President Biden emerged from his covid-19 isolation on Wednesday saying his mild case was a testament to his administration’s progress on a pandemic that has killed more than 1 million Americans, and he urged people to take advantage of vaccine boosters, antivirals and at-home tests so they, too, could have mild infections.
After Biden’s coronavirus infection was identified early thanks to a regular testing regimen, he received the antiviral Paxlovid almost immediately and was able to isolate and work remotely — a management strategy that also highlighted the inequities that persist more than two years into the pandemic.
Biden, who tested negative Wednesday morning and returned to in-person work a short time later, conceded that the virus is here to stay but stressed that his administration has made booster shots, at-home tests and antivirals available free, and emphasized that he was able to continue his work remotely.
“I got through it with no fear — a very mild discomfort because of these essentials, lifesaving tools,” Biden said in a speech from the Rose Garden. “The entire time I was in isolation, I was able to work and carry out the duties of the office and without any interruption. It’s a real statement on where we are in the fight against covid-19.”
That account meshed with the broader message the White House has sent in recent months — that Americans can move on with their lives as long as they take reasonable precautions. For millions of Americans, though, the resources and flexibility that Biden touted remain out of reach.
The federal government allows each U.S. household to order eight free at-home tests, but that is not enough for most families to test regularly if they have been exposed to the virus. While private insurance is supposed to cover purchases of at-home tests, the process remains confusing and murky, making the cost of the tests prohibitive for some Americans.
Paxlovid, which has proved highly effective in preventing severe symptoms, is difficult to obtain in some parts of the country, particularly for those who lack access to regular medical care. Many people cannot afford to stay home because paid leave protections have lapsed and some employers have lost patience with employees who miss work because of coronavirus infections.
And while vaccinations, boosters and treatments have dramatically reduced deaths and hospitalizations, millions of immunocompromised Americans remain at high risk for severe illness, and there is still little understanding of why some people contract long-haul covid.
Biden’s experience mirrors that of more privileged Americans, who have learned to live with the coronavirus as part of their new normal and for whom an infection is more a nuisance than a devastating life event.
Biden has access to ample home tests and can test himself regularly. He has the best medical care in the world, and his doctor was able to prescribe him Paxlovid right away; studies show that Paxlovid is most effective when administered early, ideally within five days of the onset of symptoms. He was able to work remotely without losing pay and could isolate without exposing at-risk family members. He has been vaccinated and received two booster shots.
And although Biden, who is 79, is at higher risk because of his age, he is otherwise healthy and does not have underlying medical conditions that could put him at increased risk of hospitalization or death.
“What President Biden was able to do is not a highlight of what all Americans can do — it’s a highlight of what most Americans can’t do,” said Abraar Karan, an infectious-disease physician and researcher at Stanford University. “It’s almost like a comedy of sorts. It’s like, ‘Well, if the president can do it, you can, too’ — which is exactly wrong.”
Biden’s infection comes as BA.5, an omicron subvariant that is the most transmissible version of the virus yet, has become dominant in the United States. The seven-day average of cases has hovered around 120,000 cases per day, but that is almost certainly an undercount given the widespread use of at-home tests that are not reported and the increasing number of people who no longer test. The true case count could be up to 1 million per day, experts say, while the seven-day average of deaths has hovered near 400 per day.
The president’s physician, Kevin O’Connor, confirmed last week that Biden was probably infected with BA.5, which along with BA.4 is responsible for about 80 percent of the coronavirus now circulating in the United States.
“The reality is that BA.5 means many of us are still going to get covid even if we take the precautions,” Biden said. “That doesn’t mean we were doing anything wrong.”
White House spokeswoman Karine Jean-Pierre said that of the 17 people identified as “close contacts” of Biden after he was infected but before he isolated, none has tested positive. As for the president, she added, “He certainly is looking forward to getting back on the road.”
The administration has struggled to contain the pandemic since Biden came into office, in part because it has faced increasingly transmissible variants with an extraordinary ability to escape immune protections afforded by vaccinations and prior infection.
Biden’s team has also run into more mundane or political problems. The White House sought to get more Americans vaccinated through a federal rule requiring businesses with at least 100 employees to mandate vaccinations or weekly testing, but the rule was struck down by the Supreme Court. Instead, the number of Americans who are vaccinated has hardly budged in more than a year, with about 67 percent vaccinated.
And although numerous studies show that booster shots significantly reduce the risk of hospitalization and death, only about a third of Americans have gotten at least one booster shot, despite the administration’s urging that people over 50 should get a second booster. Many Americans continue to insist, against overwhelming evidence, that the coronavirus is not a serious threat or that the vaccines are ineffective or even dangerous.
Many people have also lost whatever patience they had for coronavirus mitigation measures such as mask mandates and social distancing, reflected in the fact that no major city has reinstated mask mandates even as cases have surged. And Congress has so far failed to appropriate billions of dollars the White House requested for the coronavirus response.
In his speech Wednesday, Biden encouraged Congress to continue investing in “vaccinations, treatments, tests and more” to make them available to “the American people on a permanent basis.”
He also drew a contrast with the experience of President Donald Trump when he contracted the coronavirus before the advent of vaccines, noting that Trump had far more severe covid-19 and had to be hospitalized. “Here’s the bottom line: When my predecessor got covid, he had to get helicoptered to Walter Reed,” Biden said. “He was severely ill. Thankfully, he recovered. When I got covid, I worked from upstairs at the White House.”
Yet experts say many Americans now avoid testing altogether because of the disruption an infection could cause, whether it’s missed travel or an inability to get paid time off work.
“There are many people who would like to just decide to put a mask on and hope that things go well and continue on with their lives for various financial reasons,” said Mercedes Carnethon, professor and vice chair of preventive medicine at Northwestern University’s Feinberg School of Medicine.
Carnethon added that Biden’s early diagnosis and treatment with Paxlovid was crucial to his mild infection.
“If we can detect it early and treat it early, we can help ensure that more people have an experience like [Biden’s]. But there are many people who for structural reasons, access, financial barriers, aren’t going to be able to be diagnosed early as he was,” Carnethon said.
Biden on Wednesday nodded to the fact that the pandemic does not affect everyone equally, but he focused on those who are not vaccinated or boosted. He said deaths had dropped 90 percent since January 2021 and that most fatalities are among those who are not up to date on their vaccinations.
Karan said that while the administration is limited in what it can do, it should focus on reducing transmission, rather than attacking the symptoms, so that fewer people get infected in the first place.
“When the messaging is overly focused on having clinical tools when you get sick, it makes people feel like the government is no longer focused on preventing you from getting sick,” Karan said. “The problem is they’ve been pushing the narrative that ‘we have the tools.’ Many people are not included in the ‘we.’ ”