'A moment of peril': Biden's coronavirus response collides with case spikes

More than 100 million Americans have gotten at least one shot of vaccine and more than 200 million doses have been sent to states, a dramatic acceleration of the bumpy vaccine operation itinherited. Virus-related cases and deaths, which peaked in January, have fallen by about two-thirds since President Joe Biden's inauguration.

But the Biden White House is now seeing new infections climb on its own watch - a potential crisis that could erase many of the hard-won gains of the president's first 75 days, should the numbers keep rising. And after railing for a year about the last administration's responseand vowing a more muscular strategy, Biden is encountering the limits of his own authority. The president can help secure and distribute supplies and medicines, issue guidance and urge caution - but like Donald Trump before him, he has few tools when governors decide tolift coronavirus protections at the wrong moment,manufacturers botch vaccine production, or Americans refuse to wear masks or get vaccinated.

"We need you to spread the word," Biden told faith leaders last week, saying he was worried about Americans becoming "cavalier" about the virus. "They're going to listen to your words more than they are me as president of the United States."

Biden also has no more sway than Trump over a mutating virus that scientists have only begun to understand.The Washington Post's rolling seven-day national average of coronavirus cases is more than 65,000 new cases per day, an 18% uptick since the middle of last month, even as many states drop public health restrictions and new variants spread. More than 146,000 new cases were reported on Thursday and Friday, the highest two-day count in several weeks, according to state data tracked by The Post.

The B.1.1.7 variant first identified in the United Kingdom, which has been shown to be more contagious and lethal than the original "wild" virus, is now the most common lineage in the United States, administration officials said Wednesday.

After three coronavirus surges under Trump, most experts think a "fourth wave" is unlikely given the accelerating pace of vaccinations and the number of Americans who have acquired natural immunity after being infected by the virus. But the trends have alarmed some public health experts, who are calling on Biden to adopt new strategies to speed up shots or take a harder line with states relaxing restrictions.On Tuesday, the president announced he was moving up the deadline for all adults to be eligible for vaccines to April 19, although that doesn't guarantee they will be able to be inoculated right away.

"Let me be deadly earnest with you," Biden said during the announcement. "We aren't at the finish line. We still have a lot of work to do. We're still in a life-and-death race against this virus."

Public health experts say the president has benefited from good policy, as well as good luck. Virus cases, which spiked in mid-January, began to recede before Inauguration Day.Biden's team also spent months studying Trump's stumbles, while figuring out how to buildonhis successes, such as exercising contract options negotiated by the Trump administration to produce vaccine supply and avoiding unrealistic promises that could disappoint Americans.

"They benefited from Operation Warp Speed. They benefited from the variants coming in late and not supercharging what was a pretty destructive surge" in the winter, said J. Stephen Morrison, who oversees global health policyat the Center for Strategic and International Studies. "And they benefited from the six months they had in planning their response out, beginning in July 2020, and then making it a top priority and executing with a great amount of speed this year."

Nearly three-quarters of Americans approve of Biden's handling of the pandemic, including almost half of Republicans, according to an AP-NORC poll last week. Biden's poll numbers are well ahead of his predecessor's, with most Americans before November's election critical of Trump's response and saying they had lost trust in Trump's claims as the virus flared again and again.

Biden's recent poll numbers also have boosted his efforts to pass a $1.9 trillion coronavirus relief bill and pursue other priorities, like a possible $2 trillion infrastructure package, and White House officials hope that a successful coronavirus response will helpthe president restore faith in government, laying the groundwork for other goals.

But there's risk in raising expectations that are pinned tothat response, said Robert J. Blendon, a Harvard University professor who studies public opinion about health care.

"It's all tied in people's minds to what I call the key policy measure: 'Next Thanksgiving, can I eat with my family in person?'" Blendon said, adding that Americans would blame Biden if virus-related shutdowns are needed again. "They can't blame a variant."

White House officials fear their nuanced message - urging Americans to see the light ahead, while remaining vigilant against the virus - is being lost as the rising numbers of coronavirus infections and vaccinations collide, potentially stretching out the nation's pandemic fight. The challenge is compounded because public health officials are trying to speak to a fractured America. Tens of millions of people are still eager to get their first shots, many more are asking what they can do now that they're vaccinated and others remain hesitant about getting inoculated at all.

"It's important to level with the public. It's very hard to keep in your mind it'sokayto be optimistic, but also to be concerned," said Andy Slavitt, a senior adviser for the White House's coronavirus response. "But that's where we're at. The job is not done."

In statements last week, Biden stressed that, while urginggovernors to keep safeguards in place and saying in response to a reporter's question that states should alsopause reopenings. "Please, this is not politics," he said. "Reinstate the mandate if you let it down."

But governors who rolled back mask mandates and other restrictions are mostlyshrugging himoff.

North Dakota Gov. Doug Burgum, R - who tearfully begged residents last year to wear masks and to stop demonizing those who did - said he wouldface a credibilitycrisisif he reinstated a mask mandate after lifting it in January. Less than 30 people in North Dakota are hospitalized with the virus, compared with more than 300 in November when Burgum imposed it. Most new cases are among young people and college students, who are far less likely to get severely illand overload hospitals,Burgum said.

Burgum said that reinstating the mandate could be interpreted as "a huge overreach by government."

Administration officials say most conversations with governors now center on a single issue: They want more shots. Michigan Gov. Gretchen Whitmer (D) last week appealed to the White House to rush doses to her state and other areas where the virus is surging. Whitmer in February rolled back some restrictions on indoor dining and, as in North Dakota, the increase in cases has been driven by younger residents. Like Burgum,she has not reversed the rollbacks.

Public health experts said they're frustrated that states are dropping their guard before a majority of Americans are vaccinated, arguing the results are predictable: More cases now, more hospitalizations and deaths later.

"This is the pattern of every previous surge," said Atul Gawande, a surgeon and public health professor who served on Biden's coronavirus advisory board during the transition. "This is the pattern of the surge that started over a month ago in Europe and Asia and has been ongoing in Latin America. Wishful thinking is not a strategy."

- - -

Inside the White House's coronavirus response, where leaders strategize about how best to address more than a dozen pandemic scenarios as theywork to accelerate vaccine distribution, six officials described a non-blamingculturethat is unruffled by the uptick in cases, messaging missteps or a recent manufacturing error that led to the loss of millions of potential Johnson & Johnson vaccine doses.

"Prepare for the worst, hope for the best, and don't be shocked by anything in between that," said one official, speaking on the condition of anonymity to characterize private conversations. "That's been the focus from the beginning."

"We have an accelerated virus, and we have an accelerated response," said Slavitt. "What's important is that we've been readying our response to get better and better and better."

Both Biden and Ron Klain, the White House chief of staff who helped lead former president Barack Obama's response to Ebola, have continually counseled a long-term outlook and eschewed political battles. "Ron's not taking the bait from a governor who wants to pick a fight over a mask," said a senior official, who also spoke on the condition of anonymity to discuss private conversations.

Jeffrey Zients, who runs the White House coronavirus response, also has stressed a businesslike approach.

"Jeff has created a culture where we identify issues early enough and that allows people to avoid blame," Slavitt said. "He says at the end of basically every call, 'If you have a problem or concern, let us know what it is. Bring it forward and we can problem-solve.'"

It's a departure from last year's coronavirus response, when Trump publicly feuded with Democratic governors, such as Washington's Jay Inslee and New York's Andrew M. Cuomo, and internal turf wars could rage for days. Trump also cycled through leadership, first replacing then-Health and Human Services Secretary Alex Azar with the vice president as head of the White House coronavirus task force, and later sidelining then-White House coronavirus coordinator Deborah Birx and infectious-disease expert Anthony S. Fauci.

And after Trump used last year's media briefings to tout his administration's success, broadcast unproven theories about the virus and issue political attacks, this White House has opted for a lower-profile approach in which government health experts offer regular, science-focused updates three times per week. The strategy hasn't been seamless. Rochelle Walensky, director of the Centers for Disease Control and Prevention, recently warned reporters about her "feeling of impending doom."

"We have so much to look forward to, so much promise and potential of where we are, and so much reason for hope, but right now I'm scared," Walensky said last week.

Her dire remark, which she said was off the cuff, sparked days of questions.

"I'm pretty sure 'impending doom' isn't in the CDC communication playbook," said a former Obama administration official, who spoke on the condition of anonymity because of ongoing conversations with the Biden administration.

White House officials defended Walensky, saying her comments were intended to resonate with people after weeks of more formal warnings.

"She was trying to talk to people like she knew them," a senior White House official said, characterizing her remarks as a sound bite that was taken out of context. "For the 99.9 percent of Americans who didn't watch her say that, it really sounded like she was predicting doom. And she really wasn't. There's no message in which we're doomed."

- - -

Surveying the state of the response, public health experts agree that "doom" is unlikely. The next coronavirus case spike "won't be as huge and not nearly as deadly as past surges, because so many of the most vulnerable people have now been vaccinated," former CDC director Tom Frieden wrote on March 22, estimating that vaccinations had already saved at least 40,000 lives in the United States.

But he noted that the virus is a "wily enemy" and warned of emerging variants that could someday evade existing vaccines and treatments. "If we let our guard down too early, covid will take advantage," Frieden added.

The most obvious test of whether the nation will keep its guard up is the fight over mask mandates, with at least 10 governors bucking Biden's call to restore them.

"I just think we need to give ourselves another four to six weeksor so to get more people vaccinated, and then we'd be in a much better place to drop mask mandates," said Celine Gounder, an infectious-disease specialist who served on Biden's coronavirus advisory board during the transition.

Wyoming Gov. Mark Gordon, R, who on March 16 lifted a mask requirement for most public places, as well as restrictions on restaurants and gyms, was unmoved by Biden's plea. "Given Wyoming's current metrics, the governor has no plans to reinstate statewide mask protocols," spokesman Michael Pearlman wrote in an email.

A spokeswoman for Alabama Gov. Kay Ivey. R, said Ivey also would not budge on plans toend a mask mandate on April 9. "We have made progress, and we are moving toward personal responsibility and common sense, not endless government mandates," saidspokesperson Gina Maiola.

But Lina Hidalgo, a Democrat who is the top elected official in Harris County, Texas, praised Biden's call for requiring masks. Hidalgo clashed last year with Republican Gov. Greg Abbott, R, when she first attempted to impose a mask order in her county, which includes Houston, the state's largest city.Abbott rescinded a statewide mask mandate last month, effectively doing away with Harris County's order.

"The biggest challenge in this pandemic has been mixed messaging," Hidalgo said, adding that county residents were confused by the conflicting advice.

- - -

Officials and outside advisers pointed to one strategy the White House could immediately deploy to help stave off a fourth wave: find ways to get shots into arms more quickly.

Gawande, the surgeon and public health professor, said the recent uptick in coronavirus cases changed his mind about the nation's strategy to administer two doses of the Pfizer-BioNTech or Moderna vaccines in strict adherence to the three- and four-week timelines used in their clinical trials. He cited new CDC data that a single dose of either vaccine provides comparable protection to the single-shot Johnson & Johnson vaccine.

"Push the second shot out to 12 weeks and get doses into as many people as we possibly can," Gawande said, noting that it would effectively double the amount of available doses. "It is the one pathway that we have."

Gawande also noted the success of nations such as Israel and the United Kingdom, which opted to delay second doses to prioritize the first for as many people as possible. Both nations have seen coronavirus cases and deaths fall at a more rapid rate than the United States.

But Fauci and other senior doctors advising Biden continueto stand by the two-shot strategy as the safest approach to protect Americans against the virus, and White House officials say they have no plans to overrule them.

"That's a decision made by the scientists," Slavitt said.

Burgum, North Dakota's governor, said in an interview last week that Biden might also accomplish more if top administration officials, including the president and vice president, joined weekly calls with governors. He noted that Vice President Mike Pence and Trump Cabinet officials were on such calls last year, which Burgum said were a platform for candid discussions.

Vice President Kamala Harris did join Tuesday's call, and White House officials said she and the president could be made available for future events if it would help the coronavirus response. "Any feedback that you want to give us, we're happy to take," Slavitt said.

The White House also has focused on building relationships with local officials and businesses in states like Florida and Texas, recognizing the possibility of constructive partnerships even as governors roll backstatewide restrictions.

Miami Mayor Francis Suarez, a Republican, said he would give the Biden administration "an A+" for making more vaccine available, including swiftly setting up a mass vaccination site in Miami-Dade County after Suarez appealed for additional doses.

Suarez acknowledged that cases in Miami-Dade County have "slightly" trended upward following spring break celebrations.

That uptick, driven by younger Americans, is precisely what worries Morrison, the Center for Strategic and International Studies expert, who warned that the nation is still facing a "moment of peril."

"We're still at 65,000 cases per day. We've got to get to 10,000 to control this," he said, adding: "We're in a great moment of anxiety and optimism mixed together. And I don't think we're going to exit from that moment for quite a while."