For months, President Donald Trump has often focused on a quirk of the coronavirus: While it poses a severe risk to many, particularly the elderly and those with preexisting conditions, it’s estimated that roughly 40% of people may experience no symptoms at all. The president has used this to repeatedly claim that the coronavirus is not that deadly.
Now that Trump has COVID-19 — and is currently experiencing mild symptoms — there are three huge questions intersecting at the same time: Exactly what is the state of Trump’s health? How severe will his symptoms be? And how might those symptoms play out politically?
It’s unclear how the disease could progress, particularly in the week to come. Trump says he and Melania Trump are isolating, and the CDC currently recommends that self-isolation take place for at least 10 days after symptoms first appear.
Throughout the nine months since the first coronavirus cases were first reported in the US, Trump has called the severity of the illness into question, repeatedly drawing comparisons between it and the flu. In July, he said that in many cases people just "have the sniffles," suggesting that it could fade away on its own, despite the fact that there is no built-in immunity to the new virus, allowing it to spread very quickly with devastating impacts. It’s unclear if Trump will continue to downplay the risks of the virus to the public if he recovers.
If Trump’s symptoms remain mild and he recovers before Election Day, he could use himself as an example to continue to claim that the coronavirus is not as severe as health experts say it is. He could argue that social distancing, curtailing business, canceling large events, and routine mask-wearing — as scientists have advised — is not worth the economic impact, as he has done for months.
Trump’s reelection campaign has hinged on large-scale, in-person events, with limited social distancing. He has for years tried as frequently as possible to be in front of a roaring crowd of supporters. Doing so within the next two weeks would put supporters and staffers at risk.
“It is really striking to me how the strategy in the White House for protecting the president has been just testing,” said Ashish Jha, dean of the Brown University School of Public Health. “It’s only one layer of protection, and the idea that you wouldn’t wear a mask around the president, that you wouldn’t do social distancing around the president — those strike me as incredibly irresponsible. And yet that’s what we know has been happening at the White House.”
Many individuals may only experience mild COVID-19 symptoms, which can include shortness of breath, fever, and a cough. Others, particularly older people, can experience symptoms so severe — which include lung damage and pneumonia — that they may be hospitalized for long periods of time. Thousands of others have been unable to recover, continuing to experience debilitating symptoms for months.
It’s not clear yet how seriously Trump plans to take his isolation, with just a month until the presidential election.
“He is infectious to others, and so he has to stay isolated until he's no longer infectious,” Jha said.
Also unclear are Trump’s current health risks. In a striking departure from all other presidents in the modern era, he has not disclosed the full results of a physical exam, keeping his medical history largely secret.
In 2015, the president’s former doctor released a letter stating, “If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency." His doctor later admitted that Trump dictated the letter himself.
So it is unknown if the president has underlying medical conditions that are known to increase the risk of severe illness.
But some risk factors are clear. Trump is 74 years old, and older people in particular face a much higher risk of severe illness, hospitalization, and death as a result of contracting the coronavirus. Studies have shown that older men in particular may face the highest risks. A 74-year-old has a roughly 90 times higher chance of dying than an 18- to 29-year-old, according to the CDC.
"That’s enormous for the leader of the world, for the president of the United States," Ezekiel Emanuel, vice provost of global initiatives at the University of Pennsylvania and a former health policy adviser to the Obama administration, told BuzzFeed News.
In June, the president’s doctor disclosed that he weighs 244 pounds, which puts him just above the threshold for obesity for his height. Recent studies have shown that obesity may also be a risk factor for more severe illness, though scientists have not yet sorted through the role of complicating factors that often accompany excess weight, such as high blood pressure or the role that race may play. Obesity disproportionately affects Black and Latino Americans, who also face higher risks of severe illness and death as a result of COVID-19, due in part to higher rates of working essential jobs, lower rates of access to healthcare, and other inequities.
Trump also has a history of high blood cholesterol, but that had improved significantly from previous years, according to the information released in June.
The president, however, will have access to the best medical care in the world, and most people in his age group have successfully recovered. But there is huge variation in how each individual’s immune system responds to infection, making it impossible to make any precise predictions.
Death rates have also been declining, in part because doctors have gotten much better at treating the illness. "It’s different than if he got this in March or April. We know more," Emanuel said.
Some of the highest death rates have been in nursing homes, especially early in the pandemic — overall, cases linked to nursing homes account for about 40% of US deaths from COVID-19, according to the New York Times.
The president’s laissez-faire approach to masking and social distancing likely increased the chances that he exposed others around him to the virus before he was diagnosed. Supposing that he tested positive for the first time on Thursday, that would suggest that he got infected sometime between last Saturday and Monday, Jha said.
That may have also put former vice president Joe Biden at risk during the Tuesday debate. On Friday, Biden and his wife Jill tested negative for the coronavirus, but false negatives are especially possible early in an infection; the coronavirus’s incubation period can be up to 14 days.
“Even if the vice president and the president never got within 6 feet of each other, they were in a close space for quite a while, there was some loud talking and even shouting,” Jha said. “If the president was infectious during that period, I would be concerned that vice president Biden was at risk.”
Jha emphasized that the main thing that needed to happen right now is aggressive contact tracing “of anyone who’s been around the president over the last week.” All of those people need to quarantine, he added.