ROBERT COSTA: A special report on an American crisis.

ASHISH JHA, M.D.

: (From video.)

We are in the worst phase of the pandemic.

NIAID DIRECTOR ANTHONY FAUCI: (From video.)

We're now at over 250,000 dead.

You know, you could get well over 300,000 and close to even more than that if we don't turn things around.

COSTA: The numbers are staggering.

Hundreds of thousands dead and more outbreaks nationwide.

MARY TURNER: (From video.)

The pandemic is surging, and frontline workers are getting sick and dying.

COSTA: Yet, amid a ravaging pandemic, Washington is divided.

RON KLAIN: (From video.)

Instead of facilitating an orderly transition, helping to save lives in the fight against COVID, the president's thrashing around with these PR stunts.

COSTA: As the world watches, and remains hopeful about vaccines, who will lead?

And what comes next?

ANNOUNCER: This is Washington Week.

Once again, from Washington, moderator Robert Costa.

COSTA: Good evening and welcome to Washington Week.

We hope you enjoyed Thanksgiving.

We also know it wasn't easy.

The coronavirus pandemic remains a burden and a threat, families can't gather, millions are isolated and struggling, and more than 250,000 Americans have died.

So our question tonight for this special report is: What's next?

Joining us to provide answers and insights are three of the best journalists on this story.

They have been covering different aspects of the crisis.

Fareed Zakaria, host of Fareed Zakaria GPS on CNN, a Washington Post columnist, and author of Ten Lessons for a Post Pandemic World.

Yasmeen Abutaleb, a national health policy reporter for The Washington Post.

And Sarah Kliff, an investigative reporter for The New York Times, covering the American health care system.

Let's begin with Dr. Anthony Fauci, the nation's top epidemiologist, who spoke with me earlier this week.

He was upbeat about vaccines, but he warned that winter could be bleak.

NIAID DIRECTOR ANTHONY FAUCI: (From video.)

Now what we're seeing, almost the entire map of the country is lighting up with the dark colors that indicate increased test positivity.

And the slope is like that.

Which means that if, in fact, you're in a situation where you do the things that are increasing the risk - the travel, the congregant setting, not wearing masks - the chances are that you will see a surge superimposed upon a surge.

COSTA: That made me sit up, a surge superimposed upon a surge.

Yasmeen, when you listen to Dr. Fauci and when you talk to health officials, what do you hear?

What is keeping them up at night?

YASMEEN ABUTALEB: I think, you know, the biggest concern is that there really isn't a federal response right now, at this time we're at the worst point in the crisis that we've been.

You know, in the spring you saw this national shutdown, a bit more federal leadership.

And the crisis is actually worse now than it was then.

You know, there is - there is this huge fear that's been playing out that a federal response could not wait until President-elect Joe Biden takes over on January 20th.

You can't just let the crisis spread unchecked for those 10 weeks.

And that's essentially what we're seeing happen.

You see states taking different steps, you know, to try to control it.

Some states being more willing than others to take dramatic steps.

But right now, you're not seeing a lot of federal leadership.

There isn't a lot of federal messaging about what to do.

You know, there's obviously huge concern about Thanksgiving travel and get-togethers and what that's going to mean for a surge or an uptick afterwards, when we're already at around 170-180,000 cases a day.

And that these smaller health care centers and hospitals are not getting the help and resources they need.

COSTA: Sarah, you cover health care workers and patients.

So out in the country, what is their reality right now?

SARAH KLIFF: I think there's a lot of really tired health care workers who have been fighting this day-in and day-out across the country.

And really, the fear right now that I hear expressed by public health officials, by hospital executives, is that what we could see in the next few weeks is something like what happened in New York City in March and April, just this huge surge.

A need for more staff, a need for more ventilators, for more hospital rooms.

When it happened in New York, the rest of the country could help.

Other states sent ventilators; travel nurses came to New York City.

But the real fear that seems to keep these workers and public health officials up at night is that surge is going to come at so many places across the country that there won't be those resources to surge from one place to another.

And I think it's certainly true.

We've stepped up our production of PPE.

There's more masks and more ventilators too.

But the real linchpin is the people.

There's only so many people in the U.S. who know how to operate a ventilator, who know how to treat this disease.

And that's the thing that keeps, you know, the health workers and hospital executives I talk to up quite worried and alarmed, is that they might not have the staff to treat patients when the surge gets much worse in their area.

COSTA: Fareed, let me read a line from your terrific book.

You write, quote, "Nations have created mechanisms and institutions to cooperate and solve common problems.

But in the end, in extremis, they walk alone."

This is a global crisis, but which challenges are uniquely American?

FAREED ZAKARIA: You know, it's the paradox of a pandemic that while by definition it's global, it forces countries to become somewhat more isolated.

You know, you cut off or you limit travel.

You have to put your own house in order.

In the American case, I think there are two principal challenges.

We're going to go beyond Trump for a moment.

One is the crazy quilt patchwork of center, state, and local authority.

You know, the United States does not have, you know, one government that is handling the pandemic.

It has 9,000, roughly, separate units of government that have to coordinate and have similar standards and travel, and things like that.

And that has proved a huge problem.

The second is more cultural.

There is within America's DNA a certain kind of anti-statism.

You know, the kind of don't tread on me philosophy.

And so it becomes hard to get people to observe quarantines, mask wearing.

You know, the CDC has advised: Don't travel during Thanksgiving, or don't have large gatherings.

It's very hard.

That rubs against the culture of the country.

Both challenges exist for other countries, but they are in some senses specially American.

And it is certainly true that we've been especially bad at dealing with them.

COSTA: Yasmeen, what is the outlook on vaccines this week.

What are they watching for at the FDA?

ABUTALEB: Well, I think one of the rare signs of positive news in the last couple of weeks has been these three very promising vaccine candidates that have reported their first results.

So, you know, at the FDA there is an advisory committee meeting scheduled to review the data on Pfizer's vaccine on December 10th.

I think a lot of people are hoping that an emergency authorization for that vaccine comes shortly after that meeting.

And then on the other two candidates that have reported results, Moderna's vaccine and AstraZeneca, you know, it'll be the same process - the FDA reviewing the data to see, you know, if it warrants an emergency authorization, which is not the same as a full approval - which takes much more time - but basically is an assessment that the benefits of the vaccine outweigh any potential risks in the middle of a public health emergency.

COSTA: But, Sarah, is the system you cover ready to effectively distribute vaccines in the coming months?

KLIFF: Mmm hmm.

You know, that makes me think of the question you asked Fareed.

And when I think of the American experience with coronavirus one of the unique challenges we have is this incredibly fragmented health care system, where we don't have a national health care system like many of our peer countries.

We have competing health insurance plans, and some private plans, and some public, and this whole patchwork of providers.

And it will be a challenge to get the vaccine out to that system.

If you think of all the different places where Americans get their vaccines right now - sometimes at the doctor's office, sometimes at a pharmacy, sometimes through their workplace - we're going to have to figure out how to distribute it, and distribute it in an equitable way, to make sure that the people who really need this vaccine get it first.

So that's the next, you know, large hurdle we're going to deal with.

And I think it's one that public health officials are quite eager to deal with.

They want to get this vaccine out to people.

But we have a system that is, you know, not set up to be efficient because there are so many different players.

You could have places where the lack of communication makes it a bit more challenging to distribute a vaccine in our country, you know, compared to some of our peers.

COSTA: Fareed, beyond that efficiency point, will there be enough public confidence in the vaccines to get the nation out of this crisis?

You've spoken to Bill Gates in recent days about this topic.

ZAKARIA: Yeah.

Look, it's a - it's a huge problem.

And let me pose what will be a real challenge if it materializes.

Right now Donald Trump is pro-vaccine, because he sees it as something as being something that he spearheaded, and he helped fund with the Operation Warp Speed.

In a few months, the Biden - the vaccine is going to be Joe Biden's vaccine, at which point if Donald Trump becomes an anti-vaxxer - if he says: You know, I started this program well, but the Biden administration has totally screwed it up.

Don't get vaccinated.

Remember, he still has a huge number of people who support - who hang on his every word.

That massively complicates the scenario.

But let me be somewhat optimistic about this.

I think that it's worth pointing out: These vaccines have been developed faster than any vaccines that we know of.

You know, this is an extraordinary achievement.

We're probably going to have seven or eight of these.

If you think about the first phase of the health crisis was a public health response, which the United States basically botched.

The second phase is going to be therapies and vaccines, which is largely a private sector response.

I would suspect the United States will overperform or outperform on that metric in terms of production, even in terms of distribution.

The key issue is going to be the one you asked, which is public trust.

And over there, as I say, the most worrying variable is Donald Trump.

You know, and he's not the only guy.

As I point out in my book, this whole wave of populist leaders who scorn expertise, who scorn scientific knowledge, they could - they could have a second act with the vaccine because that will be a place preeminently where you need to trust experts.

COSTA: Yasmeen, I spoke to Dr. Fauci about this this week, and you've written about this in recent days.

You've reported about how the president has railed against the so-called medical deep state, his term.

So while I spoke to Dr. Fauci, and you're talking to him and other officials, who is actually in charge right now inside the federal response?

ABUTALEB: I think the problem is that it's no one is really in charge inside the federal response.

You know, the White House has really not paid a lot of attention to the coronavirus response for weeks now, preceding the election.

You know, we've spoken with several officials - both political and health officials - who said the White House coronavirus taskforce meetings at this point are little more than political theater.

So, you know, you have the agencies that have very clear work to do - the FDA on reviewing and authorizing these vaccines, distributing personal protective equipment, preparing for vaccine distribution.

But when you're talking about, you know, the entire federal response that really should be led out of the White House, there isn't really a leader there.

And I think you can see that in the conflicting messages you get from people.

You have people like Dr. Fauci, you know, really sounding the alarm for these last several weeks about the direction we're headed in.

You have the president, you know, sort of barely acknowledging the rising infection and death toll.

And then, you know, all manner of officials in between.

You know, you've got the Secretary of Health and Human Services Alex Azar reiterating basic public health tenets, talking about their vaccine progress.

But, you know, you're not seeing a coordinated, centralized federal response.

And I think that's reflected in, you know, the messages you see, depending on who's giving it that day.

COSTA: Sarah, I want to come back to your beat for a moment.

In terms of testing and treatment, what are the costs of this pandemic?

KLIFF: So for patients, they are supposed to be free.

There are some rules that Congress passed this spring that are meant to make coronavirus testing free - and with good reason.

We don't want people to be afraid of a medical bill and not get tested when they think they might have coronavirus.

So that means no copayments, no deductibles, a special fund to cover tests for those who are uninsured.

Unfortunately, what I've been finding in my reporting is that many patients are facing costs, and sometimes quite significant costs, for their coronavirus test.

You know, in rare cases over $1,000 for a test that they expected to be free.

And I think this really reflects the way that our health care system works and, again, the fragmentation.

I've talked to insurance companies that have tried to implement these rules, but the coding is quite complex.

Sometimes providers will tack on extra services patients weren't aware were being added, and they'll get billed for those things beyond their coronavirus test.

So right now we're having millions of coronavirus tests every single month.

And unfortunately you are seeing some patients get medical bills.

I think the other, you know, side of this to be aware of is you have patients who are uninsured, or patients who have gotten a surprise medical bill in the past.

And they might be a little bit nervous to get a coronavirus test because they don't think they can afford it.

I've talked to some people who faced steep costs for flu tests, for example, and now are nervous to get a coronavirus test.

So it's a unique element of the pandemic in the United States that you have this medical billing side that is going to be an element that makes it harder to control the pandemic here, versus in other countries.

COSTA: Those are challenges for President Trump, but also for President-elect Biden, who is putting together a strategy.

However, for weeks the president refused to sign off on the transition.

Finally, on Monday the head of the General Services Administration informed Biden that he could begin the process.

Yasmeen, what's your assessment of Biden and how he will handle the pandemic?

ABUTALEB: I think he made pretty clear, as soon as he was declared the winner of the election, you saw him two days later announce his coronavirus taskforce - transition taskforce, which was made up entirely of doctors and health experts.

So, you know, I think he tried to signal right out of the gate that this was going to be a science-led response.

He was going to follow the advice of scientists.

You saw him appoint Ron Klain his chief of staff, who was the Ebola czar for the Obama administration in 2014 and was generally praised for the way he coordinated across the federal government to manage the Ebola response.

So I think, you know, you see that this is going to be the top priority for the Biden administration when they come in, front and center.

You know, the Biden team has also signaled that they're going to put the CDC front and center, including career officials who were cast aside in the Trump administration for, you know, straying from the message that the Trump administration wanted to convey.

So I think he's trying to signal in every way that he can that this is going to be a much more muscular federal response.

They're going to try to help the states, as they can.

You know, the big thing to keep in mind is that they're going to inherit an enormous crisis.

You know, cases are already at almost 200,000 a day.

It's hard to predict where they'll be by the time they take over.

So it is going to be an enormous challenge that they're going to inherit.

COSTA: Fareed, what would you add here about President-elect Biden?

ZAKARIA: I think Biden has exactly the right instincts.

He has very good people around him.

But I think that one of the things that we have to understand is that the United States really failed at every level.

It's not just President Trump.

Trump, you know, you can blame him for a lot of things - and I think he deserves that blame - but it's been a broader, systemic failure.

One of the things I talk about my book is: If you look around the world you see that the countries that did well were countries that had figured out to get government right, and how to get government right in a response to a crisis like this.

So for example, Taiwan - which really gets the gold medal for this - figured out how to do not just testing but also tracing and then isolation of the people.

We see the most important thing is to get the infected and the potentially infected out of circulation.

So I would hope that what the Biden administration can do is learn from Taiwan, South Korea - by the way, all places that have no lockdowns.

The vice president of Taiwan who ran this told me: A lockdown is a sign you have already failed.

What you have to do is figure out how do you take the infected, quarantine them, isolate the potentially infected.

That's usually, he said, in his case - in Taiwan's case, it was 1 percent of the population.

That allowed the other 99 percent of the population to live life as normal.

And if we were to isolate these people - give them hotel rooms, give them, you know, five-star service - the cost would be a fraction of a fraction of what this country is losing economically as a result of the coronavirus.

So anything you can spend to have an intelligent and aggressive response would be the right answer.

One of the things we're bad at in America is learning from other countries.

You know, we think we're exceptional, we - and we are in certain ways.

But it blinds us to the reality that there are some things we do very badly, other countries do well, and it would do to have a little bit of humility and look around at best practices.

COSTA: Sarah, Congress is deeply divided here in the States.

Are you expecting more executive actions next year on issues like testing, rather than legislation?

KLIFF: I think I am, but there's only so far that executive action can get you.

You can get a lot farther if you're able to move legislation through Congress.

And I think you see this, for example, with the issue of masks.

Joe Biden has spoken positively of a mask mandate, but it does not appear that there is federal authority to create something like that.

You know, I do expect more executive action around a testing strategy.

Joe Biden has outlined a pretty comprehensive plan for how he wants to increase to about 100 million tests a month.

That would be a big jump from about the 30 or so million that we're at right now.

But a lot of it's going to be easier to do if you can get the buy-in of Congress to fund those sorts of things, and also to get the buy-in of the American people.

I think one of the things you're seeing right now is Americans are taking a lot of their cues from their political leaders.

And if you have President Trump, you know, mocking masks or, you know, not talking about the importance of getting tested, even if the capacity was there you might see some of his supporters not wanting to use those resources.

So I think part of it is getting Congress and getting the buy-in of congressional Republicans would signal to the American public that both parties feel like this is important, and this is the right thing to be doing.

COSTA: Yasmeen, quickly, what's one thing you're watching as a reporter in the weeks ahead?

ABUTALEB: I think the big thing is whether we see a big spike after Thanksgiving, and how states try to manage that.

You know, we saw a big spike after Memorial Day, when people felt it was safe to get together.

And at that point, cases were about 20(,000) or 30,000 a day.

So I think that's the big thing.

And then, of course, how the federal response changes or doesn't change in the coming weeks.

COSTA: And, Fareed, in just a few seconds, what are you watching?

ZAKARIA: The Georgia races, because everything depends on whether Biden will be able to spend money or not.

At the end of the day, as others are saying, this is all - it all becomes much weaker unless you can spend a lot of money fast.

COSTA: We must leave it there tonight, a little earlier than usual, so you can support your PBS station.

Thank you so much to Fareed Zakaria, Yasmeen Abutaleb, and Sarah Kliff.

We very much appreciate your time.

We also appreciate yours.

And we will keep taking you as close to the news as we can.

And check out our next chapter of our Bookshelf series.

You can find it on our social media and website.

I'll talk more with Fareed about his book.

I'm Robert Costa.

Stay safe, and good night from Washington.