In the eight months since the COVID-19 outbreak hit US shores over 220,000 Americans have lost their lives and millions have been infected with the disease. Millions more have lost their job, seen their business falter or fail, and every aspect of our lives– such as work, education, childcare, and leisure– have been disrupted. Experts warned us that another wave of infections and deaths would come with fall weather and that seems to be happening. Given the importance our response to the pandemic has on public life and the upcoming Presidential election, I thought it was important to look at three main questions: What is currently happening; what sensible plans can help save lives and get the country back up and running; and what are the two candidates currently offering as plans to meet the issue and move forward.

The State of COVID-19 in the US

As mentioned above, we are approaching a quarter million American being killed by COVID-19. While numbers had been slowly declining over the last several months, recent date indicates another surge of infections and hospitalizations (with deaths likely trailing behind by a few weeks, as they have throughout the process).

Here in Ohio, we have had consecutive days of record-breaking case counts. While positivity rates still trail what we saw in July, we have been on a substantial upward swing since my birthday (9/23) which have driven the records we’ve seen in the last week. Hospitalizations are on the rise as well, with today’s (10/20) case count hitting our all time high of 1154. Small town hospitals, like the two hospitals in my hometown of Lima, Ohio, are warning residents that they are again approaching capacity and further increases will negatively impact care. We are teetering on the edge of disaster just like we were back in March.

Despite the fact that the virus is again surging through our population, many schools and communities are pushing ahead with prior plans to reopen more fully. Ohio State football will begin playing games, brining with it a host of social gatherings that are almost certain to increase infection rates. These plans, created when the virus seemed to be in decline, are not being adjusted based on new data because there are no guidelines to use to determine when it is actually safe to do any of this. There is not even basic agreement over what it would mean to be safe.

In the last month, I have had several friends and family members launch into tirades about their unwillingness to have to alter their life because of “my fear.” This gets at the heart of our political conflict– about 40% of the country has a seriously bizarre understanding of what freedom means and wants to live in some fantasy land where we can all just respond to a pandemic however we individually choose.

Let me be clear– the concept of freedom outlined in the Enlightenment works our nation was founded on does not grant you the ability to do whatever you want. The understood meaning of freedom in a democracy is that you should be allowed to act as you see fit until that action would cause harm to others. The colloquial saying is some version of this: “your right to swing your fist ends where it meets my jaw.” It is literally the responsibility of the government to maintain this freedom between its citizens. In a global pandemic, this means the government should and must set guidelines for public behavior that balance your right to live as you see fit with the right of people to not be needlessly exposed to a deadly disease.

Currently, our federal government has no guidelines for what is or is not appropriate. From the beginning, it has outsourced those decisions to governors, mayors, business owners, and school leaders. It did so to insulate itself from consequences and political blowback. Those state and local leaders have then been undercut by the President declaring that certain states guidelines were “too harsh” (Republican Gov Mike DeWine faced these criticisms) or worse, yelling that private citizens needed to “liberate” their state from the tyranny of their elected officials going too far. This same process followed for mayors, business owners, and school leaders. At a moment when clear guidance from experts and a collective nationwide response was needed, we got the opposite. We face a moment very similar to the one we faced in March, only this time there is a chance for the people to voice their desires publicly by voting for the alternative visions of Donald Trump and Joe Biden.

What Should Be Done

Here are 7 steps I believe should be taken immediately to improve our situation, decrease risk, alleviate economic pain, and get our lives back on track. They are based on existing advice from professional medical organizations and leading economists. This list is by no means exhaustive, but it represents a broad approach that will save lives and prevent the economy from cratering into a depression.

1. Increase availability, accessibility, and traceability of testing. The AAMC recommends a goal of conducting 2.3 million tests per day nationally. Contrary to President Trump’s claims that increased testing is bad, increased testing gives us more data and leads to more informed decisions. More importantly, early detection leads to early treatment and better health outcomes. Testing at this level would require coordinated efforts led by the executive branch, directing efforts by the Department of Health and Human Services, the Federal Emergency Management Agency, and state public health departments to solve logistic issues with critical testing supplies, manage the supply chain for testing, direct resources to areas of particular need, and communicate supply chain issues with labs, vendors, and the general public. Transparency in communication is essential to the success of this step.
2. Establish national standards on masks. Using standards grounded in scientific knowledge about the spread of the novel coronavirus and the best way to decrease spread, the federal government should produce and promote national standards for masking. These standards should guide local and state decisions about when to mask wearing mandatory, and adjusting masking rules based on the level of community spread in a state or local area. The consensus of the medical community is that this helps, the majority of American citizens approve of mask wearing initiatives, and these practices have been shown to help reduce transmission in many other nations. They are not failsafe, but they are a cost effective way of seriously decreasing risk. It is insane that this has not happened yet.
3. Establish and enforce national criteria for local stay-at-home orders and reopening protocols, for public spaces, business, and schools. Those criteria should be based on the number of current and recent cases, the proportion of positive cases, hospitalizations, deaths, and local health care capacity. State and local governments should order and enforce mandatory stay-at-home orders and progressive reopenings guided by those criteria. They should provide guidelines for safe operation during the pandemic, including social distancing and necessary PPE. They should provide provisions for closing down or limiting opening as the data dictates. Leaving these decisions entirely up to local leaders is an abdication of duty and makes the policy choices especially venerable to political pressure and special interests.
4. Provide a robust stimulus package to support collapsing local and state government budgets, encourage consumer spending, and support businesses impacted by COVID-19. This is common sense. Massive losses in tax dollars along with increased expenses in responding to the pandemic (unemployment insurance, physical remediation, increased operating expenses) will cause catastrophic losses in services, such as K-12 education, infrastructure, and law enforcement at the state and local level. Consumer spending has dropped significantly with unemployment and uncertainty. Businesses in entertainment, travel, dining, and retail have been especially hard hit by COVID– from shutdowns and mitigation efforts to changed consumer behaviors. With historically low interest rates, federal borrowing is essentially cost-free. Emergencies like this are exactly what deficit spending are meant to be used for. By making this investment, essential services will be retained, consumer demand will keep businesses that provide goods and remote services can continue as normal, and businesses that physically cannot survive in a partially open/closed environment will be kept afloat (saving thousands of small businesses and millions of jobs).
5. Expand subsidized health insurance on the exchange for people who lost work due to COVID-19. An estimated 10 million Americans have lost access to employer-based health insurance since the pandemic began. COBRA, the temporary insurance option offered to laid-off employees is completely unaffordable for most Americans. To encourage healthy behaviors and reduce untreated illnesses that could spread COVID or cause people to develop comorbidities that could make COVID more fatal, we should provide generous subsidies that cover entirely or the majority of basic exchange insurance programs premiums.
6. Begin planning now to prioritize distribution of the vaccine. Such planning should take into account the disproportionate impact of the virus on health care workers, essential workers, the elderly, and other vulnerable groups. This plan needs to be transparent and communicated widely in the community so that people know what to expect, when it will happen, and how distribution orders were determined.
7. Inform, educate, and engage the public. Conflicting messages, especially from President Trump and his campaign surrogates, about the seriousness of the illness and how to prevent, treat, and contain the coronavirus have led to widespread confusion among the American public. Any effort to reset the nation’s response should involve a concerted effort to educate the public. On a national level, federal, state, and local public health agencies should send out daily updates about the virus and local conditions in the area. Political leaders should not be spreading disinformation, but instead should rally Americans to make short term sacrifices for long term gains in health, life, and prosperity. This is how American Presidents have always approached a major threat in the past. It’s worked pretty damn well.

What Plans Do Trump and Biden Have?

The Trump Plan

President Trump has no formal plan. The White House has guidance for opening up, but places all responsibility on states, local leaders, employers, and individual citizens. See it here: https://www.whitehouse.gov/openingamerica/

Trump’s agenda for battling the virus centers on having a vaccine widely available by the end of the year. Health experts, including those in the federal government, say that timeline is highly unlikely. Trump has promised 300 million doses of a vaccine by January 2021, but he has provided no information about how this will happen, how it will be distributed, or whether or not it will have been appropriately vetted.

Trump has also suggested basing the treatment on his own treatment and has vowed to make the drugs he had widely available. No plan to do so has been released.

This is Trump’s entire plan as outlined by his public statements. Put most directly, his plan is for other people to take care of it.

The Biden Plan

https://joebiden.com/covid-plan/ is a 15 page document that promotes increased use of federal funds to expand testing capability and access to PPE and to an eventual treatment and vaccine.

Biden wants to restore trust in the government by communicating clearly and directly with the American people about the disease and to encourage citizens to see the common purpose in fighting the pandemic. His plan calls for medical professionals to lead and for politicians to listen to guidance and act.

Biden wants testing to be paid for by the federal government and to be widely available (“tests must be in the millions, not the thousands”). That testing should be connected to tracing efforts that can limit exposure to the disease as people find out they are infected.

Biden wants to use all relevant federal agencies to coordinate resources, training, and support for areas with outbreaks, resource poor communities, frontline workers, and vulnerable populations.

Biden wants to use the full authority of the Defense Production Act to create additional personal protective equipment, which includes masks and face shields.

Biden would allocate increased federal aid to state and local governments, schools and local businesses affected by the disease. He wants to provide paid sick-leave and care-giving leave, create health-care crisis unemployment insurance, employment relief for reduced or work-share hours, expanded food relief for children and families in need, increased Medicaid funding for the states, small and medium sized business loans, support for childcare and remote learning, and funds for governors and mayors to be able to address the needs of their communities.

As for vaccine production, Biden would put $25 billion toward the manufacturing and distribution of an eventual vaccine. He does not explicitly call for a vaccine by a certain date.

Biden’s plan also outlines a variety of ways for the US to lead on COVID globally and measures to take to prevent a future pandemic from playing out this way.

This is a microcosm of the Trump and Biden choice. The President has outlined no plans, has no clear agenda, and is campaigning on rhetoric alone. Biden has normal plans that show a role for his own administration in accomplishing goals he is telling you about ahead of time and providing a checklist to evaluate both his efforts and their effects if he is elected. Even if you disagree with some of his COVID-19 response plans, at least he is telling you what he thinks the problems are and how we will address them. The President offers you nothing but empty words. This job is about leadership. You cannot lead without a plan.