Biden will try to rally exhausted Americans against omicron threat

But at a moment of great urgency - both for the nation's health and the president's standing - he has few new tools at his disposal, at least not politically palatable ones, and public health experts fear that exhausted Americans have tuned out their warnings.

Biden, who campaigned on a platform that some of the ravages of last year's pandemic were preventable, is now faced with the challenge of explaining that omicron infections may be near-inevitable even in the vaccinated. The fast-moving variant accounted for nearly three-quarters of coronavirus cases in the past week, the Centers for Disease Control and Prevention said Monday. That astonishing advance has left some administration officials and experts frustrated with the government's stay-the-course messaging, as well as its inability to ramp up the supply of rapid tests quickly enough to address demand.

Biden on Tuesday will strike a more dire tone than his earlier pleas to get vaccinated, having emphasized last week that unvaccinated Americans are facing "a winter of severe illness and death." But White House press secretary Jen Psaki said Monday that the president's speech is not "about locking the country down."

Instead, he will announce a plan to set up testing sites across the country, partly modeled on the Federal Emergency Management Agency-run vaccination sites the administration deployed during its vaccination campaign, according to people familiar with the plans who spoke on the condition of anonymity because they were not authorized. The president will also detail steps to bolster hospitals' capacity to treat patients as health officials expect them to be inundated in the coming weeks.

But Tuesday's planned remarks and actions come "too late" for many Americans trying to navigate the new risks of omicron and make holiday plans, warned William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.

"It has been very, very strange watching the storm clouds gather . . . and for the preeminent body dealing with public health to have been so quiet," Hanage added in an email, faulting Biden and the CDC for not offering new guidance on gatherings and quarantines after omicron's emergence last month.

Confirmed infections in the United States have roughly doubled since early November, rising from about 74,000 cases on Nov. 8 to about 147,000 cases on Dec. 20, according to The Washington Post's rolling seven-day average. The outbreak has been fueled by the rapid growth of the omicron variant, with cases multiplying at an unprecedented rate, as well as tens of thousands of infections linked to the older delta variant.

While many people experience only mild symptoms from omicron, and vaccine boosters appear to protect against severe illness, administration officials and allies are bracing for the new cases to swamp hospitals and health centers, many of which are already struggling with a siege of delta cases after two years of fighting the pandemic.

"It's going to be a surge like we haven't seen before, numbers that are completely out of control," former White House adviser Andy Slavitt said on MSNBC on Monday.

Biden is expected to emphasize that while fully vaccinated Americans who have received their booster shot may still get infected by the more transmissible variant, they are likely to experience mild symptoms - a sharp change from earlier this year, when the administration said breakthrough infections were rare and the country was on the precipice of declaring freedom from the virus.

Biden also is set to tout efforts to broaden access to coronavirus tests, said people with knowledge of the remarks. The administration has struggled to explain testing shortages to Americans, including Psaki's widely criticized sarcastic remark earlier this month. "Should we just send one to every American?" she said, when pressed why the administration has not made the at-home tests free and more widely available.

The president's plan will focus on "ensuring that the health system has the supports and the resources that it needs to withstand and respond to a notable uptick in patients," said a senior health official who spoke on the condition of anonymity to preview the remarks.

The new remarks come three weeks after Biden unveiled his initial plan to combat a winter surge of coronavirus cases, and administration officials say that they have rapidly mobilized to deal with the emerging omicron threat. For instance, the CDC organized a daily omicron-focused conference call with more than 250 health officials and leaders around the country, and set up a cross-state team to help investigate an early omicron outbreak at an anime convention

But as the omicron wave bears down on America, public health experts say that the Biden administration must improve its efforts in three core areas: persuading more Americans to get shots and wear masks, and making tests more available.

"We need to hear a clear strategy for how each of those tools will be re-energized through what's going to be a really bumpy few months," said Jason Schwartz, an associate professor of health policy at the Yale School of Public Health. "I'm skeptical about how much another presidential address, fact sheets and memorandums can really do at this point."

In Europe, many nations have adopted new restrictions to stop the virus's spread, even as those measures upend plans to celebrate Christmas and New Year's. The Netherlands began a so-called "snap lockdown" on Sunday afternoon, shuttering nonessential stores, bars and restaurants until mid-January. Ireland adopted an 8 p.m. curfew, France closed nightclubs and banned New Year's fireworks, and Germany barred unvaccinated people from entering nonessential stores. Meanwhile, Britain, which has seen omicron cases soar, has resisted implementing new restrictions ahead of the holidays.

Celine Gounder, an epidemiologist who advised Biden's transition team on the pandemic response, said it's critical that the president reframes how Americans understand the pandemic. Although cases are skyrocketing, she said that early evidence suggests vaccinated Americans who contract the virus are generally not becoming seriously ill.

"Refocusing on hospitalizations and deaths is really important in terms of a strategic shift," she said, adding that it would reframe "all the things we need to be doing and where to emphasize, where to prioritize."

Gounder, who remains in touch with administration officials, said there are other policy measures the president could announce, including invoking the Defense Production Act to expand testing, urging schools and business to improve ventilation and air filtration systems and reimposing mask mandates. But ultimately, she said the push for more vaccinations remains the most critical message.

"That is the fast forward button on the pandemic," she said. "That's how we get on the other side of this. That is how we rip off the Band-Aid and minimize the pain. I think that needs to be front and center."

Inside the administration, health officials are collecting data on the severity of the omicron variant, compared to earlier lineages of the virus. But even if it turns out to be less severe, as officials hope, they warn hospitals are still likely to be overwhelmed because of the sheer number of cases, which will mean that a certain percentage of those become severe.

"This is exploding," said one senior administration official on the condition of anonymity because they were not authorized to speak publicly. "Everyone is holding their breath to see what happens with severity."

Administration officials also say they are running out of tactics to encourage holdouts to take protective steps, having tried social media campaigns, vaccination lotteries and other efforts to raise awareness of vaccines. While vaccinations and boosters appear to defang the most severe consequences of omicron, tens of millions of Americans continue to balk and getting vaccinated and fewer than one-third of fully vaccinated people have received booster shots.

Testing, meanwhile, can help identify and contain outbreaks, but rapid tests are in short supply and long lines are forming at test centers around the country. And while masks have been shown to reduce viral transmission, and the CDC has urged more than 90% of counties to require masks indoors, only a handful of states and cities, such as California, New York and Washington D.C., have so far reinstated mandates.

"The government can only solve so much," said a senior health official who spoke on the condition of anonymity to discuss the government's response. "If people don't agree on the same set of facts - it's hard to get people to do the things that we know will work."

Public health experts counter that the White House could do more to inform the public. Yale's Schwartz said he's frustrated that administration officials have sidestepped questions at news conferences, such as whether the definition of "fully vaccinated" should be updated to reflect that many Americans have yet to obtain recommended boosters.

"It's fair, I think, to ask our health officials to help explain why they land at a certain point . . . and what they're keeping in mind as they think about changing it," Schwartz said. "And that gets lost with this ritual refrain about 'following the science, and it's evolving.' What frustrates me is I hear that invoked more and more frequently."

White House officials have spent three weeks intensely sifting through data about omicron, seeking to understand the new variant without alarming Americans until more was known.

In a series of meetings in late November and early December, senior health officials were briefed on findings from South Africa that showed dramatic declines in protection from a two-dose regimen of Pfizer's coronavirus vaccine, about two weeks before similar data was published last week, said two people with knowledge of the briefings.

White House officials who spoke on the condition of anonymity cautioned that the data drew on a limited study and said it would have been premature to publicize it before more was known. The findings align with a study released last week by Discovery Health, South Africa's largest health insurer, which also concluded that omicron appears to cause less severe illness than prior virus variants.

Administration officials say they have rapidly mobilized to deal with the emerging omicron threat. For instance, the Centers for Disease Control and Prevention set up a daily omicron-focused conference call with more than 250 health officials and leaders around the country, and set up a cross-state team to help investigate an early omicron outbreak at an anime convention, said Ian Sams, a spokesperson for the Department of Health and Human Services.

Omicron poses only the latest messaging challenge in a series of such difficulties related to an evolving virus and science.

As a candidate, Biden blamed former president Donald Trump for mismanaging a pandemic that he called preventable. "If the president had done his job, had done his job from the beginning, all the people would still be alive," Biden said at a town hall in September 2020.

Experts said the White House has also struggled to communicate why cases have continued to rise as new variants emerge. In a Los Angeles Times interview last week, Vice President Kamala Harris said "we didn't see delta coming . . . we didn't see omicron coming," a statement the White House walked back amid criticism from public health experts that they had consistently warned about mutated forms of the virus.

Bruce Haynes, a crisis communications expert at Sard Verbinnen & Co., said that Biden's team had repeated some of the same messaging mistakes, such as failing to share "simple, easy-to-understand messages that don't challenge the broader public."

For instance, Biden officials in May advised that masks were no longer necessary in many cases, with the president calling it a "great day" in a Rose Garden news conference - only to reinstate mask guidelines less than three months later. This fall, the White House and some of its top scientific officials publicly split over the need for widespread booster shots, with senior Food and Drug Administration officials and CDC advisers bristling at Biden's eagerness to roll out a national booster campaign. The result was a muddled message that scientific experts blamed for hindering the takeup of boosters, which have been shown to shore up waning immunity and provide key protection against omicron.

"There are always three things that you look for in crisis communications - and a pandemic is the very definition of crisis communications - and that's clarity, consistency and credibility," said Haynes. "I think both administrations have struggled to do that."