WASHINGTON – The White House unveiled a new pandemic road map on Wednesday that calls for better surveillance of new variants and dispensing antiviral pills “on the spot” when someone tests positive, but rules out school and business closings.
The plan was released hours after President Joe Biden announced a pandemic reset in his State of the Union address, asserting that the wide availability of vaccines and therapeutics had made the coronavirus threat more manageable, while taking pains to avoid last summer’s premature victory lap.
“We look to a future when Americans no longer fear lockdowns, shutdowns, and our kids not going to school,” the plan states. “It’s a future when the country relies on the powerful layers of protection we have built and invests in the next generation of tools to stay ahead of this virus.”
The 96-page road map is part of a broader White House strategy to move the country from crisis footing and convince Americans that their lives can return to normal amid the president’s tanking approval ratings and Democratic anxiety that nosediving cases and school reopenings have not buoyed a dyspeptic public. It comes after the coronavirus has claimed nearly 1 million American lives and exacted an enormous toll on every facet of life – interrupting learning for tens of millions of students, cratering livelihoods and separating families.
The White House acknowledged that toll while heralding a future in which Americans could feel more confident. Biden and his administration said they are “clear-eyed that new variants might arise,” laying out plans to be better prepared by expanding surveillance and amassing additional supplies of vaccines, antiviral medicines, masks and tests.
But the road map’s implementation largely hinges on funding from Congress, and it remains unclear whether the administration can win the support of Republican lawmakers who have demanded better accounting of existing spending to see if money might be repurposed. Federal agencies have briefed lawmakers on a price tag of more than $30 billion to cover the costs of this and other public health spending.
The plan focuses on four goals: protecting against and treating covid, including a “test to treat” initiative that would give people antiviral pills immediately if they test positive at select pharmacies and clinics; preparing for a potentially dangerous new variant; preventing economic and educational shutdowns; and expanding vaccinations worldwide – all elements Biden previewed on Tuesday night.
Under a new “coronavirus variant playbook,” health officials would identify and assess the transmissibility and severity of new variants more quickly. Officials said they would be able to produce and authorize new vaccines and treatments within 100 days of identifying a variant, if necessary, after having conducted tabletop exercises with multiple federal agencies in recent weeks.
Jeanne Marrazzo, an infectious-diseases physician at the University of Alabama at Birmingham, praised the plan’s national coordination, saying it strikes the right balance between vigilance and caution, but also acknowledges reality. “I think it’s really good,” she said.
She called the test-and-treat program particularly innovative and a potential “game-changer.”
“If we could really roll it out, make it accessible and affordable, and use it intelligently, you could really interrupt the course of disease, especially in those who are immunocompromised and other vulnerable populations,” Marrazzo said.
State and local health officials also praised the plan, saying it reflects many of their own priorities, but they were waiting to hear more details, including specifics about funding.
White House officials acknowledged in interviews that the plan is dependent on funding that was still being negotiated with Congress. One senior health official, who like others in this report spoke on the condition of anonymity to be candid, said the administration lacks money to cover purchases beyond its current orders of vaccines, antiviral drugs and monoclonal antibodies. Those orders are not sufficient for the entire year, the official said.
The administration is also navigating between dueling public pressures: It wants to ease as many restrictions as possible to enable people to go about their lives, while polls show that most Americans still want some mitigation measures in place as the virus continues to circulate.
Some of the White House’s urgency about a less disruptive pandemic response reflects polls showing a continued slide in support for Biden’s handling of the crisis. A Washington Post-ABC poll published on Tuesday found that 44% of Americans approve of his management of the pandemic, while 50% disapprove despite the sharp decline in cases and an easing of restrictions in most parts of the country.
While there are numerous signs the country is in a far better place, most Americans do not seem to be giving Biden credit for the improvements.
“Presidents always get blamed for lots of things beyond their control, and the pandemic is a very good example of that,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, a nonpartisan health research group.
Explaining the rationale for the new strategy, administration officials said the country has entered a new, less dangerous phase of the pandemic where most of those who become infected will not end up hospitalized because of wide access to vaccines, booster shots, testing and new therapeutics – making covid-19 gradually less lethal until it comes to resemble other respiratory viruses such as the flu.
They noted the Centers for Disease Control and Prevention’s new approach to measuring the disease’s impact, announced last Friday, which emphasizes that hospitalizations and hospital capacity, rather than just case counts, are a better way to assess a community’s ability to withstand the virus – and how that data support easing restrictions.
Many outside experts said they endorsed the broad outlines of the approach.
“The way people approach covid-19 is going to be based on their individual risk tolerance, instead of some government mandate,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “We have to come up with an approach that reflects the fact that there will always be covid-19. It can’t be eradicated or eliminated.”
Jeffrey Duchin, health officer for Seattle and surrounding King County, said the plan recognizes the importance of airborne transmission of the virus, a long-neglected aspect of covid-19. Right now, the guidance around indoor ventilation is complicated and many businesses, schools and day-care centers don’t know what steps to take or how to pay for improved ventilation, he said.
But some experts also expressed concern that the plan may pose greater risks for vulnerable Americans, for whom vaccines may be less effective.
Administration officials disputed that, noting the availability of new therapeutics to treat those at high risk, especially antiviral pills. CDC Director Rochelle Walensky also cited data showing that one-way masking with high-quality masks such as N95 respirators enable people to protect themselves even if others are not masked. Those masks are now available free at some pharmacies.
Officials said the new road map was shaped by feedback from experts in and out of the government, state and local officials, as well as a group of former advisers, including Ezekiel Emanuel, a University of Pennsylvania bioethicist, who in January called for a new approach to covid-19 that would focus on living with the virus rather than eradicating it.
In the intervening weeks, those individuals met regularly with the White House and federal health officials, talking through new initiatives to fight the virus, from the test and treat initiative to proposals to boost indoor air quality, according to two people who contributed to the plan.
Outside experts also helped federal health officials game out a range of future scenarios, including strategies to prevent a new variant from overwhelming the country the way omicron did.
In the best case, they said, infections might continue declining with no new variant emerging that would be capable of reinfecting large numbers of people, according to two individuals familiar with the discussions. In the worst case, the administration would need to prepare for another omicron-like variant that is able to reinfect and sicken those who are vaccinated or had previous infections – feedback the White House appeared to implement in its new plan.
“We need to be prepared for our new normal, or another new surge,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of Biden’s covid-19 transition task force. “We’ve got to do both.”
To prepare for the worst case, Osterholm and other experts said the administration needs to help states make better decisions about mitigation measures and ensure there are ample supplies of vaccines, tests, antivirals and masks. Some privately worry the administration has spent too much time addressing “yesterday’s problem,” rather taking more creative approaches, according to a person familiar with the discussions.
The administration had ramped up preparedness during the omicron surge, including purchasing hundreds of millions of rapid tests, making N95 masks freely available in pharmacies and boosting production of antivirals. While those steps came too late to really blunt the impact of omicron, experts and administration officials say it will help them be better prepared for another variant.
Also as part of the plan, Biden administration officials on Wednesday said they hoped to scale up research and treatments for long covid, the constellation of symptoms including brain fog, fatigue and heart-related problems that persist in many people for weeks or months after their initial infections.
“If we get the funding from Congress, we will launch new centers of excellence in communities across the country to provide high quality care to individuals experiencing long covid and to better understand the symptoms they’re facing,” said Xavier Becerra, Health and Human Services secretary.
Polls show most Americans have already fully or mostly returned to their pre-pandemic activities. The Post-ABC news poll showed that bipartisan majorities think the virus is only “somewhat under control” or “not at all” controlled – and most still wanted some restrictions in place.
New CDC recommendations released Friday mean about 70% of Americans can take their masks off indoors, based on current hospital data and case counts, though the guidelines came weeks after many states already took steps to ease restrictions.
State and local leaders, meanwhile, including Democrats, said they welcomed the federal government playing more of a supporting role to states. Several said the administration’s messaging and strategy has often been confusing, leaving state and local officials to fend for themselves when deciding what measures to have in place.
“I just don’t see broad-based public confidence in our national messengers at this point,” said Kansas City Mayor Quinton Lucas, a Democrat who lifted mask mandates in his city in mid-February. “I think the messaging has been jumbled, and that’s being charitable.”
Lucas said there are political consequences to pushing restrictions the public views as unnecessary, including “an angrier and angrier public.”
Michael Fraser, chief executive of the Association of State and Territorial Health Officials, applauded the changes, saying his group was cautiously optimistic the spring would bring fewer covid hospitalizations and deaths.
“We are seeing a new phase of the pandemic in the United States and around the world,” he said. “As such, our strategies and tactics need to change.”
But some experts worried the country was trying to move past the pandemic too quickly – repeating mistakes made several times over the last two years.
“My concern is, this is not the end,” said Abraar Karan, an infectious-disease physician at Stanford University. “CDC is saying because incidence is getting lower, this is the time to pull back on ‘restrictions.’ But we’ve done this so many times and we continue to have big resurgences.”
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The Washington Post’s Tony Romm and Laurie McGinley contributed to this report.
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