Eyeing a 'new normal,' former Biden health advisers call for sweeping pandemic policy changes

Health experts who previously served on the Biden-Harris Transition COVID-19 Advisory Board have penned a trio of op-eds outlining pandemic policy recommendations for the federal government.

The suggestions, published Thursday in JAMA, range from test kit distribution and reporting to pediatric vaccination requirements to a recognition that SARS-CoV-2 is persistent and unlikely to be eradicated.

“The Biden administration has taken some important steps in tackling this pandemic, but there is much more that needs to happen as we shift to this being a long-term, endemic situation,” Ezekiel Emanuel, M.D., vice provost for global initiatives at the University of Pennsylvania and an author on the recommendations, told Fierce Healthcare.

“Yes, the omicron variant is a huge concern right now, but we also need to broaden our perspective and realize that this virus is not going to go away. We need to reach a ‘new normal’ where we can safely live with it,” he said.

Joining Emanuel in the recommendations were:

  • Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota;
  • Celine Gounder, M.D., an assistant professor of medicine and infectious diseases at New York University’s Grossman School of Medicine;
  • David Michaels, professor at the George Washington University School of Public Health;
  • Rick Bright, formerly the director of the Biomedical Advanced Research and Development Agency and currently senior vice president of pandemic prevention and response at the Rockefeller Foundation; and
  • Luciana Borio, M.D., senior fellow on the Council on Foreign Relations

Defining a 'new normal'

The former advisory board members were clear that the country is still far from reaching a point of comfort with COVID-19.

But while the country works its way through another wave, policymakers could begin aggregating COVID-19 alongside measures of other circulating respiratory viral illnesses, such as deaths from influenza or pneumonia, as a singular “risk of all respiratory virus infections.”

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The “appropriate risk threshold” for these collective infections “should reflect peak weekly deaths, hospitalizations and community prevalence of viral respiratory illnesses during high-severity years, such as 2017-2018,” they wrote.

That proposed threshold translates to about 35,000 hospitalizations and 3,000 deaths during “the worst week” of a high-severity year (well below the 50,000 COVID-19 hospitalizations and 7,000 deaths reported in mid-December as omicron was gaining steam).

Establishing such a threshold would help the nation’s health systems plan for normal bed and workforce capacity, as well as set a clear cutoff for when they need to enact surge measures, the experts wrote. Policymakers could also look to these limits for guidance on when it’s appropriate to implement emergency mitigation policies against SARS-CoV-2 and other respiratory viruses.

But the road to the “new normal” will also require a conscious effort to bolster the country’s public health system for the next disease or variant, they wrote. This means establishing a modern, real-time electronic data collection system; a permanent public health implementation workforce; measures such as telemedicine waivers or cross-state practice licensure to bring additional medical services to hard-hit regions; and greater public confidence in health institutions and the value of collective actions.

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“After previous infectious disease threats, the U.S. quickly forgot and failed to institute necessary reforms,” they wrote. “That pattern must change with the COVID-19 pandemic. Without a strategic plan for the 'new normal' with endemic COVID-19, more people in the U.S. will unnecessarily experience morbidity and mortality, health inequities will widen, and trillions will be lost from the US economy.

“This time, the nation must learn and prepare effectively for the future," they wrote.

Stepping up testing, safety standards, vaccine mandates and therapeutics

In the meantime, the experts felt that the federal government and its public health institutions have room to improve on what has so far been a “seriously flawed” pandemic response.

Although the administration’s recent promise of producing and distributing hundreds of millions of at-home rapid tests “is an important step in the right direction,” the CDC should be collecting the results from these tests in real-time and, if positive, automatically providing the individual with clear guidance on isolation and accessible treatments, they wrote.

To mitigate the risk of additional spread, the country should implement and enforce Occupational Safety and Health Administration (OSHA) standards focused on workplace masking, distancing and ventilation, the experts continued.

Such standards can be supported or at least partially financed by the government, they wrote, whether that be through stronger medical leave policies, funding or tax incentives for ventilation and air filtration system improvements or a national initiative to produce and provide N95 or KN95 respirators (rather than cloth or surgical masks).

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As for the pharmaceutical side of the pandemic response, the authors strongly supported vaccine mandates with a goalline of 90% population vaccination coverage.

They advised vaccine requirements be tied to school attendance (should a large analysis of vaccinated children demonstrate a clear risk-benefit), as well as the development and implementation of an electronic vaccine certificate platform to replace the “unacceptable” paper card system in place today.

Further, they said the government should be investing in the development of future vaccines, conducting stronger genomic surveillance to better match those vaccines with future strains and devoting more resources toward boosting global vaccine access and uptake.

Outside of vaccines, the group called for greater federal support of COVID-19 therapeutics. In addition to accelerating development, production and procurement of these drugs, the government needs to make outpatient COVID-19 therapies widely available at no cost for anyone who tests positives and meets the indications for treatments, they said.

“If a patient tests positive, whether at home, a pharmacy, or hospital clinic, there must be a mechanism for treatment to be initiated immediately following diagnosis,” they wrote.

These arguments and the authors' other suggestions for the national COVID-19 response can be found in the following JAMA articles: “A National Strategy for the ‘New Normal’ of Life With COVID,” “A National Strategy for COVID-19” and “A National Strategy for COVID-19 Medical Countermeasures.”