When President-elect Joe Biden takes office in January, he will inherit a pandemic that has convulsed the country. His transition team last week announced a 13-member team of scientists and doctors who will advise on control of the coronavirus.
One of them is Dr Céline Gounder, an infectious disease specialist at Bellevue Hospital Center and assistant professor at the New York University Grossman School of Medicine. In a wide-ranging conversation with The New York Times, she discussed plans to prioritize racial inequities, to keep schools open as long as possible, and to restore the Centers for Disease Control and Prevention as the premiere public health agency in the world.
The incoming administration is contemplating state mask mandates, free testing for everyone and invocation of the Defense Production Act to ramp up supplies of protective gear for health workers. Indeed, that will be “one of the first executive orders” of the Biden administration, she said.
Below are edited excerpts from our conversation.
Tell us about Mr Biden’s COVID advisers. Who is doing what?
The coronavirus task force is the team the vice president leads within the current administration. I’m a part of the Biden-Harris advisory board. Then there’s the internal transition team, which is much bigger. The transition team has been developing a COVID blueprint, the nuts and bolts of the operations, and this is something they’ve been working on for months.
The purpose of the advisory board is really to have a group of people who think big, creatively and in interdisciplinary ways — to be a second set of eyes on the blueprint they’ve come up with, and also to function as a liaison with state and local health departments.
How often will you meet with Biden and Vice President-elect Kamala Harris?
We’re going to have, at a minimum, a weekly meeting as a group. But in addition to that, we may be asked to brief members of the transition team and the president-elect and vice president-elect. I’ve already been on two of those briefings.
They’re asking very insightful questions, very thoughtful questions, which demonstrate that they are sensitive to who has really been hit hard, who has suffered. In terms of awareness of the technologies, they understand more than I ever thought a politician would understand. Like asking what would be the appropriate timing and target populations for monoclonal antibodies. For somebody who doesn’t follow these things, that is a really good question.
What’s the plan to help communities that have been hit hardest?
Race disparities are definitely going to be a through line for all the plans — for example, with respect to testing, making sure that you are locating testing facilities in communities of color. They have not been adequately served, and the lines to wait to get tested, the turnaround times, have not been equitable.
Another area that is really of interest is Indigenous people. They are often misclassified in terms of their race and ethnicity, and that makes it very difficult to do analyses to figure out what are the trends in those communities and to target interventions accordingly. Being really attentive to detailed data surveillance, and using that to inform how we address these disparities, is going to be very, very central.
What’s the thinking on school reopenings?
If you have widespread community transmission, there may come a tipping point where you do need to go back to virtual schooling. But I think the priority is to try to keep schools open as much as possible, and to provide the resources for that to happen.
From an epidemiologic perspective, we know that the highest-risk settings are restaurants, bars, gyms, nail salons and also indoor gatherings — social gatherings and private settings.
I would consider school an essential service. Those other things are not essential services. The smarter we are about being very responsive to trends in transmission — to closing indoor restaurants sooner — the longer you’re likely to be able to keep schools open.
We know that the risk of transmission in schools is not zero, but they’re not amplifying transmission the way some of these other places are.
We need to be supporting those businesses, whether it’s the restaurant owners and the people working in those restaurants, because it is not fair that they are bearing a very heavy brunt of the economic fallout from this.
Biden has said he would invoke the Defense Production Act to get companies to manufacture protective gear.
From the beginning we have been — and I’ve seen it firsthand — in a rationing mode. And now things are getting worse again, so that is a very high priority. I think that’s going to be one of the very first executive actions that Mr. Biden would be taking.
What role do you see the CDC playing in this pandemic and in the future?
The approach is going to be much more along the lines of giving control back to the CDC. There’s recognition that the CDC is the premier public health agency in the world. And while their role has been diminished during this current crisis, they play a very important role in all this.
It’s really going to be about rebuilding public health infrastructure. Since 2008, there have been massive budget cuts, staffing losses. And so some of it will be around that, and some of it will be around tech infrastructure and building more robust surveillance systems and dashboards.
Rural areas are particularly unequipped to deal with outbreaks. How do you plan to help them?
I have myself worked on Indian reservations in the Southwest, and I know some of my colleagues are really struggling right now. Once things really start to trend up again, they simply don’t have the ICU beds — not just on the reservation, but in any kind of proximity in the state — to transfer people to. And once your hospital capacity gets saturated, case fatality rates shoot up.
I don’t have a good answer for you right now as to what we can do right away. But it’s definitely on the radar.
Biden has talked about making testing available to all. Is the plan to provide rapid antigen tests?
The issue with the antigen test is how well it performs in asymptomatic people. What we’ve seen in some cases is that the performance characteristics are just not that great, so I think that needs to be better assessed and studied.
You do also need separate regulatory pathways, one for a public health surveillance kind of test, one for a clinical diagnostic test. The sensitivity of the surveillance test does not need to be as high, especially if it’s cheap, and something you can be doing frequently, repeatedly.
What are your thoughts about vaccine distribution?
Your local doctor’s office is not going to have the deep-freeze capability that, at least for the Pfizer vaccine, you’re going to need. They’re not necessarily going to have the tech systems to track and call people back to make sure they get their second doses.
That kind of capacity really resides either in public health departments or in the private commercial sector, like CVS and Walgreens. So it’s really going to require collaboration with them.
The White House has not permitted access to information about Operation Warp Speed or any other COVID plans. How big a problem is that?
That’s clearly a frustration. The normal way of doing business has not been the case for the entire administration. So why start now?
I do think it’s important to remember, though, that you have very experienced, seasoned people on the Biden team. These are not people who are new to federal government.
It’s not just about the federal government. So much of public health happens at the state and local level, so a lot of the communication in the coming weeks is going to be with governors, state and local public health officials. For things like tests and diagnostics, the monoclonal antibodies and vaccines, those are really conversations with the private sector.
So yes, it is an obstacle. It’s rather unfortunate, but the team really does still plan to be prepared to jump right in on Day 1 and address the crisis.
Apoorva Mandavilli c.2020 The New York Times Company
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