By Kevin Liptak and Jeremy Diamond, CNN
Updated 6:48 PM EST, Sat December 18, 2021
(CNN) President Joe Biden's top health officials came to an afternoon briefing at the White House Thursday with a warning -- and a request.
Sitting at the head of his long conference table surrounded by top members of his Covid response team, Biden listened intently as the officials laid out the contours of a looming coronavirus surge that could accelerate rapidly, swamp hospitals and send the country into another bleak winter.
Yet Biden's team also came to the evergreen-bedecked Roosevelt Room with potentially more positive news: Many of those cases will remain mild or even asymptomatic in vaccinated people -- particularly those who have gotten booster shots.
It was a message the officials urged Biden to deliver to the public in the clearest terms possible, according to people familiar with the session. Only by laying out the stark difference in outcomes between vaccinated and unvaccinated infections could the gravity of the moment come through.
So Biden and his team -- which included Dr. Anthony Fauci, two top vaccine experts from the National Institutes of Health, White House Covid response coordinator Jeff Zients and his deputy Natalie Quillian -- set to work writing out by hand the grave warning he would deliver later when cameras were ushered into the room.
Biden opened his appearance by declaring he wanted to deliver a "direct message" to the American people.
"For the unvaccinated, we are looking at a winter of severe illness and death for the unvaccinated -- for themselves, their families and the hospitals they'll soon overwhelm. But there's good news: If you're vaccinated and you have your booster shot, you're protected from severe illness and death," the President said.
He'd determined ahead of time that his message would be muddled if he answered any questions afterward, so he sat uncharacteristically silent as reporters peppered him on their way out.
The emergence of the Omicron variant has thrust the nation -- and the White House -- back into an uncertain pandemic reality, posing both public health and political challenges for a leader whose ultimate success depends almost entirely on his ability to contain the virus.
Already, cases and hospitalizations are surging in some parts of the country, leading to a 31% increase in cases and a 20% increase in hospitalizations from two weeks ago.
Yet Biden and his team have all but ruled out new lockdowns, and behind the scenes, administration officials have been debating how to shift public attention from the total number of cases -- which appear likely to surge, even if many are mild -- toward the number of severe infections that are overloading health systems and causing interruptions to normal life.
Some of Biden's advisers are encouraging the administration to begin discussing publicly how to live alongside a virus that shows no signs of disappearing, a potentially stark shift in messaging for a White House that once touted "freedom from the virus."
Steering public attention away from the total number of infections and toward serious cases only -- as some Biden advisers have encouraged -- could prove a challenge after nearly two years of intense focus on the pandemic's every up and down. It is a part of a growing conundrum that Biden faces as the Covid-19 pandemic refuses to abate.
"We're getting to the point now where ... it's about severity," said Xavier Becerra, the secretary of the Department of Health and Human Services, in a meeting with reporters this week. "It's not about cases. It's about severity."
Becerra said the issue recently arose during a meeting at the White House with Biden's Covid response team. Other officials also said the issue of how to refocus the public away from total cases toward the severity of illness has been an ongoing subject of discussion within the administration.
"There's a degree of difficulty that now comes in trying to decide what means it's severe and what you have to do to stay out of that threshold of severity," Becerra said. "But I think that's where we're heading, is to try to be able to tell the public that."
Administration officials acknowledge the Omicron surge will likely rip through the country, a psychological setback for a population that's become highly attuned to the pandemic. In some places where vaccination rates lag, the consequences will be debilitating, administration officials fear. But in areas where most people have received their initial shots and boosters, the effects could be minimal.
"You have a Delta surge now that, even if we didn't have Omicron, would be a real challenge for the unvaccinated people. ... That's the ingredients of a perfect storm," a senior administration official said. "That's the reason why the message has to be, 'Get vaccinated -- and if you are vaccinated, get boosted.' "
That is the imperative Biden conveyed in the remarks he crafted with his team in the Roosevelt Room on Thursday. For the President, how to proceed with a new surge is a question not only of public health but also of politics. Biden and his team have long asserted that ending the pandemic and returning the economy to normal is the cure for his political woes. A spike in cases over the summer due to the Delta variant, paired with renewed restrictions and mask requirements, coincided with a softening of his approval ratings.
Things are different this time, Biden's aides insist, noting that more Americans are now vaccinated and citing critical lessons taken from the experience battling Delta.
"We have the tools to fight this virus, including Omicron, and we're in a very different and stronger place than we were a year ago and there is no need to lock down," Zients said this week.
Still, the emergence of Omicron has caused the White House to begin contemplating all of its options ahead of a potential surge. Officials said their priorities include making sure hospitals have the resources to deal with a potential influx of patients, particularly in areas where vaccination rates remain low. The administration has deployed public health surge teams to states experiencing rising cases and hospitalizations. And officials plan to put renewed emphasis on the importance of masking in public places.
"They have to be prepared for any scenario, even if it turns out the disease is less severe," one official said.
Becerra said during the meeting with reporters that the administration may need to ask Congress for more funding to combat the pandemic, citing the unknowns of the new variant.
"Are we going to have more than $10 billion worth of needs and costs on Covid, especially in regards to testing?" Becerra said. "There's a strong chance we will, depending on where Omicron takes us."
Biden's stark warning this week came two days after officials from the US Centers for Disease Control and Prevention presented various models showing the trajectory of the virus during a call with state and local health officials. The modeling, along with data from Europe, indicated the number of Covid-19 cases caused by the Omicron variant has the potential to double every two days.
"When you think about that this virus has the potential to double every two days, then in a couple of weeks we're going to be facing a lot of cases of Omicron," said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials, who was on part of Tuesday's call.
"That modeling implies that sometime in January, we will be at a different stage of recognizing Omicron, maybe as even a predominant virus. However, we still are learning about the severity, transmissibility," Freeman said. "The data is emerging from around the world."
There are hints from South Africa, where the variant was first identified, that cases could be less severe. And early research suggests vaccinations plus a booster shot continue to protect against severe disease, even if the number of overall cases spikes.
"When you look at the early data, it does appear that there is a diminution in the severity as expressed by hospitalization," Fauci told CNN this week. "The real question is, is that an inherent diminution of virulence of the virus or is it because there are so many people in the population who have already been infected?"
Still, concrete information about the severity of disease caused by Omicron remains something of a mystery. And less severe cases will still require widespread vaccination, which remains elusive in the United States, despite Biden's efforts.
White House officials recently announced new steps to promote vaccination and booster shots, including family clinics that make it convenient for all eligible age groups to receive doses. Yet other aspects of the President's plan to expand vaccinations have stalled. Two major vaccine mandate requirements -- one dealing with federal contractors and another aimed at companies with 100 or more employees -- have been halted by courts.
They haven't only faced legal scrutiny. The mandates have also proved politically difficult for some Democrats, including two senators who voted with Republicans last week to overturn the rule on private businesses. Some Democratic governors have also expressed unease at the mandate, including Michigan's Gretchen Whitmer, who is otherwise a close ally of the White House.
Biden himself has spared few opportunities to encourage Americans to get vaccinated. Traveling this week in Kentucky -- one of the most conservative pockets he's visited so far as President, and one where only 53.5% of residents are fully vaccinated -- he encountered a woman named Angela wearing a Green Bay Packers hat.
"God love you!" Biden exclaimed, before issuing a light rebuke of Aaron Rogers, the Green Bay player who's refused to get a shot: "Tell that quarterback he's got to get the vaccine."
Biden's aides attribute a softening in his approval ratings that began over the summer with the persistent pandemic, which gained steam as the Delta variant spread across the country. A CNN poll conducted by SSRS released this week found the President's overall approval rating holding about even from a previous survey at 49% approve to 51% disapprove. Those ratings are similar to recent polls from AP-NORC and Reuters/Ipsos.
The only issue tested where Biden's rating exceeds his overall reviews is his handling of the coronavirus pandemic, which 54% approve of. But that is far lower than in April, when 66% said they approved of his handling of Covid.
A renewed surge of Covid also threatens to overwhelm a presidential agenda that suffered another setback this week, when Democrats signaled they would punt Biden's sweeping spending plan to next year after failing to reach an agreement with Sen. Joe Manchin, the West Virginia Democrat who is now the President's chief negotiating counterpart on the plan.
At the White House, the pandemic has dampened another holiday season, despite efforts to maintain normalcy surrounding the festivities. The first lady's office decided to dramatically scale back the usual roster of holiday parties, opting instead for smaller open house-style events.
Guests attending the 30-minute walk-throughs are required to take Covid-19 tests within 48 hours prior to their visits if they cannot attest to being fully vaccinated. Typically, the President and first lady can host several dozen events during the holiday season, sometimes making appearances at more than one per day. At some, they can stand for hours taking photos and shaking hands.
This year, Biden chose instead to thank supporters at a holiday reception at a nearby hotel. Speaking at a cocktail reception there Tuesday evening, he didn't avoid his disappointment at another Christmas made less merry by the raging pandemic.
"I had hoped by now each one of you, who helped us get to where we are, would have had full access to the White House," he said. "We had all kinds of plans. ... We hoped people had moved on to getting all their vaccines."
Despite the imminent surge, he held out hope that things would soon return to normal: "Next year -- and this year, before it's over -- in the White House. In the White House," he said.