On Oct. 2, President Donald Trump revealed that he and First Lady Melania Trump had tested positive for COVID-19. Here we answer common questions about the risks of the disease, treatments available and the shortcomings of testing.
What do we know about Trump’s risk of developing serious COVID-19?
Without knowing all of Trump’s medical history, it is difficult to know how dangerous his SARS-CoV-2 infection might be. On the morning of Oct. 2, news outlets reported — and White House Chief of Staff Mark Meadows confirmed — that the president was experiencing only mild symptoms.
White House Press Secretary Kayleigh McEnany reiterated the symptoms were “mild” in the afternoon, though Trump was taken to Walter Reed National Military Medical Center and would be “working from the presidential offices at Walter Reed for the next few days,” McEnany said.
Update, Oct. 3: “The president’s vitals over the last 24 hours were very concerning and the next 48 hours will be critical in terms of his care,” a source familiar with the president’s health told a White House pool reporter in a pool report issued at about noon. “We’re still not on a clear path to a full recovery.”
The president’s doctor Navy physician, Sean P. Conley, gave a more upbeat assessment at a press conference Oct. 3, describing the president as being fever-free and “doing great.” At 74 years old, Trump is at higher risk of developing a more severe case of COVID-19 than younger people. Figures from the Centers for Disease Control and Prevention, based on data available through Aug. 6, show that people ages 65 to 74 are five times as likely as 18- to 29-year-olds to be hospitalized and 90 times more likely to die.
Other CDC data show that for the month of August, 6.5% of people between the ages of 70 and 79 who were diagnosed with COVID-19 died, and 18% were hospitalized, although some data on death or hospitalization is missing or unknown.
Trump is also a man — and males have consistently had worse outcomes, on average, than females — and his last physical showed he was mildly obese, with a body mass index of 30.5 (30 is considered obese).
According to the CDC, obesity increases the risk of a severe illness from COVID-19 and may triple the risk of hospitalization. It’s not entirely understood why this is, but carrying too much extra weight has been linked to impaired immune function and fat tissue can also push up on the diaphragm, making it more difficult to breathe.
Most people, however — even those with risk factors — do not get seriously ill, so the president’s chances for a mild infection may still be good. He is also not known to have many of the other risk factors for serious disease, such as diabetes or kidney disease, and is likely to receive the best possible medical care.
Scientists are just beginning to understand why certain people fare so poorly with a SARS-CoV-2 infection while others never develop symptoms or only get mildly ill. Recent research suggests that one difference, which may apply to about 14% of severe cases, is that some people don’t produce enough type I interferons early in infection. The proteins are key players in fighting off viruses and help kick off a robust immune response, although too much of them later on could be detrimental.
In some cases, a poor interferon response may result from people having antibodies that inappropriately target and cripple the interferon, whereas others may be due to faulty genes. The offending antibodies are much more common in males. Older people may also have defects in how their bodies mount this type of early, or innate, immune response.
Other research also indicates that older people are less likely to produce a sufficient T cell response to SARS-CoV-2. T cells are part of the body’s later, more specific immune response, and assist with producing antibodies and also kill off infected cells. With fewer of these cells, older patients don’t create a coordinated response to fight off the virus and are more likely to have poor outcomes.
What do we know about the president’s health?
The president’s doctor provided the latest update on Trump’s health on June 3. He said the president “remains healthy.” Trump was 6’3″ and weighed 244 pounds; his cholesterol was 167, lower than the previous physical. (A reading below 200 is considered desirable.) His blood pressure was normal: 121/79.
About six months prior to that report, in November 2019, Trump made an unannounced visit to Walter Reed National Military Medical Center, which he and his staff later said was to conduct part of his annual physical. Conley’s memo said his summary included information both from November and an April exam Conley conducted.
