Test to Treat

Although the coronavirus is still circulating in communities throughout the United States, Biden emphasized that the country has reached a new stage in the pandemic.

“Severe cases are down to a level not seen since July of last year,” he said. But “thanks to the progress we have made this past year, COVID-19 no longer need control our lives.”

He pointed to the Centers for Disease Control and Prevention’s revised mask guideline released last week as one sign of progress. Under this metric, much of the country now falls in a low or medium COVID-19 community risk category.

Biden also promised that “we’re leaving no one behind or ignoring anyone’s needs as we move forward.”

However, many health experts say the change in mask guidance means that as more Americans go unmasked while the coronavirus still circulates, people who are immunocompromised or otherwise vulnerable face an even greater risk.

In spite of the administration’s efforts to deal with the pandemic, a recent Axios-Ipsos poll suggests that many Americans are not giving the president credit for progress made over the past year.

While 58 percent of people said the administration did an excellent good job at the development and distribution of the COVID-19 vaccines, smaller numbers felt the administration supported businesses during the pandemic or protected healthcare workers.

Even as the president looked forward, he was careful to not rule out another COVID-19 wave. This reticence is likely driven by the administration’s premature declaration of success last July, only to be burned by the Delta and Omicron surges.

“I cannot promise a new [coronavirus] variant won’t come,” Biden said. “But I can promise you we’ll do everything within our power to be ready if it does.”

He emphasized that the fight against the virus will be ongoing, and called on Congress to provide funds to stockpile tests, masks, and antiviral treatments.

In addition, the administration will continue to encourage more Americans to get vaccinated and boosted — and will push for the approval of vaccines for children under 5 years old.

The president also emphasized the need to continue sending vaccine doses to other countries in need.

Karen L. Edwards, PhD, a professor in the public health program and chair of the department of epidemiology and biostatistics at University of California, Irvine, said these efforts will help transition the country to a more “normal state of affairs.”

“Each of [these] steps are critical in helping us move forward, but they also acknowledge and plan for the fact that COVID will be with us for the foreseeable future,” she said.

These tools are a continuation of what the country has been doing throughout the pandemic, with one new twist.

The administration’s “test to treat” initiative will enable people to get tested at hundreds of pharmacies, community health centers and other sites, and get treated with antivirals at the same location — at no cost.

“If uptake from the population is good, this should help reduce severe COVID cases,” said Edwards.

In addition, “if people who test positive continue to take appropriate precautions so as not to spread COVID, it will also help to contain future surges,” she said.

Biden has previously announced plans to lower the price of prescription drugs, but has so far been unable to achieve this. In the State of the Union address, he once again set the goal of tackling high drug costs.

“We pay more for the same drug produced by the same company in America than any other country in the world,” he said, specifically mentioning the high price that many families pay for insulin.

The president’s trillion-dollar Build Back Better legislation, which stalled in the Senate, included prescription drug pricing reform.

While not specifically mentioning this bill, the president did talk about some of the drug-related provisions that were included in it, including capping the cost of insulin at $35 a month and allowing Medicare to negotiate the price of prescription drugs.

The president also called for making permanent the reductions on the Affordable Care Act health plan premiums that were enacted as part of the American Rescue Plan.

Long-term care facilities in the United States were strongly affected during the pandemic, with more than 200,000 residents and staff dying from COVID-19. In many ways, the pandemic exposed weaknesses that were already present in the system.

In his speech, the president called out “Wall Street firms” for taking over nursing homes and raising costs while lowering quality.

“That ends on my watch,” he said. “Medicare is going to set higher standards for nursing homes and make sure your loved ones get the care they deserve and that they expect, and they will look at that closely.”

On Monday, the administration announced a set of reforms aimed at improving nursing home safety, including minimum staffing requirements, new safety measures, and fines for poorly-operated facilities.

Terry Fulmer, PhD, RN, president of The John A. Hartford Foundation, a nonpartisan philanthropy dedicated to improving the care of older adults, welcomed this plan.

“While there are many issues that need to be addressed, adequate staffing [in nursing homes] is the most essential starting point for improving quality and safety,” she said in a statement. In addition, “the people who care for older adults need the training, compensation, and support that will enable them to do their jobs effectively.”

During the pandemic, the opioid crisis deepened, with synthetic opioids such as fentanyl playing a role in a rise in overdose deaths.

To address this, Biden called for “increase funding for prevention, treatment, harm reduction, and recovery,” as well as efforts to “stop the flow of illicit drugs by working with state and local law enforcement to go after the traffickers.”

During the pandemic, mental health has been in the spotlight, as the pandemic and related economic disruption has exposed weaknesses in the healthcare system.

To address this, the president called for strengthening mental health supports, “especially among our children, whose lives and education have been turned upside down.”

“Children were also struggling before the pandemic — bullying, violence, trauma, and the harms of social media,” he said.

Yesterday the administration released a wide-ranging national mental health plan to enhance the behavioral health workforce and connect more Americans with treatments.

This plan, which would require new funding from Congress, also calls for “full parity between physical and mental health care,” said Biden, which means mental health care should not cost more than essential care for physical conditions.

In addition, the plan addresses the negative impacts of social media on youth mental health.

American Federation of Teachers president Randi Weingarten welcomed the renewed focus on mental health.

“The health, well-being, and academic recovery of students is every teacher’s priority, and the pandemic has multiplied the stresses and strains on us all,” she said in a statement. “We share the president’s concerns over the mental health crisis facing our young people, including the negative effects of unbridled social media, because we live with the fallout every day.”

Calling U.S. veterans the “backbone and spine of this country,” Biden said the administration will be providing healthcare for lower-income veterans through the Veterans Administration debt-free.

He also highlighted the health risks that troops face in conflict zones, such as “burn pits” that incinerate medical and hazardous wastes, jet fuel, and other potentially toxic materials.

“I’m also calling on Congress to pass a law to make sure veterans devastated by toxic exposures in Iraq and Afghanistan finally get the benefits and comprehensive healthcare they deserve,” he said.

Last month, Biden announced a plan to “supercharge” the Cancer Moonshot that was started under President Barack Obama.

“Our goal is to cut the cancer death rates by at least 50 percent over the next 25 years,” he said “Turn more cancers from death sentences into treatable diseases.”

To help get there, Biden called for Congress to fund the Advanced Research Projects Agency for Health (ARPA-H).

The goal of this program would be to drive breakthroughs in cancer, Alzheimer’s, diabetes, and other diseases, similar to how the Department of Defense’s DARPA program led to the internet and other technology innovations.

During the State of the Union, the president lauded the passage of the $550 billion bipartisan infrastructure law, which directs new spending toward roads, bridges, water pipelines, and other major projects.

While the focus of this spending is on infrastructure, the enhancements will also help safeguard the country from the impacts of climate change, including the direct and indirect health-related effects of severe weather.

“We’ll do it to withstand the devastating effects of climate crisis and promote environmental justice,” he said. “We’ll build a national network of 500,000 electric vehicles charging stations, begin to replace the poisonous lead pipes, so every child, every American has clean water to drink at home and at school.”

The Environmental Protection Agency released a report last year, which found that “the most severe harms from climate change fall disproportionately upon underserved communities.”