Why Covid-19 is always one step ahead of the US response

3 factors make it hard for the US to respond nimbly to new pandemic threats.

The Biden administration’s response to the omicron variant is belatedly kicking into gear. The White House announced Wednesday that it would soon ship 400 million N95 masks to US pharmacies and community health centers to be given away. Americans can submit their bills for at-home tests to their health insurer for reimbursement, and on Tuesday, a new federal website launched that lets people order a few free at-home coronavirus tests.

Free tests and free masks are finally here — after some public health experts have been calling for them since omicron was first detected around Thanksgiving or even earlier. But the tests and masks might not arrive in Americans’ hands until the end of the month.

“By the time the masks and tests get there, the surge will probably be over,” Monica Gandhi, an infectious diseases doctor at the University of California San Francisco, told me. It’s possible — but far from certain — that the omicron wave has already peaked. The average number of daily cases has dropped by 50,000 in the last week, a 6 percent decline.

From the very beginning of the pandemic, the US response was defined by slow action on tests and masks. Two years after the first coronavirus case on American soil was diagnosed, the national strategy to combat the virus is still too little, too late. The Biden administration’s response to omicron, experts say, will likely not arrive in time to meaningfully change the course of the latest pandemic wave.

“At this point, not sure widespread testing is going to be helpful until this wave calms down,” said David Celentano, who leads the epidemiology department at the Johns Hopkins School of Public Health.

Why America’s response to omicron was so slow

On December 1, the US was averaging 87,000 new Covid-19 cases per day. It’s now averaging more than 750,000 new cases daily, according to New York Times data. There are a record 158,638 Americans hospitalized with Covid-19. Roughly 1,900 people are dying of Covid-19 each day, a figure that has more than doubled since late November.

Other countries were caught off guard by omicron, too, but they were able to act quickly once it arrived. In the UK, for example, free at-home tests were already the norm. In the fall, before the omicron wave, Brits could walk into any pharmacy in the country and get five or seven testing kits free of charge.

Experts point to three main factors in the US government’s slow response to omicron: an over-reliance on vaccines, a failure to develop contingency plans, and the fracturing of the expert consensus on what the appropriate public health interventions would be.

Some experts say the Biden administration and federal officials put too much faith in the power of vaccines alone to end the pandemic. Advisers to the White House told the Washington Post last month that the eye-popping data reported in the initial Pfizer and Moderna clinical trials, showing those vaccines more than 90 percent effective at preventing all infections, contributed to a belief within the administration that sufficient vaccination would be enough to bring the pandemic to an end.

“I think the Biden transition team saw the first, highly promising vaccine efficacy results from Pfizer in fall 2020 and decided against making serious investments in so-called ‘non-pharmaceutical interventions’ from the beginning,” Justin Feldman, a social epidemiologist at Harvard, said. “This vaccine-only strategy was never a good idea, but there were wake-up calls that were missed.”

For example, by late July of 2021, the Centers for Disease Control and Prevention already knew that vaccine efficacy was waning and the delta variant was more contagious than its predecessors, which threatened a new wave of infections, according to internal documents leaked at the time to the Post. Around the same time, Israel started offering booster shots to its most vulnerable residents, a step the US would not take for two more months.

The vaccines did fundamentally change the pandemic. Suddenly, tens of millions of people could safely acquire some immunity from Covid-19, and the vaccines offered particularly strong protection against severe illness. But they were never a panacea. Even in clinical trials, the vaccines were not 100 percent protective against infection. Over time, their effectiveness in stopping infections declined, even as they remained powerful in preventing the worst outcomes from Covid-19.

That made a vaccine-only strategy insufficient. The virus was still spreading widely. There were still millions of people who either refused to get vaccinated or for whom the vaccines did not provide as strong of protection as they do for younger and healthier people. And there was always the threat of a new variant that would be more resistant to the vaccines.

There are limits on what the federal government can do under our federalist system of government. Mask mandates and social distancing restrictions are largely the purviews of state and local authorities. The Biden administration did attempt to take sweeping actions, such as a vaccine mandate for large employers, that got tied up in the courts.

But there were also clearly missed opportunities ahead of the omicron surge.

In October, with the delta wave underway, the White House rejected a plan to manufacture and distribute at-home rapid tests for the winter holidays, according to a Vanity Fair report from late December. Over the summer, Abbott Laboratories — the largest manufacturer of at-home rapid tests in the US — actually started destroying some of its test inventory because it did not anticipate a market for those tests and the government had not bought the excess supply. This meant that when omicron start to spread, there was not a stockpile of masks or tests to distribute to people quickly.

And once the new omicron variant was spreading, it was already too late anyway. As several experts emphasized to me, the government does not move swiftly, even in the face of an emergency. It can take days for public health guidance to be revised. Setting up a website where people could order free tests took weeks. And the facts on the ground are always changing. With omicron, for example, the evidence is growing that throat swabs may be more sensitive in the early days of an infection than the nasal swabs included in most testing kits.

US health agencies are not accustomed to making and revising policy quickly, as demonstrated by the delay in revising the CDC’s isolation guidelines or a long-overdue update on which face masks are recommended.

“A rapid response is not possible within the way policies are normally formulated and implemented,” Bill Hanage, a Harvard University epidemiologist, told me. “We’re not caught fighting the last battle, but the one before that.”

The public health consensus on the best Covid-19 response has fractured

The government’s ability to act quickly has been complicated by another factor: Public health experts are increasingly divided on what the country should be doing in its pandemic response. It’s hard to plan ahead or change plans quickly when experts can’t even agree on what you should do.

Public health experts were never a monolith. But early in the pandemic, there was a fairly clear consensus about what to do about Covid-19: Close some businesses, ban most large gatherings, mandate masks, and develop a vaccine. A New York Times survey of hundreds of epidemiologists found in the summer of 2020 that more than half were in agreement about the timeline for resuming many activities that had been stopped because of Covid-19, such as vacationing within driving distance or eating out at a restaurant.

But as the pandemic has dragged on, expert opinions diverged. In spring 2021, the Times ran another survey of epidemiologists, asking them how long people would need to wear masks indoors, the answers varied wildly; 20 percent said half a year or less, while another 26 percent said people would wear masks indefinitely, at least in certain situations. As the Biden administration debated booster shots this summer and fall, some experts were full-throated supporters of giving everybody an additional dose, while other prominent experts argued boosters made sense only for certain people.

Even as I asked experts whether the White House’s proposals to distribute tests and masks were coming too late, there was disagreement about whether these plans were even necessary. Some said testing should be concentrated on nursing homes and on other high-risk populations. Some argued we should stop testing asymptomatic kids in schools.

And many of them continued to say that vaccines, more than any other intervention, are still the best way to bring Covid-19 under control. If the Biden administration neglected other parts of the pandemic response, it was partly following the belief among public health experts that vaccination trumps everything else in stopping Covid-19.

But some experts warned that future waves — or variants — could threaten the tentative victory the country appeared to have won in the spring and early summer of 2021.

Rather than take proactive steps to prepare for that eventuality, the Biden administration sidestepped those decisions, and now the country is struggling to catch up to omicron.

“When it comes to public health overall, I think there is a relentless tendency to allow the perfect to be the enemy of the good,” Hanage told me. “When you are facing an exponentially growing wave of infections, we do not have the time to identify and demonstrate which policies are optimal, and that means we are caught out over and over again.”