Covid year in review

Last week I took the opportunity of the first anniversary of President Biden’s worker protection Executive Order to review the past year of federal efforts to protect workers from COVID-19.

Meanwhile, much bigger minds than I have also looked at Biden’s overall COVID policies and why they have not been as successful as the could have been (to put it mildly.) I summarize two of those below.

But first a caution:  I’m not coming here to bury Biden, nor certainly to praise him. I am a student of public policy — having been “raised” in labor unions, I’ve learned that translating obvious solutions to worker injury, illness and death into actual laws, standards and public policies is challenging and frustrating, but also not impossible. So I look to these critiques for the lessons they have to teach current and future policy-makers.

Justin Feldman

The most thorough — and biting — review was written by Harvard University’s Justin Feldman who starts off asking “How did we get in a situation where a Democratic president — who ran, in part, against
Trump’s horrid pandemic response — is letting the virus rip?”

Feldman comes to the same conclusion I’ve discussed many times: the administration’s singular focus on vaccinating its way out of the pandemic:

The Biden administration, I argue, made a strategic decision to prepare for one specific pandemic scenario. In that scenario, high levels of disease and death would continue in early 2021, followed by widespread population immunity from both vaccination and prior infection. This population immunity would lower the death toll to manageable, ignorable levels, like that of seasonal flu. In this scenario, the Biden administration’s pandemic response would focus on vaccination and medical treatment while largely rejecting other public health measures –so-called “non-pharmaceutical intervention” policies ranging from contact tracing to mass testing to temporary closures of nonessential businesses.

And, at least last Winter and Spring, the vaccines were miraculous and people were fighting to get them.  But the policy implications were unfortunate:

As far as I can tell, from January 2021, the key players in the administration’s pandemic response policy (Jeffrey Zients as well as White House Chief of Staff Ron Klain) planned to phase out any remaining
support for public health measures once all adults were eligible for vaccination.

As I’ve often discussed, one of the victims of that policy was the death of OSHA’s COVID-19 comprehensive Emergency Temporary Standard which went into White House review covering all workers and came out covering only health care workers. Feldman notes that

The agency had proposed requirements for masking, testing, and paid quarantine and isolation, among other provisions, but had become the target of various business groups. Instead, the administration went forward with a narrower rule restricted to health care workers.

Promoting mask mandates or OSHA standards covering all workers would only further inflame Republican opposition, waste political capital and cost struggling businesses.  And like many analyses of Biden’s approach to COVID, this story comes with a villain: Jeff Zients.

For his top pandemic policy advisor, Biden appointed Jeffrey Zients, a wealthy campaign donor with a background in private equity and management consulting, not public health. Zients has been known as the “ambassador to the business community” under the Obama administration.

Feldman’s most devastating critique was of the administration’s shift from public health policy to blaming the continuing pandemic on the “irresponsibility of unvaccinated people.” And while much has been made of the partisan divide between the vaccinated and unvaccinated, Feldman points out additional factors:

It’s also notable that half of unvaccinated adults didn’t vote for Trump — many did not vote at all. The unvaccinated are largely low income, uninsured, pregnant, incarcerated, and children (including those under 5, for whom vaccination has not been authorized). While vaccination rates are high for people ages 65 and up, those in their late 70s and older have lower vaccination rates than younger seniors, suggesting a lack of autonomy (i.e. needing to rely on others to access health care) may play a role. And while racial gaps in vaccination rates have narrowed considerably, huge inequalities in covid death rates remain.

Ultimately, “framing vaccination as a way to opt out of the pandemic, and understanding the unvaccinated to be political enemies, has helped absolve the administration of its responsibilities.”

Add to all this, the Administration’s conflicting messages on booster shots, severe (but predictable) shortages of home-tests and the failure of the administration to strongly promote effective masks (leaving it to personal choice) added to the chaos. The final straw for workers is the administration’s recent decision to monkey with the previous isolation guidance in order to “help ensure that businesses and schools would stay open through the wave of infection. According to Feldman, the policy can best be described as ‘go back to work or school while you still may be contagious’.”

Feldman cites Great Britain’s Health Security Agency (the British CDC) which stated “it believes CDC’s policy would allow between 10 and 30 percent of workers to still be contagious upon return.”

Feldman concludes that things could have gone better and notes the failure “of the media, the political left, scientists, and unions, to pressure the Biden administration into a course of action that would better prevent mass death.”

New York Times

The New York Times also chimed in from more of an operational, bureaucratic perspective, pointing out that no one is really in charge of Biden’s COVID response. Referring to several confusing policy changes from the CDC, the Times points out that

The episode laid bare a fundamental problem. Some of the administration’s most difficult public health decisions are essentially hammered out by a handful of senior health officials who hold roughly the same status, none of whom are in charge. They are overseen by Mr. Zients, a former economic policy adviser to President Barack Obama who is known for his logistical and planning skills but has no public health expertise. No single public health expert has the role of guiding the response, running interference between various players or standing up to the White House when necessary.

“There is no formal decision-making process,” one senior federal official said, speaking on the condition of anonymity. “Who is in charge of all this?”

CDC Director Rachel Walensky’s inexperience with the policy-making process seems to be the problem. Walensky may be one of the country’s leading infectious disease experts, but that’s not enough to be successful in her position. First, public health is different that practicing medicine. Where her career has focused on infectious diseases, public health looks at the health of a population as a whole — and more important — government policies that can improve public health.  Public policy making is an art unto itself and requires the ability to transform good public health ideas into workable and effective national policies that can be communicated to people and implemented.

Dr. Walensky’s announcement in May that fully vaccinated people need not wear a mask or physically distance from others, indoors or outdoors, was an example of uncoordinated policymaking.

Mr. Biden and Mr. Zients had indicated publicly that such a change might be coming. But some White House aides learned of the change only the night before Dr. Walensky announced it to the public, and there was no coordinated strategy in place to explain or defend it.

“It wasn’t like, ‘OK, let’s have a Zoom call tonight about the pros and the cons of the mask mandate.’ That didn’t happen,” Dr. Fauci said. Asked whether he tried to modify Dr. Walensky’s decision beforehand, he said, “You have to know the decision is being made before you modify it.”

Feldman and I have pointed to the administration’s single-minded focus on vaccines as a victory of hope over experience (and evidence). So, as the Times points out, one wonders why, if by late July, the realization that vaccinated persons could still spread Delta had forced the Administration to question their “single-minded focus” on the vaccine, they nevertheless doubled down on vaccines less than two months later.

Vaccines had been the core of President Biden’s pandemic strategy from the moment he took office. But as Dr. Walensky was briefed about a cluster of breakthrough cases in Provincetown, Mass., the reality sank in. The Delta variant, which had ravaged other parts of the world, was taking hold in the United States. And being vaccinated would not, it turned out, prevent people from becoming infected with the variant or transmitting it.

It was a “heart sink” moment, Dr. Walensky recalled in a recent interview. The discovery called into question the Biden administration’s almost single-minded focus on vaccination as the path out of the pandemic. And it made Mr. Biden’s July 4 message that the nation had moved “closer than ever to declaring our independence from a deadly virus” sound naïve.

What it all means

Public policy making is never easy, even in quiet times.  The past year has been even harder than normal: The administration had to jump headfirst into the biggest public health crisis in a century, following a disorganized, disinterested Trump administration that was not just incompetent, but hostile to basic public health principles.  There’s always a steep learning curve coming into the jungle of national policy-making at the beginning of a new administration and it’s even harder when many of the people you need to work and build close relationships with are only visible on your computer screen.

Nevertheless, new administrations in the middle of crises are not allowed to have the same lengthy learning curves as in normal times.  In fact, some would argue that over the past year, there’s been very little sign of any learning at all.  Man of the main actors (like Walensky) may have been new, but but Washington DC (and the country as a whole) is overflowing with knowledgeable experts who have had experience in government policy-making who could have been consulted with —  and listened to.  For the most part, they weren’t. For example, in the area of worker protection,  there was a shocking lack of consultation with workplace experts in labor unions, schools of public health, and government agencies like OSHA and NIOSH.   The White House (or CDC) knew best. Period.

Now, a year later, we’re still reaping the whirlwind — especially workers. Let’s hope the White House is also looking back over the last year and learning the important lessons.

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