President Donald Trump stunned the world on early Friday morning when he tweeted that he and First Lady Melania Trump had been diagnosed with COVID-19. Later that day, he was hospitalized at Walter Reed to be treated for his condition. One day earlier it was announced that Trump's senior adviser Hope Hicks, who regularly travels with him, had also tested positive for the deadly disease.
The 74-year-old Trump's diagnosis is alarming given the health risks that someone of his age and disposition faces. As a recent compilation of COVID-19 studies reported in Nature noted, the statistics are grim for seniors who are diagnosed with COVID-19. Indeed, of those in their mid-seventies and older who test positive for COVID-19, roughly 116 out of 1,000 (meaning 11.6%) will die. Those mortality statistics are based on the cases observed in the United States; so far, over 200,000 Americans have died of COVID-19, and its victims are disproportionately elderly.
Dr. Russell Medford, chairman of the Center for Global Health Innovation and Global Health Crisis Coordination Center, warned that Trump has compounding health conditions that may make his diagnosis more severe.
"The president has several risk factors that we know factor into a more serious response to a COVID-19 infection compared to a younger person or a person without those risk factors," Medford told Salon. "These include his age, his weight and other factors involving metabolic syndrome, potentially. All of these we know, from past experience with patients with COVID, confer a higher risk for complications and potential mortality. I cannot comment on the specific case for the president."
Dr. Monica Gandhi, infectious disease doctor and professor of medicine at the University of California — San Francisco, wrote to Salon that recent data shows people with higher viral loads are more likely to exhibit severe symptoms. She added that "the viral inoculum (dose) that a patient imbibes is decreased from masking and social distancing. The ability of this lower dose to lead to less severe disease is from a more organized adaptive immune response and a less disregulated innate immune response." Trump has observably been reluctant to wear a mask and observe social distancing, which means that voters should be alarmed if Trump is exhibiting symptoms, since "this indicates that those with symptoms are more likely to have higher viral loads, which is played out in other studies (but not all)."
Indeed, studies have found that mask-wearing limits the dose of virus that a potential patient inhales, and that those who frequently wear masks tend to get far less sick even if they do contract COVID-19. Trump's recently-documented behavior — he was observed in groups not wearing a mask multiple times in the days preceding his diagnosis — means he is more likely to have a higher viral load. As the New York Times reported, "On the way back from the [presidential] debate, Jared Kushner, the president's senior adviser and son-in-law, could be seen in a staff cabin, speaking animatedly to his colleagues with no mask covering his face. Upon landing at Joint Base Andrews in the middle of a heavy rainstorm, others on Air Force One huddled together to share an umbrella."
Like Medford, Gandhi argued that Trump "has four risk factors for severe disease in my opinion — being 74 years old, being overweight, the possibility he has been exposed to a higher viral inoculum or dose because he doesn't mask and the fact that he was exposed to someone who was symptomatic (Hope Hicks)."
Melania Trump is at much lower risk for COVID-19. For those in their 50s, as Melania Trump is, only 5 in 1000 died of COVID-19 or complications, the same Nature report noted.
Trump being infected with the novel coronavirus is perhaps not surprising, given that he himself has eschewed the wisdom of the scientific community that advised him on how to prevent and stave off the virus.
"There is no question that [the administration's] whole approach to this disease has not been science-based. It remains to be seen who gets sick and and how they got sick," Dr. Georges Benjamin, executive director of the American Public Health Association (APHA) and former secretary of health in Maryland, told Salon. "The question is whether or not he infected others or others infected him. We don't know yet, but he certainly did not use all of the public health protections that we have. A mask, as an example, is the obvious one to give himself the best protection that he could have had."
There is evidence backing up Benjamin's hypothesis. The director of the Tulsa Health Department claimed in July that Trump's political rally in that state "more than likely" led to a surge of COVID-19 cases. Likewise, it has been confirmed that Trump had close contact with "dozens" of people after being exposed to the disease. Trump admitted to reporter Bob Woodward back in February that he was downplaying the virus, and he waited more than 10 weeks to declare a national emergency after first being informed that the pandemic had reached the United States.
Trump has repeatedly denigrated Biden for taking precautions like wearing a mask, saying during the presidential debate earlier this week that "I wear a mask, when needed — when needed, I wear masks. I don't — I don't wear masks like him. Every time you see him, he's got a mask. He could be speaking 200 feet away from me, and he shows up with the biggest mask I've ever seen." He also claimed that "so far we have had no problem whatsoever" when it comes to people getting sick at his rallies, and insisted that Biden was not holding large rallies because he was not popular.
Trump has downplayed the need to wear masks on many other occasions as well, prompting Dr. Allan Lichtman, a political scientist at American University, to tell Salon in July that "it's a horrible message. It shows he doesn't care about the health of his constituents. He cares more about his own image than he does about keeping the people around him safe." Lichtman also pointed out that "there is nothing unmasculine about wearing a mask. It is not a show of weakness to wear a mask anymore than it is a show of weakness not to drive drunk."