WASHINGTON — The Biden administration’s effort over the past month to develop a new Covid-19 strategy has sparked an internal debate about how far to go in lifting mitigation measures like masks and how to know when the country is entering that new phase of the pandemic.
Administration officials began a “listening tour” in early January to inform the new strategy and have been soliciting input from outside medical experts and state and local public health officials as well as consulting with governors, administration officials said.
President Joe Biden in an interview with NBC News’ Lester Holt on Thursday acknowledged there is tremendous political pressure to move beyond the current restrictions.
“Omicron and the variants, all the variants have had a profound impact on the psyche of the American people,” Biden said. “They’ve had profound impact.”
As Biden, who promised to end the pandemic, seeks to pivot to a strategy of living with the virus, his aides are grappling with how to recast federal recommendations around masking, define what benchmarks should be used to determine when this phase begins and identify what type of infrastructure will be needed for testing and drug distribution going forward, according to people familiar with the discussions.
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A risk for the administration is whether states get far ahead of the federal government, potentially causing more mixed messages about the level of mitigation needed. Since the pandemic's early days, there have been incongruent messages between federal and state governments, but as more Democratic governors opt to scale back mitigation measures at a faster rate than the Biden administration recommends, that gap is growing wider.
“What we’re really asking ourselves is how do we live with this virus that may still deliver us more surprises,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy, who was included in the White House conversations with health experts. “We have to move on and find our new normal, but we better damn well be prepared.”
Administration officials announced the development of a new Covid strategy Wednesday, saying it was part of Biden’s efforts to move the country into a new phase of living with the pandemic as public health experts increasingly believe the virus will continue circulating in some form for the foreseeable future. Officials would not disclose a timeline for when that strategy could be finalized.
“The president’s Covid plan is working,” Jeffrey Zients, the top White House Covid aide, said during a briefing with reporters Wednesday. “We’re moving toward a time when Covid won’t disrupt our daily lives, a time when Covid won’t be a constant crisis, but rather will be something we can protect against and treat.”
The effort comes as a growing number of governors are moving forward on rescinding their mask mandates. Administration officials said those moves were expected, and the federal government will follow with its own announcements.
Some federal public health officials believe the start of a next phase should be based on levels of transmission, one public health expert involved in the conversations said. Others prefer a mixed approach that takes into account test results, hospitalizations and the number of prescriptions for Covid treatments. Home testing has complicated the metrics because many cases go unreported.
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The administration is also considering what a new phase looks like inside the federal government, including whether the White House will shift more work from its internal team to the Department of Health and Human Services and determine which CDC teams will no longer be needed to work with the White House on a regular basis, redeploying some staff and having groups meet less frequently, the person said.
The administration’s new Covid strategy will also coincide with the Centers for Disease Control and Prevention's ongoing review of its guidance — including masking, schools, social distancing and the recommended size of gatherings.
“You can’t be a day late and a dollar short,” Osterholm said. “One of the things the administration is looking at very carefully is what kind of infrastructure we have to have in place, what kind of testing facilities, how we deliver drugs. Those are all things we can plan for during a period when you have low virus activity so it’s ready to go. They are doing that legitimately.”
Masking recommendations have emerged as a key point of contention among public health officials inside and outside the administration with disagreements over how and when to change guidance from the CDC.
“CDC has to move carefully and deliberately, to make sure these good trends are confirmed across the nation,” a person familiar with the White House’s thinking said. “CDC also has a responsibility to make guidance for the entire country and must consider its impact on a variety of constituencies including people who are disabled, immunocompromised and most vulnerable.”
“As we move toward this next phase, there’s a huge responsibility on them to get this right — and get it right for everyone and every community. That isn’t on these states; it’s on us,” the person said.
“We’re planning for the realities of today but also what it could bring in the future.”
An administration official said
Dr. Anthony Fauci, Biden’s top medical adviser, told the Financial Times this week that restrictions like masking could end “soon.”
Another masking question being mulled is the future of federal mandates that require masks to be worn on airplanes and buses and in federal buildings.
There is no imminent change on masking planned, according to two public health experts outside the administration and one administration official, but they all expect the push to de-mask to grow louder.
The transportation mandate expires March 18. The masking requirements for federal buildings and land lack the same expiration.
Some officials inside and outside the administration are concerned that if mitigation efforts are discarded, it will be difficult to get Americans to return to them if needed in the future. The new Covid plan would be accompanied by public messaging to caution that any mitigation efforts that get rolled back could be reimplemented if another surge or variant emerges, an administration official said.
It also would be buttressed by tools that are now more readily available, such as testing, high-quality masks, Covid treatments, vaccinations, booster shots and military efforts to help overwhelmed hospitals, the official said. The administration can “dial up and dial down” its Covid response effort if needed, the official said.
“We’re planning for the realities of today but also what it could bring in the future,” the official said.