And there it is: President Joe Biden has tested positive for the coronavirus, the White House announced Thursday morning, and is dosing up with Paxlovid to keep his so-far “very mild symptoms” from turning severe.
In some ways, this is one of the cases the entire world has been waiting for—not sadistically, necessarily, but simply because, like so many other infections as of late, it has felt inevitable. Once, it might have seemed possible to avoid this virus; now most Americans have had it. SARS-CoV-2 has been spewing out variants and subvariants at an absolutely blistering clip, and wave after wave of infections has slammed the nation, collapsing case peaks into a never-ending plateau. Vice President Kamala Harris caught the coronavirus in April; Anthony Fauci got it in June.
Perhaps the most notable aspect of these high-profile cases is not that they happened, but when. Though certainly on the front lines of the country’s COVID response, these officials have enjoyed the privilege of protection throughout the pandemic, with access to masks, tests, vaccines, and, most recently, antivirals; the comfort and security of jobs that can be done while in isolation; the socioeconomic means to separate themselves from colleagues and loved ones, and the support staff to alert close contacts about exposures. They, as much as anyone feasibly could, “have had access to all the available tools” the country has to fight the coronavirus, says Anne Sosin, a public-health researcher at Dartmouth College, so much so that they’ve even had the liberty to get a bit avant-garde. Fauci, for instance, received two courses of Paxlovid when his symptoms vanished and then reappeared—an unsanctioned use of the drug that sparked some criticism from infectious-disease experts who thought the move unwarranted and potentially baffling for a public unsure of who should be taking the drug and how.
Avoiding the virus, or at least a known, test-confirmed infection, up until this point of the pandemic does have real value. In the U.S., our collective capability to evade any serious outcome is much higher than it was in, say, October 2020, when then-President Donald Trump tested positive. Trump’s tussle with the virus unfurled at a time before COVID vaccines were available, and his doctors treated his illness as a pressing medical emergency, rushing him to the hospital for observation and treatment. At the time, COVID therapies were focused on the severely sick, and had to be administered by a trained health-care professional, typically in a medical setting; like Biden, Trump got the best care that was available at the time, but in the first year of the crisis, that entailed the trifecta of remdesivir, steroids, and still-experimental monoclonal antibodies, which Trump later touted, misleadingly, as a “cure.” Most monoclonal-antibody treatments, including the specific cocktail Trump received, have since fallen out of use because they’re less effective against the variants circulating today.
Today, President Biden may not need anything beyond Paxlovid, which the FDA greenlit late last year and can be taken as a pill at home. “We know so much more now,” says Taison Bell, a critical-care and infectious-disease physician at UVA Health. “We understand what treatments work, what treatments don’t.” Although Biden is 79—an age that puts him at high risk of severe outcomes from the virus—he’s quadruply vaccinated, having received his second booster in late March. And clinical trials have shown Paxlovid to be nearly 90 percent effective at slashing the risk of COVID hospitalizations or deaths (though those data were gleaned from an entirely unvaccinated population; real-world estimates of the drug’s performance have been far more mixed). Kevin O’Connor, the president’s physician, wrote in a letter today that “I anticipate that he will respond favorably, as most maximally protected patients do.”
In the third year of the pandemic, just as unsurprising as Biden’s illness is the pressure for the White House to leverage it as a statement on the right approach to COVID control. In 2020, Trump alarmed experts by peeling off his mask and walking into the White House just after being discharged from the hospital that treated him for COVID. Nearly two years later, Biden, to begin with, is apparently modeling some version of business as usual: The White House has already announced that he “continues to carry out the full duties of the office while in isolation” … which somehow involves the country’s chief decision maker tweeting out maskless photos (taken by someone else, presumably) of himself doing paperwork at his desk.
But, like Trump’s, Biden’s experience—including any performative professional displays—is still an exception among exceptions. “The president, as we would want, has access to therapies,” says Utibe Essien, a physician and health-equity researcher at the University of Pittsburgh. “We would hope that everyone should.”
They do not. Although the White House has made plenty of noise about the need for funding to keep the country awash in tests, treatments, and vaccines, Congress has not provided those resources, and the administration has not marshaled the political will to change that situation. Nor has it sparked the enthusiasm necessary to reignite America’s pandemic response where it has flagged. Cases remain undercounted; tests remain underused. Vaccination rates—especially boosting rates—remain worrisomely low. Effective treatments have been collecting dust on shelves amid enormous disparities in access. And gathering restrictions and masks are now mostly mitigation measures of the past, even though the CDC’s loosened guidelines currently recommend that people in more than a third of the country’s counties should be covering their face to control the coronavirus’s spread. At the beginning of this month, in a Fourth of July celebration, the president crowed that the country was “closer than ever to declaring our independence from a deadly virus”; weeks later, he is playing host to that same foe. And although he might have had access to the tools needed to combat it, “that doesn’t mean they’re going into the hands of the people who need them,” Essien told me.
That the president’s infection happened now, during the nation’s roiling, months-long, multi-subvariant wave, speaks to the bad cycle that the country has found itself in. The current surge shows few signs of slowing; more iterations of the virus are undoubtedly on their way. And yet little is being done in response to the danger, let alone as a preventive to keep the situation from going further off the rails. The U.S. has defaulted to acceptance, Sosin told me, of the status quo: uncontrolled transmission, viral evolution on loop.
Biden could have delayed his encounter with the disease a bit longer, buying time for the development of even better antivirals, clarity on the risks of long COVID, or, at the very least, fall’s highly anticipated BA.4/5 vaccine update. Doing that, though, would have required more investment—from him, perhaps, as an individual, but in particular from his country, under his leadership, to collectively tamp down transmission. In this current environment, however, “the virus has that many more pathways to spread through the community,” Bell told me—up to and including the president.