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I don't know that he's actually significantly worse off than he was before, but he may be heading to the point where, regardless of his health, he has lost the confidence of the electorate in his health.
This debate, and all of his post-debate has hurt him, surely. But its detached from reality to suggest that Biden wasn't "severely injured" going into this debate. The difference was that we saw an energized, verbal, focused, able to maintain eye contact and remember the first half of his sentence Joe Biden during the SOTU back in March. Bidens debate was a geriatric who is clearly "sunsetting". Bidens post debate interviews re-enforced that.
Biden needs to be leading by 5 (50-55%) in the polls nationally to demonstrate that he had the "confidence" of the electorate. He was leading by 5 in 2020 and barely managed a victory in the EC by 40k net votes. If Biden is at 45% in the polls, he's not winning the election. Biden is at 35% and dropping.
Biden hasn't had the confidence of the electorate, basically ever, in this election cycle. At no point has he been "winning" or even really viable in this campaign. This is just purely what the data show us. Its what Nate Silvers been saying for over a year, its what Ezra Klein has been saying for a long time. The apologists around Biden protected him from any kind of real primary, or significant criticism in what has been the most critical period for evaluating his sufficiency around him as candidate. We were prevented from doing the kind of due diligence required.
Main points, Biden wasn't winning this when it wasn't about his health. Layer in the appallingly clear indications around his health and extrapolate. Biden was doing way better in terms of demonstrating his ability to "be the president" with the SOTU back in March. Draw a line from then to now, and then see where that line puts you 3 months from now. If you've ever had an elderly family member "sunset" on you, it is like, shocking how fast it happens.