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Trump's age, health woes raise his risk for COVID-19 illness

Posted October 2, 2020 5:50 p.m. EDT
Updated October 2, 2020 7:02 p.m. EDT

— 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 early Friday.

Trump was fatigued and will spend a “few days” at a military hospital, White House officials said later in the day.

“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.

“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 with no or mild symptoms, but Trump's physician, Dr. Sean Conley, said the president was given an experimental drug aimed at supplying antibodies to help fight the infection.

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.

"When you look at someone’s age of 74 and you know that they have COVID, the biggest thing at the moment is time," said Cameron Wolfe, an infectious disease specialist with the Duke University Health System. "It’s not surprising when people in their 70s, even if they have mild symptoms to begin with, in fact become a little more labored with their symptoms as the next few days go on, and I think we just have to watch really carefully for that."

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.

"Even after his recovery, it would be very common for people to be quite fatigued, not back to their normal energetic self, often for some weeks," Wolfe said.

"Problems with concentration and mentation are problems for somebody who is making life-and-death decisions as a president," said Dr. David Weber, Distinguished Professor of Medicine, Pediatrics and Epidemiology at the University of North Carolina at Chapel Hill. "The older you are, the more likely you are to have persistent symptoms. The sicker you are, the more likely you are to have persistent symptoms."

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 diseases 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 U.S. Centers for Disease Control and Prevention. The risks rise exponentially at older ages.

"The single biggest determinant of whether you develop severe symptoms and need hospitalization and become more ill is age," Weber said. "His age puts him at substantially higher risk than a younger person."

"When you’re in your 70s or 80s or above, that risk really exponentially starts to rise," Wolfe agreed. "You then need to understand a little bit about his past medical history and what issues he may carry. Weight is clearly related to poor COVID outcomes."

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.

"From what I’ve read, he makes it into the obesity scale, and that gives you about a twofold higher risk, roughly, of death than a person who was thinner," Weber said. "Again, age is the most important factor, but being obese puts him at higher risk."

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

Next steps

Doctors likely will check Trump 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.

Trump was given an experimental antibody drug that’s currently in late-stage studies from Regeneron Pharmaceuticals Inc.

Antibodies are proteins the body makes when an infection occurs. They attach to a virus and help it be eliminated. The Regeneron drug is made with purified versions of two such antibodies.

"I do believe that early and proper medical care does improve the treatment and course of COVID," Weber said.

"A really challenging conversation that the physicians looking after the president [and] the first lady will need to have is to say, 'How much data do we know about those treatments? Do they look like they are preventative of deterioration?'" Wolfe said. "There is no standard approach, at this point, that has been proven to help."

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.

“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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