In early 2021, the new Biden administration had every expectation of saving America from the previous regime Lord of the flies–like pandemic response, with states fighting each other over scarce supplies and advisors proposing controversial recommendations to allow the virus to spread unchecked to achieve herd immunity. Joe Biden‘s team deployed a massive and well-organized vaccine rollout, getting the life-saving syringes to almost every US home within five miles and vaccinating approximately 215 million Americans.

Just over a year later, with a staggering 1 million U.S. deaths from COVID-19 — nearly half came after vaccines became freely available amid a battle with wildly infectious variants and rampant anti-vaccination disinformation — Biden’s team seems to agree be switching to a new approach.

Faced with an exhausted and divided public, limited legal options to maintain vaccination and masking mandates and ominous polls ahead of midterm elections, the government has backed away from top-down efforts to control the spread of the virus. The goal is to transform the disease into a treatable, survivable condition that does not require hospitalization. To make that possible, the government wants to make sure Americans have access to plenty of vaccines, effective therapeutics like Pfizer’s Paxlovid, and a host of other treatments like monoclonal antibodies. “If you can aim [these tools] practically no one should die for the right people,” said a senior administration official vanity fair.

With that goal has come a marked shift in the way federal officials talk about the pandemic. “You’re going to see them shift the message around personal responsibility,” said Dr. scott gottlieb, who served as FDA commissioner under donald trump “Don’t be the idiot who introduces COVID into a restaurant. Don’t be the carefree person holding a super spreader event.’ They try to incite good behavior on the fringes.”

But that attempt to transition to a new normal of safe living with COVID-19 faces an immediate obstacle: SARS-CoV-2 itself, which is emerging at an alarming rate with new and more easily transmissible variants. “This virus is in hypermutation mode,” said Dr. Rick Hell, CEO of the Rockefeller Foundation’s Pandemic Prevention Institute. “It’s an ugly virus that causes ugly diseases.”

The administration is also hearing complaints — both privately and on Twitter — from a sizeable number of doctors and public health officials, who have called both the administration’s new approach and tone a foul.

Gregg Gonsalves, an associate professor of epidemiology at the Yale School of Public Health, believes the shift in messaging has more to do with a “new political era” than any new scientific or medical reality. He calls it a “rhetorical move in the midst of mass extinctions… We are still in the middle of a pandemic with all the uncertainty.”

Preventing new infections remains crucial, some doctors and scientists say, especially with a virus as dangerous and unpredictable as this one. “You never know: Is this the infection that’s going to kill you?” Michael Osterholm, Epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. A new analysis by nonprofit organization FAIR Health found that over 75% of patients with long-standing COVID, a constellation of disabling symptoms ranging from fatigue to shortness of breath, initially had a mild or asymptomatic case and were not hospitalized when initially diagnosed.

A White House spokesman, Kevin Munoz, told vanity fair, “The President released a comprehensive, 100-page plan in March emphasizing that COVID-19 is not over and providing a detailed roadmap for how we can continue to protect people from COVID and prevent COVID from becoming the disruptive.” The hallmark is that it has been around for so long and is safely moving America forward – recognizing that we now have more tools than ever before… and a strong foundation to build on.” He added that “countless outside experts ‘ helped the White House develop its plan, but Congress has so far failed to provide funding for its further implementation.

Shortly after Biden took office, his new surgeon general, Dr. Vivek Murthy, began a series of confidential meetings with influential physicians and public health experts. The confabs acted as auditions for some participants who wanted a role in the new government. But they also allowed Team Biden to update medical influencers and let them voice criticism behind closed doors before going public. “I kind of find the calls pointless and useless, except that I felt special when I was invited,” said a doctor who visits them.

More recently, the medical huddles have become something else: a place for frustrated exchanges between administrators and physicians about the fundamental goal of the federal COVID policy, according to half a dozen participating physicians who spoke to vanity fair. Is the goal to prevent COVID-19 infections nationwide, or simply allow Americans to choose the level of risk that’s right for them as long as hospitals don’t become overcrowded?

In a May 5 call, dozens of doctors listened in as the recently appointed White House COVID-19 czar, Dr. Ashish Jha, enumerated the limitations of a federal pandemic response that had run out of money. Without new congressional funding, Jha told the group, monoclonal antibody and vaccine supplies would dwindle and not all treatments would continue to be covered by COVID-19 aid funds.

It wasn’t the government’s fault that Congress failed to fund these measures. But for the willing doctors fighting for health equity, it was painfully obvious that a cheap COVID response would disproportionately hit disadvantaged communities.

A week before the conference call, the White House Correspondents’ Dinner had become a battlefield over what constitutes an acceptable risk. Even as cases spiked again, fueled by Omicron subvariants BA.2 and BA.2.12.1, the federal response shifted away from mandatory precautions and toward a personal risk assessment.

Jha seemed to support that view, telling Fox News ahead of the dinner: “I think if people take good safety precautions they can make it a lot safer – make sure people are vaccinated, make sure that.” They conduct tests, improve ventilation. These are strategies we’ve learned over the past two years.’ Anton Fauci Jha deliberately skipped dinner and, like most of the guests, attended without a mask. The inevitable number of sick correspondents afterwards indicated that the banquet had been a super spreader event.

But for the health justice advocates on the call, including Dr. Ebony Hilton, a Virginia anesthetist, the event underscored a fundamental injustice at the heart of the pandemic response. Sick media managers and high-profile journalists can usually be tested free of charge, consult their family doctor and, if necessary, take the antiviral drug Paxlovid. But the servers, drivers and other support staff they came into contact with over the course of the weekend’s celebrations may have to pay for tests, seek costly medical care and search for someone willing to prescribe them the drug.

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