When we learned on Thursday that President Biden had tested positive for COVID-19, it served as a powerful reminder that no one is immune to this infection and that our recent tendency to wish away the pandemic is senseless. We should not be surprised that a 79-year-old president, even though he has been fully vaccinated and boosted twice, came down with a relatively mild case of this disease. The president has not been wearing a mask consistently nor following social distancing protocols, and has recently interacted overseas with foreign leaders on a whirlwind tour.
Biden is now recuperating in the White House, and both his spokesperson and physician have assured us that all CDC-recommended steps, including putting Biden in isolation and contact tracing all individuals who have recently met with him, is underway. He is undergoing antiviral therapy with nirmatrelvir-ritonavir (Paxlovid), which received FDA emergency use authorization late last year for treatment of high-risk patients with mild-to-moderate disease.
This apparently disciplined approach to managing President Biden’s COVID-19 is both a tribute to the rapid progress we have made in managing this disease and a stark contrast to what took place when then-President Trump was diagnosed in October 2020, less than 2 years ago. In that pre-vaccination time, the mask-averse chief executive was rushed to Walter Reed Hospital despite his strenuous objections. Determined to show his constituency that he remained in charge, he almost immediately overruled his doctors, the Secret Service, and CDC guidance to go on an evening drive-by while he waved at news cameras outside the hospital’s walls. We were never told exactly how sick he was. We do know he was not placed on a ventilator, certainly did not inject bleach, and we hope his doctors did not prescribe hydroxychloroquine. He received a monoclonal antibody treatment from Regeneron, as well as remdesivir (Veklury), a now-approved antiviral for COVID-19. The combination of Trump’s obesity, age, and unvaccinated status certainly put him at greater risk than his successor. However, he was able to recover and run for re-election before any vaccines were authorized. He has subsequently been vaccinated.
We should be relieved that our capacity for managing presidential cases of COVID-19 has improved, but we should by no means be complacent. President Biden will probably recover quickly and fully, but he and his doctors must remain vigilant for COVID rebound after nirmatrelvir-ritonavir or symptoms of long COVID, the often-debilitating and little-understood syndrome that affects a minority of patients and was this week the subject of a congressional hearing. Fortunately for President Biden, long COVID is more likely to be identified among the unvaccinated.
Above all, we must recognize now, in July 2022, that when the president tests positive for COVID-19, in this case with the BA.5 variant, it is a sure sign that the pandemic is not even close to over. It offers a teachable moment for the president and the public to take stock of the government’s approach to managing it — and what’s clear is that the Biden administration needs to better manage the pandemic response with the goal of signaling to the public that this remains a public health emergency. The administration must continue to do everything possible to keep people healthy.
By now, almost everyone knows someone who has had COVID-19 or, worse still, died of it. Now, with a reported 126,000 new cases a day, only 28.5% of American adults over 50 double boosted, less than a third of kids 5-11 fully vaccinated with the primary series, and 21% — one in five of us — not vaccinated at all, we can be certain that more will die.
We wish President Biden a speedy recovery, but as he now has some enforced downtime, we hope he gives some fresh thought to how his team is managing the nation’s COVID-19 response. This president does not overrule or denigrate his scientific and medical advisers as his predecessor did, much less bring ill-qualified and divisive ones into the White House, but that does not mean that the approach to pandemic management in this administration has been exemplary. The issue now is not talent: Surgeon General Vivek Murthy, MD, MBA, and White House COVID-19 Response Coordinator Ashish Jha, MD, MPH, are world class experts; Anthony Fauci, MD, at National Institute of Allergy and Infectious Diseases (for the rest of this President’s term) and Robert Califf, MD, at FDA also know their stuff; and Rochelle Walensky, MD, at CDC has learned from earlier mistakes.
The problem remains accountability and discipline.
Unfortunately, this week’s announcement of a new division of pandemic response within the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR), reportedly on equal footing with FDA, CDC, and NIH, seems wrong-headed at worst and a serious slap in the face to CDC at best. All the scientific expertise and partnerships with states reside in Atlanta, while ASPR is decidedly an inside-the-beltway political entity. How could a president who has for 40 years had a ringside seat at the perennial bureaucratic boundary disputes between FDA, CDC, and NIH think that a fourth bureaucracy could possibly get us out the woods at this point? Moreover, what does the addition of this bureaucracy say about the strategic management approach of HHS Secretary Xavier Becerra, JD, who had no previous experience in science and public health despite his admirable legal and legislative background? The “strategic” management piece is nowhere to be found.
Get better, President Biden. And do better, too.
Scott C. Ratzan, MD, MPA, MA, is distinguished lecturer at CUNY Graduate School of Public Health & Health Policy and editor-in-chief of the Journal of Health Communication. Kenneth H. Rabin, PhD, MA, is senior scholar at CUNY Graduate School of Public Health & Health Policy. Lawrence O. Gostin, JD, is university professor, Georgetown University’s highest academic rank, where he directs the O’Neill Institute for National & Global Health Law. He is also director of the World Health Organization Collaborating Center on National & Global Health Law. He is the author of the book, Global Health Security: A Blueprint for the Future.