News : A quarter-million deaths and counting — Biden’s dilemma: What to do with Deborah Birx — Getting to know Biden adviser Marcella Nunez-Smith

Thursday, November 19, 2020

A quarter-million deaths and counting — Biden’s dilemma: What to do with Deborah Birx — Getting to know Biden adviser Marcella Nunez-Smith

Nov 19, 2020

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By Adam Cancryn and Dan Diamond

Presented by

With Alice Miranda Ollstein and Susannah Luthi

PROGRAMMING NOTE: PULSE will not publish on Thursday Nov. 26 and Friday Nov. 27. We'll be back on our normal schedule on Monday Nov. 30.

Quick Fix

— The coronavirus has killed more than 250,000 Americans, amid a pandemic surge that's likely to only accelerate the death toll in the coming weeks.

— President-elect Joe Biden's transition team is weighing whether to give Trump administration coronavirus coordinator Deborah Birx a role in its Covid-19 response.

— Biden's appointment of health inequality researcher Marcella Nunez-Smith as Covid-19 advisory board co-chair signals a fresh emphasis on addressing disparities in communities of color.

WELCOME TO THURSDAY PULSE — where the NBA's pandemic success faces a new test: the myriad maskless draft night parties featuring its newest crop of stars.

Training camp starts in less than two weeks – or just under a single round of quarantining. Tips to ddiamond@politico.com and acancryn@politico.com.

A message from the Partnership for America's Health Care Future:

Every American deserves access to affordable, high-quality health coverage and care and the vast majority of Americans support building on and improving what's working in health care to provide patients with the coverage and care they need. Learn more.

Driving the Day

A QUARTER-MILLION DEATHS AND COUNTING — In late March, President Donald Trump warned Americans that they were in for a "hell of a bad two weeks," with the White House projecting the nation could suffer up to 240,000 Covid-19 deaths if people didn't take the pandemic threat seriously.

Two weeks has since turned into seven months, and on Wednesday the U.S. blew past the 250,000 mark — with the death toll only likely to accelerate further.

— How we got here is clear: From the president on down, too much of the U.S. didn't take the pandemic seriously enough. The White House politicized and then largely abandoned its role in the daily response, basic health measures became partisan issues, hospitals and health officials were left manning the front lines with too few resources and — slowly but surely — uncontrolled community spread became a way of life.

— Where we're headed is even scarier: "We're going to look back at 150,000 cases a day and 70,00 hospitalizations as almost quaint in a few weeks," Craig Spencer, an emergency room doctor and Columbia health professor, told PULSE.

That's the consensus from the public health community, which has long warned the nation faces a grim winter despite the promise of vaccines on the horizon. Providers are already facing staffing shortages and ICUs nearly at capacity, POLITICO's Tucker Doherty reports, and major hospitals in some areas are once again shutting down all elective procedures.

It's a return to the early days of the Covid-19 crisis — only this time, the surge is hitting the entire country all at the same time.

BIDEN's DILEMMA: WHAT TO DO WITH DEBORAH BIRX — Joe Biden's transition team is debating whether to give Trump administration coronavirus coordinator Deborah Birx a role in its Covid-19 response, POLITICO's Adam Cancryn reports.

The deliberations come amid preparations for a broader purge of those closely tied to Trump's handling of the pandemic, with Birx's advocates arguing she is among the few who could play a valuable role in the incoming administration.

— The case for Birx hinges on her expertise. The longtime public health official has led the federal response for nine months, overseeing extensive efforts to collect better Covid-19 data and coordinate states' efforts against the virus.

Biden officials already view her as integral to getting the new administration up to speed during the transition, and some believe her experience and relationships with state officials could be a boon for a Biden Covid-19 team that will be thrust into the middle of a worsening crisis come Jan. 20.

— The case against Birx is simple: She's tainted by Trump. Even Birx's most ardent defenders acknowledge that her ties to the Trump administration mean she can't play any prominent role in guiding Biden's response.

And many Democrats worry her time in the White House permanently eroded her credibility — pointing in particular to her April defense of Trump's suggestion that injecting disinfectant might deter Covid-19. Keeping Birx on board in spite of that, they argued, would jeopardize Biden's plan to sell Americans on a full reset of the government's pandemic response.

"It's complicated," said Céline Gounder, who sits on Biden's Covid-19 advisory board. "It's almost like she herself has been politicized."

HAPPENING TODAY - A CONVERSATION ON COVID-19, MENTAL HEALTH AND FLORIDA: The coronavirus pandemic—and the anxiety, isolation and disruption of routines and support that it has wrought—has exacerbated the mental health crisis in America. Join POLITICO for a forward-looking conversation on how we can emerge from this crisis with a strong approach to mental and behavioral health. Florida—one of the hardest-hit states in the nation—will be our case study. REGISTER HERE.

KNOWING BIDEN ADVISER MARCELLA NUNEZ-SMITH — The Yale researcher brings vast experience studying health care inequality to Biden's Covid-19 advisory board — a sign that the pandemic's disproportionate impact on communities of color will be central to the new administration's response, POLITICO's Joanne Kenen reports.

One of the board's three co-chairs, Nunez-Smith said in one of her first interviews since joining the transition that's she's focused on two immediate concerns: ensuring minority communities get priority access to vaccines, and restoring those communities' frayed trust in science and government.

The advisory board will also emphasize boosting testing and contact tracing of minorities, in part by drawing on health workers already in the community.

— Those challenges could prove daunting. Minorities historically have less access to health care, less trust in the health system and a higher rate of chronic conditions that elevate their Covid-19 risk.

Poor housing, education and worse access to food and public transportation also all contribute to worse health outcomes.

— But beating the pandemic requires curbing the virus' spread in the hardest-hit areas. Covid-19 has disproportionately hammered Black, Latino and Native American people compared with white Americans, meaning there is little hope of ending the national crisis without first containing the threat within minority communities.

Biden World

TODAY: BIDEN, HARRIS MEETING WITH GOVS ON VIRUS RESPONSE — Biden and Vice President-elect Kamala Harris hold a virtual meeting with the National Governors Association's executive committee today — the next step in their charm offensive with the state and local officials they'll need cooperation from on mask mandates and other measures to curb the pandemic, POLITICO's Alice Miranda Ollstein reports.

The bipartisan list of governors expected to attend: Democrats Andrew Cuomo of New York, Jared Polis of Colorado, Gretchen Whitmer of Michigan and Michelle Lujan Grisham of New Mexico; and Republicans Asa Hutchinson of Arkansas, Kay Ivey of Alabama, Larry Hogan of Maryland, Charlie Baker of Massachusetts and Utah's Gary Herbert.

— But Biden's message will be aimed elsewhere. Every governor on the call has already imposed mask mandates, and Biden said this week he plans to "not only thank the governors who have already moved, but call on all leaders in the states to have mandatory masking, testing, tracing and social distancing." Roughly a dozen governors are still refusing to require mask wearing.

On the Hill

WHAT LIBERALS WANT FROM BIDEN — Leading House progressives on Wednesday night laid out their health care demands for the incoming Biden administration, in a sign they're going to continue pushing the party toward "Medicare for All," POLITICO's Susannah Luthi reports.

At an event with Medicare for All advocate Wendell Potter, Reps. Pramila Jayapal, Katie Porter and Alexandria Ocasio-Cortez listed off what they called their policy "floor" for the next few years.

— What that agenda includes: A de-linking of health insurance from employment, automatic health coverage through Medicare for people who lose their jobs and a lowering of the Medicare eligibility age to 50 (a full decade earlier than Biden's Medicare-at-60 plan).

The group also called for drug price negotiation across Medicare and private insurance, health coverage for undocumented immigrants and DACA recipents and greater investment in long-term care.

— Get ready for more Medicare for All hearings. Jayapal touted a commitment from the House Small Business Committee to hold a hearing on the single-payer health plan, adding that she's still pushing for a hearing in front of the full Energy and Commerce Committee.

FIRST IN PULSE: WYDEN PROBING UNITEDHEALTH OVER MENTAL HEALTH COVERAGE — The Senate Finance Committee's top Democrat is seeking information from UnitedHealth about its administration of mental health and substance use disorder benefits, in the wake of a series of lawsuits over its coverage denials.

"These unlawful practices had devastating consequences for UnitedHealth's members, including adults of children, many of whom suffered severe health setbacks," Wyden wrote in a letter demanding details on the management of its behavioral health business.

A message from the Partnership for America's Health Care Future:

We should build on what's working where private coverage, Medicare and Medicaid work together instead of starting over with a one-size-fits-all new government health insurance system that would force Americans to pay more for worse care.

During this critical time, private and public plans are working together to help American patients get healthy and stay healthy. We must continue building on and improving what's working in health care where today 54 million Americans living with pre-existing conditions have access to the care they need and nearly 150 million Americans have access to free preventative services with no out-of-pocket costs. Learn more.

Obamacare

FIRST IN PULSE: NEW COALITION PAIRS MASK WEARING AND ACA ENROLLMENT — A coalition of states, consumer groups and providers is launching a national campaign today encouraging Americans to both wear face masks and enroll in Obamacare plans.

It's a twist on prior outside campaigns to sign people up for Obamacare during annual enrollment, with the group pointing to Covid-19 as a key reason for the uninsured to seek coverage.

The effort is co-chaired by former Obama health official and Get America Covered co-founder Joshua Peck, Kentucky Cabinet for Health and Family Services Deputy Secretary Carrie Banahan and Peter Lee, the executive director of California's health exchange.

KEEP UP WITH THE GLOBAL HEALTH AGENDA IN 2021: If nothing else, the past year has revealed how critical it is to keep up with the politics, policy, and people driving global health. A new Biden administration comes with the expectation that America will reclaim its leadership on global health. But will it be that easy? What impact could Joe Biden's presidency have on global vaccine access and the international response to the pandemic? Our Global Pulse newsletter connects leaders, policymakers, and advocates to the people, and politics impacting our global health. Join the conversation and subscribe today.

What We're Reading

The CDC has quietly withdrawn a school reopening document that prompted criticism at the time for echoing Trump's push to restart in-person learning and downplaying Covid-19's risk to children, The New York Times' Erica Green reports.

A wrongful death lawsuit alleges that supervisors at a Tyson Foods plant in Iowa wagered money on how many workers would contract Covid-19, Iowa Capital Dispatch's Clark Kauffman reports.

In a Washington Post op-ed, seven governors are urging Americans to stay home and reconsider spending Thanksgiving with people outside their households.

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