Let’s agree that total lockdown is the most ruinous of all options, and the one we’d like to use least. We have tools we could deploy to avoid it, but we’d need to start quickly. One is rapid, at-home testing. The technology exists to produce tens of millions of cheap, at-home antigen test strips each day. These strips are highly accurate during the period that matters most — when we are infected and contagious. Used widely, they’d let all of us check, daily, if we were potentially infected, so we could then isolate and avoid infecting others. “This is a public health issue and if we don’t empower the public to deal with it we won’t be able to defeat it,” Michael Mina, an epidemiologist at Harvard, told me.
The problem here is the Food and Drug Administration. They have been disastrously slow in approving these tests and have held them to a standard more appropriate to doctor’s offices than home testing. “The F.D.A. needs to catch up to the science,” Mina said, frustration evident in his voice. “They are inadvertently killing people by not following the science.” On my podcast, I asked Vivek Murthy, President Biden’s nominee for surgeon general, whether the F.D.A. had been too cautious. “I do think we’ve been too conservative,” he told me. Murthy went on to argue that there’s a difference between the diagnostic testing doctors do and the surveillance testing the public could do and that the F.D.A. had failed to appreciate the difference. Speeding the F.D.A. on this issue will be an early, and crucial, test for the Biden administration. In this case, Democrats need to deregulate.
Biden has proposed spending $50 billion on testing, and a chunk of that money will go to genomic sequencing. This is crucial, because the virus is mutating, and we need to know how, and where, and we need to know it quickly. Natalie Dean, a biostatistician at the University of Florida, told me that this moment feels to her like a year ago, when we knew the coronavirus was spreading, but we didn’t have the basic testing to map the problem. “Given that we don’t have adequate genomics surveillance, we have the same déjà vu that there is something out there circulating and we’re not appropriately measuring it,” she says. Congress needs to pass Biden’s plan, right now.
Better masking would also make a difference. Many of us — and I include myself here — are wandering around in cotton masks whose construction we know little about. That’s better than nothing, but a year into this pandemic, we should have stronger guidance on choosing the most effective masks. “I want to see very direct guidance from the C.D.C. of masks people should be wearing in different contexts,” Jha told me. He said that with the new strains, he won’t go into a grocery store unless he’s double-masked, or wearing an N95, or the South Korean equivalent, a KF94. In September, we learned the Trump administration had scrapped the United States Postal Service’s plan to send masks to every American residence. During our conversation, I asked Murthy if having the government produce and directly distribute high quality masks is an idea worth revisiting. “I think so,” he said.
Then, of course, there’s vaccination. We live in an age of marvels. That we already have two vaccines, both of them over 90 percent effective against the virus, is a wonder. Early testing shows the vaccines easily neutralize the B.1.1.7 variant, and while there is a South Africa strain that shows some resistance to the vaccine, the level of antibodies the vaccine produces should still be sufficient. If it isn’t, BioNTech says they could produce a targeted booster in about six weeks.
Biden first promised 100 million shots in the first 100 days of his presidency. Now, he is suggesting that we could reach 150 million. Romer’s calculations suggest that two million vaccinations a day could keep us ahead of the new strains, and blunt their impact almost entirely. I recognize the political appeal of underpromising and overdelivering, but the danger of a modest goal is that you can fool yourself into believing you’ve succeeded when in fact you’ve failed. Biden has said the Trump administration’s vaccination rollout was “a dismal failure,” and he was right. But if we’re delivering 1.3 million shots a day now, even before the Biden administration has implemented their new distribution program, then two million per day seems like a reasonable goal to reach for.
There is an end in sight. But this could end with 300,000 more deaths, or it could end with a fraction of that. What we do these next few months will make all the difference.