Odds are he’ll have mild illness, but virus is unpredictable

Trump’s age, health woes raise his risk level in COVID-19 illness

At 74, president’s age would be the primary risk factor, says infectious disease expert; Trump’s also obese, with a BMI over 30, which lowers immunity to virus

In this September 29, 2020, file photo, US President Donald Trump holds out his face mask during the first presidential debate  at Case Western University and Cleveland Clinic, in Cleveland, Ohio. (AP/Julio Cortez, File)
In this September 29, 2020, file photo, US President Donald Trump holds out his face mask during the first presidential debate at Case Western University and Cleveland Clinic, in Cleveland, Ohio. (AP/Julio Cortez, File)

AP — US President Donald Trump has several strikes against him — age, obesity, elevated cholesterol and being male — that could put him at greater risk of becoming seriously ill from the coronavirus infection he disclosed late Thursday.

Trump and first lady Melania Trump, who also tested positive, “are both well at this time” and plan to remain at the White House while recovering and being closely monitored, according to a statement from his physician, Dr. Sean Conley.

A White House official said Friday that Trump was having mild symptoms.

“The odds are far and away that he’ll have a mild illness” as most people with the virus do, said Dr. Gregory Poland, an infectious disease specialist at the Mayo Clinic who has no role in Trump’s care.

But COVID-19 is very unpredictable, he stressed.

In this July 27, 2020, file photo, US President Donald Trump wears a face mask as he participates in a tour of Bioprocess Innovation Center at Fujifilm Diosynth Biotechnologies in Morrisville, North Carolina. (AP/Evan Vucci, File)

“We have young people who die. We have nursing home patients, a lot of them, who actually do quite well,” Poland said.

No treatments have proven effective for preventing illness in someone who is infected but with no or mild symptoms. That includes hydroxychloroquine, a drug Trump long promoted and even took himself earlier this year after a White House staffer tested positive for the virus.

Here’s what experts say about Trump’s outlook and next steps.

Signs and symptoms

Infection causes mild or no symptoms in about 80% of cases. About 15% of people become seriously ill and 5% get critically ill.

Symptoms, when they do occur, usually appear two to 14 days after infection and can include loss of smell or taste, coughing, a sore throat, trouble breathing, fatigue, muscle or body aches, headache, nausea or vomiting, diarrhea and fever.

Up to half of patients who are hospitalized don’t have a fever when admitted but nearly all develop one. How people fare varies widely — some seem to be recovering and then suddenly worsen.

Pneumonia, often with a specific appearance on X-rays, sometimes develops but complications in virtually every organ of the body have been reported.

Doctors also increasingly recognize that some people have long-lasting symptoms.

US President Donald Trump and First Lady Melania Trump step off Air Force One upon arrival at Cleveland Hopkins International Airport in Cleveland, Ohio on September 29, 2020 (MANDEL NGAN / AFP)

Trump’s risks

Older age, being male and having any other health problems increase the chance of severe illness, and Trump has those.

At 74, “his age would be the primary risk factor,” said Dr. David Banach, an infectious disease physician at the University of Connecticut’s health system.

People ages 65 to 74 are seven times more likely to be hospitalized for COVID-19 than those who are 18 to 29 years old, according to the US Centers for Disease Control and Prevention. The risks rise exponentially at older ages.

Trump also is obese, with a body mass index just past 30.

“Obesity is a state of chronic lowered immunity. In other words, you don’t respond to vaccines as well, you don’t respond to infections as well” as people of normal weight, Poland said.

Trump takes a statin drug to lower his cholesterol, and that condition also raises his risk for COVID-19 complications, doctors said.

US President Donald Trump stands on stage with first lady Melania Trump after the first presidential debate with Democratic presidential candidate Joe Biden, September 29, 2020, at Case Western University and Cleveland Clinic, in Cleveland, Ohio. (AP Photo/Julio Cortez)

Next steps

There’s no need yet for tests such as X-rays, but doctors likely will check him often for any difficulty breathing, coughing or other symptoms, Banach said.

No drugs are known to help for people with no or very mild symptoms; remdesivir and steroids have shown benefit for certain moderately and severely ill patients.

Nevertheless, Dr. David Boulware, a University of Minnesota infectious disease specialist who has led studies of some coronavirus treatments, speculated that Trump’s doctors might try promising therapies being tested in studies now, such as antibody drugs or convalescent plasma — blood from COVID-19 survivors.

“More than likely, he’s going to get treated upfront,” Boulware said. “They’re not going to just sit around and watch to see if he gets sick.”

Risk to others

Could Trump have infected Democratic presidential nominee Joe Biden during the debate Tuesday night?

Possible, but not likely, experts said. The candidates were more than 6 feet apart. But both candidates, especially Trump, spoke loudly, which research suggests can make virus particles travel farther, Poland said.

Biden said Friday on Twitter that he and his wife, Jill, tested negative.

Dr. George Abraham, who heads the infectious disease board for the American Board of Internal Medicine, warned that “a negative test doesn’t guarantee that someone is not harboring virus” because there might be too little to detect early in infection.

US President Donald Trump stands in front of supporters against a backdrop of a logging truck at Duluth International Airport on September 30, 2020, in Duluth, Minn. (AP Photo/Jack Rendulich)

“This is a wakeup call” that shows the need for social distancing, wearing masks and other measures to reduce spread, Abraham said.

Biden similarly tweeted, “I hope this serves as a reminder: wear a mask, keep social distance, and wash your hands.”

A myriad of other people who have been around Trump in the previous 48 hours are at risk, doctors said.

“Contact tracing is going to be really important,” Banach said. “The president comes into contact with many individuals during the day.”

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