By Dhruv Khullar
In a midnight tweet, the President of the United States revealed that he and the First Lady have both tested positive for the coronavirus, raising concerns about his health and upending an already chaotic campaign season just thirty-two days before the election. The virus—which has transformed American life, killed more than two hundred thousand Americans, and devastated the U.S. economy—now threatens the health of the President and senior government officials. The White House has said that the President is experiencing mild symptoms. Melania Trump has tweeted that the First Couple is “feeling good”; Sean Conley, the White House physician, has released a statement saying that he expects the President “to continue carrying out his duties without disruption.” Even so, on Friday it was announced that the President would be taken to Walter Reed National Military Medical Center, where he is expected to stay for several days. Without further details about the reasons for the move—the White House has attributed it to “an abundance of caution”—it’s hard to say what the hospitalization portends. From here, Trump’s illness might dissipate or grow much more severe.
Trump—by virtue of his age, gender, and weight—is at relatively high risk for serious complications from the coronavirus infection. People over the age of sixty-five account for more than eighty per cent of covid-19 deaths in the United States. Compared to a twentysomething, a septuagenarian is more than five times as likely to be hospitalized and is ninety times more likely to die of the coronavirus. For Americans in their seventies, the case fatality rate—a measure of a person’s chance of dying after being diagnosed—is around ten per cent. The true rate of death in that age group is almost certainly lower, since some people who contract the virus never develop symptoms and are never tested for it. On the other hand, we know that older men are more likely to die than women, possibly because of gendered differences in the way the immune system responds to the virus. At six feet three and two hundred and forty-three pounds, the President is also obese, which increases the risk of hospitalization, I.C.U. admission, and death.
Still, in all likelihood, Trump will get through this. Most Americans, even older ones with preëxisting conditions, survive coronavirus infection. Moreover, statistics are, by definition, averages—and the President is not an average American. He will receive constant, world-class medical care; he will also benefit from months of scientific advancement in the treatment of covid-19. Since April, when Boris Johnson, the British Prime Minister, was admitted to the I.C.U., we’ve learned a great deal about how to attack the disease and its complications. It’s possible that the President will receive the antiviral drug remdesivir, perhaps in combination with convalescent plasma, which, in August, the F.D.A. authorized for emergency use. He also has access to some of the promising antibody drugs currently in development, which Phase II studies have shown may reduce the risk of being hospitalized. According to an announcement from Conley, Trump has already received “a single 8 gram dose of Regeneron’s polyclonal antibody cocktail.” The President’s early diagnosis could matter; so could close monitoring and a speedy intervention. All this is good news. The bad news is that the coronavirus is a capricious killer; this week, a previously healthy nineteen-year-old college student died of covid-19.
The President isn’t the only one who could fall ill. Even in cases when the risk to any particular individual is low, the chance that the virus will spread to someone who goes on to become seriously ill, or die, is considerable. Trump’s schedule of events—and his refusal to adhere to basic public-health guidance—makes him a potential superspreader. The President has repeatedly expressed disdain for masks, mocking Joe Biden for wearing them as recently as Tuesday, at the Presidential debate. (“I don’t wear a mask like him,” Trump said. “Every time you see him, he’s got a mask.”)
It’s not clear when Trump was infected or how many people he has since exposed to the virus, but the fallout could be substantial. On Monday, Trump held a Rose Garden press conference at which he said that “we’re rounding the corner” on the pandemic; in attendance were Vice-President Mike Pence and Alex Azar and Betsy DeVos, members of the President’s Cabinet. On Tuesday, Chris Christie and several other advisers helped prepare the President for the debate; no one was wearing masks. On Wednesday, Trump boarded a flight with senior officials including Hope Hicks—who was later confirmed to have the coronavirus—as well as Stephen Miller, Jared Kushner, and Dan Scavino. On Thursday, even after knowing he’d been exposed to the virus, Trump flew with his team to a fund-raiser in New Jersey, where he did not wear a mask and met with dozens of campaign supporters, displaying a familiar disregard for the health and safety of those around him. The test results are beginning to trickle in. John Jenkins, the president of Notre Dame, tested positive after attending a White House ceremony, on September 26th, for Trump’s Supreme Court nominee, Amy Coney Barrett; Senator Mike Lee, who met with Barrett on September 29th, without a mask, tested positive two days later. Ronna McDaniel, the chair of the Republican National Committee, has also tested positive; she last met with Trump on September 25th.
The President’s infection, and the exposure of dozens of other high-ranking government officials, highlight the limitations of the White House’s approach to the coronavirus. It has relied heavily on testing to justify a lack of masks and distance. The inadequacy of such a strategy became evident long ago, as many members of Trump’s inner circle—including his national-security adviser, his son’s girlfriend, and the Vice-President’s press secretary—were infected. Months into the pandemic, the White House’s protocols for preventing the spread of the coronavirus within its walls remain insufficient. Visitors undergo minimal screening upon arrival; the President delivers addresses with little regard for social distancing; aides congregate in offices, without masks, breathing shared air. Coronavirus tests have limitations: the false-negative rate among symptomatic people is higher than twenty per cent, and rises further among those who are pre-symptomatic. For this reason, we should be cautious about assurances that other leaders, such as Mike Pence, have tested negative. In truth, their negative results do not obviate the need for quarantine; ideally, everyone who has been exposed would isolate for weeks, regardless of test results.
The epidemiological playbook, then, is fairly clear. The politics of the President’s infection are murkier. If Trump experiences only mild symptoms, he may feel that he has acquired new ammunition with which to attack the advice of public-health officials. Alternatively, if his symptoms worsen, it could take him weeks to recover; if his condition grows serious, that could cast doubt about whether he should remain on the ballot. Even if he stays well, his campaign strategy has been thrown into disarray. The President’s infection will undoubtedly insure that his bungling of the pandemic—which continues to kill nearly a thousand Americans a day, and to sicken thousands more—remains the overriding story of the campaign. He’ll be forced to cancel scheduled campaign rallies, at which he routinely brings together thousands of unmasked Americans. His participation in the next Presidential debate, in less than two weeks, is now uncertain.
Trump’s infection further highlights what has been obvious from the start of the pandemic: the coronavirus respects no boundaries. Trump cannot wish the virus away; denial and deflection can’t change biology. It also throws into sharp relief the virus’s sheer contagiousness, and the monumental challenges we continue to face in containing it. The President is, in theory, among the most protected people in America. Those interacting with him are regularly tested; so is he. All the same, the virus broke through. It’s possible that someone in the early days of an infection tested negative in the morning—when the virus’s circulation in the body was below a certain threshold—and then infected the President that same evening, after it had used that person’s cellular machinery to multiply itself by orders of magnitude. It’s also possible that a test was simply incorrect, as many are. A truly responsible approach to Trump’s infection includes universal masks, social distancing, and, for the many people the President has exposed, isolation. The response of Trump’s circle to this new crisis will reveal whether they are coming to grips with reality, or continuing to flee from it.
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