COVID and Biden: Top 7 things new president and his team must do

Marc Siegel, M.D. is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is the author of "COVID: The Politics of Fear and the Power of Science."

By Marc Siegel

As Joe Biden becomes president this week Americans everywhere are frightened by the growing numbers of coronavirus infections and death. They are looking for direction from the new president and his team.

With a new year just beginning it’s important to remember what I wrote in my latest book “COVID: the Politics of Fear and the Power of Science.” Fear mushrooms from inconsistencies, pseudo-science and dogma, whereas consistency and perspective reassure us.

Here are the top things our new president must do.

First and foremost, President-elect Biden must resist the temptation to fear monger, to place blame, to make sweeping cure-all statements or to pursue obsessive masking or lockdowns with an almost religious fervor without regard to scientific evidence that’s accumulated since the coronavirus first arrived in the U.S. almost a year ago.

Perhaps the most important thing that President Biden and his coronavirus task force can accomplish in his first one hundred days is to deliver on his promise to vaccinate one hundred million people against the SARS COV-2 virus.

I agree with Biden’s plan to provide $160 billion in funding for a national rollout including FEMA support.

We are in the midst of a national disaster of almost unprecedented proportions and a federal response must predominate.

Support from the feds in terms of production, supplies, distribution, staffing, and building mass vaccination centers can go a long way to ensuring that a large percentage of the population is vaccinated quickly. But any vaccination strategy must also include an emphasis on pharmacy chains, doctors’ offices, clinics, and hospitals, where vaccinations have always been given and can be quickly now.

The longer mass vaccinations take, the more virus is circulating, the more likely that a variant will emerge (possibly the strain in South Africa) that is resistant to the vaccines.

Yes, masking is clearly beneficial, but it is only part of the solution and is most effective when the mask is worn properly and is accompanied by proper physical distancing.

A national mask mandate is worth considering but may create more division and rebellious non-compliance than helping to control spread.

On the other hand, there is evidence that regional mask mandates have worked. Dr. Paul Carson, professor of Practice Management of Infectious Diseases in the Department of Public Health at North Dakota State University told me in an interview this week that the mask mandate instituted in his state clearly led to a decrease in cases.

The same is not true for lockdowns.

Another thing that President Biden must consider carefully is the evidence that lockdowns — once an area is already infested with the virus – (the UK and LA County are prime examples) are not an effective strategy.

Once embedded in a community, COVID spreads mostly within households.

The most effective lockdowns have been accomplished in countries like Australia, New Zealand, Singapore, and even China where the numbers have been much much lower than currently in the U.S. or the U.K. and then only when accompanied by severe travel restrictions and massive testing programs.

If we are able to reduce the numbers in the U.S. (currently still at well over 200,000 new cases per day) President Biden should consider closing interstate highways and airports to protect certain states and regions like Vermont or Maine where infections are occurring at a much lower rate.

In the meantime, large gatherings of any kind should be made off-limits all across the country. Everything from large parties and celebrations to protests and riots must be banned.

Too many of these gatherings have clearly been super spreader events, whether indoors or outdoors, accompanied by mask-wearing or not.

Too many people are dying or being hospitalized. The risks are simply too high and testing as a pre-admission strategy is not foolproof because of problems with accuracy.

This is not about politics. It doesn’t matter to the virus who is protesting. The president should not differentiate either especially at a time when more transmissible strains are emerging that could soon predominate.

At the same time, rapid self-testing in the U.S. must be expanded immediately. There are several companies now (Ellume, Lucira, Abbott) that have received Emergency Use Authorizations from the FDA for accurate cheap home tests but they are still not in widespread use.

President Biden can help by providing both federal monetary support as well as invoking the Defense Production Act. Countless cases could be prevented by contact tracing and self-isolation if a person knew they had the virus earlier.

Biden could also act to increase availability of the polyclonal/monoclonal antibodies produced by Regeneron and Lilly. They appear to be effective in decreasing illness severity when given soon after diagnosis, as I have seen demonstrated in many of my patients. But as with the early vaccine rollout, too many superimposed restrictive guidelines have interfered with getting the treatment to many who might benefit.

Finally, I would advise the new president to accept scientific input even from those who may disagree with him politically.

Science and political dogma don’t mix. True leaders build a consensus by bringing together seemingly disparate views. This is especially true in the midst of the raging pandemic, where so much is still not known and there is so little time to change the current trajectory.

(Marc Siegel, M.D. is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is the author of “COVID: The Politics of Fear and the Power of Science.” Follow him on Twitter @drmarcsiegel.)