A pair of pedestrians wear masks in Portland on Friday while walking by a sign urging them to do so. Credit: Troy R. Bennett / BDN

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Stefan Baral is an associate professor in the Department of Epidemiology within the Johns Hopkins School of Public Health. Gregg Gonsalves is an assistant professor in the Department of Epidemiology at the Yale School of Public Health and 2018 MacArthur Fellow.

By the time Joe Biden assumes the role of president of the United States, we are likely to be in the throes of a worsening epidemic, as COVID-19 cases, hospitalizations and deaths continue the upward trajectory begun this fall.

After Inauguration Day, President Biden will have a monumental task ahead to contain COVID-19 transmission across the U.S., even in the context of promising news of a vaccine, with a populace that is weary from the continuing sacrifices they have made since March and with state officials who may resist what comes out of Washington, D.C., on partisan grounds.

Biden’s approach to addressing the pandemic is crucial. The temptation will be to put the burdens on ordinary Americans, including some of our nation’s most economically marginalized communities. The stay-at-home orders this spring likely blunted the epidemic in many places across the U.S. However, the ability to stay home is something that is only feasible for some. Many Americans kept society afloat by continuing to deliver goods, support infrastructure and sustain essential services such as grocery stores, farms, home care medical services and pharmacies.

These jobs that require people to show up to work in a pandemic often are twinned with regular close physical contact, enhancing risk of COVID-19. And those filling these jobs, as University of Chicago labor economists Simon Mongey and Alex Weinberg have noted, are less likely to be white, to have a college degree or to have employer-provided health care. And they are more likely to be in the bottom half of the income distribution scale. They are also less likely to have had stable jobs, more likely to have been unemployed in the last year and less likely to be employed full-time. Moreover, this economic precarity often also intersects with crowded living environments, where people are less likely to have at least one room per person available in a household, which makes effective quarantine or isolation challenging, should someone in the household be exposed or fall sick.

The pandemic relief bills this spring had little in the way of sustained direct support for ordinary Americans. The Congress largely focused on big business — Wall Street not Main Street — sending millions of Americans into unemployment without a safety net to catch them as they fell with poverty rising, hunger and food insecurity following, with many unable to pay their rents throughout the pandemic.

President-elect Biden’s plans for COVID-19 must ensure that the social goods of effective quarantine and isolation are supported by society, including the provision of paid leave and temporary housing support, especially for those in multigenerational households, and alleviating barriers to testing and health care. He must address the economic and social insecurity millions of Americans are facing at the same time he seeks to scale-up basic public health measures.

The pandemic is the worst public health disaster in the U.S. in over a century, but the social and economic catastrophe beneath the surface, which was largely ignored by politicians since all this began, is devastating in its own right. President-elect Biden cannot delay addressing the historical causes of these disparities — including systemic racism, which we’ve seen demonstrated in lopsided counts of infections with SARS-CoV-2 and deaths from COVID-19 in many communities — with immediate relief, sustained and substantial, for those who need it. A modest, one-time payout like we saw earlier this year was insufficient to keep most people afloat. We need a comprehensive economic and social relief package to accompany any public health one.

In the context of COVID-19, being well is not just being free of a virus. If we do not address the economic and social needs of Americans right now, we will not contain the downstream effects of the pandemic, and we will only make the lives and health of many in this country worse than when this virus emerged among us.