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Despite debate talk, Biden virus approach differs from Trump’s

Their plans share some broad similarities but diverge on the role of the federal government

Former Vice President Joe Biden’s plan for addressing the COVID-19 pandemic has much in common with what the Trump administration has attempted so far, but Biden’s overall approach would likely differ from Trump’s in important ways, experts say.

Both campaigns emphasize access to testing, developing vaccines and making more medical supplies in the United States. The broad similarities provided Vice President Mike Pence with a stinging attack line in Wednesday night’s debate with Biden’s running mate, Sen. Kamala Harris, D-Calif. 

“When you look at the Biden plan, it reads an awful lot like what President Trump and I and our task force have been doing every step of the way,” Pence said, describing the plan as “plagiarism” and alluding to a 1987 incident when Biden copied a British politician’s speech. 

But Biden seems more likely to unify the planning into a cohesive national strategy and respect science, public health experts say, while President Donald Trump has prioritized reopening the economy over safety. Trump also has personally shared misinformation and flouted his own administration’s plans. 

Another key difference between the candidates is the role of the federal government, said Jennifer Kates, senior vice president and director of global health and HIV policy at the nonpartisan Henry J. Kaiser Family Foundation.

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“The administration has divested the responsibility to states for testing, for contact tracing, for securing adequate supplies,” she said. “Vice President Biden has said in his plans that he would have a strong federal response and the federal government would be in charge of setting the standards.”

Trump’s coronavirus response and Biden’s plans were a focal point of Wednesday night’s vice presidential debate.

“They still don’t have a plan,” Harris said of the Trump administration, despite more than 7 million cases of COVID-19 and 210,000 deaths. She did not get into the specifics of Biden’s plans, except to imply he would be more straightforward with the American people about the facts they need to protect themselves. 

She also predicted more of a “national strategy.” Her general critique echoed a point many make when the Trump administration defends its response. 

“Whatever the vice president is claiming the administration has done, clearly it hasn’t worked,” she said. 

Challenges ahead

To be sure, the Trump administration has made progress in specific areas, and its defenders say those who criticize the administration for having no plans are simply not reading them. That was the theme House Republicans put forward last week during a hearing of the Select Subcommittee on the Coronavirus Crisis.

A House Republican report released before the hearing highlights the administration’s plans to secure protective equipment, slow the spread of the coronavirus, increase testing, develop vaccines, and reopen the economy and schools. Supply shortages persist but have improved, as has testing, and a vaccine might be available faster than any top officials predicted at the start of the pandemic. 

However, implementation problems and a lack of coordination have hampered the response. Newer and faster tests are being purchased and sent out, but not in a way that some experts say would be the most useful. Plans to slow the spread were pushed aside in favor of Trump’s pressure to reopen the economy. 

A vaccine might be authorized this year, but states may not have the resources to distribute them.

While the economy improved after lockdowns ended, the states that reopened most quickly, mostly in the South, had some of the worst outbreaks. New daily cases, hospitalizations and deaths all have declined when compared with the summer, but none of those metrics are better than before the rush to reopen in late spring.

And the outlook is worsening. Thirty-two states have more new cases this week than last week, according to Johns Hopkins University data.

An unusually scathing editorial in the New England Journal of Medicine on Wednesday blasted the Trump administration, noting how quarantine measures have been inconsistent and restrictions were loosened without the disease actually being controlled.

“Our current leadership takes pride in the economy, but while most of the world has opened up to some extent, the United States still suffers from disease rates that have prevented many businesses from reopening, with a resultant loss of hundreds of billions of dollars and millions of jobs,” the editors said. 

Other experts similarly point to an overall lack of coherence and are frustrated by what they call a scattershot approach. 

“There has been a lack of leadership and guidance coming from this administration. It’s been confused, and it has conflicted with what the best science has said even from early on,” said Joseph Allen, Harvard T.H. Chan School of Public Health assistant professor of exposure assessment science. 

With Biden, experts predict that the federal government would make stronger attempts to guide state policies, help governors get what they need and emphasize controlling disease spread before moving ahead with reopenings.

“Across testing, vaccines, treatment and economic recovery, we’ve seen the Trump administration err on the side of state-by-state policies, while the Biden campaign has promoted a more centralized national approach,” said Gayle Mauser, a Manatt Health senior manager. 

Biden’s approach would involve creating a board to oversee test kit production and distribution. He would boost the federal government’s role in establishing testing sites, including doubling the number of drive-thru sites. He would intervene more in the market to ensure that supplies are adequate and closely manage data reporting. 

Biden would hire 100,000 workers to support states with tasks like tracing the contacts of infected people. Trump’s approach is more state-led, with states getting $11 billion appropriated by Congress to use for testing-related activities, including contact tracing.

Georges Benjamin, executive director of the American Public Health Association, is encouraged by the Biden campaign’s emphasis on unified planning. 

“There ought to be a common message about protecting the public, some understanding about the science, making sure that there is policy coherence on everything that you do, so that something that’s done on the economic side is in line with what’s done on the health side,” he said. 

Having a detailed plan is important because “it takes more time and resources to clean it up on the back end if you don’t spend the time planning,” he said. “You can do it faster and easier, with less effort and making fewer mistakes.” 

National oversight

Many experts point to testing as an area where a stronger national strategy is needed. The Trump administration recently announced it would distribute 150 million rapid testing kits, with some sent to nursing homes and assisted living facilities, home health care organizations and certain colleges. States will also get tests, and the White House is encouraging their use in settings where they would make a difference, like schools.

Michael Mina, a Harvard T.H. Chan School of Public Health epidemiology professor, worries that the administration is distributing the tests in a way that will result in them being depleted too quickly. 

“Most states won’t necessarily have the expertise to figure out how to use these most appropriately,” he said. “I think there needs to be strong guidance from the [Centers for Disease Control and Prevention] about how to do this.” 

At the first presidential debate, Biden also highlighted his pledge to give schools and businesses resources to reopen safely. The Trump administration was criticized for a lack of coordinated planning on reopenings. 

“We’re stuck with an ad hoc approach, state by state,” Allen said. ”Right now that’s happening to schools. We’re trying to figure it out school district by school district. This is not the way it should be done.”  

He noted that earlier in the pandemic, a lack of coordination led to states competing over scarce protective equipment supplies that were overwhelmed by demand.

A more top-down approach may have its challenges, given conservatives’ support for state rights and a distrust of federal mandates. 

For example, Biden has said he would implement a mask mandate nationally if elected, an idea medical experts praised. But bipartisan groups like the National Governors Association said the idea is not uniformly backed by its members.

Biden also plans to expand the social safety net more aggressively than Trump and Senate Republicans want to, by expanding enrollment periods for people to buy individual health insurance, increasing federal Medicaid payments and offering people free COVID-19 tests regardless of their immigration status.

Biden also would push for sick leave policies that apply regardless of a business’s size, extra pay for health care workers and stronger workplace safety standards.

Biden says he will listen to scientists and let them communicate with the public. By contrast, the White House sometimes blocked federal officials from testifying before Congress or conducting interviews and watered down CDC information.

“There’s been a questioning of science and medicine, and in some cases an undermining of the scientific authority to get the information out about what we know and what we don’t know. And that’s left people, that’s left states, that’s left employers really on their own,” said Kates. “Vice President Biden has said that he would fully embrace the science.”

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