First the Pandemic

Dear President-elect Biden,

First, congratulations on your recent election victory.  Your presidency arrives at one of the most pivotal moments in the history of our country.  Changing the course of the COVID-19 pandemic will shape the initial stages of your presidency and offers real hope to re-instill confidence and pride in our nation and in our government.  

Your credibility as a leader, and indeed the United States’ credibility as a leading nation and global power, are at stake. Also at stake is our collective prosperity. Real economic progress – job growth, wage growth, the survival and success of countless small businesses – depends on getting this virus under control.  

Notwithstanding the many issues competing for your attention in the first days of your Presidency, it will be critical to focus all your energies and many faculties of the federal government on the response to COVID-19 as the cornerstone of your domestic agenda.  Begin by reinvigorating and significantly expanding our public health service corps.  Widen the scope to include community and lay health workers who can assist medical providers in distributing the vaccine, contact tracing, testing and ensuring treatment availability. All options ought to be on the table, including federal assistance, loan forgiveness, and other incentives to enlist a much wider swath of the public in the response.  With burnout in the clinical workforce at unprecedented levels and a long winter ahead, we need a standing army ready to mobilize to support the frontlines in this battle and to tackle future threats and outbreaks in the years to come. 

Simultaneously, authorize and use the Defense Production Act (DPA) to radically scale-up the production and distribution of personal protective equipment (PPE) and other necessary supplies. Leverage the military’s supply chain and logistics expertise to get ALL supplies – vaccines, tests, proven treatments, PPE – to everyone, everywhere, at once.  Our health care workforce is at the breaking point. COVID-19 has exacerbated an existing crisis of burnout among health professionals. They need our support, but much more importantly, they need action. Authorize a national bonus payment to all health care workers in recognition of their sacrifice and their commitment. And invest in the overlooked, underfunded parts of our health system – the nursing homes and other long-term care facilities; the community clinics; the primary care centers; and the pieces of the safety-net that so many depend on.  

The approach to nursing homes, in particular, needs to be fundamentally re-examined.  The traditional approach of providing guidelines, inspecting, and disciplining those that are under-performing has failed.  We need careful analysis of root causes of under-performance and thoughtful policy options that would create opportunities for continuous improvement of the system. A model for a different approach might be found in the AHRQ-ECHO National Nursing home network that is presently bringing much needed COVID-19 knowledge and implementation advice to over 8000 nursing homes nationwide. 

And lastly, use this moment to demonstrate for all to see that the inequities that plague every aspect of our society will no longer be tolerated. Every decision on how to defeat COVID, and every policy decision thereafter, must be informed by clear answers to the questions: Who benefits? and Who gets left behind?  

With these measures, you will simultaneously resolve the greatest threat to American lives and American livelihood in recent memory and mobilize the bipartisan confidence and support needed to pass additional aspects of your domestic and foreign policy agenda.