Dan Gorenstein: We’ve spent the last two weeks talking about lots of really important health policies.

But the health care issue that continues to disrupt many of our lives the most right now has to be the pandemic.

Former Vice President Joe Biden: As president, the first step I will take will be to get control of the virus that has ruined so many lives.

DG: Today, we wrap up our series on health care and the presidential election by exploring former Vice President Joe Biden’s plan to tackle COVID-19.

From the Annenberg Studio at the University of Pennsylvania, I’m Dan Gorenstein, and this is Tradeoffs.

CNN Debate: So let’s begin with the most important issue right now, the coronavirus and what you would do as president in the face of it. Vice President Biden, let me start with you.

DG: Joe Biden unveiled his COVID-19 plan when he was running for the Democratic nomination this spring.

Biden: There are three pieces to this first of all…

DG: And he talked about it when he accepted that nomination in August.

Biden: If I’m your president on day one, we will implement the national strategy I’ve been laying out since March.

DG: Today we’ve got another three act play for y’all, each featuring a different expert breaking down part of Biden’s plan.

Act I: Testing.

Biden: We’ll develop and deploy rapid tests with results available immediately.

Brooke Nichols: I am Brooke Nichols. I am an assistant professor at the Boston University School of Public Health, and I am an infectious disease mathematical modeler and a health economist.

DG: I know the president likes to talk about how we’re doing more tests than any other country in the world. And it is true, last I saw, we’re doing more than about 5 million tests a week. But experts like you say we need to be doing closer to something like 30 million, with most of those being rapid tests. At a high level, Brooke, what’s stopping us from doing enough tests right now?

BN: The short answer is that we don’t have enough, we don’t have enough tests. So we need the rapid development and deployment of these rapid tests that we can really get our results straight away.

DG: These rapid tests are different from the so-called PCR tests that make up most of the market right now.

PCR tests involve complex lab processing that can take days to turn around.

News clip: Some patients report waiting more than 10 days to learn whether they have the virus, or by that point, had the virus.

Rapid tests can be run at the office, a neighborhood pharmacy or even in your living room with results in minutes. 

News clip: It’s about the size of a credit card and works with similar technology to a home pregnancy test.
News clip: Could be cheaper, faster and simpler.

DG: Brooke says production of these tests is just beginning to ramp up, though, and we’re still a long way from having the supply experts say we need.

So that’s the fundamental problem. Vice President Biden has an extensive plan to fix this. In one word or phrase, how would you describe that plan?

BN: Ambitious. (laugh) You said one word!

DG: Go on. How exactly does Biden propose to increase testing?

BN: So first he wants to set up a pandemic testing board. So instead of each state acting alone, this would really be the federal government sort of dictating how we can allocate resources over time where hot spots are occurring and sort of making our plans accordingly. He wants to double the number of drive-through testing sites. And then finally, the sort of the critical piece of all of this is the development and deployment of rapid tests that will give you an immediate test result.

DG: So, Brooke, how does this plan stack up against what we need to do based on the evidence that we have so far?

BN: So on the broad level, this is what we need in terms of testing. We need to be able to rapidly scale up testing capacity. We need immediate results, and these rapid tests are what can get us there. A lot of public health experts agree on this point. The other side of the coin is that there’s concern that these tests are less precise. So they won’t give you the correct answer as often. But let’s say we can only do 5 million a week and let’s say 4.8 million are correct. And then let’s say we can all of a sudden do 30 million a week, but only 20 million are correct. We still have more people with that correct result. So even though the proportion that’s correct is lower, we still have a greater absolute number of people that have that correct result and can act on it.

DG: So assuming he could get Congressional approval. What actually could trip up Biden’s plan?

BN: The main thing that could trip up the plan is, we haven’t talked about human behavior. So, A, there needs to be uptake. People need to use them. And then second, people need to act appropriately based on the test result. And I think it’s asking, it’s expecting a lot that all Americans will be fully adherent to taking the tests and to acting on the results.

DG: Biden is calling for the federal government to cover paid leave for anyone who gets COVID or has to care for someone who has COVID, which may help address this adherence issue.

Do you have an idea, Brooke, of the price tag of Biden’s plan?

BN: A lot. It’ll cost a lot. But is it worth it is like the classic health economist question. If we can implement this plan starting in January. We implement it over January, February, March. And then, we reap the benefits throughout the spring. Let’s say a vaccine comes in the fall of 2021. Then at least we have bought ourselves six months of sort of normal life.

DG: Act II: PPE and supply chains.

Biden: We’ll make the medical supplies and protective equipment that our country needs, and we’ll make them here in America. 

Nicolette Louissaint: My name is Nicolette Louissaint. I serve as the executive director of Healthcare Ready, a national nonprofit organization focused on supply chain preparedness and response.

DG: Why do you think something as critical and essential as supply chain is so often, not always, but is so often such an afterthought?

NL: We tend to take things for granted when they work day in and day out, and we only focus on them or complain about them when they are not working. So more often than not, supply chains are working and so we don’t have a reason to focus on them or complain about them.

DG: Even at this point in September, I still feel like I’m hearing a lot of stories about physicians, nursing homes and other folks not having enough PPE.

News clip: Personal protective equipment.
News clip: This is still a real problem.
News clip: When so many skilled nursing facilities have less than a one week supply of N95 masks, surgical masks…

DG: In one word or phrase, how would you describe Biden’s plans on shoring this up?

NL: I think his plans are strong, but incomplete. It recognizes that there is a need to increase production. There is a need to address potential vulnerabilities. There’s a role of the federal government to make sure that those stockpiles are stronger. There does need to be better coordination with the private sector. That’s why I say it’s strong, but it’s incomplete in that the nuance, the details, the policy blueprint of how they’re going to be able to achieve those plans — it’s really difficult for a system like a supply chain to have a plan in, you know, 2,000 words or less. 

DG: So you’re talking about his plans to ramp up production by using what’s called the Defense Production Act, and this is a law that would force companies to make more supplies like PPE. 

And also having what Biden has called a national “supply commander” to oversee distribution across the country.

But all of that really just gets at the most immediate problem. He also has plans beyond the current crisis.  What do those look like?

NL: So in the plans, there is language about a 100-day review process to determine the best way to proceed towards building supply chain resilience in a mid- and a long-term. But then there’s this other piece about domestic manufacturing.

Biden: Let’s use this opportunity to take bold investments in American industry and innovation, so the future is made in America. All in America.

NL: I have been cautioning against that as a single strategy. If we’re bringing production back to the U.S., the assumption is it won’t matter, you know, the next time we need the product, it will already be here. That’s not how supply chains work. Supply chains are global. Let’s say, God forbid, something happens in the U.S. And we don’t have geographical resilience. Then what? 

DG: So has Biden talked about partnerships abroad or anything like that?

NL: Yes, so I think that a big part of his plan has been manufacturing. But there’s a recognition that we do need to work with international partners. So this is why I think that 100-day review of supply chains is really important because I think that’s the opportunity to actually create an evidence base for whatever the actions are. And that’s what I’m hoping for.

DG: Act III: Masks.

Biden: We’ll have a national mandate to wear a mask, not as a burden, but as a patriotic duty to protect one another.

Leana Wen: I’m Dr. Leana Wen. I’m an emergency physician and public health professor at George Washington University, and I previously served as the health commissioner for the city of Baltimore.

DG: So right now, more than 30 states have some kind of mask mandate in place, but we have no national mandate. President Trump is opposed to the concept. In one word or phrase, what does Vice President Joe Biden want to do here?

LW: One phrase would be that he wants to have a national strategy of which a national mask mandate is a critical part.

DG: So, Leana, Biden has said he would do “everything possible” to require people to wear a mask in public, but how would he actually implement this mandate? 

LW: There are different ways of getting to a mask mandate as the U.S. There could be a top-down federal approach.

Reporter: Couldn’t you use your federal leverage to mandate that, though?
Biden: Yes.
Reporter: And would you?
Biden: Yes, I would, from an executive standpoint, yes I would.

LW: Or there could be convincing the states to each apply their individual state mandates. 

Biden: And I’d go to governors, Republican and Democratic governors, and I’d say we have to have this national mandate.

LW: But the challenges of getting any of that to happen is the same. It’s not just a question of having the mandate on the books. You also need people to abide by them. And so what does enforcement look like? And so I think ultimately having a national mandate is important because it sets the right tone. It will also set the right tone if all of our leaders are going to be modeling the type of behavior that we expect everyone to have, including wearing masks in public places.

News clip: After he wrapped up a campaign event here, we came no closer than 8 feet apart and we kept our masks on the whole time. Joe Biden says we need to see more of that.

LW: But we also need to be convincing people too. And I think that’s going to be Vice President Biden’s biggest challenge.

DG: Right, because even though we know from evidence that mask wearing and mask mandates in many places have been effective, we also know that about 40% of people who aren’t wearing masks say it’s because it’s their “right as an American.”

Leana, big picture here: What do you like about Vice President Biden’s plan and what worries you?

LW: My thoughts about the vice president’s plan on mask mandates is similar to the benefits and the concerns about his plan overall on COVID-19. It is science based. It does outline a coherent national strategy. The problem is that that national strategy would work if it’s applied today. We just don’t know what’s going to happen between now and January. And the question, the big question that’s going to face Vice President Biden, if he were to become president in January, is how is he going to regain the trust of the American public? Ultimately, public health depends on public trust.

DG: There’s a lot at stake in this election when it comes to health policy, from COVID-19 to the price of prescription drugs to the future of the Affordable Care Act.

We hope this series helps you better understand the candidates’ positions.

You can find all of our reporting — including a detailed breakdown of Trump’s record and Biden’s plans — on our website: tradeoffs.org/trumpbiden.

I’m Dan Gorenstein, and this is Tradeoffs.