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Covid ( @UCSF) Chronicles, Day 236
1/ I don’t know any scientists or clinicians who aren’t thrilled about Biden’s victory https://tinyurl.com/y43cwpln The only way to defeat Covid is by being frank about the challenges while following the science & evidence. Biden will do all of that.
1/ I don’t know any scientists or clinicians who aren’t thrilled about Biden’s victory https://tinyurl.com/y43cwpln The only way to defeat Covid is by being frank about the challenges while following the science & evidence. Biden will do all of that.
2/ Biden is set to introduce his Covid team tomorrow, led by Obama's surgeon general @vivek_murthy, & @DavidAKesslerMD, former FDA head (& ex- @UCSF dean) https://tinyurl.com/y2rwyaks I know both well & am confident that they’ll be excellent leaders. (Role of M. Nunez-Smith still TBD.)
3/ Biden’s decision to announce this task force as his first major act as Prez-elect is important & strategic. He knows that if he doesn’t get the pandemic under control there’s little else he will achieve as #46.
And, it goes without saying that the administration’s success…
And, it goes without saying that the administration’s success…
4/ … in dealing with Covid could well determine whether more than 100,000 Americans live or die. To borrow Biden’s whispered remark to Obama when the Affordable Care Act passed, dealing effectively with Covid is “a big f-ing deal.” https://tinyurl.com/yyb6duor
5/ As I mentioned in my prior thread https://twitter.com/Bob_Wachter/status/1323494646773735425, Biden's first days will be colored by the state of the pandemic on 1/20/21. One can paint a scenario in which the current surge is improving – the prior 2 phases (spring & summer) each peaked & fell in about 2 months…
6/ … So, if this surge follows suit, cases could be falling by late January, which would allow the Biden administration to concentrate on preventing a fourth surge (through promoting masking/distancing/etc. and enacting a strong testing and contact tracing plan)…
7/ … along with making plans to distribute one or more vaccines (if approved).
Conversely, its an equally plausible scenario that combo of more cold weather, X-mas & Covid fatigue means we’re still surging on Jan 20, making B's first days far harder https://tinyurl.com/y2qmalgn ...
Conversely, its an equally plausible scenario that combo of more cold weather, X-mas & Covid fatigue means we’re still surging on Jan 20, making B's first days far harder https://tinyurl.com/y2qmalgn ...
8/ In either case, the transition will be for planning but also for setting a tone: one in which competence is expected & celebrated, expert opinion is elicited & heeded, & every effort is made to reach out to both policy makers (esp. governors) & citizens (esp. in red states)…
9/ … encouraging all to take the threat seriously and act responsibly.
Will it work? The pandemic response to date has been so partisan, it’s hard to know. But perhaps a major uptick in cases, hospitalizations, and deaths will create the opportunity for a teachable moment.
Will it work? The pandemic response to date has been so partisan, it’s hard to know. But perhaps a major uptick in cases, hospitalizations, and deaths will create the opportunity for a teachable moment.
10/ The transition team has released an early plan https://tinyurl.com/y4hu3n38 My summary of the plan is below (figure); it seems perfectly sound to me.
Rather than looking at the plan by initiative (ie, testing, vaccines), I find it helpful to view it through a different lens…
Rather than looking at the plan by initiative (ie, testing, vaccines), I find it helpful to view it through a different lens…
11/ namely, by the type of change that's needed to make it work. I find this lens useful, because it helps illustrate what Biden might be able to do, & when. The four main categories are:
a) Policy changes, b) Changing behavior, c) Scientific advances, and d) Logistics & Ops.
a) Policy changes, b) Changing behavior, c) Scientific advances, and d) Logistics & Ops.
12/ First category is Policy. Biden has signaled his preference for a nat'l mask “mandate,” though his power to enforce such a thing is limited https://tinyurl.com/y55jyc2c . (Too bad: this paper https://tinyurl.com/y3kthorg shows universal masking could save >100K lives.) What can he do?
13/ He can, and likely will, require masks on federal property, & maybe in interstate travel. Most interesting question will be whether he, or Congress, will threaten to withhold fed funding (such as public health or hospital support $ s) to states that fail to enact mandates.
14/ Of course, the more aggressive Biden is, the more pushback he’ll get from red state guvs. His likelier path, then, will be to promote masks thru the bully pulpit, visibly supporting CDC & creating regional/state dashboards that allow one to see (& compare) the state of Covid.
15/ Even w/ mandates, it’s unlikely we’ll see people fined (or even cited) for not wearing masks. So the next area of focus is Behavior. How can he convince people to wear masks? To be tested when appropriate? To answer a call from a contact tracer? To isolate? To take a vaccine?
16/ Biden's talk of unity – during the campaign & in last night’s speech – is an effort to move in this direction. Will it work – who knows? There seems little hope that highly political issues like tax cuts or judges can be de-partisanized. But masks? Maybe, if he succeeds in…
17/ … convincing people that it's non-sensical for mask-wearing to be a sign of which team you root for. Rather, wearing a mask shows your concern for yourself, your family, & your community. Not an easy sell, but do-able, w/ a combo of evidence, role-modeling, gentle shaming…
18/ …and a powerful public campaign, involving influencers of all types. Getting this right will teach us a lot about the prospects for successfully dealing with a similar, maybe harder, behavioral challenge that we hope to face in a few months: getting people to take a vaccine.
19/ Job 1 there will be to reestablish the FDA as a science-driven org whose approval is seen as ironclad evidence that a vaccine is safe & effective. But more will be needed to prevent vaccines, like masks, from getting mired in partisan politics. Perhaps a Republican FDA chief?
20/ The next category is Science. Here, the agenda's clearer: continued support for scientific research on epi/prevention, on therapeutics, and on vaccines. Giving credit where it’s due, this latter category is the one area of Covid in which the Trump team did quite well.
21/ The final category: Logistics & Operations, the boring stuff that makes all the difference. Biden’s experience in running the federal recovery program in '09-10 will be very useful. There will be plenty of opportunities in this category: getting more test kits manufactured…
22/… and distributed. Ditto PPE. And, as the FDA green-lights them, vaccines. This is the last-mile stuff that will determine whether the plans really work. It will take competence, patience, and focus – qualities the Trump administration never mastered, but Biden’s likely will.
23/ Biden’s job in the next 2 mths is to set the stage for all of this: by bringing in experts, developing smart, realistic plans, working w/ various stakeholders (particularly those who didn’t vote for him), & creating a plan marked by empathy, competence, & respect for science.
24/ It may seem like a moonshot, but it’s really not that hard. We now know a ton about the virus, how to prevent its spread, & how best to treat Covid. We also know what it’s costing us: in lives, money, & peace of mind. So finding the dollars to defeat it should be fairly easy.
25/ The challenge is to develop a science-driven plan & then to execute it. And, mostly, to win hearts and minds. Assuming we’re realistic about the challenges, particularly the hearts and minds part, it seems achievable.
No harder, really, than beating an incumbent president.
No harder, really, than beating an incumbent president.
