beyond the genetic sequencing, the Biden administration is also facing the many of the same challenges that have persisted since the beginning of the pandemic: a lack of testing, contact tracing, personal protective equipment, high-quality masks, social distancing, data collection and communication. They also need to build basic metrics and guidelines to safely and sensibly know how and what to open — and what to keep closed. And ongoing public education about a shifting virus.
“The most important thing you want when you have an emergency is to have good situational awareness,’ said Georges Benjamin, the executive director of the American Public Health Association. That didn’t happen during the first year, he said. “We never fixed the fundamentals.”
The Biden White House, which has introduced a strategy that is more consistent and more science-based than the Trump administration’s, isn’t pretending it can fix everything all at once in his first weeks in office.
“Step by step. Day by day. It’s the only answer,” said one White House official. “It’s not our attitude that you can fix everything at once. It is our attitude that you can make progress every day.”
Some old problems are getting a new look. The Centers for Disease Control, for instance, just put out new advice on what kinds of masks people should wear, and how to wear them correctly to maximize protection. The Defense Production Act was triggered to plug gaps in supply chains. It’s impossible to contact trace every case in an outbreak this big; that opportunity was lost months ago. But public health officials are working on how to leverage some contact tracing to focus on new threats and variants.
And some of the ongoing problems will need to be looked at anew in the changing context — an all out push to expand vaccination, at the same time the variants are creating a new layer of threats and uncertainty.
For instance, the problem now isn’t just making sure that testing capacity meets the need, without getting overwhelmed when there are spikes in infection. It’s also about how to connect the new kinds of testing becoming more available — at home tests and rapid tests — with the larger public health system.
If people take a home test, it’s not just enough for that person to know the results. The public health system needs to know where and how the virus is hitting. But people have to know how to report information — and it has to be easy, said Sarah Fortune, the chair of the immunology and infectious diseases department at Harvard’s public health school.
An even more complicated problem is how to communicate to people who have been vaccinated but who may still get sick down the road. They may dismiss it as a cold or flu, but they should still get tested, she said. If they have Covid, it could mean that another variant is circulating — one which the current vaccines don’t combat as well. And the public health system needs to know about that, too, Fortune said, so we’re no longer “11 steps behind” an advancing virus.
Public health officials give the Biden team credit for collaborating more closely with the states, rather than forcing them to fend for themselves and compete for scarce resources. They also note that Biden is leaving most of the communication to doctors and scientists, in contrast to former President Donald Trump, who repeated misinformation on treatments ranging from hydroxychloroquine to laundry bleach.
But Biden’s hit some bumps, including some contradictory statements about whether teachers have to be vaccinated before schools can open. And his powers have persuasion haven’t gotten governors to tighten mask mandates. To the contrary, several conservative states are rolling them back — and several Democratic-led states are loosening up on indoor restaurant dining and similar activities.
Biden has one huge tool in his favor: Two vaccines are in use in the U.S., and more are likely to gain authorization this spring. In less than a month his administration has picked up the pace of vaccination, now running about 1.5 million shots a day, sometimes more. Ramping it up further depends on a fragile supply chain, and how well states can improve the messy sign up and distribution systems that are frustrating seniors and bypassing minorities.
But while vaccines are essential, the slim stream of shots the Biden administration has available right now can’t alone defeat the virus, especially because they don’t seem to work as well against some variants, particularly one that was first detected in South Africa. And since viruses mutate frequently, other variants may already be emerging, as yet undetected.
So even though things are looking up right now — new infections and deaths are down sharply from the spike that followed the December holiday season — it could all go awry in a flash.
“I don’t want to give the message that vaccines are not the scientific triumph that they are,” said Angela Rasmussen, a virologist at Georgetown University. “But I also don’t want people to rely too heavily on the vaccines right now. We’re not really at the stage of the pandemic where we can say, ‘OK, vaccination is enough.’”
And Marta Wosinska, a deputy director of the Duke-Margolis Center for Health Policy, warned that even when things look better, they don’t always stay better. Each time the U.S. has loosened up prematurely, another spike followed. “We might be in the eye of the hurricane,” she said. And that doesn’t mean the storm is over.