The Perfect Enemy | Biden COVID diagnosis highlights value of vaccinations and boosters
August 11, 2022

Biden COVID diagnosis highlights value of vaccinations and boosters

Biden COVID diagnosis highlights value of vaccinations and boosters  USA TODAYView Full Coverage on Google News

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While President Joe Biden, 79, was diagnosed with COVID-19 Thursday morning, doctors said they expect him to cope well with the infection, highlighting his overall health, treatment and fully vaccinated status.

He has a runny nose, an occasional dry cough and is fatigued, his doctor, Kevin O’Connor, wrote in a letter early Thursday to the White House that was made public.

“The President is fully vaccinated and twice-boosted, so I anticipate that he will respond favorably, as most maximally protected patients do,” O’Connor wrote. 

COVID-19 vaccines have been shown extremely effective at preventing severe disease and death, though they do not prevent all infections. O’Connor quickly prescribed Paxlovid, an antiviral that is known to reduce the risk of severe disease.

Other doctors agreed that the president’s vaccinations and treatment suggest he will have a mild disease course. 

“I would expect him to do quite well,” said Dr. Daniel Griffin, an infectious disease specialist with Pro Health Care in New York. 

Vaccines and two booster shots would have reduced Biden’s risk of a severe case of COVID-19 by about 90%, Griffin said, and the Paxlovid by another 90%.

Older adults struggle more with COVID-19    

Older people tend to have more severe COVID-19 than younger patents, and the majority of deaths from the virus over the past 2½ years have been among those over 75.

But Biden is healthy and active and is not known to have any conditions, such as diabetes, that are associated with bad outcomes from the virus. 

“He’s really quite fit,” said Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine in Nashville, Tennessee.

Schaffner said he has known many people of Biden’s age who contracted COVID-19 after being vaccinated and boosted and were able to continue working through their illness – though they had to reduce their busy schedules and take naps for a few days.

At this point in the pandemic, when it comes to those who end up hospitalized and dying because of COVID-19, “it’s not a 79-year-old who’s healthy, whose weight is in check, who’s active” and fully vaccinated and boosted, Griffin said. Rather, most of the hospital admissions he sees are among the 20% of New Yorkers who are still unvaccinated. 

Despite the vaccines’ effectiveness, older people may need boosters more often, said Dr. Ofer Levy, who directs the Precision Vaccines Program at Boston Children’s Hospital and sits on a federal panel that reviews vaccines. Biden received a two-course vaccine and has since gotten two booster shots, following federal recommendations.

The human immune system is “weakest when we’re very little and when we’re old,” Levy said, which is why younger children need a lower vaccine dose than other people and why older adults may need boosters more often than younger people. 

“The immune system is less powerful as we age,” he said. “Even if you’re very healthy and active, age is a risk factor for progression and serious disease.”

Men also fare worse than women with many diseases, including COVID-19, because their immune system is less active, Levy said.

Older people may take longer to recover from COVID-19 and can experience different symptoms than younger ones, said Dr. Kenneth Koncilja, a geriatrician at the Cleveland Clinic in Ohio. 

Many of his patients arrive with gastrointestinal problems, fatigue and “brain fog” instead of typical respiratory symptoms, he said, which can delay their diagnosis. 

He has had patients so confused they can’t tell day from night, who are initially thought to have a urinary tract infection. “Hopefully, we have none of that from someone so important,” Koncilja said of the president.

In Cleveland Clinic facilities in Ohio and Florida, people over 65 have fared well with vaccines, even against the BA.4 and BA.5 variants now dominating in the U.S., Koncilja said.

Lifestyle strongly affects how an older person will respond to vaccines and infection, he said. “Healthy diet, healthy exercise, managing your other medical problems. Those things all matter.”

Getting treatment   

President Donald Trump was also diagnosed with COVID-19 while in office, in late 2020. He received a long list of therapies, not all of which were backed by science or appropriate for someone at an early stage of disease. His quick recovery was attributed to an experimental monoclonal antibody that was later authorized for use by the general public.

Today, Griffin said, the antiviral Paxlovid is considered more effective than monoclonal antibodies, most of which don’t work well against the omicron variant of the virus and its subvariants.

Griffin said it made sense to start Biden on Paxlovid right after diagnosis.

Although some people have claimed that initiating the antiviral too early may lead to rebound infections, Griffin said he has seen symptoms recur with another antiviral as well as with no treatment at all.

President Joe Biden holds a baby as he visits a COVID-19 vaccination clinic at the Church of the Holy Communion Tuesday, June 21, 2022, in Washington.

Plus, evidence suggests Paxlovid is most effective if given within three days of the start of symptoms. Delaying renders it less effective.

“The whole idea of waiting to start a treatment, which we know is associated with harm, I think is dangerous messaging,” Griffin said.

Dr. Anthony Fauci, 81, chief medical adviser to the president, recently endured a rebound effect after taking Paxlovid for COVID-19, though he bounced back from that, too. 

Rebounds are often milder than initial infections, and few people of those people need medical care.

Pfizer, which makes Paxlovid, said it has not seen resistance develop in people taking the drug. 

Although Paxlovid has been widely available since early this year, many people without the resources of the White House have either not known about it or not been able to access the prescription medication. It can be challenging to receive a diagnosis and prescription within five days of the onset of symptoms, though the Biden administration has launched a “test to treat” program to make the drug more widely available. 

In parts of the country there’s little access to primary care, which makes it tough for people to receive lifesaving drugs in time.

“People who have resources do better than those who don’t,” Koncilja said. Of course, the president will have the best possible care: “What better resources could you have than being the commander in chief?”

One bright spot to Biden’s COVID-19 diagnosis: People who have been fully vaccinated and then infected seem to have the best protection against reinfection and severe disease, Schaffner said.

“That’s the little glimmer of sunshine in the clouds today.”

Contributing: Adrianna Rodriguez

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.