Covid Under Biden: What Can be Done?
As the US confronts both a political crisis of presidential succession and a worsening pandemic, it might be instructive, though perhaps not comforting, to learn that we’ve been here before.
In the period between the 1773 Boston Tea Party up through the start of the American Revolution with the battles of Lexington and Concord and on into late 1775, the citizens of Boston were under the thumb of a tyrannical autocrat, Gen. Thomas Gage, a leader who not only closed off economic life by shutting down Boston harbor as punishment for the city’s acts of rebellion, but also ignored a worsening smallpox epidemic, preventing local authorities from taking action to contain it.
Recounting that historic time of political and medical crisis, Charles Vidich, author of a forthcoming book Germs at Bay: Politics, Public Health & American Quarantine (Praeger, 2021), on the history of quarantines in America dating back to the early colonial era, notes that Gage’s unwillingness to heed experienced local authorities about the dangers of not dealing with smallpox led to public anger, contributed to the support in Boston for the growing insurgency against British rule, and ultimately undermined his ability to resist the uprising. Indeed the widespread smallpox epidemic in Boston quickly infected to his own Redcoat garrison in their cramped barracks in the city because of his mismanagement, diminishing the forces he had available.
Does this tale of an autocratic ruler brought down nearly two and a half centuries ago by his own ego and his failure to take advice in confronting an epidemic sound oddly familiar?
It might appear that Vidich has shown an amazing sense of timing. His book after alll is set to come out on Jan. 31, just as the Coronavirus pandemic could be peaking, and only days after a newly inaugurated 
president will successfully oust from power an autocrat who like Gen. Gage, has ignored a virulent disease and who has obstinately continue to refuse to concede his loss.
Actually, Vidich, who was incident commander for the US Postal Service’s Unified Incident Command Center during the Anthrax attacks in 2001-2, and who in his work at the USPS worked closely with the CDC, EPA, OSHA and the US Army Medical Research Institute of Infectious Diseases, says he has been researching his book for more than a decade, much of that time as a research scholar at Harvard. The book’s timing, he insists, was just serendipity. We are however, fortunate to be getting access to this beautifully written and well researched and documented book at a time when we most need to learn from it.
Vidich, who holds a PhD in Public Health from Harvard, surveys the ongoing disaster of the Trump Administration’s handling or rather lack of or mishandling, of the pandemic, says, “The US has certainly suffered from a failure in leadership, but there are many things that went wrong, including a mistaken belief among many in the health policy field that we’d really conquered epidemics so funding for preparedness could be cut back and cut back.” These failings go a long way towards explaining why the US, with just four percent of the world’s population, accounts for a sixth of all Covid-19 cases and a sixth of global deaths from the disease.
Vidich says, “One of the biggest things needed in an epidemic is to have a nationally coordinated approach, but we have not had that. Right now you’ve got 50 governors responsible for their states’ responses, all taking different approaches.” As an example, he points to the issue of wearing masks. Despite clear evidence that widespread mask wearing deters viral spread, he reports that there is still, despite a soaring resurgence of new cases and of hospitalizations of Coronavirus victims in almost every state in the union, no national policy for their use. “As of last week there were still eight states that not mandating mask wearing at all,” he says, “but even in states that do have a mandate of one kind or another, most of them have exceptions, and those exceptions are often quite different.” With a laugh, he said, “I’ve checked the regulations in all 50 states and only Maine says,’no exceptions,”\’ while some states list as many as 20.”
In North Dakota, for instance, Vidich points to an exception tht allows up to 10 people in a vehicle to ride without masks. “Ten people! That’s about the most that can fit into a clown car!” he laughs. “Obviously, it’s an ideal situation for a contagious person to infect everyone.”
Mask wearing, he says, is a good example of the impact of having a lack of leadership, not just at the national but also the state level. Only about 80% of Americans are reportedly wearing masks, he notes, and that is not all the time. “The problem,” he says, “when there are a significant number or people going mask-less, is that we’re all at the risk of the one who’s least responsible spreading the virus or bringing it home and spreading it. And if the people who talk the loudest, those who are spit-talkers, are in the 20% who are going mask-less, you’ve got a real problem!”
In a slam at lame-duck one-term President Trump, Vidich says, “At this point what we really need is a Pied Piper to lead people to do the right thing. Instead we have had, and still have a Pied Piper who’s been leading people in the wrong direction towards the wrong bridge!”
With Pennsylvania’s conclusive certification and locking in of its 20 Electors for Biden at the upcoming Electoral College meeting on December 18, Democrat Joe Biden is now widely acknowledged as the President-Elect. Remaining Trump campaign legal challenges to Biden’s victory in other so-called “swing states” are now pointless and likely to be mooted in the courts. With those added Pennsylvania electors alone, Biden has a lock on the 270 Electoral College votes he needs to win the presidency. What happens to challenges and recounts in Wisconsin, Michigan, Arizona, Georgia and Nevada really no longer matters.
Emily Murphy, the Trump-appointed Administrator of the General Services Administration, on Monday accepted that Biden is the “likely” winner of the election and has overridden Trump’s refusal to grant his victorious Democratic opponent access to transition office space, public transition funding or access to officials in government departments. This means the president-elect and his transition team can now start seriously planning to take charge of the US government — and most urgently can now prepare in earnest to deal with the raging pandemic — from day one of his presidency on Jan. 20.
So what should actions should the country’s new president be preparing to take?
“There are some basic things that need to happen,” says Vidich. Firstly, he says that the Center for Disease Control (CDC) needs to be made more independent. Under the Trump administration, he explains, the CSC had been made subordinate to the administration-run and heavily politicized Department of Health and Human Services. “I’ve worked at the CDC,” he says, “and they have some really brilliant people there. But brilliant people don’t help much if there are structural problems. Biden needs to decide: Who’s in charge of pandemic policy? Is it the president, or an independent body?”
Second, he says, “There needs to be strategic planning. Obama had a strategic plan for a future major flu epidemic, but the Trump administration got rid of it because it was created in the Obama administration. So when Covid-19 came along, Trump and his administration had no plan. With this pandemic there was a lot of pussyfooting around until enough people had died that they started to act. But it was pretty late by then.”
Vidich notes that Biden’s plan will urge all governors to order wearing of masks, but he says, “The exceptions need to go — especially the one that says six feet of separation in any size group or any size room is sufficient to drop the need to wear a mask.” He explains, “That rule is a total myth dating back more than a century. It’s based on an erroneous belief that only heavy particles of saliva or mucous from the mouth or nose could carry the virus. But studies show people can sneeze smaller virus-carrying particles out 18-20 feet. He adds, “Also, duration of exposure matters, since the risk of exposure to such a [virus-containing] sneeze increases the longer one is close to infected people.”
Vidich attributes all the current exceptions included in different states’ regulations on mask wearing to “attorneys who have too much time on their hands.”
“It’s also politics,” he says. “The policies you’re getting in some of these Republican states are just pure fiction — life as they want it, not science-based policies.”
Beyond that, Vidich says Biden needs to push through Congress a new financial support plan to allow people to live, to work remotely where possible, and to receive income support if they lose their jobs in businesses that need to be temporarily closed. “The fiscal part is critical,” he says, “but any plan also needs to include expanded contact tracing, and funding for probably at least 10 mobile hospitals for regions where hospitals get overrun with cases.”
Asked about vaccines, he says, “The issue is how much testing they are doing. If you only test 100 people, you miss the one in 1000 who has a severe reaction. If you only test 1000, you miss the problem that shows up in 1 in 10,000 cases. Whenever you do testing of a new vaccine quickly or cut the sample size you can run into a problem. Also you can have quality control problems when you’re rushing production. That is what has happened with attenuated virus vaccines like the oral polio vaccine: some of the doses aren’t always entirely attenuated so people actually can get the disease.” He says Pfizer’s vaccine, because of the low temperatures required to keep the doses useable, means it will likely only be available in wealthy countries.
“I would say if India develops a vaccine it will be more widely available, because that will be a focus of their research,” he says. He adds, “I would not rule out the Russian vaccine either. “The Russians have been very sophisticated in their research on germ weapons. They’ve got some brilliant people over there in the field of vaccines.”
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