The pandemic refuses to quit. What can the White House do about it?
Experts were already a little worried about another winter surge of Covid-19. Now the omicron variant has amplified those concerns, though we still don’t know to what extent it will alter the course of the pandemic.
The Biden administration is trying to get ahead of the threat, detailing a new plan to accelerate vaccinations, increase testing, make treatments widely available, and deploy teams of public health experts to any hot spots that emerge in the coming months.
Taken together, the plan reads like the consensus you would probably find if you asked a few hundred public health experts what we should be doing; in fact, some experts are annoyed some of these things weren’t already being done. Even so, a few provisions — such as promising insurance reimbursement for tests rather than providing them for free — raise eyebrows.
But overall, experts seem to think the plan hits the important points. The real question is how much of an impact any program from the federal government can have at this point. Some state governments are resistant to even the most basic measures, such as masks in schools; 16 percent of adults said in October they will definitely not get the Covid-19 vaccine, the highest share recorded by the Kaiser Family Foundation (KFF) in its vaccine surveys. People have dug in.
The administration knows it can’t stop Covid-19, omicron variant or otherwise. But this is its attempt to lower the barriers for people to coexist with Covid-19: by making it easier to get a vaccine, to get tested, and to get meds if you are sick.
Biden’s winter Covid-19 plan, briefly explained
The plan announced Thursday by the Biden administration covers the full spectrum of the federal response. It starts with booster shots.
The Centers for Disease Control and Prevention (CDC) has already revised its recommendations, urging all adults over 18 to get an additional dose of a Covid-19 vaccine six months after their second Moderna or Pfizer/BioNTech shot (or two months after their first shot if they received the Johnson & Johnson vaccine). Many experts are cautiously optimistic that boosters received now will also be protective against omicron if the variant starts to spread widely in the US, though how much protection the current vaccines provide remains to be seen.
The Biden administration is partnering with the AARP for an education campaign to get seniors boosted and plans outreach from Medicare as well. While there is still some debate about the value of boosters for young and healthy adults, almost every expert agrees that older Americans and people who have a compromised immune system should receive another shot. AARP also pledged to coordinate ride-hailing programs to get people to their booster appointments, and the White House is calling on employers to give workers paid time off to get their shots.
However, 30 percent of Americans remain unvaccinated — including a lot of kids between 5 and 12, who are currently eligible for the vaccines. (Shots for kids younger than 5 are expected to be approved sometime early next year.) Community health centers are going to hold family vaccination days and FEMA is going to set up mobile vaccination clinics. Medicaid will also reimburse doctors for talking with families about getting children vaccinated.
This will be an uphill battle: According to the KFF October survey, 30 percent of parents say they will “definitely not” get their child vaccinated and another 33 percent plan to wait and see. And many adults who are currently unvaccinated insist they will never get a shot.
Testing remains essential to tracking and stemming the virus’s spread, letting people know if they need to isolate or seek medical attention. The Biden administration plans to issue new regulations to permit patients to seek reimbursement from their health insurer if they purchase an over-the-counter test; they also plan to distribute more tests for free through community health centers and other providers including pharmacies.
Another component of the plan is “strike” teams that can be deployed to support hospitals strained because of staffing shortages, to provide monoclonal antibody treatments in areas with high spread, and disease investigators to assist with tracking the virus.
There are also stricter rules for international travelers, requiring a negative Covid-19 test within a day before boarding a plane. And as part of the plan, the federal government will take responsibility for doling out the new antiviral medications if and when they are authorized by the FDA.
It’s a pretty comprehensive plan, though experts still see some shortcomings.
“What other partners could they employ other than AARP to reach others who are not of retirement age?” Tara Smith, a public health professor at Kent State University, told me. “I like that partnership and the things they are doing there — but we need that for other age groups too. I like their family vaccination clinics, but why wasn’t this started in January?”
Should the tests just be free?
One part of the plan, though, drew particular scrutiny: It calls for patients to seek reimbursement from their health insurer if they purchase an over-the-counter test. Some people are getting billed for Covid-19 tests currently, which might discourage them from taking a test at all; and expanded insurance coverage could help ameliorate that problem. But there will likely still be an obstacle between purchasing the test yourself and getting your money back.
It has been well documented in US health care that even small financial obligations can have a sizable effect on people’s actions. The so-called “shoebox effect” — when people who are asked to submit reimbursements on their own never end up doing so because it’s a hassle — could also kick in.
“Insurance reimbursement for at-home tests will increase access and mean more people will use the tests, but it’s not a panacea,” Larry Levitt, executive vice president at the Kaiser Family Foundation, told me. “Having to pay upfront will discourage some people, and the hassles of having to file for reimbursement from your insurer will mean that many receipts will just end up sitting in shoeboxes.”
Why isn’t the federal government just buying hundreds of millions of tests and giving them away? It’s a matter of funding. Even 500 million rapid at-home tests would barely be enough for one for every person in the US. Abbott’s rapid testing kits currently retail for $24 for two tests at CVS.
It could all add up quickly and, while we can debate whether the government should buy and give away the tests anyway, that much money would likely require creative accounting by federal agencies or else new funding approved by Congress. From the government’s perspective, having patients submit bills directly to the insurer is certainly easier. But it’s more difficult for the patient.
The US government also does not typically pay, for all its citizens, the kind of routine medical services that Covid-19 tests will likely become, though most other wealthy countries do so in one way or another. A more conventional American market is expected to emerge, with insurers covering Covid-19 tests as they do other routine tests.
“This is our fragmented health care system at work,” Levitt said.
The Biden plan looks like a path from an epidemic to a new normal
The plan provides a playbook of sorts for how we start to live with Covid-19. Because eradication is out of the question, experts are thinking about how to reduce risk and harm as much as possible, while also allowing life to return to normal as much as possible.
“Because Covid-19 is becoming an endemic infection, teaching people how to risk-calculate with an everyday threat is very important,” Amesh Adalja, senior scholar at the Johns Hopkins University Center for Health Security, told me. “To that end, home testing, antivirals, monoclonal antibodies, and boosting of the high-risk are really important.”
Nobody wants to go back into lockdown, and in the US, there isn’t the political will or public buy-in to do it anyway. The Biden administration is trying to create a plan while facing a big dilemma: Millions of people are still vulnerable to the virus — and that number could grow depending on how effective omicron is at overcoming prior immunity, which we don’t know — but many of them don’t have any interest in getting vaccinated or even getting tested.
“Many people are just done. They won’t get boosters, at least right now,” Smith said. “They won’t wear masks short of a serious mandate. They certainly won’t be buying tests.”
The federal government has already run into some of the limits of its power: The Biden administration’s vaccine mandate for large employers is tied up in court. The threat of a mandate did appear to have motivated a lot of businesses to require vaccines and a lot of people to get them; research shows mandates could be effective and new vaccinations did spike after the White House had finalized its regulations. Sometimes, sending the signal can be the next best thing to concrete policy.
So they came up with this all-of-the-above approach. Boosters and tests for people who want them. For those who end up getting sick, we have more treatment options than before, with the new antivirals expected to come on the market any day, and the Biden winter plan includes measures for getting the medications out into the country.
A new normal isn’t a world without any Covid-19, but a world in which we can live with it. Nature itself will have something to say about that, as omicron reminds us. But this is what the Biden administration says it is doing to prepare.