President Donald Trump announced in a tweet late Thursday night that he and his wife Melania have tested positive for the virus that causes Covid-19, the pandemic disease that has killed more than a million people worldwide in just nine months—and one whose severity the president has consistently downplayed.
It’s an extraordinary turn of events just 32 days before Election Day. White House spokespeople had, only hours before, announced that the president’s close adviser Hope Hicks was ill with Covid-19. She, the president, and the first lady have had close contact with innumerable aides, family members, campaign staff, reporters, and security detail members who have accompanied the president on the trail over the last few weeks, including to Tuesday’s debate with former vice president Joe Biden. As recently as this week, the president and Vice President Mike Pence were holding rallies with hundreds of people, sometimes crowded into enclosed spaces, mostly without wearing face masks—exactly the kind of behaviors known to spread the virus.
Actual details of the president’s illness are scant; his physician Sean Conley wrote a memorandum released by the White House press office saying that “the President and First Lady are both well at this time.” Melania Trump tweeted, “We are feeling good.” At a rally two weeks ago, Trump told the crowd that the virus “affects virtually no one.”
Not only is that not true, but the possible consequences are much more severe for people who are older and obese. In a weird twist of luck for Trump, though, Covid-19 has been around for long enough that health care workers and scientists have begun to come up with ways to treat it. Here are the kinds of options health care workers might consider for someone like the president.
Even though people of any age and any health status can get very sick and die from Covid-19, three of the things that make the disease most deadly are being male, old, and overweight. That’s not great for the president. Trump is 74 years old and, as of June, weighed 244 pounds. Technically that makes him mildly obese. Across an entire population, all other things being equal, Covid-19 kills hardly anyone under 50. But over 50, the numbers start to climb. For people older than their mid-seventies, the mortality rate for Covid-19 is around 4 percent. “Compared to an 18- to 29-year-old, someone aged 73 is about 5 times more likely to be hospitalized and about 90 times more likely to die of Covid,” says Bob Wachter, chair of the department of medicine at UC San Francisco. “Once you’re up to age 75, that death number becomes 220 times more likely to die.”
Obesity makes the numbers even worse, though no one’s really sure why. So do other chronic illnesses that often go along with age, like diabetes and heart conditions. “This has nothing to do with the president’s specific situation, just the odds in a population,” Wachter says. “But the odds of someone that age with comorbidities getting sick enough to be hospitalized are well above 10 percent, and the odds of dying are probably in the 5 to 10 percent range.”
The president’s physicians have repeatedly reported that he is healthier than even younger, lighter men. (Of course, in 2015, when Trump was a candidate, he apparently dictated his own doctor’s letter.) Trump doesn’t smoke tobacco or drink alcohol, but he also doesn’t seem to engage in regular exercise outside golf. And other weird events have given rise to concerns and whispers that Trump’s health was in fact secretly not so great. Occasionally, he seems to slur his words or seem unsteady at public events, as when he apparently had trouble navigating down a shallow ramp after a speech at the US Military Academy. And then there was the sudden and unsatisfactorily explained emergency trip by motorcade to Walter Reed Medical Center in 2019.
Still, the president will certainly get the best possible care if he starts to worsen. Mild Covid-19 symptoms get treated the same as any other viral infection—rest, liquids, anti-inflammatories like acetaminophen or ibuprofen. “It’ll be interesting to see if they try to do something more experimental,” Wachter says. “The treatments that have been demonstrated to be beneficial in patients that are sicker, it wouldn’t be shocking to think they’d be considered in this particular case.”
It’s not a sure thing that the president will get sick at all, of course. The White House doctor said that the president will continue to perform his duties. Even so, people who end up hospitalized, needing oxygen or assisted breathing, do have some treatment options. Hydroxychloroquine likely won’t be one; for months Trump touted the preventative and curative properties of the drug, but major studies eventually found it didn’t help. Physicians might administer convalescent plasma, basically the immunological components of the blood of recovered Covid-19 patients. It, too, hasn’t been shown definitively to help, but it has proven safe in use so far and has a history of benefits in other pandemics. An antiviral drug, remdesivir, seems to reduce the length of hospital stays, and it’s commonly administered now.
The only drug to have been shown, cleanly, to reduce overall mortality is a corticosteroid called dexamethasone, but doctors don’t use steroids in the early phase of the disease. “Starting that early would be absolutely wrong,” Wachter says. Steroids suppress the immune system, and “if you’re mucking around with your body’s effort to mount an immune response early in an infection, that’s a bad thing to do.” But severe Covid-19 can involve a second phase in which a person’s immune system gets overactive and starts to damage the body. That’s where steroids have helped.
One possible therapy that hasn’t been completely tested yet but shows enough promise that a president’s doctors might consider it is the use monoclonal antibodies. These are engineered proteins designed to specifically prevent SARS-CoV-2, the virus that causes Covid-19, from attaching to and entering a person’s cells. At least two companies have monoclonal antibodies, or mAbs, in phase 3 clinical trials, and early results at least hint at safety and maybe even efficacy. If the situation was dire enough and the patient was getting all possible care, it’s possible to imagine doctors using the experimental therapy as a Hail Mary. “I have to assume that they will consider that. It’s not far enough along to be approved for widespread use,” Wachter says, “but in this particular case, almost ironically, they will be looking at all the scientific evidence.”
Really, though, the options for a person with Covid-19, whether it’s mild to severe, don’t vary much whether that person is a president or not. “It’s not like there’s a magic treatment where we unlock the box and give it to him,” Wachter says. “The magic treatments are the ones where we don’t know if they work.” The hope, of course, is that neither the president nor his wife will need magic, or even science—that simple rest and care will see them through.