The U.S. can expect increased Covid-19 testing, a national mask policy and the possibility of nationwide lockdowns once President-elect Joe Biden takes office Jan. 20.
The Biden-Harris campaign laid out a step-by-step plan for addressing the coronavirus pandemic that includes more testing, increasing use of the Defense Production Act to make protective equipment for frontline workers and restoring the U.S. relationship with the World Health Organization. The transition team wasted no time, announcing Monday its own Covid-19 advisory board co-chaired by former FDA Commissioner Dr. David Kessler, former Surgeon General Dr. Vivek Murthy and Dr. Marcella Nunez-Smith, the associate dean for health equity research at the Yale School of Medicine.
Covid-19 outbreaks are worsening in communities across the country as cases reach record-high levels of more than 100,000 cases a day and scientists warn Americans to prepare for a difficult winter. Meanwhile, potential vaccines are rounding the final turn toward emergency approval as states formulate how they'll distribute doses — despite numerous uncertainties and lack of federal funding.
On Monday, Pfizer and BioNTech announced that their coronavirus vaccine was more than 90% effective in preventing Covid-19.
President Donald Trump, who is contesting the results of the race, has pointed to the historically fast development of medicines against the virus under the administration's Operation Warp Speed while downplaying the threat of the disease. Trump, who spent three days in the hospital with Covid-19 last month, has also ramped up accusations in recent weeks that Biden would shut down the economy if he wins the election.
"This election is a choice between a Trump boom and a Biden lockdown," Trump said in Arizona, while insisting that the pandemic is taking a turn for the better, though the data suggests that's not, in fact, the case.
Biden has repeatedly said he would listen to scientists like Dr. Anthony Fauci, the head of the National Institute for Allergy and Infectious Diseases.
"I would be prepared to do whatever it takes to save lives, because we cannot get the country moving until we control the virus," Biden told ABC News during an August interview with now-Vice President-elect Kamala Harris. "In order to keep the country running and moving and the economy growing, and people employed, you have to fix the virus."
"I would shut it down. I would listen to the scientists," he said.
The Trump administration, by contrast, has allowed state governors to decide whether and when to shut down or reopen businesses, impose mask requirements and purchase their own testing materials and personal protective gear.
"It's been 50 states going in 50 different directions from the beginning," Dr. Howard Koh, a professor at the Harvard T.H. Chan School of Public Health and former assistant secretary for health at the Department of Health and Human Services during the Obama administration, told CNBC.
"And as a result, we have witnessed this rolling thunder of disease and death that's lasted into the 10th month and counting," he said.
Biden's plan, in contrast, calls for a coordinated national strategy. That would include broader use of the Defense Production Act, which Trump was hesitant to deploy early on, to ensure that the U.S. has a greater supply than demand of essential health-care equipment, like masks and face shields.
The plans also suggests significantly increasing the nation's testing by doubling the number of drive-through sites — at least 10 per state — and investing in at-home tests. So far, the nation's coronavirus response has depended on molecular tests that require lab equipment and trained personnel. The White House announced in August that it would buy 150 million rapid tests as part of a $750 million agreement with Abbott Laboratories.
On top of that, Biden says he would establish a U.S. public health jobs corps to "mobilize at least 100,000 Americans across the country" to support contact tracing efforts, which has largely been left for the states to arrange, and assist populations at higher risk.
"We should be investing a great deal more money in testing and tracing," Biden said in a recent interview with CBS' 60 Minutes.
Biden has called for national mask requirements, though experts say it's unclear how that would be executed. In an Oct. 23 speech, Biden said he would " go to every governor and urge them to mandate mask wearing in their states." And if that doesn't work, Biden said he would turn to mayors and county executives to institute local mandates.
Masks would be required in all federal buildings and interstate transportation systems under his authority as president, he added.
Biden would also direct the CDC to provide communities with evidence-based guidance on when to close some business or schools depending on the degree of viral spread, according to the campaign's Covid plan. The CDC would be empowered to guide states when to place appropriate restrictions on gathering sizes and when to issue stay-at-home orders.
Those plans could change once he's in office and a nationwide lockdown could still be avoided.
"We're still three months away" from the inauguration, said Dr. Zeke Emanuel, a bioethicist and oncologist who's advising Biden on health-care issues. "I don't know where we're going to be then, and a lot depends on what we do now."
Emanuel, who was named to Biden's task force on Monday, explained in an interview that there are emerging Covid-19 hotspots, as well as spikes across the country. But he also said that Americans have adapted since the early days of the pandemic. When New York City was surging in March, he said, residents took the public health guidelines extremely seriously.
What may be a better course of action, he suggests, is for Biden to rally the states to get local political leaders to set an example. That might not include a full lockdown, but it may require careful planning and preparation before opening up bars for indoor drinking or venues for large crowd-gathering.
Shortly before the election, Trump has indicated he might fire Fauci, who's a member of the White House coronavirus task force and the nation's leading infectious disease expert. He's advised six U.S. presidents dating to Ronald Reagan.
A "Fire Fauci" chant broke out during a Trump rally days before the election as the president defended his handling of the virus. In response to the chant, Trump said: "Don't tell anybody, but let me wait until a little bit after the election."
However, Fauci has previously told CNBC he's prepared to continue his work fighting Covid-19 despite who the president is. Indicating his support for Fauci, Biden tweeted in response to the chant: "We need a president who actually listens to experts like Dr. Fauci."
"We have not had regular national press briefings from the White House that featured and empowered the top public health scientists like Dr. Fauci," Koh said, adding that earlier this year the White House task force used to join Trump, but those briefings have since disappeared.
"I would expect that under President Biden, he would reinstitute regular briefings, galvanized by the White House, but empowering the top scientists to convey their knowledge and guidance on behalf of the American people," he said.
Biden's plan also includes repairing the United States' battered relationship with the World Health Organization after Trump began the process of severing financial commitments to the global health agency.
"You can't fight a global pandemic without a global approach and allies," said Ron Klain, the former White House Ebola response coordinator who is widely rumored to be in the running for Biden's chief of staff, said in a campaign ad in July.
When Biden takes office in January, it's likely that the initial doses of coronavirus vaccine will be made available to priority populations, like health-care workers and the elderly, across the country, experts say.
"It's clear that this vaccine, even if approved, will not be widely available for many months yet to come," Biden said Monday, after Pfizer and BioNTech announced that their vaccine is more than 90% effective in preventing Covid-19 among those without prior evidence of infection.
"The challenge before us right now is still immense and growing," Biden stressed.
Every state has submitted a plan to the CDC on how they intend to inoculate hundreds of millions of Americans against Covid-19 once that vaccine is approved. However, associations representing state and local public health departments have called for more than $8 billion to fund the plans.
That money would help ramp up their health-care staff, improve their data systems, pay for the ultra-cold freezers needed to store some of the vaccines and prepare educational material to ease people's potential safety concerns, they say.
Biden's plan suggests investing $25 billion for vaccine development and distribution, guaranteeing that "it gets to every American, cost-free." Under Biden, the U.S. would also call for the creation of a global health emergency board that would convene the leaders of G-7 countries and others in support of the WHO to help offset the costs of vaccine deployment to developing countries.
The WHO has already established the Covid-19 Vaccines Global Access Facility, or COVAX, which includes more than 170 nations with the aim of working with vaccine manufacturers to provide countries with "equitable access to safe and effective vaccines." The Trump administration said in early September that the U.S. will not join the initiative.
"Discovering a vaccine isn't enough if it gets distributed in the same kind of fiasco as Trump's testing mess," Klain said in the July campaign ad.
Correction: An earlier version misstated the dates of the Trump rally and Biden's response to the "Fire Fauci" chant.