President Joe Biden’s announcement Thursday that he tested positive for Covid-19 threw a spotlight on the administration’s flagging efforts to contain the virus — and the president’s health.
Eighteen months into Biden’s presidency, roughly 125,000 people a day are reporting new cases, according to the Centers for Disease Control and Prevention. The real number is much higher, as people test at home or never test at all. Nearly 400 people are dying each day.
While Biden is vaccinated and twice-boosted — putting him at less risk than President Donald Trump during his October 2020 diagnosis — people above age 70 are still nearly three times more likely to be hospitalized and also to get long Covid, a range of symptoms that can persist for months.
Why wasn’t Biden masking up?
The White House’s announcement came on the heels of Biden’s four-day visit to Israel and Saudi Arabia, the sixth international trip of his presidency.
The president met with Saudi Crown Prince Mohammed bin Salman and other Saudi officials indoors without masks for extended periods of time, a move that may have exposed him to the virus.
“We follow protocols of the countries we visit,” said a White House official.
That’s indicative of how the willingness to take precautions has changed since the deadly winter wave.
“As we start to see fatalities creep up and hospitalizations creep up, everything about recommendations now is up in the air,” said Irwin Redlener, director of the Pandemic Resource and Response Initiative at Columbia University.
Just last week, Biden’s top medical adviser, Anthony Fauci, called briefly unmasking at a college reunion a “lapse” in judgment that led to his Covid-19 diagnosis last month.
“As I was doing it, I was saying to myself, I hope I’m not making a mistake,” the National Institutes of Allergy and Infectious Disease director said in an interview with POLITICO a week prior to the president’s case.
“White House protocols are rooted in and sometimes exceed CDC guidance,” the White House official said, adding that people are still required to test for the virus before meeting with the president. It is not clear whether foreign dignitaries were also tested during Biden’s Middle East trip. “The White House is a unique place to work and as such we have distinct protocols to ensure that our staff can operate safely and effectively.”
What is a “mild” case for a 79-year-old?
Biden’s physician, Kevin O’Connor, said in a memo Friday that Biden had a slightly high temperature Thursday evening but his symptoms have improved after his first full day of Paxlovid, a 30-pill regimen taken over five days.
Still, Biden’s symptoms include a runny nose, fatigue and a cough. O’Connor also said Biden was pausing other medications such as a daily blood thinner while on the antiviral. “The President is fully vaccinated and twice-boosted, so I anticipate that he will respond favorably, as most maximally protected patients do.”
While fewer people are dying from the virus than in previous waves, deaths and severe cases are still disproportionately among older Americans according to CDC data. The data are still coming in on the highly transmissible subvariant BA.5, which swiftly became the country’s dominant strain, prompting federal health officials to call for every adult to receive another booster.
Biden’s case sounds similar to that of the 81-year-old Fauci, whose symptoms — except for fatigue — cleared during his first course of Paxlovid. Fauci told POLITICO that he experienced Paxlovid rebound, testing negative for two days before the virus reared up again, causing fever, fatigue and other symptoms. He then began a second course of Paxlovid, which health experts are already speculating Biden may do.
Does all this mean that CDC guidance should change?
The administration would risk a political backlash by asking states to impose new mask mandates, but public health experts say the surge driven by Omicron subvariant BA.5 necessitates more stringent measures — including longer quarantine periods.
The president is going beyond “flawed” CDC guidance to quarantine for five days after testing positive, then wear a mask for five days, saying he will test each day and will not end quarantine until he tests negative, said Eric Topol, a physician and founder of the Scripps Research Translational Institute.
Topol said the CDC should recommend a longer isolation period: “It’s a real embarrassment that the president’s isolation plan is different than the CDC’s recommendation.”
Many countries recommend quarantining for a week and testing negative for two days before ending isolation. The CDC changed its guidance in December amid the original Omicron wave. Biden is also following the broader White House protocol for staff and reporters who test positive and are required to test negative before returning to the building.
The CDC did not immediately respond to requests for comment about whether the agency was considering changing its quarantine guidance.
Richard Besser, CEO of the Robert Wood Johnson Foundation and a former acting CDC director, said that under ideal circumstances, everyone would follow Biden’s lead in waiting to test negative before exiting isolation.
But he defended the current guidelines for recognizing that millions of Americans simply can’t afford to hole up for a week or more.
“For many people, isolating for 10 days is extremely challenging,” Besser said. “Not everyone has the luxury to be able to do that.”
Instead, Besser said he favors federal officials encouraging people to wear higher-quality N95 and KN95 masks that are shown to do a far better job preventing the virus’ spread than cloth masks.
What is the risk for someone Biden’s age who is vaccinated and boosted?
Since he’s vaccinated and taking Paxlovid, Biden’s case is likely to stay mild, but scientists still understand relatively little about the long-term Covid-19 symptoms affecting as many as three in 10 people who’ve had the disease.
“I would say his risk of hospitalization is exceedingly low,” said Céline Gounder, an infectious disease specialist and epidemiologist who’s also editor-at-large for public health at Kaiser Health News. “To me, that’s probably the most significant question, is whether he has long Covid.”
Long Covid is an umbrella term for a range of mild to severe symptoms from breathing problems to brain fog and serious organ damage. The CDC is investigating whether the long-term disease can lead to death after an analysis of death certificates over the past two years found 100 possible cases.
But it’s still difficult to say what the current risk is for a senior who is vaccinated and boosted as health officials scramble to better understand the BA.5 variant and distill nationwide data on its severity.
“From the standpoint of immune escape, transmission, spread contagiousness, it is the worst variant since the beginning of the pandemic,” Topol said. “The only reason we’re not seeing more deaths and more hospitalizations is because we have this built up immunity wall from all the infections, boosters, vaccinations and combinations of all that.”
Daniel Payne contributed to this report.