Both men are in their 70s. Both caught COVID-19. And both tested positive while serving in the White House. But, apart from those similarities, the experiences of President Joseph R. Biden and former President Donald J. Trump could not be more different — a contrast that tells the story of the pandemic so far.
When Trump, then 74, fell ill in October 2020, vaccines were not yet available. Struggling to breathe, he was flown to Walter Reed National Military Medical Center, where he spent the weekend. There, doctors gave him supplemental oxygen and reportedly considered putting him on a ventilator. They also administered an array of unproven treatments.
Biden, at 79, was reported on Thursday to be suffering from fatigue, a runny nose, and an occasional dry cough. On Friday, his physician, Dr. Kevin C. O’Connor, wrote that Biden’s symptoms have improved and that his “pulse, blood pressure, respiratory rate and oxygen saturation remain entirely normal, on room air.”
Biden said he’s received four vaccine doses, and the White House also reported that he’s taking the antiviral drug Paxlovid, the first choice among several effective options now available for outpatients.
In the eyes of some, the fact that Biden even caught the virus highlights the failure to stop the virus’s transmission, as ever-more-contagious variants evolve and spread.
But on the flip side, his reportedly mild symptoms demonstrate medical science’s extraordinary success at reducing severe illness and death from COVID-19, primarily with vaccines but also improved treatment.
“The biggest difference is that President Biden is well-vaccinated,” said Dr. Camille Kotton, an infectious disease specialist at Massachusetts General Hospital. “That has been a major game changer for a lot of the disease we are seeing now.”
Another major change is that most of the care is offered on an outpatient basis, and there are several options for treatments that keep people out of the hospital, Kotton said.
“President Trump’s outlook was a lot more bleak,” said Dr. Shira I. Doron, hospital epidemiologist at Tufts Medical Center.
Doron counted eight drugs that were given to Trump, from aspirin to the antiviral remdesivir, in what observers at the time called a “kitchen-sink” approach. Most of those drugs were probably ineffective, she said.
Biden, by contrast, is getting one drug, Paxlovid — pills that are part of a new outpatient arsenal. In clinical trials, Paxlovid reduced the risk of severe illness by 90 percent.
But not everyone can take those pills because they interact with many other drugs. The alternative is an infusion of monoclonal antibodies, a treatment that requires an hour-long visit to an infusion center but is also effective at preventing severe illness. A third option is outpatient remdesivir, an antiviral drug that needs to be infused on three consecutive days. And, finally, there is molnupiravir, another antiviral pill, considered less effective than Paxlovid.
Doron says it’s likely that Biden will recover well but cautions that mild symptoms “don’t necessarily portend how a person will ultimately do, one way or the other. Everyone infected with COVID starts out with mild symptoms.”
In the unlikely event that Biden ends up in the hospital, he will encounter doctors well-prepared to manage COVID-19 after two years of practice.
“We have a much better understanding of which therapies work better than others, especially compared to the beginning of the pandemic,” Kotton said.
Dr. Nicholas A. Smyrnios, medical director of two intensive care units at UMass Memorial Medical Center, said that during the spring of 2020 and again the following winter, all the ICUs were filled with COVID-19 patients. “Now, if we have [COVID-19] patients, it’s one or two at a time,” he said. Those patients are usually unvaccinated, or else chronically ill or old.
Doctors typically treat hospital patients with steroids, remdesivir, and monoclonal antibodies. They’ve refined their techniques for supplemental oxygen and ventilation.
“He is a relatively healthy man for his age, but he is 79,” Smyrnios said of Biden. “You would always be concerned about someone that age. Among the people that age he’s got as good a chance of doing well as anyone.”
COVID-19 death rates have fallen even among the most vulnerable.
Trevor Bedford, a Seattle-based computational biologist, estimated in a recent Twitter thread that because of widespread immunity — from infections and vaccines — the likelihood of death from a COVID-19 infection is 10 times lower today than in 2020; among those who get infected today, half of 1 percent die.
Dr. Bob Wachter, chair of the Department of Medicine at the University of California, San Francisco, noted on Twitter that two years ago, “the probability of death for a 79-year-old with Covid would have been fairly high (>1-2%). Today, with Omicron’s relative mildness, 4 vaccine shots, and Paxlovid, in a healthy 79 yo, risk is close to zero.”
But Biden faces other risks, Wachter wrote. One is the possibility of persistent symptoms, such as exhaustion or brain fog, and “a small but significant increased long-term risk of heart attack, stroke.” Another risk is “Paxlovid rebound,” a phenomenon in which COVID-19 symptoms return after the five-day treatment ends.
Wachter ended his Twitter comments on a positive note. “The fact that, at age 79, POTUS – and we – really don’t need to worry about Biden dying of a disease that has killed more than 1 million Americans is a great testament to the science, and to the importance of staying up to date on vaccines. Wishing him an easy course.”