Dr. Céline Gounder, adviser to Biden, on the next COVID attack plan
By Apoorva Mandavilli
When President-elect Joe Biden takes office in January, he will inherit a pandemic that has convulsed the country. His transition team last week announced a 13-member team of scientists and doctors who will advise on control of the coronavirus.
One of them is Dr. Céline Gounder, an infectious disease specialist at Bellevue Hospital Center and assistant professor at the New York University Grossman School of Medicine. In a wide-ranging conversation with The New York Times, she discussed plans to prioritize racial inequities, to keep schools open as long as possible, and to restore the Centers for Disease Control and Prevention as the premiere public health agency in the world.
The incoming administration is contemplating state mask mandates, free testing for everyone and invocation of the Defense Production Act to ramp up supplies of protective gear for health workers. Indeed, that will be “one of the first executive orders” of the Biden administration, she said.
Below are edited excerpts from our conversation.
Q: Tell us about Mr. Biden’s COVID advisers. Who is doing what?
A: The coronavirus task force is the team the vice president leads within the current administration. I’m a part of the Biden-Harris advisory board. Then there’s the internal transition team, which is much bigger. The transition team has been developing a COVID blueprint, the nuts and bolts of the operations, and this is something they’ve been working on for months.
The purpose of the advisory board is really to have a group of people who think big, creatively and in interdisciplinary ways — to be a second set of eyes on the blueprint they’ve come up with, and also to function as a liaison with state and local health departments.
Q: What’s the plan to help communities that have been hit hardest?
A: Race disparities are definitely going to be a through line for all the plans — for example, with respect to testing, making sure that you are locating testing facilities in communities of color. They have not been adequately served, and the lines to wait to get tested, the turnaround times, have not been equitable.
Another area that is really of interest is Indigenous people. They are often misclassified in terms of their race and ethnicity, and that makes it very difficult to do analyses to figure out what are the trends in those communities and to target interventions accordingly. Being really attentive to detailed data surveillance, and using that to inform how we address these disparities, is going to be very, very central.
Q: What’s the thinking on school reopenings?
A: If you have widespread community transmission, there may come a tipping point where you do need to go back to virtual schooling. But I think the priority is to try to keep schools open as much as possible, and to provide the resources for that to happen.
From an epidemiologic perspective, we know that the highest-risk settings are restaurants, bars, gyms, nail salons and also indoor gatherings — social gatherings and private settings.
I would consider school an essential service. Those other things are not essential services. The smarter we are about being very responsive to trends in transmission — to closing indoor restaurants sooner — the longer you’re likely to be able to keep schools open.
Q: Biden has said he would invoke the Defense Production Act to get companies to manufacture protective gear.
A: From the beginning we have been — and I’ve seen it firsthand — in a rationing mode. And now things are getting worse again, so that is a very high priority. I think that’s going to be one of the very first executive actions that Mr. Biden would be taking.
Q: What role do you see the CDC playing in this pandemic and in the future?
A: The approach is going to be much more along the lines of giving control back to the CDC. There’s recognition that the CDC is the premier public health agency in the world. And while their role has been diminished during this current crisis, they play a very important role in all this.
It’s really going to be about rebuilding public health infrastructure. Since 2008, there have been massive budget cuts, staffing losses. And so some of it will be around that, and some of it will be around tech infrastructure and building more robust surveillance systems and dashboards.
Q: Biden has talked about making testing available to all. Is the plan to provide rapid antigen tests?
A: The issue with the antigen test is how well it performs in asymptomatic people. What we’ve seen in some cases is that the performance characteristics are just not that great, so I think that needs to be better assessed and studied.
You do also need separate regulatory pathways, one for a public health surveillance kind of test, one for a clinical diagnostic test. The sensitivity of the surveillance test does not need to be as high, especially if it’s cheap, and something you can be doing frequently, repeatedly.
Q: What are your thoughts about vaccine distribution?
A: Your local doctor’s office is not going to have the deep-freeze capability that, at least for the Pfizer vaccine, you’re going to need. They’re not necessarily going to have the tech systems to track and call people back to make sure they get their second doses.
That kind of capacity really resides either in public health departments or in the private commercial sector, like CVS and Walgreens. So it’s really going to require collaboration with them.