Get COVID-19 under control
"I’m never going to raise the white flag and surrender. We’re going to beat this virus. We’re going to get it under control, I promise you. "
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"I’m never going to raise the white flag and surrender. We’re going to beat this virus. We’re going to get it under control, I promise you. "
On the campaign trail last year, Joe Biden promised that if elected president, he would get COVID-19 under control. Since assuming office in January, he has continued to pledge that his administration would do its best to get Americans vaccinated against COVID-19 and allow life to return to some semblance of normal.
There have been both signs of progress and setbacks along the way.
As the vaccine became available early this year, demand initially exceeded supply, frustrating many. Eventually, as supplies grew, all those who wanted a shot were able to get one.
In May and June, new COVID-19 cases, hospitalizations and deaths dramatically fell, prompting the Biden administration to ease mask requirements and guidance for fully vaccinated people. But many states and localities responded by dropping mask mandates altogether, even for people who were not inoculated.
The summer also ushered in the highly contagious delta variant, causing another pandemic wave. By Labor Day, daily cases in the U.S. were at their highest point since last winter. Deaths, too, were rising.
On Sept. 9, Biden announced a six-part plan to combat the delta variant and step up efforts to get control of COVID-19. The plan includes vaccine mandates for federal workers, government contractors, and those working at private companies with 100 or more employees; requirements that employers offer paid time off for those getting the shot; increased distribution and lower costs for COVID-19 tests, including rapid at-home tests; and stonger COVID-19 safety protocols in schools and on interstate transportation.
The vaccine mandate for private employers includes an option for workers to be tested weekly instead of getting the shot. Federal workers won't have that option.
While the plan is a "big step in the right direction," says Dr. Leana Wen, a visiting professor of health policy and management at George Washington University, it should have been released two months ago. That would have slowed the delta variant from gaining such a strong foothold in the U.S.
"Had they acted much earlier, we would be in a different position," she said.
And the current plan doesn't go quite far enough, said Wen, who urged the Biden administration to incentivize companies and jurisdictions to require proof of vaccination before entry for restaurants and other businesses, as New York City and San Francisco have done.
"That would send the message of 'you don't get to enjoy the privileges of pre-pandemic life unless you're vaccinated,'" said Wen. "Right now, the vaccinated are being held hostage by the unvaccinated. The vaccinated are having breakthrough infections and the unvaccinated are endangering those who cannot get vaccinated, like kids."
Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, is optimistic that Biden's plan will move the needle, "but it's hard to know how much."
The vaccination mandates for employers, for example, will definitely be helpful in states where similar measures, such as requirements that state workers get vaccinated or test regularly, have already started, he said. It "will reinforce what the state is trying to do."
But it's less clear what will happen in states with strong political opposition to mandates. "There will be partisan disagreement on this," said Plescia.
Biden's proposal has already elicited broad opposition from many Republican governors, with some already pledging to fight it. Others issued more tempered statements. Ohio Gov. Mike DeWine, a Republican, told a Cincinnati radio station the plan may hamper efforts to educate people on the importance of vaccines because "we're going to now be talking about a federal mandate, which no one likes, instead of talking about, 'Llook, here's the science.'"
But Plescia is pleased the vaccination mandate broadly extends the requirement for health care workers to get vaccinated. It now goes beyond nursing home workers to include staff at just about all health facilities that receive federal funding, such as Medicare or Medicaid.
An August announcement that targeted mainly nursing home workers raised concern that some employees would simply quit and find work in other health care settings where vaccines were not required, further exacerbating a shortage of nursing home workers.
The president's new move "levels the playing field," Plescia said. The same goes for other industries.
And making employers enforce the rules might trigger less resistance from some unvaccinated adults, said Dr. Georges Benjamin, executive director of the American Public Health Association.
"The person telling them what to do is their boss at their job," he said. "That's a different leverage point than the government."
However, Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, said the testing option for companies with 100 or more workers could slow any positive impact of the vaccine push.
It will also take time to see how the mandates and requirements are implemented. The potential for legal challenges could delay or damp their impact, as could the regulatory steps involved in the the employer vaccination requirement, which will rely on the Occupational Safety and Health Administration for enforcement.
The goal to get more testing kits to health centers and to make home test kits available through major retailers for a lower price could also be helpful, Plescia said.
Benjamin gives Biden a "healthy B-plus" on progress in getting COVID-19 under control, citing the more than 200 million Americans who have had at least one shot, even as he acknowledges that. "as a nation, we haven't achieved critical vaccination levels in enough of the country."
Currently, 63% of the U.S. population ages 12 and over is fully vaccinated. But in many pockets of the country, not even half the population is vaccinated, far short of the levels many public health experts believe necessary to tamp down the virus.
"It's pretty clear the carrot has not worked," said Benjamin, referring to the government's incentive-based approach. "We have enormous forces pushing back, both the usual anti-vaccine community plus the politicization at the most senior levels."
Disparities in vaccination rates also remain between white people and people of color, though the gap has been shrinking recently. In most states, a smaller share of vaccines has been given to Black and Hispanic people compared with their shares of COVID-19 cases and the total population.
Continuing to reach out to these populations will be important in increasing the vaccination rate across the U.S. and slowing down the delta variant.
Despite all of this, Dr. William Schaffner, a professor of medicine in the Division of Infectious Diseases at Vanderbilt University in Nashville, Tenn., is hopeful.
If things move forward expeditiously, "by sometime this winter we could have COVID under control," he said. That doesn't mean it will be completely gone.
Instead, Schaffner said, "we would be on the same track as before delta, entering a new normal."
Kates envisions a point in which COVID-19 does become manageable, if the U.S. is able to significantly increase vaccination rates. But she also thinks the virus will still likely be circulating and become an endemic disease.
"The likelihood of it not being an issue is diminishing since vaccine coverage is so poor in other countries. Containing COVID depends on what we do globally, too," said Kates. "The likely scenario of the U.S. is we'll be living with it for a while, and containment will be dependent on vaccination rates."
We continue to rate this promise In the Works.
Centers for Disease Control and Prevention, COVID Data Tracker - COVID-19 Vaccinations in the United States, Accessed Sept. 13, 2021
Centers for Disease Control and Prevention, COVID Data Tracker - Trends in Number of COVID-19 Cases and Deaths in the US Reported to CDC, by State/Territory, Accessed Sept. 13, 2021
The Columbus Dispatch, "'The President Made a Mistake', Gov. Mike Dewine Comes Down Against Biden Vaccine Order," Sept. 10, 2021
Kaiser Family Foundation, Latest Data on COVID-19 Vaccinations by Race/Ethnicity, Sept. 9, 2021
Phone interview with Jen Kates, senior vice president and director of global health and HIV policy at the Kaiser Family Foundation, Sept. 13, 2021
Phone interview with Dr. Leana Wen, a visiting professor of health policy and management at George Washington University, Sept. 10, 2021
Phone interview with Dr. Marcus Plescia, chief medical officer, Association of State and Territorial Health Officials, Sept. 10, 2021
Phone interview with Dr. William Schaffner, professor of preventive medicine in the Department of Health Policy and professor of medicine in the Division of Infectious Diseases at Vanderbilt University School of Medicine, Sept. 10, 2021
Phone interview with Dr. Georges Benjamin, executive director of the American Public Health Association, Sept. 10, 2021
The White House, Path out of the Pandemic - President Biden's COVID-19 Action Plan, Sept. 2021
More than anything else, Joe Biden emphasized in his campaign last year that, if elected, he would get control of the COVID-19 pandemic. For most of 2020, the virus raged across the U.S., vaccines were not yet available and then-President Donald Trump often ignored the pandemic's seriousness.
"I'm never going to raise the white flag and surrender," Biden said during a campaign rally on Nov. 2, 2020. "We're going to beat this virus. We're going to get it under control, I promise you."
On Biden's first full day in office, Jan. 21, 2021, the number of COVID-19 cases in the U.S. was at one of its peaks: more than 193,000 new cases were reported that day.
But in the almost five months since, cases have been on a steady decline, largely due to the vaccination rollout. On June 6, just over 10,000 new COVID-19 cases were reported. That's a 95% drop in cases from Jan. 21.
Deaths due to COVID-19 have also plummeted. On Jan. 21 there were more than 3,000 deaths in one day. On June 6 there were 225. That's a 93% reduction.
Biden took over an initially disjointed COVID-19 vaccine rollout from the Trump administration and has been successful in getting at least one shot into the arms of more than 63% of the U.S. adult population.
Some experts say, though, the initial vaccine distribution would likely have been bumpy whoever was president at the time. The Biden administration has also faced some rough spots, especially in the early spring months when people who were eligible for vaccinations were not able to get them.
But in early April, Biden directed states to make all U.S. adults eligible for the vaccine by April 19. Vaccinations surged from March through April at rates of 2 million to 3 million shots per day. The numbers have recently leveled out to less than a million per day on average, as the people most eager to get vaccinated have already received their doses, leaving behind those who have more difficulty accessing the vaccine or may be more hesitant to get it.
Experts said it's clear that Biden has made significant progress in curbing the number of cases in the U.S. and making vaccines more widely available.
"If we could say six months ago where we would be now is well over 60% [of the U.S. adult population vaccinated], ideally approaching 70% of all adults, that is really incredible," said Dr. Leana Wen, visiting professor of health policy and management at the George Washington University's Milken School of Public Health. "We should give the Biden administration an extraordinary amount of credit for what they have done for vaccine distribution and production."
Still, Wen said the pandemic is not over and there is still much work to be done on vaccination.
While the overall U.S. vaccination rate is promising, some states are lagging behind.
According to the New York Times COVID Vaccination Tracker, in Alabama, Mississippi, Wyoming, Louisiana and Tennessee, fewer than 50% of people have received at least one dose of the vaccine. At this pace, it may take them up to a year to reach the 70% mark. Meanwhile, states such as Vermont, Hawaii, Massachusetts and Connecticut have already surpassed 70%.
"There is vast inequity in vaccination uptake if you look at geography, and so what I worry about is regionalized outbreaks occurring throughout the summer," said Wen. "And coming into the fall and winter, we may not have enough vaccination or immunity in the population to fend off a surge in the colder weather or variants."
And though there has been progress in recent weeks in reducing racial and ethnic inequities in vaccination, there are still disparities in vaccination rates between white people and people of color.
Demographic data is available for only 57% of those who have been vaccinated. But of that group, 9% were Black, 14.5% were Hispanic/Latino and 61% were white. For Black and Hispanic people, those percentages are lower than their share of the U.S. population: 12.4% and 17.2%, respectively. Meanwhile, white people make up 61% of the total U.S. population. The Kaiser Family Foundation's most recent weekly demographic report shows Black and Hispanic people have also received smaller shares of vaccinations compared with their share of cases in most states. For example in Colorado, 11% of vaccinations have gone to Hispanic people, while they account for 41% of cases and 25% of deaths.
There's also a gap in vaccine acceptance between Democrats and Republicans: A different KFF April report found that 20% of Republicans say they will "definitely not" get vaccinated, compared with 13% of independents and 4% of Democrats.
"So long as there are groups or regions where vaccination rates are low, there's the potential for severe illness and death from COVID," Larry Levitt, executive vice president for health policy at KFF wrote in an email. "Truly keeping the pandemic under control in the U.S. requires narrowing the vaccination disparities."
On June 2, Biden announced a "National Month of Action," which involves a variety of programs that aim to encourage more Americans to get vaccinated and to reach his goal of having 70% of the U.S. population vaccinated by July 4. The initiatives include providing free childcare for those getting vaccinated, extending pharmacy hours, hosting community canvassing events, engaging with Black-owned barbershops and airing vaccine education segments on the radio. Incentives include sweepstakes and giveaways from prominent companies like Anheuser Busch, Microsoft and Kroger.
It remains to be seen if these efforts will work.
Experts acknowledge that COVID-19 will likely never be eliminated completely and the world will have to learn to live with it. Scientists also say that it may be difficult or impossible for the U.S. to reach herd immunity against COVID-19 — but that what matters is as many people get vaccinated as possible. Combining those vaccinations with those who have natural immunity from infection, they say, the U.S. is likely to eventually reach levels where cases are very low and hospitalizations and deaths are rare.
But for now COVID-19 cannot be declared completely under control yet. We continue to rate this promise In the Works.
Bloomberg, "More Than 2.12 Billion Shots Given: Covid-19 Tracker," June 6, 2021
Centers for Disease Control and Prevention, COVID Data Tracker - Trends in Number of COVID-19 Cases and Deaths in the US Reported to CDC, by State/Territory, Accessed June 7, 2021
Email interview with Larry Levitt, executive vice president for health policy at KFF, June 3, 2021
Kaiser Family Foundation, KFF COVID-19 Vaccine Monitor - April 2021, May 6, 2021
Kaiser Family Foundation, Latest Data on COVID-19 Vaccinations Race/Ethnicity, May 26, 2021
The New York Times, "Covid-19: Hopes for 'Herd Immunity' Fade as Virus Hurtles Toward Becoming Endemic," May 16, 2021
The New York Times, "Reaching 'Herd Immunity' Is Unlikely in the U.S., Experts Now Believe," May 3, 2021
The New York Times, "See Which States Are Falling Behind Biden's Vaccination Goal," June 3, 2021
Phone interview with Dr. Leana Wen, visiting professor of health policy and management at George Washington University, June 3, 2021
Rev.com, Joe Biden Drive-in Rally Speech Transcript Cleveland November 2, Nov. 2, 2020
The White House, Remarks by President Biden on the COVID-19 Response and Vaccination Program, June 2, 2021
The White House, Press Briefing by White House COVID-19 Response Team and Public Health Officials, May 13, 2021
The White House, Remarks by President Biden Marking the 150 Millionth COVID-19 Vaccine Shot, April 6, 2021
President Joe Biden campaigned on a promise to get COVID-19 under control. He often outlined how his response would differ from that of former President Donald Trump's: He would listen to scientists, encourage the use of masks and give the federal government a stronger role in addressing the pandemic.
"We can overcome the deadly virus," Biden reiterated during his inaugural address on Jan. 20.
On Inauguration Day and the first day of his presidency, Biden signed several executive orders marking his first official steps to help get COVID under control. He also halted the U.S. withdrawal from the World Health Organization, which Trump initiated.
One of the executive orders requires masks and physical distancing in all federal buildings. It also asks the Centers for Disease Control and Prevention to work with states and territories to implement masking policies.
Another order Biden signed on Jan. 20 created a new position within the Executive Office of the President of COVID-19 response coordinator, and revived the National Security Council's Directorate for Global Health Security and Biodefense, a group that disintegrated under the Trump administration.
The COVID-19 response coordinator will report directly to Biden and direct the federal government's efforts to ensure a reliable supply of personal protective equipment, increase testing capacity across the nation and oversee vaccine distribution. The order reflects Biden's push for a more active federal role in addressing the pandemic.
Biden has already tapped Jeff Zients, an Obama-era official, to be response coordinator. During his time in the Obama administration, Zients worked to fix the rollout of healthcare.gov, the Affordable Care Act's marketplace website. Since the position doesn't require Senate confirmation, Zients can begin working immediately.
The President also released a flurry of eight executive orders on Jan. 21 addressing the COVID pandemic, which included:
The White House also released a 198-page national COVID-19 response plan, which includes a section on the vaccine distribution strategy. In addition, the president signed a memo that said the federal government would fund 100% of states' costs for using the National Guard to help with COVID-19 response efforts through Sept. 30, up from 75% under The Trump administration.
With these executive orders, Biden is putting the federal government squarely behind addressing the pandemic, while Trump left many aspects of the response largely to states, said Larry Levitt, executive vice president for health policy at Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of KFF).
"But these orders, along with the broader plan released by the Biden administration, are really just the pandemic instruction manual for the federal government," Levitt wrote in an email. "Now the whole apparatus has to actually be assembled. We are seeing a very different direction charted immediately, but it will take time to see the effects."
The masking executive orders particularly represent an important step toward aligning the country on a consistent message that masking works to prevent disease spread, said Dr. Leana Wen, a public health expert and visiting professor of health policy and management at George Washington University. Still, there is resistance to mask-wearing among some people, and it remains to be seen if Biden's executive orders will change that.
"At this point, there is so much pandemic fatigue and so much misinformation that I don't think these efforts alone will be enough to stop the pandemic," Wen wrote in an email. "Our last and best hope is the vaccine. That should be president Biden's No. 1, No. 2, and No. 3 focus."
Biden is inheriting a jumbled vaccine distribution plan from the Trump administration that is rolling out more slowly than government officials had hoped. The president will have to quickly increase and organize vaccine distribution and administration to get millions of Americans vaccinated over the next couple of months, which won't be easy. In addition, experts say that in order to actually contain the transmission of COVID-19, Biden will need to increase testing across the country.
Increases in testing and vaccination will require funds from Congress. Biden proposed a $1.9 trillion plan the week before his inauguration that would fund these efforts, but the president could face opposition in getting it passed.
If Biden can overcome all of these challenges, he may be able to control the spread of COVID-19, but there are still a lot of tasks to complete before this mission will be accomplished.
We rate this promise In the Works.
Email interview with Larry Levitt, executive vice president for health policy at KFF, Jan. 21, 2021.
Email interview with Dr. Leana Wen, visiting professor of health policy and management at George Washington University, Jan. 20, 2021
KHN/Politifact, "Biden's Covid Challenge: 100 Million Vaccinations in the First 100 Days. It Won't Be Easy." Jan. 20, 2021
KHN/Politifact, "Did Donald Trump fire pandemic officials, defund CDC?" Feb. 28, 2020
Politifact, "What's in Joe Biden's $1.9 Trillion American Rescue Plan?," Jan. 15, 2021
Rev.com, Joe Biden First Speech as President: Full Transcript at Inauguration, Jan, 20, 2021
The Wall Street Journal, Coronavirus Live Updates: U.S. Reports Second-Highest Number of Deaths in a Day, Jan. 21, 2021
The White House, Executive Order on Organizing and Mobilizing the United States Government to Provide a Unified and Effective Response to Combat COVID-19 and to Provide United States Leadership on Global Health and Security, Jan. 20, 2021
The White House, Executive Order on Protecting the Federal Workforce and Requiring Mask-Wearing, Jan. 20, 2021
The White House, Letter to His Excellency António Guterres, Jan. 20, 2021
The White House, National Strategy for the COVID-19 Response and Pandemic Preparedness, Jan. 21, 2021
The White House, Executive Order on Protecting Worker Health and Safety, Jan. 21, 2021
The White House, Executive Order on Supporting the Reopening and Continuing Operation of Schools and Early Childhood Education Providers, Jan. 21, 2021
The White House, Executive Order on Ensuring an Equitable Pandemic Response and Recovery, Jan. 21, 2021
The White House, Executive Order on a Sustainable Public Health Supply Chain, Jan. 21, 2021
The White House, Executive Order on Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats, Jan. 21, 2020
The White House, Executive Order on Improving and Expanding Access to Care and Treatments for COVID-19, Jan. 21, 2021
The White House, Executive Order on Promoting COVID-19 Safety in Domestic and International Travel, Jan. 21, 2021
The White House, Memorandum to Extend Federal Support to Governors' Use of the National Guard to Respond to COVID-19 and to Increase Reimbursement and Other Assistance Provided to States, Jan. 21, 2020