The White House is racing to prevent and prepare for a potential fourth coronavirus surge as more transmissible coronavirus variants spread across the US -- investing billions of dollars to boost coronavirus preparedness, accelerating the pace of vaccinations and working to prepare the public and governors for the prospect of another surge.
In what would be a first, the White House is drawing up plans to surge vaccines to emerging hotspots in an attempt to blunt the virus' trajectory and protect those at highest risk, two senior administration officials told CNN.
While the number of daily coronavirus cases continues to decline and more than 2 million Americans are now being vaccinated daily, the White House Covid-19 response team has been preparing for the worst. Officials have been combing through data to plot the virus's trajectory, mapping out different scenarios and drawing up plans for how the federal government would snap into action.
"Everything we do is with the thought in mind that there might be another surge," a senior administration official said, summing up the administration's efforts to combat the virus and prepare for a surge.
That focus has increased in recent weeks as the decline in new daily cases slowed, leveling off at a worryingly high level. The US Centers for Disease Control and Prevention believes the more transmissible B.1.1.7 variant, which was first identified in the United Kingdom, will be the dominant strain within weeks. There are also concerns about governors and local officials prematurely loosening public health restrictions in a slew of states.
A fourth surge would be the first on President Joe Biden's watch and a major test for the new administration. And while some constraints still remain -- including the lopsided authority of state and local officials over the federal government in implementing public health restrictions -- a half-dozen Biden administration officials told CNN they believe the federal government is better prepared than ever before to handle a surge.
More than anything, the accelerating pace of vaccinations is helping to head off a potential surge. One in five people in the US have now gotten at least one shot, including nearly 65% of people 65 and older, who account for about 80% of all Covid-19 deaths in the US.
Every shot gets the US closer to avoiding another deadly surge, but Biden officials know they are racing against time.
"I think we need to be very humble with this virus," Dr. Anne Schuchat, the CDC's No. 2 official, told CNN. "While many indicators are going in the right direction and more and more people are being vaccinated every day, we need to be ready for wild cards and worsening."
Surging vaccines to hotspots
Just as federal officials mobilized testing resources and set up "surge" testing sites in hotspots around the country during the summer and fall, federal officials are preparing to deploy a similar effort using federally run or supported vaccination centers. A senior official said one example of this effort would involve vaccinating workers in high-risk settings such as a meat processing plant in areas where cases are beginning to surge.
The federal government could also leverage an expanded, federally controlled pipeline of vaccine to pharmacies across the country -- soon expected to swell to more than 20,000 -- to surge doses to hard-hit areas, the officials said.
One official said the administration is also considering administering monoclonal antibody treatments -- of which the administration bought another 100,000 doses in February -- in hotspots as a prophylaxis.
"We have different tools than we did last year," the official said. "We can't play yesterday's game against this virus."
To that end, the White House has invested hundreds of millions of dollars to boost surveillance testing and close testing supply gaps, including $200 million to boost genomic sequencing to track the spread of variants. The American Rescue Plan, which Biden signed into law on Thursday, invests another $47.8 billion in coronavirus testing measures. The bill also adds $7.66 billion to hire 100,000 public health workers to boost vaccination and contact tracing efforts.
At the forefront of the administration's efforts to prepare for a surge -- and how its response would be different from the past administration's -- has been the dramatic shift to public messaging that has seen health experts and the President speaking with one voice.
That's why in the last week, the CDC Director Dr. Rochelle Walensky, National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci and Biden have all warned about the dangers of the variants and the possibility of another surge.
"A lot can happen. Conditions can change. The scientists have made clear that things may get worse again as new variants of the virus spread," Biden said during a prime-time address to the nation last Thursday. "If we don't stay vigilant and the conditions change, then we may have to reinstate restrictions to get back on track."
While federal health officials frequently found themselves hedging their public pronouncements to avoid contradicting President Donald Trump, public health officials now find themselves empowered to stick to the data, resulting in one uniform message from the federal government on the threats of the pandemic and the measures that need to be taken to address those threats.
"We have more consistent messaging now around the interventions that we know work: masks, social distancing measures," said Schuchat, who also served as deputy CDC director during the Trump administration. "There's a strong commitment at CDC and in this administration to transparent communication -- if there's bad news, to share it, if there's good news, to be open and honest about it -- to make sure we can communicate clearly and consistently about what we think is going on and what we think needs to be done."
White House rejects more aggressive strategies
On other fronts, the administration has declined to change the game entirely, rejecting calls to prioritize getting more first doses of two-dose vaccines in Americans' arms and delaying the administration of second doses -- as the UK did. Instead, the White House has prioritised giving full protection to fewer Americans amid concerns that a single dose could be less effective against the more transmissible coronavirus variants.
They have also resisted calls to take a more muscular role in compelling states to speed vaccine administration and implement public health measures, refusing to tie funding or vaccine deliveries to either, viewing those steps as counter-productive.
"Getting into a heated public argument over this is exactly what sometimes plays into people's hands who are making these decisions," a senior administration official said. "The President's general view of the world is to not take the bait, not heighten the rhetoric, not trying to create a war."
And while public health experts, including the Biden administration's soon-to-be surgeon general Dr. Vivek Murthy, have advocated for clearer guidelines and warning systems from the federal government to lay out when states and localities should reimpose coronavirus mitigation measures -- such as business closures and capacity restrictions -- the Biden administration has so far demurred on that front.
Most states have already established their own gating criteria by this point in the pandemic and administration officials said vaccinations and the prevalence of under-reported at-home tests complicate efforts to tie case levels to specific mitigation steps.
"We're in a fairly unusual place right now as more and more people are vaccinated," Schuchat said. "We're looking carefully at this moment in the pandemic and what the best metrics are to be tracking."
Speaking with states
In lieu of prescriptive guidance, the White House has sought to work more closely with state and local officials. Senior White House officials participate in calls with state and local officials multiple times a week -- including adding six regional meetings to the weekly calls between the White House and governors.
Biden officials say they watched as Trump tried and failed to pressure states to adopt or discard certain public health measures and have sought to avoid putting themselves in a similar position -- instead working to quietly influence governors' decision-making behind the scenes and preparing them for a potential surge.
"We're helping them think things through and not paint themselves into a corner," a senior administration official said. "But believe me, telling a governor that they can't do something that they know they have the authority to do -- I don't think that's the sophisticated move."
Where the administration's pleas to governors fail -- as they did when Texas and Mississippi's governors revoked their states' mask mandates -- the administration has turned to local officials and business leaders to continue to require masks and implement other mitigation measures.
But even as the White House looks to prepare governors for a potential fourth surge, officials are also contemplating the possibility that a fourth surge will not strain hospitals or lead to as many deaths as previous surges.
"In 2020 we'd say, OK, we see a rising number of cases, we know we're going to see a rising number of hospitalisations and deaths," a senior administration official said. "But today ... it's not a very clear picture."
text by Jeremy Diamond, CNN