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WASHINGTON — No president has ever inherited a pandemic.

But if Joe Biden is elected in November, he has made clear that his first moments in office would mark a dramatic shift in the nation’s approach to Covid-19.

Biden’s first post-election phone call, he has said, would be to Anthony Fauci, requesting that the renowned infectious disease researcher continue his government service. For months, he and his staff have pressed for specific answers about how many coronavirus tests the U.S. could conduct by January, when he’d be sworn in as the 46th president. (Biden’s optimistic target: 100 million per month.) And he has pledged to institute daily pandemic briefings for the American public — conducted by scientists and public health experts, not by politicians.

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The platform is as much a rebuke of President Trump as it is a pandemic-response roadmap. Throughout the past six months, Trump has repeatedly undermined Fauci, suggested that the government should “slow down” coronavirus testing, and has taken center stage at careening, misinformation-heavy press briefings.

In interviews with STAT, numerous campaign surrogates, scientific advisers to Biden’s campaign, and an array of former U.S. health policy officials have made clear that Biden’s inauguration, and the weeks leading up to it, would set off a mad dash to reverse the country’s pandemic misfortunes. They described in detail a de facto Covid-19 war room, and identified the key aides who brief the former vice president.

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The Biden advisers acknowledge that after 170,000 American deaths, Covid-19 will not be easily tamed, no matter who is in the Oval Office. Partisan defiance of public health guidance is likely to persist under any president, and Biden’s administration might still face resistance from individual governors.

Nonetheless, the Biden camp says it is hatching plans for a slate of executive orders and federal guidance that could land as soon as Inauguration Day. In the hours after he’s inaugurated, his advisers said, the Senate could move to quickly confirm top health care officials — and the federal government could launch aggressive new messaging campaigns on vaccines, mask use, and social distancing.

In making the case for how he would govern, Biden’s campaign has been more concrete in how he would approach the country’s coronavirus response than perhaps any other issue. He has pledged to dramatically ramp up testing efforts, restore a biodefense official to the National Security Council, and improve Covid-19 surveillance by revamping insurance claims data.

The planning is informed by a cast of physicians who include a top Obama administration pandemic-response expert, a former Food and Drug Administration commissioner, a former surgeon general, and a Yale researcher focused on health disparities.

“You need to put in place, one Day 1, a team of people who have been planning and thinking deeply about this, and who know what they’re doing,” said Nicole Lurie, the assistant health secretary for preparedness and response from 2009 to 2015 and a current adviser to Biden. “A really great thing about working with this campaign, from my perspective, is that it’s really been the A-team.”

Biden Delaware State University
Joe Biden arrives to speak at Delaware State University’s student center in Dover, Del., on June 5, 2020. JIM WATSON/AFP via Getty Images

On March 13, Biden’s campaign faced an urgent decision about its own operations: Across the country, health officials had reported thousands of new Covid-19 cases. The escalating pandemic was racing across the U.S., but Biden was only midway through a bruising primary campaign.

The question on the table: Should Biden shut down his campaign headquarters in Philadelphia?

In a conference call, his aides brought together a group of doctors that included David Kessler, the former FDA commissioner, to seek advice.

“We recommended on that day, my first phone call, to shut down campaign headquarters,’’ Kessler told STAT. “And to the campaign’s credit, they did that within two hours.” Biden’s campaign, he noted, made that call before there was clear guidance from the local or federal governments.

The newly work-by-Zoom campaign went beyond following Kessler’s counsel on shutting down its headquarters. Before long, Biden’s policy team brought on Kessler and Vivek Murthy, the former surgeon general, to provide daily pandemic briefings to the former vice president and his top advisers.

Biden quickly labeled the pair “The Docs,” and turned to Kessler and Murthy as his top lieutenants on the pandemic, urging staff to workshop language in speeches and public statements by the physicians for their approval.

Murthy and Kessler have served as Biden’s eyes and ears on issues ranging from mask use to vaccine development to diagnostic testing. They assembled 80- to 90-page memos, briefing Biden at such length that Kessler occasionally fretted to high-level aides that he and Murthy were taking up too much of the candidate’s time.

Stef Feldman, Biden’s policy director, and Jake Sullivan, a senior adviser, frequently sat in, peppering Murthy and Kessler with their own questions. Biden, Kessler recalled, often drilled down and demanded specific estimates of how many tests the U.S. could administer by January.

Other conversations have drilled down on the supply of masks, protective gear for medical workers, and Covid-19 kits, Lurie said.

“He has been really clear that he’s going to appoint a supply-chain commander,” she said. “Clearly, the supply-chain issues are pretty significant, whether it’s about masks and PPE — none of us think right now that if there’s a really bad surge this fall and winter, that we have enough masks to protect health care workers — or whether it’s about the supply chain for diagnostics.”

While they’ve long been conducted without much public attention, the briefings in recent weeks have figured prominently into Biden’s campaign: The day he unveiled Sen. Kamala Harris of California as his running mate, he brought her to his informal Covid-19 war room. There, she sat in on a videoconference with Kessler, Murthy, Lurie, and Marcella Nunez-Smith, a physician and Yale researcher.

“We’re going to get what I get four times a week: A briefing on the state of coronavirus here and around the world, and what we should and shouldn’t be doing,” Biden told Harris, according to pool reports. “It usually takes somewhere between an hour and an hour and a half.”

Biden and his staff have pressed Kessler and Murthy, in particular, on issues as specific as equipment to transport vaccines that must be stored at below-freezing temperatures, advisers aid.

The campaign has also followed news regarding potential coronavirus treatments like dexamethasone, a steroid shown to reduce Covid-19 death rates, and remdesivir, the Gilead Sciences antiviral that has shown some impact on death rates and the duration of Covid-19 patients’ hospital stays.

“He’ll sometimes hear an expert on TV or read an expert study, and he’ll bring that question to us of what he’s heard or read,” Kessler said. “But we brought to him the clinical trials on remdesivir when that data was available. We brought to him the clinical trial data on dexamethasone. So we’re presenting him the data — obviously, he is attuned to this independently, but he’ll bring anything he hears to us, and we’ll all discuss it.”

When President Trump began to aggressively tout hydroxychloroquine, another antimalarial drug, as a Covid-19 cure-all, Biden, of course, wanted to know more.

“On hydroxychloroquine, very early on there were questions — and I simply said, Mr. Vice President, I need more time to see the data,” Kessler said. “Until I can see clinical trial data, I can’t give you a judgment on what works or doesn’t work. And he was fine with that.”

Biden’s allies are already laying out plans for a brutal transition — acknowledging that, if Biden wins, they don’t expect much bipartisan goodwill between outgoing Trump administration staffers and their incoming Biden administration counterparts.

“My guess is there won’t be a lot of reliance on the Trump team to brief the incoming Biden team,” said Kathleen Sebelius, the Obama administration health secretary who oversaw the implementation of the Affordable Care Act. “There will be information gathered from the Obama era, as much as possible, to then brief the incoming Biden team. Because I don’t know that the Trump folks paid much attention at all to the briefing books, and I’m not sure that most departments bear any resemblance to the way they were left.”

The Trump administration has been criticized for its scattered and inefficient approach to procuring masks and tests, and for abruptly undercutting the Centers for Disease Control and Prevention from collecting basic data about Covid-19 hospitalizations and infections.

“We know that there have been major problems with data and transparency,” Lurie said. “Whether it’s about some aspect of epidemiology, or whether it’s the supply chain, you’ve got to pretty rapidly get your arms around a set of facts that you can really count on — that has to be done really during the transition, and before.”

The administration would also install new leadership atop key health care agencies, like the Department of Health and Human Services, the CDC, and the FDA.

Much of Biden’s health policy team, nonetheless, would need to be confirmed by the Senate, and therefore would likely not be in place for weeks or months after his inauguration, forcing a newly sworn-in president to rely on career staff and acting officials to steer the pandemic response.

There’s already a playbook for such a scenario, however: In interviews, numerous Democratic operatives noted that Biden already has experience taking over a country in crisis and charting a new course even in the absence of a full cabinet.

In 2009, Biden was sworn in alongside President Obama amid the worst economic crisis since the Great Depression.

Within a month, Congress had passed a sweeping stimulus package that many in his inner circle view as a template for significant Covid-19 dealmaking in the opening weeks of his presidency.

Still, some confirmations could come quickly — Sebelius noted that some cabinet officials were sworn in within days of Obama’s inauguration. (The Senate confirmed Hillary Clinton, the secretary of state, on the second day of his presidency.)

“That’s how I would expect Joe Biden to act,” Sebelius said. “He will tee people up, he will ask the committees to meet, he will actually be able to swear a number of secretaries in on Day 1.”

But outside experts have warned that Biden shouldn’t expect to orchestrate a major course-correction instantly, or at all. And some of Biden’s plans are perhaps too optimistic, such as his hope of conducting 100 million tests per month by January (the country has conducted just 73 million, to date), or of establishing a new insurance code for Covid-19 treatment, to be used for federal pandemic surveillance (such claims data is typically gathered long after patients receive care).

“I don’t think anyone is suggesting that we can reverse” the past six months, said Sheila Burke, the former chief of staff to Sen. Bob Dole, the longtime Republican majority leader. “But rather we can improve upon the situation going forward — whether it’s the availability of testing, whether it’s the availability of PPE, or whether it is establishing an expectation standards with respect to the use of masks.”

Even in the face of the Trump administration’s haphazard response, however, leading Republicans in Congress have argued Biden isn’t up to the job of managing a pandemic.

“If Joe Biden was president, we’d still be debating whether planes from China should be coming to America instead of discussing the six vaccines we have about ready to go through BARDA or the more than 600 therapeutics we have about to come online,” said Kevin McCarthy, the top House Republican, in a recent Fox News interview. (Biden did not oppose Trump’s ban on direct flights from China when it was issued, and the U.S. government has not yet approved a vaccine for Covid-19, though it has issued a number of emergency authorizations for therapeutics.)

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Biden participates in a 2016 press briefing on the Zika virus with President Obama, health secretary Sylvia Burwell, CDC director Tom Frieden, and Fauci. Mark Wilson/Getty Images

In a speech last week, Trump leveled his latest attack on Biden’s coronavirus approach, accusing him of “ignoring the scientific evidence and putting left-wing politics before facts and evidence.” Trump’s campaign has also repeatedly rebroadcast a remark from Ron Klain, the former Biden chief of staff and Obama administration Ebola czar, recalling that the administration “did every possible thing wrong” in responding to H1N1.

Biden, throughout his campaign, has punched back.

“I don’t think he’s competent enough to know what to do. He just waved the white flag.”

Joe Biden, in remarks about President Trump's response to the Covid-19 pandemic

“You know, I used to think it was because of his personality, but I just don’t think he can intellectually handle it,” he told reporters on Wednesday. “I don’t think he’s competent enough to know what to do. He just waved the white flag.”

At the Democratic National Convention this week, Biden’s supporters have doubled down: Former president Bill Clinton described Trump’s pandemic response as “only chaos.” Kristin Urquiza, a Democratic voter, blamed Trump’s disdain for stay-at-home orders and Arizona’s hasty reopening for her father’s death.

In making their case, Biden’s backers argue that he would take charge of the public health crisis with the benefit of his decades-deep web of connections in Washington’s health care intelligentsia.

As vice president, he frequently crossed paths with Fauci, the director of the National Institute of Allergy and Infectious Disease, particularly during the H1N1 flu pandemic of 2009 and the Ebola scare several years later. Fauci, Biden has pledged, would have “full access to the Oval Office.”

Despite Trump’s criticism of Biden for his role in the Obama administration’s response to H1N1, which sickened 60 million Americans but killed only 12,469 — roughly 7% of Covid-19’s U.S. death toll to date — Biden’s campaign has cast his pandemic-response experience as a strength.

His chief of staff during the early Obama years, Klain, has remained outspoken on Covid-19 issues throughout the pandemic.

Another key campaign adviser, Chris Jennings, is a health policy veteran who worked in the Obama administration alongside Lurie, the government’s top pandemic-preparedness official, and Murthy, a surgeon general known for his focus on addiction, gun violence, and the phenomenon of loneliness as a public health crisis.

And as FDA commissioner, Kessler, now a top adviser, worked closely with Fauci during the HIV/AIDS crisis of the 1980s and 1990s.

Another occasional campaign adviser, Greg Simon, is a longtime Biden confidant dating back to the vice president’s “Cancer Moonshot” in 2016, following the death of his son, former Delaware attorney general Beau Biden, from brain cancer. Following Trump’s election, Biden hired Simon to run the Biden Cancer Initiative, the cancer-research nonprofit that folded once Biden declared his candidacy last year.

“He’s grounded” in health care issues, Kessler said. “He knows the players. He has enormous admiration for Dr. Fauci.”

Should Biden become president, advisers said he would immediately emphasize the stark differences between Trump’s regime and his own. The most important element of Biden’s plan, they say, is simply that it exists.

“I expect will be very clear, unambiguous communication, coming from the very top, about what needs to be done,” Lurie said.

  • DrKnowitAll – Testing seems to be of very limited value. We hear about it all the time, and obviously we need some to monitor how severe the epidemic is, to make decisions on shutdowns but it is not going to do much overall, the overemphasis on it is an automatic response from public health people who ought to know better.
    Unlike VD and TB, with the Wuhan coronavirus, those who are sick soon recover, or get worse, but anyway, do not continue to spread it. The “value” of finding an infected person after 3 weeks is generally zero. A person with syphilis might spread it for decades with no signs. Finding him or her is very helpful.

    Unlike VD or TB, Wuhan spreads very easily – so finding all the people one person might have infected is often impossible – if the patient took the subway, maybe someone got it from him there- or ate in McDonalds, etc, etc.
    With VD, most of the people know who they had sex with and can give the public heatlh people a name and number.

    Unlike VD and TB, most people, when contacted, want to be tested and cured- which is possible – I have not seen data on it, but why does everyone presume Wuhan patient’s take ANY action ? Hopefully they do, many people are responsible, but using an honor system – with 35% of people having no symptoms at all- and not feeling sick to keep them at home – and easily able to rationalize “I am not sick, I do not need to quarantine” – does that really work? Why assume it does? In some people maybe it has unintended consequences – someone who was worried about getting sick, and therefore careful, finds out they are already sick and decides to stop taking any precautions at all, even from infecting others.
    And finally, even with testing, we do not have good contact tracing – which may be partly Trump’s fault but seems to be mostly, by tradition, the job of local public health departments, who are not up to it. Too many people to trace, not enough trained tracers to do it. It is not their fault probably, it needs to be done by apps, but someone resists that, though Google already knows where most of us are most of the time anyway, so that is not done.

    Trump may have done a poor job with testing, but it’s doubtful anyone could make it work – in fact, Biden’s emphasis on it makes me wonder if he really understands it is nowhere near the main issue.

  • As he would take charge not earlier than Jan 2021, by then, the US might have reached herd immunity the hard way.
    BTW, latest CDC data put excess deaths between 210k and 270k as of August 8th

  • Hard to deny that the willful mismanagement of the pandemic will have resulted in hundreds of thousands of unnecessary deaths, and millions more with long-term sequelae.

    Joe Biden will let the experts lead the way. Science isn’t perfect — especially not with a brand new coronavirus — but it’s the best tool we have. If this administration had taken an apolitical path, which it still is failing to do, we would not have a pandemic currently ravaging this country.

    I only hope that January won’t be too late.

    • Dr. Knowitall – I do not find it hard to deny. I think Trump is over his head, but not “willfully mismanging” it – but not to quibble over words- he did not let the scientists do all they wanted, Biden probably will. But considering the fact many countries screwed up to varying degress, in 20/20 hindsight, I am not sure how much death and destruction you can attribute to Trump, vs. the American character and other official’s mistakes. Mask wearing is being presented by the media as a partisan issue – but from local media reports of people living in Manhattan – and elected officials early on – the resistance was bipartisan, at least at first. The epidemic in New York has been shown to be the primary seed for the epidemic nationwide – and, even now, look at some pictures of street life in New York – open air bars and such – about 3/4 of the people have masks, some not on.
      So, did Trump fail to stop the epidemic in New York, or did deBlasio and Cuomo? Or how about the people who did not wear masks? Well, the CDC, including Dr. Fauci who i respect but do not view an infallible, were downplaying airborne transmssion, not because the science said it did not happen, but because they did not want a run on masks, because then doctors and nurses would not have them.
      I think the sad non-partisan conclusion has to be, EVERYONE screwed up – and NOT because the science was not known, or at least strongly suspected. They all knew, or should have known, better- the politicians in cities with big Chinatowns urged people to go out to celebrate Chinese New Years, a few weeks before they shutdowns. Massive endemic incompetence.

  • (Biden’s optimistic target: 100 million per month) Taking that info -> 328.24 million (2019) is the USA Population, whats he plan to do in April after testing every one, start on Illegals with free health care at the cost of tax paying Americans. Just love it how they all have a plan to get elected but when they KNEW nothing back in FEB or did they KNOW it all then and kept it a secret just to get elected. 40 yrs a Political Hack now a Rocket Scientist.

    • Joe’s not claiming to a rocket scientist. He will rely on the experts. He won’t prevent shipments of PPE from entering the United States. He will support testing. Three massive improvements.

      Citing “illegals” is a dog whistle to the cult who elected this president. All human beings deserve adequate if not excellent health care. Especially during a pandemic

  • This article is so politically biased – it’s ridiculous. When the pandemic started, I read StatNews because, unlike a lot of our media right now, it seemed like a “neutral” source for science based news. But you all have clearly been taken in by the lure of the click bait.

    • The issue is that Biden gets what is needed and Trump never has and never will. That this article is supportive of Biden lies in the fact that Biden supports the science and Trump does not. How can the article be neutral?

  • The political bias reflected in this article overshadows the intended needed objectivity of the matter of Coronavirus! I found it hard to read, looking for a fair assessment of what Biden would do differently. Stat readers deserve non-political, partisan biased reporting!

  • so if one really analyzes this article it is practically all biased with every person being quoted from prior Obama administration officials ; criticism of Trump is actually irrelevant to control the spread of the virus but finding a vaccine will be the only way to end the virus . The last striking point here is no bias article ever brings up is the day after Biden is inaugerated if he wins the virus could cares less who was there both before and after that ceremony because it is irrelevant the way it behaves .

  • Why is this still a crisis? The CDC says the Infection Fatality Rate is 0.26; on the same order as the seasonal flu. The number of cases is going up (which is to be expected as the number of tests go up and the pathogen makes its way through the population).

    The issue: once a pathogen, such as COVID-19, is recognized as a pathogen it is already wide-spread in the population. There is virtually nothing that can be done to effectively stop the spread except for inducing herd immunity (which has began) or inoculating the population with a vaccine (which is not yet available).

    The idea of contact tracing was based on a slow contagion requiring intimate contact. Neither is applicable here.

    All the heavy lifting has been done. The Trump administration did an admirable job on logistics. I doubt any administration could have done better.

    • The fatality rate may be low, but there are still very valid question about the medium and long term health effects that many people seem to be experiencing. These range from fatigue to potential damage to vital organs. Until we have more definitive answers about how many people are experiencing these longer term effect / how many are suffering from organ damage I think that caution is still a good idea.

      I would add that while that .026 number is small, it isn’t small when you are burying someone you know who died from it as I am tomorrow.

  • I am not defending Trump or saying Biden can not do better handling the epidemic, but what I see here is not much different. Mandatory masks and “more testing”.

    There seems to be no question masks work and if we would all use them, and take some other measures, we could keep the country mostly open and have far fewer cases.

    But I am skeptical more testing, to be combined with contact tracing, is going to do much.

    Wuhan virus is not VD or tuberculosis- you get it very easily, unlike VD, and you get over it very quickly, unlike VD and TB – often, it is flat out impossible to trace contracts, because people spread it to strangers with casual contact.

    I am not knocking Biden, but he does not have any new ideas, and will do nothing different than Trump is doing now.

    • Testing is proceeding apace everywhere. I can go to a local urgent care and get tested and results the same day. My understanding is that most of the testing problems until now have been due to processing delays. As more rapid testing is approved anyone who wants a test will get one – although that is pretty much true now.

      Biden offers nothing new.

    • I think the article brings up something important, indirectly. It claims Biden’s plans for a task force are well planned and everyone will hit the ground running. Everyone being highly experienced government public health officials.

      But, what about now? Except for a mask mandate – which seems to not really be legal if issued by the President – he has nothing different offered NOW – I know he is not President yet but as an opposition leader he should have more concrete plans and offer them up now.

      I agree supply chains are badly insufficient- this far into the epidemic, I should be able to go to Costco and buy all the PPE I can afford – including PAPR and such – but they do not even have N95s – you either find them somewhere online or order KN95s from China and hope they are the real thing – but what has he done NOW, to make them better? Of course that is Trump’s responsibility, primarily, but is that an excuse? If I could order the good PPE from the Democrat National Committee, and they had a solid vaccine program on fast track – that is probably enough to get my vote. What I seem to see is nearly every government in the world hamstrung by inappropriate concepts like “First, do no harm” – so human challenge vaccine tests are off limits – while China and Russia race by the West. It is very likely, in a few months, their societies will be 100% open, while we struggle on, because no one here would do what needed to be done.

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