What Biden’s COVID diagnosis tells us about the state of the pandemic, from a Philly-area infectious disease specialist

President Joe Biden tested positive for COVID-19 on Wednesday, a high-profile example of how the latest coronavirus variant is impacting the nation.

According to a letter from Kevin O’Connor, physician to the president, Biden started to experience mild symptoms on Tuesday evening, including fatigue, a runny nose, and a dry cough. He is receiving Paxlovid — oral antiviral pills.

Biden is fully vaccinated and twice boosted, leading his physician to conclude: “I anticipate that he will respond favorably, as most maximally protected patients do.”

Biden is the second U.S. president to contract coronavirus. In October 2020, then-President Donald Trump was rushed to Walter Reed Medical Center after testing positive for the virus. His infection — before the rollout of protective vaccines — prompted far more concern.

The experiences of the two presidents, testing positive to COVID-19 nearly two years apart, are emblematic of significantly different moments in the pandemic.

» READ MORE: Biden tests positive for COVID-19, has ‘very mild symptoms’

The national daily average new cases are nearly triple what they were in early fall of 2020, but the number of deaths is nearly half. While hospitalizations have risen in recent months, the proportion of patients who go to an ICU are dramatically lower — about 1-in-10 compared with 1-in-4.

In Philadelphia, in the last two weeks, the new-case rate has increased by 42%, while the death rate has stayed the same. The number of reported cases is now widely considered an undercount, due to the prevalence of at-home testing.

On one hand, COVID-19 remains a serious illness that kills hundreds of people in the U.S. daily. But on the other hand, not every positive test leads to the fear that was common in the early days of the pandemic.

The Inquirer talked to Lawrence Livornese, an infectious disease specialist and system chair of the department of medicine at Main Line Health about what to make of this moment in the pandemic.

Responses have been lightly edited for clarity and length.

There’s no question that people who are older are still at a higher risk than people who are younger. I think the difference is we have tools that are available now to decrease that risk.

People who are vaccinated have much better outcomes than those who are not.

This plays a big role in what we’re seeing in hospitals. We know that transmission is higher than it’s been in almost 12 months now. It’s like there is COVID everywhere. And the numbers in the hospitals are going up, but my impression is that cases are much less severe.

When you vaccinate someone you really have two goals in mind. One, you want to eliminate their chance of getting an infection, and some vaccines do that — measles would be a good example. The other reason to vaccinate is to ameliorate the severity of the disease. The COVID vaccines aren’t particularly good at number one, but they are really good at number two. It doesn’t really stop the spread, but it does a very good job at decreasing the severity of the disease.

» READ MORE: Why BA.5 is not a super-virus, and how the vaccines are still the best option against COVID

Paxlovid is an antiviral agent. And when administered in the early part of the infection, it decreases the risk of going on to severe infection by as much as 90%. So it’s really a highly effective agent for avoiding some of the serious complications that we’re worried about.

Paxlovid is indicated for people who are at a higher risk for progressing to severe disease. That’s defined by a number of things. First of all, everybody over age 65 would fall in that category. But people with other significant medical conditions — such as kidney disease, severe asthma, underlying lung disease, etc. — would fall into that group, as well.

I have to answer that with caution, because we are looking at a population now that a majority of people are vaccinated or have been exposed to the virus. So, overall, we are seeing a little bit of a milder response across the population.

I can’t tell you that the actual illness looks different than the disease we saw before.

I don’t know. I am not aware of a good clinical tool, or a set of symptoms that allow us to predict who’s going to develop long symptoms with COVIDs versus those who don’t.

The majority of people do not have lasting symptoms, but many people have symptoms that go on for weeks and sometimes months.

» READ MORE: COVID cases keep rising and so does the risk of long COVID. Philly researchers are trying to understand why.

There’s so much COVID right now. We know masking works. We know it protects people. I would like to see stronger statements from our departments of health encouraging masking.