How does Biden’s case of Covid-19 compare to Trump’s?

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President Joe Biden on Thursday tested positive for Covid-19, but his infection, while potentially serious, does not put him at the same risk as former President Donald Trump, who was infected just before the 2020 election.

Biden, who is twice boosted and has already started Paxlovid, is experiencing mild symptoms, according to the White House.

Here are four reasons Biden’s case isn’t like Trump’s.

Vaccines

The key difference between Trump’s infection — which landed him in Walter Reed Military Medical Center for three nights — and Biden’s is the vaccines, experts said.

Biden has gotten four doses so far, developing a high level of protection against hospitalization and death. When Trump contracted the virus, no vaccines were available.

The Centers for Disease Control and Prevention found that in January, during the height of the Omicron wave, an unvaccinated person was 12 times more likely to be hospitalized than a boosted individual.

“It is just a completely different scenario, though, to talk about a Covid infection and somebody who's quadruple vaccinated versus somebody who has not vaccinated,” Céline Gounder, a physician at Bellevue Hospital and epidemiologist at the NYU Grossman School of Medicine, said in a May interview. “And I think that message still does not seem to get through to people — that the vaccines are truly highly effective in preventing against hospitalization and death.”

Without access to vaccines, Trump faced a much higher risk from the infection.

“[Trump] would have been quite ill — at his age, predicted to be quite ill,” said Eric Topol, a physician, molecular medicine professor and founder of the Scripps Research Translational Institute. “And in fact, he was.”

Treatments

Biden also has new treatment options to help fight the infection, including Pfizer’s antiviral pill, Paxlovid.

“We know Paxlovid is highly effective at keeping people out of the hospital as well,” Gounder said.

Pfizer’s antiviral Covid-19 pill reduced the risk of hospitalization or death by 89 percent in high-risk patients who’d been experiencing symptoms for three days or less, according to trial results the company released in December.

While relapses with the antiviral are possible — an issue that is still being researched — it remains a highly effective solution and another level of protection.

When Trump had Covid-19, he was given a monoclonal antibody treatment made by Regeneron, as well as remdesivir, an antiviral.

Monoclonal antibody treatment is also an option for Biden, if needed, experts said, but it doesn't work as well as — and there are fewer options for treatment — compared to when Trump was infected.

“We’re running out of chances for monoclonal antibodies to help. There's so much immune escape for this variant,” Topol said of the Omicron variant, including subvariants like BA.2 and BA.5.

Variants

The new strains of the virus, now far more transmissible than the original version, are another difference.

Trump caught a less infectious but more virulent strain, public health experts say.

The virus is still evolving, with several subvariants recently emerging around the world.

“There is a small risk of [Biden] having severe covid — severe disease — and requiring hospitalization,” Topol said. “Fortunately, that risk is small, but it has increased as the virus evolved to these much more difficult variants.”

While treatments may be less effective because of new strains of the virus, the dominant variants circulating today aren’t known to be significantly deadlier than earlier versions.

Underlying conditions

Another difference between Biden and Trump’s infections is their comorbidities.

“The main risk factor for Trump was his obesity, and we know that that carried a significant risk for Covid,” Topol said. “Obviously, that isn't a problem with Biden. I'm not aware of other comorbidities that Biden has outside of his age.”

While comprehensive medical records are not available, both administrations have released some details of Trump and Biden’s health. In 2020, just before Trump was infected, the White House released his physical. Trump weighed 244 pounds and stood 6 feet, 3 inches. That meets the clinical definition of obesity and put him at higher risk of hospitalization from Covid-19, according to the CDC. Biden is a shade under 6 feet tall and weighs 184 pounds, according to his physical.

Biden is 79 years old. Trump was 74 when he caught Covid. The risk increases for people in their 50s and increases more for those in their 60s, 70s and 80s, according to the CDC. People 85 and older are the most likely to get very sick.

Long Covid

Biden could still be susceptible to long Covid. The post-viral condition, which sometimes includes severe fatigue, ongoing respiratory issues or cognitive impairments, is not yet well understood.

Now, experts note, the wide-ranging list of symptoms has disabled some, even those who have been vaccinated. Though a minority of people who are infected experience long Covid, according to early data, well over a million people in the U.K. have reported lingering symptoms from Covid-19.

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