Then-President-elect Joe Biden receives a COVID-19 vaccination from Tabe Masa, Nurse Practitioner and Head of Employee Health Services, at the Christiana Care campus in Newark, Delaware on Dec. 21, 2020. Several of Biden's ex-advisers on the coronavirus suggest a new strategy that takes into account an endemic quality to the disease.

WASHINGTON, D.C. — Several of President Joe Biden’s former advisers want the country take a new approach to its COVID-19 response.

The group, all of whom served on Biden’s transition team, penned three opinion pieces published Thursday, Jan. 6, in the Journal of the American Medical Association suggesting an overhaul of the country’s response — focusing around what they call a “new normal” instead of eliminating the coronavirus.

Their pieces include suggested improvements to the country’s testing, mitigation and surveillance strategies, and improvements to COVID-19 vaccines and therapeutics that they say are necessary for a new normal.

They come as the country is grappling with a surge in infections sparked by the omicron variant, which seems to be able to transmit and evade COVID-19 vaccines more easily than past strains. Some experts have said the variant could mark a shift in the pandemic.

“I do think that omicron represents a turning point in the pandemic because of its immune evasive potential and the sheer force of infection that it can produce,” Dr. Amesh Adalja, an infectious disease expert and senior scholar at the Johns Hopkins University Center for Health Security, told McClatchy News in an email. “It may be that this is the biggest (step) the virus takes towards endemicity and becoming a seasonal coronavirus.”

COVID-19 may eventually evolve into a seasonal illness — like common colds, a study predicts.

They also come after Biden in December announced new actions to fight the omicron variant. White House press secretary Jen Psaki said Jan. 6 that she has not had the chance to read the pieces.

“The president’s goal is to defeat the virus,” she said. “The president’s focus and objective now is to save as many lives as possible, and we know what works, and we know that pushing more people, getting more people vaccinated, getting more people boosted, encouraging mask wearing, making sure schools have the resources they need to stay open and do that in a safe way — these are steps that work.”

Drs. Ezekiel Emanuel, Michael Osterholm and Celine Gounder wrote in one of the three pieces that omicron demonstrates “COVID-19 is here to stay.” They suggested the U.S. update its pandemic strategy and that leaders “specify the goals and strategies for the ‘new normal’ of life with COVID-19.”

“The goal for the ‘new normal’ with COVID-19 does not include eradication or elimination, eg, the ‘zero COVID’ strategy,” they wrote. “Neither COVID-19 vaccination nor infection appear to confer lifelong immunity. Current vaccines do not offer sterilizing immunity against SARS-CoV-2 infection. Infectious diseases cannot be eradicated when there is limited long-term immunity following infection or vaccination or nonhuman reservoirs of infection.”

It’s also unclear if the virus will become seasonal, whether therapeutics will help prevent “long COVID,” and whether more transmissible or vaccine-evading variants will emerge in the future.

Instead, the new normal requires recognizing that the coronavirus is one of several respiratory viruses circulating and addressing them together, the authors say. They recommend that leaders establish hospitalization, death and “community prevalence” benchmarks to determine when emergency measures are needed.

Emanuel and Drs. David Michaels and Rick Bright wrote in a second opinion piece that the country’s “testing, surveillance, masking and ventilation” all need to be significantly improved to reach and sustain the new normal and to lower the transmission and mortality of COVID-19.

Among their suggestions are having a “comprehensive testing and reporting system for all viral respiratory illnesses” and ensuring everyone in the U.S. has access to affordable COVID-19 tests.

The Biden administration recently announced plans to buy 500 million rapid, at-home COVID-19 tests to be sent, for free, to Americans who want them.

The authors said the plan is an “important step in the right direction” but that “many more are needed.”

In terms of surveillance, the group suggested that the country needs a “comprehensive, nationwide environmental surveillance system that includes wastewater and air sampling to monitor for potential outbreaks of viral and bacterial illnesses,” a “comprehensive genomic surveillance system” to predict to emergence of new variants and a “real-time, opt-out digital surveillance system” to monitor breakthrough infections and “waning immunity.”

The group’s suggested mitigation strategies include encouraging people to stay home when they may be sick through access to testing and paid leave, upgrading ventilation and air-filtration systems, and encouraging the use of high-quality masks, such as N95s and KN95s instead of cloth or surgical masks.

Recently, health experts have been pushing people to upgrade their face masks as cloth masks do not provide enough protection against omicron.

“To reduce COVID-19 transmission, achieve and sustain a ‘new normal,’ and preempt future emergencies, the nation needs to build and sustain a greatly improved public health infrastructure, including a comprehensive, permanently funded system for testing, surveillance, and mitigation measures that does not currently exist,” the piece concluded.

In a third opinion piece, Emanuel, Bright and Dr. Luciana Borio wrote that a new normal will be achieved when “total respiratory viral infections, hospitalizations, and deaths inclusive of those from COVID-19 are no higher than what typically occurred in the most severe influenza years before the current pandemic.”

A faster development and deployment of therapeutics and vaccines are crucial to reaching that point, they wrote.

The authors wrote that some estimates have suggested 90% of the population will need immunity from COVID-19 to minimize the virus’s effects on daily life and that achieving that will “require mandates.”

They also urged a further development of vaccines, efforts to develop a universal vaccine to protect against “known coronaviruses” and the establishment of an “electronic vaccine certificate platform,” among other things. They said the U.S. should invest in “variant-specific vaccines, alternative vaccine administration mechanisms, and research into the optimal vaccination strategies.”

In terms of therapeutics, the authors said the U.S. should “accelerate development, production, and procurement of COVID-19 drugs that are easier to manufacture and administer” and to make free outpatient COVID-19 treatments widely available.

“There has been tremendous progress in rapidly creating novel COVID-19 vaccines and therapeutics,” they wrote. “Nevertheless, these efforts have been insufficient to achieve a “new normal,” in which the combined risk of all viral respiratory illnesses, including COVID-19, does not exceed the risk during pre-COVID-19 years.”

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