Rae Woods:
From Advisory Board, we're bringing you a radio advisory. My name is Rachel Woods. You can call me Rae. Tomorrow, Joe Biden will be sworn in as the next president of the United States, and he will have a lot of work ahead of him. There's shoring up the economy, addressing climate change, and doing that during an environment that's politically maybe even more divided than it's ever been. And obviously, he will also have to focus on fighting the biggest healthcare crisis of our time, COVID-19.

Rae Woods:
To talk about Biden's COVID-19 plan, I've brought back strategy expert, Christopher Kerns, and also policy expert, Yulan Egan. Hey, Christopher. Hey, Yulan. Yulan, you're officially now a veteran of the pod, right? First time, just before the end of the year, and now, you are going to be a regular guest, I guess.

Yulan Egan:
Yeah. Thanks for having me back.

Rae Woods:
No pressure, Christopher on getting you on some of the more advanced equipment that you and I have earned over the last 10 months or so.

Christopher Kerns:
Oh, that's true. We need to get her a solid ASMR mic, too.

Rae Woods:
Add it to the expense list.

Rae Woods:
I want to dive in to do a bit of an update on where we stand when it comes to the battle against COVID-19. It's actually been a while since we've talked explicitly about the pandemic on Radio Advisory. We are just over two weeks into January, after a lot of Americans gathered indoors for the holidays, despite recommendations not to. Where does that actually leave us when it comes to the impact of COVID-19?

Christopher Kerns:
Well, most of the places that we've been talking to, most of the providers who we've been talking to have not said they've seen a significant spike since the holidays, but they have seen a continued upward rise, so the increase in cases still persists. Closing in on 3,500 daily deaths, still hitting new records, new records for cases, so we are still seeing an increase despite the vaccinations that have been deployed across the country.

Rae Woods:
I do think it's easy to get a little bit numb to the numbers that we've been releasing since March, right? 3,500 deaths a day is a really big deal. And at the same time, we're battling a new, very highly transmissible strain of this virus. Where does that leave hospital capacity?

Christopher Kerns:
Pretty strained across the board. When we look at ICU utilization rates across the country, they're all well above normal, but they do range from the low 40s, which was the last numbers that I saw for Wisconsin, to nearly 90% in states such as California and Texas, Oklahoma and Georgia, which is at 91%. So we are seeing quite a bit of utilization, and just about every region of the country is feeling pretty significant strain, which places a lot of strain on resources to deploy across state lines. Back at the beginning of the pandemic, you saw states like New York, Michigan, Louisiana, they were able to draw on nursing staff and supplies from other parts of the country. That's just not possible this time around.

Yulan Egan:
Yeah. I live in Los Angeles, which is the county, which has, I think, some of the highest per capita case counts and death rates right now. And what we've seen here is that bed capacity has certainly been strained for the past few weeks. We've been running into staffing shortages. The new thing we've been hearing, though, is actually a need to limit oxygen, so it's been interesting to see, I think, how different supplies have run short at different stages across the pandemic, and that seems to be the latest concern.

Rae Woods:
And this is obviously a huge problem for everyday Americans. It is a problem for our hospital and health system leaders, but it's also going to be a huge challenge for the Biden administration, which obviously has a very difficult set of challenges ahead. When it comes to COVID-19, do we have a sense of the first steps that the Biden administration will take tomorrow?

Yulan Egan:
Well, I think they've already started, to a large extent. This is one of the first things that the Biden team got started on after the election, and the first thing they did was to assemble a transition team. More recently, I think they've started to name kind of more permanent folks who are going to be leading this, at least for the next couple of years, so we're starting to get more and more healthcare appointments, including some positions that are specifically focused on pandemic response.

Rae Woods:
Let's talk about that a little bit more. Who do we actually know is on the team?

Christopher Kerns:
Well, the most prominent person on the team right now of course is Jeff Zients, who should always point out is a former CEO of Advisory Board. Was also responsible for fixing the ACA exchange website several years ago and is now tasked with fixing the federal government's response to the COVID crisis.

Yulan Egan:
I think we're also seeing Dr. Fauci being elevated to a slightly more prominent position. Also seeing Vivek Murthy come back to the role of surgeon general, so not a COVID-19 specific role, but he's been pretty explicit that in the early days, he's going to be very, very focused on vaccine rollout.

Rae Woods:
And then, of course, last week, Biden also announced that he was picking the former FDA chief, Dr. David Kessler, to lead the vaccine effort more specifically. When we look at the kind of permanent members of the team that are going to be on the forefront of battling COVID, is there anything, based on their past behavior, based on what we know about them as people and as leaders, that kind of change the way we predict how the Biden administration is going to go about combating this disease?

Christopher Kerns:
We know that one of the advisers to the COVID team is, of course, Zeke Emanuel, who has advocated for pretty strict lockdowns, economic lockdowns across the country. And there is an expectation among many that there will be more mandates, such as a mask mandate. It's a little unclear as to whether or not the federal government will be able to actually enforce any sort of mandate or whether they would want to take the political hit for doing so, just given the unpopularity of such a move in lots of different parts of the country. But I think you can expect more stringent guidelines and more specific guidelines coming out from the feds.

Yulan Egan:
There are two things that really jump out to me if I look at the announcements and the appointments thus far. One is that there are a lot of familiar names, so to a certain extent, I think there's a desire to kind of project stability during this time. The other thing I think we're seeing is a lot of clinicians and a lot of scientists, so I would imagine that we're going to continue to see that emphasis and potentially just hear a lot more from the administration about pandemic response, much in the same way that we were hearing a lot from the Trump administration in the initial days of the outbreak.

Rae Woods:
And Yulan, you mentioned that some of the first steps that the administration is going to take have happened already, even before January 20. I think the other one is, of course, that Biden also unveiled a $1.9 trillion spending package last week. And this is for the direct impacts of the pandemic, but also the indirect impacts, like the economic downturn. Let's talk about what that spending package means. What are the big areas of focus?

Yulan Egan:
From a healthcare perspective, there was a big emphasis on vaccination and testing, so dedicated funding for both of those efforts. Actually, even more funding, I think, for testing, than he wants to set aside for the vaccination efforts. And then, as you said, a lot of focus on the economic effects, as well, so more relief for state and local governments and more relief for individuals.

Christopher Kerns:
I think there's also more funding for centralizing the distribution of the vaccine, so the current strategy is to distribute the vaccine doses to the various states and then leave it to the states to distribute among their population. I think, at the very least, we're likely to see more centralized guidelines for exactly how that distribution should look. There are some guidelines now, but I think we can expect a great deal more specificity and potentially some more funding for the actual distribution efforts themselves.

Rae Woods:
I think that's right, and I know that the kind of formal announcement of the plan happened last week, but that's something that the three of us, and I'm sure many others, could have guessed would come out of a Biden administration that would be very different from a Trump administration. When it comes to a more centralized approach, you mentioned guidelines. But what else might that mean in practice compared to what we've seen thus far?

Yulan Egan:
A lot of what we're going to see is focused on more funding, more communication, more forceful recommendations and guidelines. I'm not actually convinced we're going to see all that much more in terms of nationwide mandates or restrictions or things of that nature. That was something that Biden talked a lot about in the early days of his campaign, but he's really kind of backed off of that language across the past few weeks and months.

Rae Woods:
Yeah, and that's something that I will admit has really been keeping me up at night because I know that any sort of lockdown would have a pretty dramatic impact on especially those independent physician practices that are just trying to weather the storm.

Christopher Kerns:
Yeah. Let's remember that the amount of money that was put into the provider relief fund was actually relatively small in the last round of COVID relief that was passed at the end of the year. So unless they want to significantly up the amount that they would include in that, I think that locking down cases, locking down economies is going to be very, very difficult for the Biden administration to do.

Yulan Egan:
But I think it's actually telling that we didn't hear, I think, any talk really about sort of a nationwide lockdown. If anything, there was a lot of focus on the need to reopen schools in particular. That's something that the Trump administration has obviously talked about quite a bit. It's been a bipartisan area of focus, but that was more of the focus last week on reopening as opposed to further lockdown.

Rae Woods:
Alongside the plan that Biden outlined, we also saw, again, ahead of January 20, that Biden announced he would move to release all vaccine doses. And this is part of the goal to just speed things up, which comes back to Christopher, your comment of a more centralized approach. My question for both of you is do you think this is a good move?

Christopher Kerns:
I have to say, it kind of surprised me at first that they would want to release all of the doses because that would mean there's a great deal of confidence that manufacturing will make up the doses that would be deployed right away for the second dose that will be required within a few weeks. I suspect that the Biden administration would not take such a move unless they had a great deal of confidence in the manufacturing capacity to supply the extra doses that will be needed.

Yulan Egan:
And in fact, I think earlier this week, the Trump administration actually made a similar announcement that they would be releasing more of the doses, so I think the fact that we're seeing that coming from both the Trump team, as well as the Biden transition team, is pretty telling. And I would underscore what Christopher's saying. I doubt that both teams would be pursuing that strategy if they didn't have pretty strong evidence that it was a good idea.

Rae Woods:
I think that's right. I can definitely play both sides of this here. I have been pretty vocal about my general pessimism around the vaccine rollout process, so I'll admit that my fear is that more doses out means more opportunities for things to go wrong, especially when it comes to kind of spoiling doses if they aren't kept at the appropriate refrigeration and so on and so forth. But I agree with the big picture push that if we're going to get ahead of this thing, we just have to get as many people vaccinated as possible.

Christopher Kerns:
And I think part of the logic here is that the number of people who have been getting vaccinated is less than a lot of people would have expected.

Rae Woods:
That's right.

Christopher Kerns:
And convincing enough people to take the vaccine has been a pretty significant challenge as we've talked about before. So I think part of the logic here is to expend the number of doses that are out there just so that people who really want to get vaccinated can get vaccinated as soon as possible.

Rae Woods:
And we are going to be coming back on the podcast next week with Brandi Greenberg and even a new voice to talk about that vaccine rollout process here in the United States, as well as on the global stage. We've talked about a more centralized approach when it comes to things like funding, providing consistent guidelines, even maybe consistent distribution of the vaccine. And I think in general, that's kind of a welcome approach, both for vaccination and for testing. But I do have to believe that there are some areas where a state-based approach might still be the right answer. Are there areas where the Biden administration would still pursue this kind of state-based approach?

Christopher Kerns:
I think in states where we are seeing significant vaccination rates or solid vaccination rates, there's a sense of don't fix it if it ain't broke. So I think we are likely to see states that have been making significant progress be allowed to do so is my suspicion.

Yulan Egan:
And I think this is probably one of the biggest reasons that we're probably not headed for a nationwide lockdown. One thing that we've seen since the beginning of this pandemic is that it tends to sort of move around geographically. Different markets and different states tend to be hotspots at different times.

Rae Woods:
That's right.

Yulan Egan:
So I expect when it comes to kind of locking down businesses, when it comes to canceling electives, a lot of that will continue. A lot of those decisions will continue to be made at the state and even county level.

Rae Woods:
And let's, maybe, I'm going to knock on wood as I say this, but let's hope that the kind of truly national crisis that we are seeing with COVID right now is something that is temporary because that is really the first time we've seen rates, ICU bed utilization, et cetera, be this bad across the US, as opposed to in the specific hotspots.

Christopher Kerns:
Exactly.

Rae Woods:
We've spent a fair amount of time talking about what would be new in a Biden-led administration. But I do think it's important to remember that the new administration is probably not going to just throw the old playbook out the window entirely. Are there areas where the Biden administration will continue the same approach as the Trump administration?

Christopher Kerns:
Well, I think one area would be in ensuring sufficient PPE, so approaches that allow for more domestic production, for example, or require greater stockpiling. I think those are going to continue. I think you can also expect some similar guidelines around who gets the vaccine first, so focusing on the most vulnerable populations and then working their way into the least vulnerable populations, so I think that's likely to be maintained in the Biden world, too.

Yulan Egan:
Yeah. This is a question I've thought about a lot across the past few months. And I think it's very possible that if Biden had been president when the outbreak first started, he might've approached things slightly differently than President Trump did, but it's very different to inherit or walk into a crisis midway through than it is to kind of grapple with it from the very beginning.

Rae Woods:
And I think that's why, up to this point, we've seen kind of expected moves that I think more reflect just how the Democratic Party chooses to do things compared to Republicans. I guess a kind of follow up to that is, is there actually an area where Biden is truly throwing out the playbook and starting anything from scratch?

Yulan Egan:
I don't know that I can really think of one, to be honest.

Christopher Kerns:
And I don't know if he would even want to do so at this point. There is a real value in a certain level of continuity, given that there have been a whole slew of government responses across the course of the last year. And one could argue that some have been more effective than others, but as Yulan mentioned, you don't want to completely upset the applecart midway through the stream, if I may use very clunky mixed metaphors there.

Rae Woods:
Especially when things are this bad, perhaps.

Christopher Kerns:
Exactly.

Rae Woods:
That said, I think it is safe to assume that at least some change is going to be coming in the way that we fight this virus. How soon can we expect some of those changes to take place?

Christopher Kerns:
Well, there's one change that we can expect to take place right away. And if I may say so, probably a great deal more consistency coming from the president himself because that is something we just didn't see at the very beginning of the pandemic last time. And I think, if anything, we're likely to see a lot more consistency coming from the remarks from President Biden because if there was one consistent and completely fair criticism of President Trump, it was inconsistency in his own comments.

Rae Woods:
How about when it comes to how quickly we'll see some of the potential changes that Biden announced as part of his plan last week?

Yulan Egan:
The funding changes, I think, will take a little bit of time because those do have to go through Congress. And I think one of the things we're going to be watching for is whether Congress manages to pull this off on a bipartisan basis, which is what Biden said that he would prefer in his remarks last week, or whether Democrats have to pivot to the budget reconciliation process to get this across with a simple majority. I think we'll learn very quickly what the tone of those conversations is going to look like, but it's going to take a little bit of time regardless.

Christopher Kerns:
I will say that so far, a lot of what we've been hearing from the Republicans has been pretty muted, so I think they are weighing what kind of response they want to provide here. And if anything, the response that they come back with is likely to be more of degree than kind. So should we spend this much, or should it be this much less? But I don't think it's going to be significantly different in the approach.

Yulan Egan:
Yeah, and keep in mind with anything that we're watching coming out of Congress, that they're going to have a full plate. They're going to have a busy schedule. They've got to confirm Biden's cabinet nominees. They also potentially are going to be grappling with impeachment hearings. And we're already hearing conversation about how do we divide up the schedule between those two objectives? So once you add in COVID-19 relief to that mix, it's going to be a packed first few weeks for Congress.

Rae Woods:
That's right.

Christopher Kerns:
And those impeachment hearings, or I should say the impeachment trial, could certainly delay any of the legislation getting to President Biden's desk, so that's something we just need to watch for.

Rae Woods:
Hmm. Well, Yulan, Christopher, thank you so much for coming back on Radio Advisory. You know at this point what my final question is going to be. What do you want Radio Advisory listeners to be focused on this week?

Yulan Egan:
Yeah, so I know inauguration's obviously tomorrow, and a lot of us are going to be watching that pretty closely. I'm also going to be watching very closely to see what conversations we're hearing coming out of Congress. With all of the events of the past few weeks, we're hearing that there are some interpersonal tensions within Congress right now, and those divides aren't necessarily partisan. There's some tension between, for example, those who voted for certification and against, and that didn't break down cleanly along party lines. Those types of tensions, I think will play a very important role in what we see, not only for COVID-19 relief, but healthcare reform more broadly.

Rae Woods:
Yeah.

Christopher Kerns:
I'm in Washington, DC. This entire city is on edge on what could potentially happen on Wednesday. I am hoping that everything goes smoothly and that we have a smooth and peaceful transfer of power. If we do not, I imagine that is what everyone will be focused on. But when you ask me, what do I think people should be focused on, well, what I hope that they are focused on is continuing to get as much of their population vaccinated as possible. That is by far the biggest priority, in addition to caring for the people who are already infected. I hope that is all that we really have to focus on, at least for the next week.

Rae Woods:
Well, Yulan, Christopher, stay safe out there.

Yulan Egan:
You too.

Christopher Kerns:
Stay healthy.

Rae Woods:
I mentioned this last week, but it's certainly still true today. Change is coming in healthcare, whether it's a centralized approach to vaccinations and testing or different health policy coming out, maybe even the differences in funding for hospitals versus physician groups. And when those things happen, you'll be sure to hear about them right here on Radio Advisory. And until then, remember, we're here to help you.