Biden's bout with covid tests his return-to-normal strategy

En esta fotografía proporcionada por la Casa Blanca, el presidente Joe Biden habla con el senador demócrata Bob Casey por vía telefónica desde la residencia presidencial, el jueves 21 de julio de 2022, en Washington. (Adam Schultz/Casa Blanca vía AP) (ASSOCIATED PRESS)
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The Biden administration's refrain that Americans fully vaccinated and boosted against the coronavirus could safely resume their lives is now being tested on the First Patient, the 79-year-old leader of the free world, who made a point Thursday of publicly working through his illness.

"Folks, I'm doing great," President Joe Biden tweeted after the White House announced his infection, sharing a photo of him behind his desk. "Keeping busy!"

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If Biden emerges quickly from his bout with covid-19, it will be a high-profile demonstration of his broader vow: A return to normalcy is possible thanks to vaccines and treatments, despite surging cases and the ongoing pandemic. But if the president should be sick for an extended period or, worse, fall gravely ill, he'll join many other Americans who have struggled to remain healthy in a world with scant mask-wearing and social distancing, and fuel further criticism that his virus strategy falls short, especially for the most vulnerable.

"I think Biden's own covid response is what made this [illness] inevitable, really," said Artie Vierkant, co-host of "Death Panel," a left-leaning podcast that has criticized the administration for not pursuing a universal mask mandate and paid sick leave for coronavirus-positive people, among other mitigations. "He's just one of tens or hundreds of thousands of people who are going to test positive for covid today."

Others see his illness as a function of a highly contagious virus, as Americans weigh the trade-offs of social gatherings, wearing masks and other decisions against the prospect of getting sick.

"I think the president's case says more about covid than about the White House strategy - it's astonishingly infectious," countered Tom Frieden, a former director of the Centers for Disease Control and Prevention. Frieden added that vaccines remain "astonishingly effective" at preventing severe illness and praised the decision to prescribe paxlovid, an antiviral pill, to reduce the chances that Biden might develop complications.

"It also says a lot about where we are in the pandemic," Frieden said. "We're adjusting to covid, and as new variants emerge, we may need to adjust again."

In interviews, tweets and comments, White House officials emphasized that their strategy had prepared them for the president to test positive, with covid coordinator Ashish Jha telling reporters that he wanted to "mark this moment" - in which Biden is relying on medical breakthroughs that are broadly available to the general public.

"It's a reminder of the reason that we all work so hard to make sure that every American has the same level of protection that the president has, that every American has the same level of immunity and why we have worked so hard to make sure that people have access to lifesaving treatments like paxlovid," Jha said at a briefing.

"These are incredibly important things for the president to have," he said. "They're incredibly important things for every American to have."

Jha declined to answer questions about Biden's prognosis, saying he wanted to "avoid hypotheticals."

But the details of Biden's infection and treatment, made public on Thursday, were immediately scrutinized by doctors, epidemiologists and other experts, some of whom questioned why the president has been so frequently maskless in close conversations with others. And as they pored over the early reports of the nation's most high-profile covid case, some criticized the White House for playing down the risks to the president rather than spotlighting the ongoing toll of the disease. The virus is killing more than 400 people a day, according to The Washington Post's seven-day average.

"I think this is a moment to reckon with high transmission and that we should aspire to a better normal than this," said Julia Raifman, a public health professor at Boston University who has called for federal support for mask mandates, holding more gatherings outdoors and other mitigations. "We've already lost more than 500,000 people to covid during this administration. . . . This is an opportunity to not minimize or exaggerate the president's infection - and to acknowledge that it is a serious illness for people who are over 70."

Experts also emphasized that Biden's case is being handled with a level of caution they think should be standard for all Americans.

For instance, the White House said Biden would remain in isolation until he tested negative for the virus, going beyond CDC guidance - a move that sparked backlash from some experts who asked why all Americans are not urged to do the same.

"The fact they are overriding CDC recommendations that are flawed, without any evidence to support them, is telling," said Eric Topol, director of the Scripps Research Translational Institute, "for all of us, not just the president."

Topol and others have called for all Americans to test negative before leaving isolation, saying the CDC's failure to recommend such a test result means that many Americans are prematurely leaving isolation and infecting others.

Ezekiel Emanuel, a University of Pennsylvania bioethicist who has advised the White House on covid strategy and repeatedly called on officials to go further, said that he wished the administration had more aggressively pushed measures such as improving indoor air quality, but he said Biden has encountered widespread resistance to many recommendations.

"What I want the public to do and what the public will do are two different things," Emanuel said.

He added that Biden's infection, despite the use of testing, screening and mask-wearing around him for indoor meetings, underscored that "BA.5 is really contagious. He's probably the person in America with the best protections. No one can rest assured that they won't get infected."

While Biden is the second president to test positive for the virus, the circumstances are far different from his predecessor's, at least so far. When President Donald Trump tested positive in late 2020, before the vaccines were ready, he required hospitalization and aides worried that he might die. He got access to antiviral drugs that were not yet authorized by regulators.

In contrast, Biden's positive test comes after he received two initial doses of the Pfizer-BioNTech vaccine and two booster shots, reducing the risk of severe disease, and also after a slew of senior administration officials have tested positive - including 81-year-old Anthony Fauci, who suffered an infection this summer and has returned to work.

"We have said for some time that there was a substantial possibility that the President - like anyone else - could get COVID," White House Chief of Staff Ron Klain wrote colleagues on Thursday. Klain also took to Twitter to share commentary that Biden was right to adopt an increasingly visible public role, after spending much of the first year of his presidency physically removed from others.

"Would the country have been better off had Biden remained extremely physically isolated from other people, avoided travel, etc., a la [Russian President Vladimir] Putin?" journalist Nate Silver asked in a tweet amplified by Klain. "I tend not to think so."

That public role has relied on the White House's vaccination-focused strategy, with Biden initially echoing the assertions of public health experts that the shots also protected against infections - a claim that a then-new delta variant would turn on its head last summer.

"You're not going to get covid if you have these vaccinations," Biden said on July 21, 2021, at a CNN town hall - a year to the day before the president would test positive.

Asked this week what should be done about the nation's rising case count, the president had a two-word response: Get vaccinated.

"We have the capacity to control it," Biden said Wednesday, adding a message for holdouts. "They should get vaccinated now."

Experts such as Boston University's Raifman contend that the White House has remained too focused on vaccinations, even as variants have evolved to dodge some protections - and not enough on mitigations such as social distancing and mask-wearing.

"This all started with a premature back-to-normal [declaration] that we then didn't correct when there was a delta surge, or when there was an omicron surge," said Raifman, referencing a White House celebration last summer. "I'm very worried about not correcting again on new variants," she added.

Beatrice Adler-Bolton, who co-hosts the podcast with Vierkant and who is immunocompromised, said she was concerned by the White House's message that the president was working through his illness - particularly after her own infection last winter left her with complications for three months.

"It contributes to this idea that we are living in a moment where covid is no longer disruptive, which obviously doesn't match a lot of the day-to-day experiences of working people diagnosed with covid," she said.

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