The President and the Virus: What It All Means

The shocking announcement, as has often been the case during the Trump presidency, came in form of a tweet the middle of the night. The president’s message was simple and straightforward: “Tonight, @FLOTUS and I tested positive for COVID-19. We will begin our quarantine and recovery process immediately. We will get through this TOGETHER!” (https://twitter.com/realdonaldtrump/status/1311892190680014849?s=11)

The realization that Donald Trump, who has been described during the COVID-19 pandemic as “the world’s most tested man,” had contracted the disease himself only reinforced what has become increasingly evident in the past few months: No one is safe.

Over the 24 hour period after the presidential announcement, numerous members of the White House inner circle and a large number of other presidential contacts were found to have tested positive: Trump advisors Hope Hicks and Kellyanne Conway, campaign manager Bill Stepien, Republican National Committee Chairwoman Ronna McDaniel, former New Jersey Governor Chris Christie, Republican Senators Mike Lee and Thom Tillis, and even Notre Dame President John Jenkins, all of whom attended federal judge Amy Coney Barrett’s Rose Garden nomination ceremony last Saturday. Health care professionals watching both that ceremony and the first presidential debate proceedings in Cleveland were mortified to see many participants not wearing masks—including all of the Trump family members in attendance at the debate. The President even ridiculed Vice President Biden about his mask-wearing during the debate, saying, “You could be speaking 200 feet away from him and he shows up with the biggest mask I’ve ever seen.”

But it was an over-reliance on an inherently fallible SARS CoV-2 antigen test, and disdain for social distancing and mask-wearing, that likely allowed COVID-19 to breach the White House bubble.

The COVID-19 pandemic has defined 2020 in a way that is unprecedented in modern history. A highly contagious viral illness which is at once capricious and potentially deadly, it can manifest itself in some without any symptoms at all, allowing it in many instances to spread unchecked. In others, however, it can unleash a lethal organ-destroying immunologic firestorm. Such is the nature of SARS CoV-2, the invisible pathogen which has unleashed the most substantial pandemic in a century.

Statistically speaking, the president is most likely to make a full recovery—but his age (74), his gender and the fact that he is obese work against him.

According to CDC data, about 8% of COVID-19 patients aged 65-74 die from the disease, and 18% of those aged 75-84 (https://covid.cdc.gov/covid-data-tracker/#demographics). Males have a worse outcome than females with COVID-19, both in terms of the seriousness of the illness and in the risk of death (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31748-7/fulltext).

The president, with a body mass index of 30.5 according to his June 2020 health survey, also qualifies as obese. Obese patients with COVID-19 are 74% more likely to be admitted to an ICU and 48% more likely to die (https://www.sciencemag.org/news/2020/09/why-covid-19-more-deadly-people-obesity-even-if-theyre-young).

However, the President does have the advantage of access to the very best health care in the world, as evidenced by his early treatment with an experimental antibody cocktail made by the biotech company Regeneron (https://www.nytimes.com/2020/10/02/health/trump-antibody-treatment.html?referringSource=articleShare) and subsequent infusions of the antiviral drug Remdesivir. According to his personal physician, Naval Commander Sean P. Conley, the president is also being given zinc, Vitamin D, melatonin, aspirin and famotidine as adjunctive therapies. Although there are anecdotal data suggesting that some of these interventions may have some efficacy against SARS CoV-2, no large-scale randomized controlled trial data are available. Still, they are unlikely to hurt, so it makes sense that Trump receive them.

In terms of the president’s recovery, the next week or two will be critical. Many patients remain mildly symptomatic and recover fully after a few days. Others who are initially mildly symptomatic can take a turn for the worse after 5-7 days or more and end up in the ICU as the virus begins to wreak havoc on the body’s organs via its effects on the patient’s immune system. Such is the nature of this unpredictable infection.

So what happens if President Trump is incapacitated? In that event, the 25th Amendment, enacted in the aftermath of the Kennedy assassination, comes into play. Vice President Mike Pence would then become acting President. That’s not an issue right now: President Trump, who has relocated to the Presidential Suite at Walter Reed Army Medical Center in Maryland, is currently still functioning in full capacity as President. But there are contingencies in place for a transition of power, if that is deemed necessary.

While the President’s COVID-19 diagnosis is emblematic of the 2020 election year, serious presidential illness is not without precedent. Of course, assassinations and attempted assassinations (Lincoln, Garfield, McKinley, Kennedy, Teddy Roosevelt and Reagan) have played a role in the office’s history. William Henry Harrison died of pneumonia (or typhoid fever) only a month after he took office in 1841. President Zachary Taylor died of cholera in 1850 after only 16 months in office. Grover Cleveland successfully (and secretly) had a cancerous tumor of the jaw removed aboard a friend’s yacht at sea in 1893. In 1919, while in Paris to negotiate the terms for the end of World War I, Woodrow Wilson became a victim of the H1N1 influenza pandemic. His illness allowed French Prime Minister Georges Clemenceau to take the lead in the negotiations, resulting in an infamously harsh treaty with Germany which, in turn, led to the rise of Adolf Hitler and the Second World War. Wilson survived the flu but had a stroke six months later. His wife Edith Wilson became the de facto president after that event until Wilson left office in 1921. Two years later, in 1923, Warren G. Harding, Wilson’s successor, died of a heart attack while in office. In 1945, Franklin Delano Roosevelt died of a stroke at the most critical portion of the Second World War and was succeeded by Harry Truman. Dwight Eisenhower had a heart attack while he was president, in 1955, and had emergency surgery for a bowel obstruction nine months later, leading to a diagnosis of Crohn’s disease. Eisenhower also had a stroke in 1957 but managed to complete his term in office. And Ronald Reagan, who survived a 1981 assassination attempt, had a malignant colon polyp surgically removed in 1985, missing only a week’s work.

The COVID 19 outbreak at the White House only underscores what health care professionals have been saying all along: The SARS CoV-2 virus is not political. It does not discriminate. It has infected a documented 35 million people worldwide and has killed over a million, including nearly 214,000 Americans. In the absence of a vaccine (which will not likely be widely available until early 2021), our only defense against its spread are the simple and effective public health measures which have been widely politicized and ridiculed: Social distancing, avoiding indoor gatherings of more than 10 people, and universal mask-wearing. If anything, we should all be chastened by recent events—and redouble our collective efforts to thwart the virus by doing the best we can to take care of one another.

Zara Rahim, a former spokeswoman for Hillary Clinton’s 2016 presidential campaign, tweeted after Trump’s diagnosis, “I hope he dies.” This sort of statement is fundamentally wrong. Our prayers for a speedy recovery should go out to the President, the First Lady, and all of the others who are infected with COVID-19. Perhaps, after this event, we can stop treating the pandemic as a political football and instead deal with it as the very real public health issue that it is. At the end of the day, we are all human beings. It’s past time we recognized that.