President Joe Biden said his top experts anticipate COVID-19 cases to increase in the weeks and months ahead as the omicron variant is likely to spread throughout the United States this winter, so he called on Americans to defend the nation with a unified front.

“This is a point to get the nation to come together, to unite the nation in a common purpose … and to think of it in terms of literally a patriotic responsibility rather than somehow you’re denying people their basic rights,” Biden said Thursday during a visit to the National Institutes of Health.

Biden laid out a strategy to avoid another winter shutdown by beefing up COVID-19 testing, vaccinations and boosters. The White House wants to get the nation as protected as possible while scientists work to learn more about the omicron variant’s transmissibility and whether it can evade vaccine protection.

“We are better positioned than we were a year ago to fight COVID-19,” Biden said, noting that last Christmas fewer than 1 percent of adults were fully vaccinated, while now over 71 percent of adults are fully vaccinated. 

Biden said his plan doesn’t expand any mandates. Meanwhile, some Republicans on Capitol Hill are pushing for a vote on an amendment that they say would defund a rule requiring employees at large businesses to be vaccinated against COVID-19 or submit to regular testing. That rule is also being challenged in several courts. Those Republicans want to attach the amendment to the continuing resolution that Congress must pass by the end of Friday to avoid a partial government shutdown. 

Two cases of the new variant have been detected in the United States since the World Health Organization designated omicron as a variant of concern on Nov. 26. Little is yet known about its transmissibility and ability to evade vaccines, but scientists suspect its many mutations could spell trouble. 

The White House is working with Moderna, Pfizer and Johnson & Johnson to develop contingency plans for revised vaccines and boosters if needed. White House Chief Medical Adviser Anthony Fauci expects to have data on the variant’s ability to escape vaccine protection and severity within two to four weeks. Pfizer-BioNTech said it could have an updated shot within 100 days, if needed. 

Scientists expected more virus mutations to follow the recent delta surge, and stress that the world has more tools to combat COVID-19 than last year. 

“We see this as the future. But we’re not going to be complacent about it,” Association of State and Territorial Health Officials chief medical officer Marcus Plescia said of omicron at a briefing Thursday. “I mean, every virus has to be taken very seriously, and until we know more, we have to prepare for the worst.”

Biden’s plan

So far, about 42 million Americans have received a COVID-19 booster shot, but nearly 100 million eligible adults have not received their boosters yet. The Biden administration wants to change that as soon as possible by expanding pharmacy availability through December and reaching out to seniors. 

Fauci, the director of the National Institute of Allergy and Infectious Diseases, has said that the more vaccine protection individuals have, the better suited they will be to combat the virus. 

Extra antibody protection is especially important for vulnerable individuals and older Americans. The Centers for Medicare and Medicaid Services is launching an outreach and education campaign to help get older Americans boosted. AARP will join this effort and provide rides for seniors to booster shot locations. 

The administration is calling on employers to follow the federal government’s lead and provide paid time off for employees to get boosted. Currently about one-third of workers report not getting time off for vaccinations. That number is even higher for Black and Hispanic workers.

“No one should have to choose between their paycheck and getting the additional protection of a booster shot or a child vaccination,” Biden said Thursday.

Now that kids ages 5 and up have the ability to get vaccinated, the administration wants to limit school closures this winter. The U.S. leads the world in vaccinating young children, but many more young kids remain unprotected due to a combination of vaccine hesitancy and lack of access to shots. 

The Biden administration is opening hundreds of family vaccination centers around the country where kids and adults can get their shots. The Health Resources and Services Administration plans to host “family vaccination days” and hundreds of community health clinics throughout December. Thousands of pharmacies will make family-based vaccination scheduling available over the coming months as well. 

Medicaid and the Children’s Health Insurance Program providers will receive extra incentives to vaccinate kids. The two government health programs now will reimburse providers for time spent talking to children and families about COVID-19 vaccines, something they were not previously compensated for.

Ramping up testing and response efforts

Testing is a crucial tool for detecting COVID-19 before it spreads, but at-home tests have been too expensive for most people to use with any regularity.

Under Biden’s plan, people with private insurance would be able to get the costs of their at-home COVID-19 tests reimbursed. This will not retroactively cover costs for at-home tests Americans may have already purchased, though. Americans who don’t have private insurance are expected to be able to access at-home tests for free at health centers, rural clinics and other community clinics.

Michael Bagel, the director of public policy at the Alliance of Community Health Plans, said the group expects the Health and Human Services Department to issue an interim final rule or update existing guidance by mid-January. That would give the group and others time to speak with administration officials about reimbursement rates and what guardrails to set up around the policy.

Insurers’ concerns include how to encourage individuals to purchase the most affordable at-home tests and prevent bad actors from abusing the policy, such as by getting reimbursed for buying at-home tests they then re-sell or give away. The group will also likely weigh in on how to handle tests done to monitor workplaces or schools.

“When there are some sporting events requiring you to be tested before you go in or employers or people wanting to have some, you know, some comfort before they go to a social activity, you know, who should be responsible for covering those costs?” Bagel said. “And how do we do that in the most efficacious way so that we’re not driving up the cost of providing health insurance?”

White House Press Secretary Jen Psaki said the administration considered policies that would be most effective and “implementable.”

Larry Levitt, an executive vice president for health policy at the Kaiser Family Foundation, said on Twitter that claims could be subject to the “shoebox effect,” and individuals might never actually file the claims for at-home tests.

“Insurance reimbursement for at-home tests will expand access and help to slow the spread of the virus,” he wrote. “But, it is cumbersome compared to places like the UK, where tests are free online and in pharmacies.”

Several states are still struggling to access enough at-home rapid COVID-19 tests to meet the demand for return to school and the workplace, Nirav Shah, president of the Association of State and Territorial Health Officials, told reporters on Thursday.

“It’s great to see that coverage may be more easily accessible and attainable, but we need to make sure that the supply is there to meet that forthcoming demand right now,” Shah said, noting several states are still having issues obtaining Abbott BinaxNOW tests. 

The administration also is stepping up its testing efforts for individuals traveling to the U.S. from other countries. Now all incoming international travelers must test negative for the virus within one day of departure, regardless of nationality or vaccination status. The administration is also extending the masking requirement for public transit, air travel and trains through March 18.

Travel restrictions and testing protocols will not stop omicron from spreading, but they can help slow its spread.

On the homefront, the Biden administration plans to deploy over 60 rapid response teams across the nation to combat rising case numbers this winter. These teams are intended to help staff overcrowded hospitals, administer monoclonal antibody treatments and provide epidemiological support.

Finally, the U.S. will scale up its worldwide vaccine donations over the next 100 days and donate 200 million doses to countries in need during that time. So far, the Biden administration has delivered 275 million COVID-19 doses to 110 countries and pledged to donate 1.2 billion doses of the vaccine around the world. 

Public health officials stressed that it’s important to be flexible, as virus mutations are par for the course.

“We just need to make sure that we’re ready from a surveillance perspective and disease control perspective,” Shah told reporters Thursday.