Fireside chats, hard-hitting ads, owning mistakes: 5 experts lay out how America should wage an effective COVID-19 fight

  • A new administration led by President-elect Joe Biden is starting soon, promising a vastly different approach to the coronavirus pandemic.
  • Five public-health experts say there needs to be an aggressive all-hands-on-deck approach to get the virus under control.
  • Strategies they suggest would partly borrow from the playbook used to discourage tobacco use, including scaring people with real-life stories of COVID-19 survivors.
  • Visit Business Insider's homepage for more stories.

America is getting a new president and a shot in the arm by way of the coronavirus vaccine, but a return to some semblance of normality is far off since the US still lacks an effective strategy for handling a runaway pandemic that it was woefully unprepared for.

The country now faces a grim winter holiday season. Healthcare workers are burned out, drug overdoses have increased, businesses are shuttered, millions are jobless and hungry, and children are struggling with virtual learning. Grimmest of all: 320,000 people and counting are dead. People of color and older adults have been hit hardest. 

"These are the ramifications of all of the unpreparedness and poor decisions to this day, which continue," Richard Carmona, who was the surgeon general in the George W. Bush administration, told Insider.

Once Joe Biden becomes president on January 20, he'll inherit the Trump administration's disjointed approach and have to figure out a new strategy to get the pandemic under control. His team has released a plan for his first 100 days in office that includes signing a mask mandate and vowing 100 million shots will be distributed, enough for 50 million people.

"My first 100 days won't end the COVID-19 virus — I can't promise that," Biden said at a December 11 event in Delaware. "But we did not get in this mess quickly, we're not going to get out of it quickly. It's going to take some time."

Five public-health experts told Insider it would take an aggressive all-hands-on-deck strategy to pull the US out of the mess it's in.

It would have to include a massive vaccination effort, fireside chats, public-service announcements featuring trusted leaders, and even scaring people with real-life anecdotes that shock them into taking the virus seriously.

Keep doing what's working

The experts Insider interviewed said the Trump administration overall did a poor job addressing the pandemic but credited the president for pushing government agencies to move quickly on a vaccine. The Food and Drug Administration has approved two coronavirus vaccines and will probably give the green light to more.

But the experts also acknowledged that the public pressure Trump put on scientists damaged his efforts because it made people distrust the vaccine, with many polled saying they consider it unsafe and rushed for political reasons.

As he received his shot on Monday, Biden said the Trump administration deserved "some credit" for fast-tracking the vaccine.

Soon, Biden's team will be in charge of finishing the job Trump started, and a lot can go wrong from the time a vaccine is manufactured to when a shot makes it into people's arms. 

"In our lifetimes, we've never faced a pandemic of this severity," Rear Adm. Boris Lushniak, the former deputy surgeon general during the Obama administration, told Insider. "We've also as a nation, have never mounted a national vaccination program of this high level."

Mass coronavirus vaccinations are a huge logistical challenge in terms of getting vaccines to the right people, making enough of them, keeping them stored properly, and making sure they don't expire.

"Every step along the way is a danger point," said Lushniak, who is now dean of the Maryland School of Public Health. 

One thing he wouldn't change about the vaccine rollout? That the Trump administration tapped the military to oversee the logistics. Carmona agreed.

"There is nobody in the world that has the logistical capability like the US military," said Carmona, who served in the Army early in his career. "They're used to moving thousands of trucks and cars and planes and hundreds of thousands of troops and drugs and food to support our soldiers, sailors, airmen, and public-health officers around the world."  

'Targeted restrictions,' rather than a national shutdown 

Not everyone will get a vaccine right away. Front-line healthcare workers and people who live in nursing homes are first in line.

Scientists still don't know whether people who get vaccinated can still infect others. That means Americans can't yet say goodbye to social distancing, wearing masks, thorough handwashing, and state-ordered shutdowns.

"People have to do more than they've been doing," said Eileen Crimmins, a professor of gerontology and sociology at the University of Southern California.

Her research has found that people are willing to wear masks at the grocery store but are less likely to put off gathering with their families for the holidays or other events, which leads to a surge in infections.

Health experts say the federal government should scale up its guidance to state and local health departments. For months the Trump administration instead let states take the lead while the president and his political appointees interfered with or contradicted CDC guidelines.

Carmona said the federal government needed to lay out "clear, focused, uniform guidance" through the CDC, specifying when states and localities should shut down. Carmona is incident commander for the University of Arizona, where he also teaches public health. He has created playbooks for dealing with different public crises, including mass shootings, earthquakes, or even a pandemic.

"Our nation responded like 50 separate countries, not like a uniform United States," Carmona said, adding that it was still appropriate for different parts of the country to respond more or less rigidly depending on their infection rates in their particular region. But the response in each area facing a surge needed to be similar, he said.

Getting the messaging right

It would be helpful, Carmona said, for a trusted official to speak directly to the country about how it should come together against the pandemic. That's what President Franklin Roosevelt did by famously holding regular fireside chats during the Great Depression and World War II.

The messaging wouldn't always have to come from the president. It can be from scientists or other officials, Carmona said. The federal government should work with lawmakers and governors, he added, to carry the same message, model the behavior they want the public to follow, and explain to people how to end the pandemic together.

"It's about regaining trust, positive messaging, staying engaged, using influencers, using every possible modality, social media, newscasts, and so on with a common message," said Carmona, who lost a 2012 campaign for the US Senate as a Democrat in Arizona. 

Peter Sandman, a longtime risk-communications consultant, said top officials at the CDC should hold regular press conferences and run a vaccination ad campaign.

"I don't begin to know exactly under what circumstances you get Donald Trump to make a pro-vaccination PSA, but it's not out of the question," he said. "And there's a huge audience for whom that would be very meaningful."

Since the November election, more Americans have said they're willing to get a vaccine, according to a recent Gallup poll. But Sandman said some people would remain skeptical, and the federal government won't necessarily be the best entity to win them over. That's especially the case if they voted for the losing party or have a long-standing distrust of the government.

Instead, Sandman said, federal leaders should tap educational groups, religious leaders, or local politicians to deliver the vaccine message to their communities. People listen to their doctors, friends, and neighbors, he said. 

"There needs to be a campaign, but I'm not looking for one massive campaign," Sandman said. "I'm looking for lots of campaigns that are informed by our understanding of how specific audiences are likely to respond." 

One way to do it would be to have people tell stories about how they didn't think the virus was a big deal so they took a risk — such as going to a party or a rally — but then ended up in the ICU, barely living to regret it. 

"All the available social science says if you've got an audience that's not frightened enough about COVID-19 then it will be useful to frighten them," Sandman said. "And, to be sure, people are more frightened by images and anecdotes than they are by statistics." 

A similar strategy about the dangers of tobacco has been used successfully to reduce smoking rates.

Admitting mistakes

No one in charge of public-health policy today has ever had to deal with anything as severe as the coronavirus pandemic, and there will likely be mistakes.

"I've never seen anything like this," Lushniak said. "And, historically, you have to go back 100 years for our nation to have seen something like this. That's the reality. We're learning as we're doing."

Admitting mistakes hasn't been a big part of the Trump administration's playbook, and experts told Insider that it should have been, since little was known about the novel coronavirus. It would have helped to build public trust, they said.

Gen. Gustave Perna, the four-star general overseeing vaccine distribution to states, surprised the public when he recently took the blame for the fact that some states wouldn't receive as many doses of the vaccine as they expected. He apologized for the problem during a press conference on November 19.

"This is a Herculean effort and we are not perfect," he said. "The key is to be transparent and to openly communicate at all levels, step by step."

Sandman said that kind of mea culpa is key to building public trust. It's worse for officials to try to cover up a screw-up and have the details leak later, he added.

"It wasn't big news that he screwed up," Sandman said of Perna. "It was big news that he said he screwed up."

Massively ramp up testing and contact tracing

If there's one thing that Crimmins wishes had happened early in the pandemic to protect older adults, it would be "testing in nursing homes — testing, testing, testing, testing."

The delay in mass testing and contract tracing is perhaps one of the biggest failures of the US's handling of the pandemic.

While testing has improved, it's still not as widespread in the US as public-health experts recommend. Ideally, people would know their status before they head to work or spend time around people outside their households.

People would also have an inexpensive spit test they could take at home, Lushniak said. The next-closest level to that should be that people would have easier access to testing through their doctors and other healthcare providers, and would find out their results quickly — within hours, not days, as is still the case for most tests.

The federal government could help the country get there. The FDA in November approved an at-home nasal-swab test that provides results within 30 minutes. But people still need a doctor's prescription to take it.

As cases start to go down, the federal government could use contact tracers to find hot spots, Lushniak said. (He helped with the Ebola response in Liberia.)

"In the midst of all this right now, I can't even imagine that contact tracing is playing any role, but as we get better at this, it's going to play a critical role," he said.

Pass another coronavirus stimulus

The $900 billion coronavirus aid package that Congress recently sent to Trump's desk would not be nearly enough to help struggling businesses, laid-off workers, and hungry families. More aid is necessary.

Congressional leaders and Biden have promised another stimulus, and experts say it's an opportunity to improve the federal response, whether through boosting domestic production of medicines or improving data collection, including on the so-called long-haulers.

Anita Chandra, the vice president and director of Rand Social and Economic Well-Being, said that anecdotal reports show that some people continue to have symptoms long after being treated for COVID-19, but there's limited data on those cases. She said it was important to get better data on the effects of coronavirus based on race, ethnicity, and preexisting illnesses.

Chandra added that it would also be important for politicians to look at public-health funding and reforms alongside economic and social recovery. The goal would be to help health systems respond faster when there's another pandemic, but also to improve prevention and health, social, and economic well-being.

"The level of health and morbidity that we had in this country pre-COVID certainly didn't help us any," Chandra said. "Now our response has not been where it should have been. And there are a lot of things that we could have done differently, but we can't discount our general health fundamentally." 

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