For weeks, the coronavirus has been closing in on the Oval Office.
In late March, White House press secretary Jen Psaki tested positive for the virus, her second breakthrough infection. A few weeks later, an outbreak at the annual Gridiron Club dinner seeded infections among House Speaker Nancy Pelosi and three members of President Biden’s cabinet. And on Tuesday, Vice President Kamala Harris tested positive at the White House and had to cancel a meeting with Biden.
Yet on Saturday, Biden is planning to step into a tuxedo and into a cavernous underground ballroom for the White House Correspondents’ Dinner, the first time a sitting president has attended since 2016. Despite rising coronavirus cases in the D.C. region, up to 2,600 guests are expected to attend in full pre-pandemic “Nerd Prom” regalia — satin lapels, glittering gowns, and mask-free faces — albeit with proof of vaccination and a same-day negative Covid test.
When President Trump became infected with Covid in October 2020, he had to be airlifted to Walter Reed Medical Center for treatment. If Biden, who is 79, were to become infected with Covid, how worried should Americans be?
While age remains a strong risk factor with Covid, vaccines and treatments have greatly decreased the threat of grave illness, experts said. “The president is vaccinated, boosted, and will be receiving very good medical care,” said William Hanage, an epidemiologist at Harvard’s T.H. Chan School of Public Health. “He’s also relatively healthy. Under the circumstances, it’s about as good as you can get.”
When the super-contagious Omicron variant first emerged late last year, Hanage said he and other public health experts immediately worried about the virus reaching Biden. Age is the single biggest risk factor for severe complications of Covid-19; people over 75 are 140 times more likely to die if infected than 18- to 29-year-olds, according to hospital data from the Centers for Disease Control and Prevention that includes both vaccinated and unvaccinated individuals.
“But one thing that has become clear since then is that Omicron is intrinsically more mild than Delta,” said Hanage. Large studies in South Africa and the U.K. both showed that an infection with Omicron carried with it lower risks of hospitalization. Notably, the U.K. study found that the older a person was, the higher those reductions in risk were. “That’s very important because if you’re an older person, you’re far better off getting infected with what’s going around now then what was going around six months ago,” said Hanage.
What has also become clear is how well vaccination protects against the most severe outcomes of Covid-19. Especially with a booster. Data from the U.K. showed that three doses of the Pfizer-BioNTech vaccine cut the risk of death from an Omicron infection by 95% in individuals over the age of 50.
“Age is the most powerful unifying feature of the people getting hospitalized now,” said Peter Chin-Hong, an infectious disease physician at the University of California, San Francisco. These days he mostly sees people in their 70s and 80s, and because he’s in the Bay Area, most of those people are vaccinated. “But a common theme in the older folks coming is that they haven’t been boosted.”
As months pass from vaccination, neutralizing antibody levels tend to tail off, and breakthrough infections become more common — driven in part by the spread of the Omicron family of variants which are more adept at evading initial immune defenses. A third shot, given at least six months later, can help restore protection.
Data on the benefits of a second booster are still trickling in. Most of what we know at this point comes from a large study published this month showing that additional jabs guarded against death during the country’s Omicron wave. A second booster of the Pfizer-BioNTech vaccine lowered mortality rates by 78% among older adults. But some experts are concerned that the U.S. may be sleepwalking into a policy of perpetual boosters, without the evidence that shows they are actually needed.
Biden received the first dose of the Pfizer vaccine in December 2020 and the second in January 2021 — both jabs were televised live. He received the Pfizer booster in September 2021, and another booster, also from Pfizer, on March 30, the day after the Food and Drug Adminstration approved a second booster for people over 50. That means he should still be in the window where his body is ramping up antibody production. More antibodies circulating means a higher chance his immune system will be alerted early in the event of any viruses arriving.
“It still remains rare to see someone die of Covid who is vaccinated, especially if they’ve received a booster dose,” said Graham Snyder, medical director of infection prevention and hospital epidemiology at the University of Pittsburgh Medical Center. “If you can get treated with monoclonal antibodies or Paxlovid, your chances of dying are really, really small.”
It’s not the way it was when Trump was infected.
At the time of Trump’s hospitalization, the only authorized treatments were remdesivir and convalescent plasma. The World Health Organization now advises against administering plasma and conditionally recommends remdesivir for those at high risk of hospitalization — if Paxlovid is unavailable or the patient is ineligible due to other drugs they’re on, like certain blood thinners. Trump’s medical team rushed a request to use Regeneron’s experimental monoclonal antibody cocktail, which has since been authorized by the FDA.
Now there are other monoclonals, some which work better against Omicron than others, and antiviral drugs like Paxlovid, which has been shown to slash risks of hospitalization by 89%. “I will always have a heightened level of concern for any older person regardless of vaccination status,” said Chin-Hong. “But we’re in a very different scenario than when President Trump was infected.”
The White House wants to project a return to normalcy. “We’ve reached a new moment,” Biden told the nation in the State of the Union address last month. “Covid-19 need no longer control our lives.” And on Tuesday, when asked about the coming correspondents’ dinner hours after Harris tested positive, Psaki said, “He made a decision, through consultations, that it was an event he could attend and wanted to attend again. Just like many Americans, he makes risk assessments,” she said.
At least one other American weighing similar risks reached a different conclusion. Late Tuesday night CNN reported that Anthony Fauci, the 81-year-old infectious disease expert and Biden’s chief medical adviser, would no longer attend the dinner amid concerns for his own health and worries it could turn into another superspreading event.
The diverging calculus between the two men highlights the moment we now find ourselves in. Covid-19 isn’t over; millions of Americans are still vulnerable to the worst outcomes of the disease — including immunocompromised individuals and the unvaccinated. But with vaccines and treatments, for most people going to a party is no longer a mortal gamble. The White House is sending a message that risks are now something to be weighed as individuals, not negated by collective action. That means a lot more people are going to be infected. You might be one of them. So might President Biden. But that isn’t reason for despair, said Hanage.
“It’s unlikely any of us will avoid it in the long run,” Hanage said.
He added: “At this point people might feel like the steps they took and the sacrifices they made were pointless because the virus is still with us. But the virus that’s with us now isn’t the same threat it was. And I think we can stand to be a little calmer about the consequences of infection, while recognizing that things can still change in the future.”
This story has been updated to clarify WHO’s recommendations for remdesivir.
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