When President-elect Joseph R. Biden Jr. takes office in January, he will inherit a pandemic that has rocked the country. His transition team last week announced a team of 13 scientists and doctors to advise on how to fight the coronavirus.
One of them is Dr. Celine Gounder, an Infectious Disease Specialist at Bellevue Hospital Center and Assistant Professor at New York University’s Grossman School of Medicine. In a full interview with the New York Times, she discussed plans to prioritize racial inequalities, keep schools open as long as possible, and restore the Centers for Disease Control and Prevention as the world’s leading health agency.
In-depth management is considering government mask mandates, free testing for everyone, and enlisting the Defense Production Act to increase the supply of protective equipment to health workers. In fact, this will be “one of the first executive orders” from the Biden administration, she said.
Below you will find edited excerpts from our conversation.
Tell us about Mr. Biden’s Covid advisors. Who does what?
The Coronavirus Task Force is the team that the Vice President leads within the current administration. I’m on the Biden Harris Advisory Board. Then there is the internal transition team, which is much larger. The transition team developed a draft Covid, the basics of operation, and they have been working on it for months.
The purpose of the advisory board is really to have a group of people who think big, creative, and interdisciplinary – to be a second look at the blueprint they came up with and also to act as a liaison with the state and local health departments.
How often will you meet with Mr. Biden and Vice President-elect Kamala Harris?
We will have at least one weekly group meeting. In addition, we may be asked to inform members of the transition team and the President-Elect and Vice-President-Elect. I’ve been to two of these briefings.
They ask very insightful questions, very thoughtful questions that show that they are sensitive to who was really hit hard, who suffered. In terms of technology awareness, they understand more than I ever thought a politician would understand. Like asking what the appropriate timing and target populations would be for monoclonal antibodies. For someone who doesn’t follow these things, this is a really good question.
What is the plan to help the hardest hit communities?
Racial differences will definitely be a line of passage for all plans – regarding testing, for example, to make sure you can find testing facilities in color communities. They were not adequately served and the waiting times to be tested, the turnaround times, were not fair.
Another area that is really of interest is the indigenous people. They are often misclassified as to their race and ethnicity, and this makes it very difficult to conduct analysis to find out trends in these communities and tailor interventions accordingly. It will be very, very central to really pay attention to detailed data monitoring and to use it to inform how we fix these differences.
What do you think of the school reopening?
When you have a widespread community broadcast, there may be a tipping point where you need to get back to virtual school. However, I think the priority is to keep the schools open as much as possible and to allocate the resources for it.
From an epidemiological perspective, we know that restaurants, bars, gyms, nail salons, and even indoor gatherings – social gatherings and private facilities – are the most risky environments.
I would consider school an essential service. These other things are not essential services. The smarter it is to respond to broadcast trends – to close restaurants earlier – the longer you can likely keep schools open.
We know the risk of transmission is not zero in schools, but they don’t increase transmission like some of these other places do.
We have to support these companies, whether they are the restaurant owners or the people who work in these restaurants, because it is not fair that they should bear a very heavy brunt of the economic consequences.
Mr Biden said he was relying on the Defense Manufacturing Act to get companies to manufacture protective equipment.
From the start – and I’ve seen it firsthand – we’ve been in a rationing mode. And now it’s getting worse again, so that’s a very high priority. I think this will be one of the first executive measures Mr Biden will take.
The transition of the president
What role do you see in the C.D.C. play in this pandemic and in the future?
The approach will be much more to give the C.D.C. to return control. It is recognized that the C.D.C. is the world’s leading health agency. And although their role has diminished in this current crisis, they play a very important role in it.
It will really be about rebuilding the public health infrastructure. Since 2008 there have been massive budget cuts and staff losses. Part of that will take care of that, and another part will deal with the technical infrastructure and building more robust monitoring systems and dashboards.
Rural areas are particularly unequipped to deal with outbreaks. How are you going to help them?
I’ve worked on Indian reservations in the southwest myself, and I know some of my colleagues are really having problems right now. Once things get really moving again, they just don’t have I.C.U. Beds – not just on the reservation, but in some vicinity in the state – to transfer people. And once your hospital capacity is saturated, death rates go up.
I don’t have a good answer for you right now, what we can do right now. But it’s definitely on the radar.
Mr Biden talked about making tests available to everyone. Are you planning to perform rapid antigen tests?
The problem with the antigen test is how well it works in asymptomatic people. In some cases we have seen that the performance characteristics are just not that good. I think that needs to be better assessed and investigated.
You also need separate regulatory pathways, one for a public health surveillance test and one for a clinical diagnostic test. The sensitivity of the surveillance test doesn’t have to be as high, especially if it is cheap and you can do it frequently and repeatedly.
What do you think about vaccine distribution?
Your local doctor’s office will not have the freezer feature that you at least need for the Pfizer vaccine. You won’t necessarily have the tech systems to track and call back people to make sure they get their second dose.
This type of capacity is either in public health departments or in the private trading sector like CVS and Walgreens. So it is really going to require working with them.
The White House has not given access to information about Operation Warp Speed or any other Covid plan. How big is the problem?
This is clearly a frustration. The normal way of doing business was not the case for the entire administration. So why start now?
I think it’s important to remember that you have very experienced, experienced people on the Biden team. These are not people who are new to the federal government.
It’s not just about the federal government. So much public health is happening at the state and local levels that much of the communication over the coming weeks will be with governors, state and local health officials. For things like testing and diagnostics, the monoclonal antibodies and vaccines, these are really private sector talks.
So yeah, it’s an obstacle. It’s pretty unfortunate but the team really still plans to be ready to jump right in on day one and tackle the crisis.