If this sounds familiar it’s because he already mandated vaccination for federal workers and contractors at the end of July. But in that case, with the magnitude of America’s Delta wave still uncertain, he gave the unvaccinated the option of being tested regularly instead.

Now, with America averaging around 1,500 deaths per day for the first time since March, that testing option is being taken away. If you work for, or do business with, the feds and you value that relationship, it’s immunization or bust.

That’ll be the headline for stories about his speech this afternoon but I think the bigger news lies elsewhere.

Biden on Thursday also plans to announce a major expansion to free testing, a step public health officials have said is critical to containing the virus, particularly as children return to school and some workers return to offices…

A White House official said the six pillars of Biden’s plan include: vaccinating the unvaccinated; further protecting the vaccinated through booster shots; keeping schools open; increasing testing and requiring masks; protecting the economic recovery; and improving care for those with Covid-19…

Biden has identified schools as a key area of focus, given the broader effect that having children in classrooms has on the economy, particularly for women.

That’s the big news, that he’s calling for more aggressive testing in schools. Experts have been following the numbers of kids getting infected since school resumed last month and tearing their hair out that administrators haven’t done more to try to limit contagion in the classroom. Biden’s going to twist their arms today, apparently:

their schools for students, teachers and staff consistent with CDC guidance," the official said.

3. This is ptc important for elementary kids. Important to understand that many schools are NOT DOING THIS.

Or they're doing it wrong. IE only testing symptomatic or only staff.

— Heidi Przybyla (@HeidiNBC) September 9, 2021

Kids account for more than a quarter of all new COVID cases with 252,000 more added last week, the highest seven-day number for children since the start of the pandemic. Delta plus close quarters in the classroom equals lots of spread, and lots of spread means even uninfected kids getting sent home for long stretches potentially due to quarantine rules. As of last Friday, a fifth of hard-hit Kentucky’s school districts had already had to close their doors for some time due to outbreaks even though the new school year is only a few weeks old. How can we keep kids under 12 who aren’t eligible yet for vaccination safe *and* in the classroom?

We can have schools test their students more frequently to try to intercept the infected before they spread Delta around. Scott Gottlieb called for action on that yesterday:

The goal is to keep kids safe and preserve in class learning. Studies show weekly testing can help. In one analysis, 5-day school attendance with weekly screening had lower cost than hybrid models without screening and similarly low rates of transmission https://t.co/OcFA9iab9U

— Scott Gottlieb, MD (@ScottGottliebMD) September 8, 2021

But schools need turnkey solutions. California built its own lab. New York City uses spit tests provided by Mount Sinai Hospital. The Broad is doing testing for many New England schools. Private testing companies are stepping in too to assist many states.https://t.co/GcbMGUVxwu

— Scott Gottlieb, MD (@ScottGottliebMD) September 8, 2021

The feds appropriated $10 billion for this purpose months ago, Gottlieb notes. Biden’s going to remind governors of that today. The more infected kids can be screened out before they enter the building, the less disruption there’ll be to other students.

Question, though: Even if the money’s there, are the tests? America’s testing regime is an absolute debacle, Scott Lincicome reported recently. The rapid antigen tests that can detect an infection within 15 minutes and which would be ideal for school use are ubiquitous and dirt cheap in Europe, but in the U.S. they cost 20 bucks or more — if you can find one. Only a very few have been approved by the FDA so far and the existing supply has already been snapped up, leading to shortages everywhere. How are we supposed to test kids if there are no tests to be had? Lincicome:

[T]he FDA didn’t first issue an emergency approval for an over‐​the‐​counter, at‐​home rapid test until mid‐​December 2020—and that Australian‐​made Ellume test was available only in extremely limited quantities (and required a smartphone app to use!). Since then, the FDA has approved only five more, bringing the grand total of approved at‐​home antigen tests in the United States to a whopping six: Ellume; Abbott Labs’ BinaxNOW; Quidel’s QuickVue; OraSure’s Intelliswab; Access Bio’s CareStart; and Becton Dickinson’s BD Veritor. Really, though, we have just three at‐​home antigen tests right now because, as the Wall Street Journal reported, the last three listed above were approved only recently and thus aren’t yet on the market here. (The final two were approved last week!)

This dearth of home tests is not for lack of companies trying: Public health expert Dr. Eric Topol stated in February of this year that there were more than 30 different rapid home tests sitting at the FDA awaiting approval—some since April 2020! Furthermore, other jurisdictions have approved dozens of tests: Germany, for example, has authorized more than 60 self‐​tests from producers all over the world—including several made in the United States and approved for export only.

School districts should have had regular testing regimes in place months ago, long before the fall semester. To the extent they didn’t, Biden and state governors should have been riding their asses and making sure that the U.S. had a stockpile ready to go, with the FDA in overdrive to approve more before fall. Now the school year has begun and only today will this be treated as an urgent national priority.

As for the vaccine mandate component of today’s news, Biden’s targeting federal workers and contractors simply because that’s as far as his executive authority can reach. He’s doing whatever he can to boost vaccination rates in the U.S. in hopes of easing the strain on hospitals. Protection from severe illness is the vaccines’ great blessing, as more and more data affirms:

One final piece from this report: daily cases, hospitalizations and deaths by vax status. Again, the “not fully vaxxed” could include several previously infected. So the ratios of cases & hosp. for vaxxed v. “non-immune” are probably quite a bit higher than 3.5X and 47.5X. pic.twitter.com/pHlL0o066j

— Aaron Astor (@AstorAaron) September 9, 2021

What happens to hospitalizations among unvaccinated & fully vaccinated during the Delta wave? US data is hard to come by, but Utah gives us a look. They approximately doublehttps://t.co/6mAEkduSNJ
July ->
Fully vaccinated 2 -> 4/100,000
Unvaccinated 7 -> 16/100,000@MCSlab_uiuc pic.twitter.com/2APGJLN42C

— Eric Topol (@EricTopol) September 8, 2021

Biden’s probably a bit embarrassed about this too, and if he isn’t he should be:

Japan and South Korea are going to overtake the US in the number of people at least first-dose vaccinated in the next few weeks unless something drastic changes. Australia and New Zealand not far behind. pic.twitter.com/xX4fzNyFuP

— Mike Bird (@Birdyword) September 7, 2021

If preserving hospital capacity requires twisting some arms to increase vaccinations, the administration’s going to twist the arms that it can. Especially since Biden surely understands by now from his declining job approval that getting a hold on COVID is crucial to his party’s chances next fall. They’re probably cooked either way, but Democrats overperforming requires turning a corner — durably — on the pandemic.