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Biden is battling a pandemic that has killed nearly 600,000 Americans and still infects about 60,000 people a day. It is moving forward with a national immunization strategy, an equity task force for reaching vulnerable communities and regular briefings on Covid by experts like Anthony Fauci, the leading infectious disease physician. of the government. The success of this strategy will determine how quickly American life and the economy will return to some semblance of normalcy.

Vaccination remains the centerpiece of the response – and Biden urged Americans to get vaccinated in his speech to Congress on Wednesday night. The gunfire helped bring the death toll from more than 4,300 a day in January to around 700 now. “This is message number one,” Andy Slavitt, senior advisor to the White House Covid response team, told POLITICO.

In the best-case scenario, public confidence in the shootings will continue to increase, especially among the most vulnerable, including minority groups the administration seeks to reach. Federal, state and local public health officials will quickly deploy extensive tools such as rapid tests, wastewater monitoring and contact tracing to spot and contain new outbreaks before they trigger a larger wave.

New antiviral drugs, already in development, may become available in the foreseeable future, so those infected could be treated at home before they become seriously ill.

“I don’t think we’re going to flip a switch and make this go away,” said Scott Harris, Alabama public health official. His condition is still eroding high levels of vaccine reluctance, including among rural Republicans. But he says state epidemiologists know how to identify and respond to epidemics, whether it’s an old enemy like the flu or a new danger like Covid.

But while Biden can push vaccination, testing and tracing, he can’t control what’s going on in other countries or what the ever-evolving virus is doing. And he can’t control what Americans are doing who are resistant to vaccines and avoiding masks. Even if the country is “close to normal” by July 4, as Biden envisioned, everything could still turn badly on Labor Day or Thanksgiving.

“We’re on that precipice,” said Rachael Banks, director of public health in Oregon, who has seen her daily cases triple in the past month, even though nearly a third of the population has been fully vaccinated. .

BIden celebrated the progress in his speech, referring to images of grandparents hugging their families “instead of pressing their hands against a window to say goodbye.” But he was frank about the lingering threats. “There is still work to be done to defeat this virus,” Biden told the country. “We cannot let our guard down.”

As the Biden administration celebrates the administration of 220 million vaccines and making everyone 16 and over eligible for vaccines, vaccinations have declined over the past three weeks. Some states have such an overabundance of vaccines that they do not order new allocations from the federal government.

With vaccination slowing down and many people feeling overconfident, Public Health 101 is at risk of being undermined by Virus Politics 2021.

Biden overestimated his ability to unify the country, to get Americans to “hide” patriotically for 100 days. Today, governors are reopening their economies, even in states with low vaccination rates and against the advice of the Centers for Disease Control and Prevention. Virus skeptics still avoid masks and social distancing. Americans tired by the crisis are starting to travel again.

That’s understandable, as things are improving – deaths, hospitalizations, and cases have all dropped in those first 100 days. Schools are reopening, but not as fast as Biden had promised shortly after his election. Everyone wants to move on. But it perpetuates the risk.

“We’re not out of the woods,” said Julie Morita, executive vice president of the Robert Wood Johnson Foundation and former Chicago health commissioner, who advised Biden on the pandemic during the transition.

Some Republicans, whose ranks have largely downplayed the Covid threat, now say the virus is fundamentally defeated, even though public health experts recommend constant caution. “The coronavirus is on the run!” Senator Tim Scott (RS.C.) said in the GOP response to Biden’s speech, adding that the president had “inherited a tide that had already turned” under former President Donald Trump.

Progress is unlikely to follow a straight line and new hot spots continue to emerge. All eyes were recently on Michigan’s soaring number of cases. It’s improving now, but the state, with 3% of the U.S. population, still accounts for nearly 10% of the nation’s new cases. Colorado counties with the lowest vaccination rates are experiencing spikes in infections. Washington state’s case rate has doubled in the past month.

With its emphasis on vaccination, the administration recently launched its Covid-19 Community Corps, a group of volunteers that draws from many social, religious and business sectors to amplify the message around the safety and effectiveness of vaccines.

The Federal Emergency Management Agency has set up community vaccination centers and dispatched mobile vaccination units to vulnerable populations in rural and tribal areas with little medical infrastructure. The vaccination campaign has encountered many obstacles, including the mess surrounding vaccine manufacturing partner Johnson & Johnson, but it is still making progress.

Some people can still avoid the shots, Slavitt said, but it is the government’s job to make sure that “everyone has access, that there are no barriers” no matter what. decision they ultimately make. The White House is also working with employers and businesses to strengthen safety messages and create incentives, like paid time off to get vaccinated.

Vaccination is the best tool, given the scale of the US pandemic and the country’s resistance to masks or more drastic measures like lockdowns. But vaccines alone are not enough – not in a country where millions of people insist on not getting vaccinated and where millions more regularly struggle to access care. Social distancing, masks in many contexts and related measures will always be necessary.

“We’re going to be constantly concerned about potential outbreaks in the future at the local level as long as we have large pockets of population that aren’t vaccinated,” said Angela Rasmussen, an affiliate virologist at Georgetown University and Vaccine and Infectious Disease Organization-International Vaccine Center, which sees both progress and a need for ongoing public health measures. “I’m worried about the winter, when it’s cooler and people are going inside.”

Biden’s Covid narrative would then be turned upside down, especially if epidemics threaten the rituals and family time like Thanksgiving and Christmas.

Alabama offers a case study. Vaccination rates are among the lowest in the country, but Covid-19 no longer threatens the state’s health system as it did earlier this year. Yet it persists – around 400 new cases a day – and remains a potentially fatal disease.

“We feel like overall we’ve hit a plateau,” Harris said. “We are not where we would like to be, but [we’re] miles better than in January. “

His point of view is consistent with most state officials and public health experts who generally agree that things are better.

“I feel like we finally have the upper hand,” said Marcus Plescia, chief medical officer of the Association of State and Territory Health Officials. “We have two extremely effective vaccines. … We started to vaccinate people better than I expected.

In West Virginia, which has performed well on immunization but continues to suffer from hesitation, Health Commissioner Ayne Amjad reflected on how to communicate with the public, especially in the next phase of reducing epidemics before they trigger surges.

The phrase “contact tracing,” she noted, made people fear their privacy had been violated. She prefers “Covid Support Services” or saying “let me call your family or friends you’ve been with.” “Warp Speed,” the description of the government’s vaccine accelerator, scared people into thinking the injections were created too quickly. Vaccine “deliberation” is better than “hesitation”.

“Language matters,” she says. “You can’t convince someone by arguing with them or telling them they’re stupid.”

Beyond that, some experts worry that the CDC’s guidance to states regarding the reopening of schools and businesses is not specific enough.

“We’re going to face big tests when we try new steps towards reopening – big events, back to school,” said Mark McClellan of Duke University, a former FDA commissioner under President George. W. Bush. “We must be vigilant.”

Raising awareness among minorities has also not achieved its objectives. They are always vaccinated at a disproportionately low rate. And they tend to live in densely populated areas where the virus can spread quickly.

“You are battling centuries of systemic barriers, and to assume that we would close the gap immediately would be naive,” said Shereef Elnahal, CEO of Newark University Hospital, NJ, and former state health commissioner. . “That said, in terms of access, we’re not there yet for communities of color.”

Banks, director of public health for Oregon, also believes that access remains more of an issue than demand in communities of color. If this is not resolved, a slow-burning Covid epidemic in these communities, long underserved by the health system, could add an additional layer of persistent inequality in health care.

“It is heartbreaking to see these inequalities unfold before our eyes,” she said.

And while the Biden administration, working with state and local authorities, manages to overcome all of these national challenges, uncontrolled outbreaks in Brazil, India and parts of Europe threaten prospects in the United States.

“There is this mid-term uncertainty as to whether there will be a variant that is now or is coming that really escapes vaccines,” said Marc Lipsitch, an epidemiologist at Harvard University.

However, it’s hard to live with the uncertainty, it’s better than the chaos and crisis of a few months ago, experts say. Amjad knows things can still go wrong, but she always sees progress. “A year ago,” she said, “we were asking for samples.”

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