• December 4, 2021

President Donald Trump Tests Positive for Covid-19

The president’s physicians have repeatedly reported that he is healthier than even younger, lighter men. (Of course, in 2015, when Trump was a candidate, he apparently dictated his own doctor’s letter.) Trump doesn’t smoke tobacco or drink alcohol, but he also doesn’t seem to engage in regular exercise outside golf. And other weird events have given rise to concerns and whispers that Trump’s health was in fact secretly not so great. Occasionally, he seems to slur his words or seem unsteady at public events, as when he apparently had trouble navigating down a shallow ramp after a speech at the US Military Academy. And then there was the sudden and unsatisfactorily explained emergency trip by motorcade to Walter Reed Medical Center in 2019.

Still, the president will certainly get the best possible care if he starts to worsen. Mild Covid-19 symptoms get treated the same as any other viral infection—rest, liquids, anti-inflammatories like acetaminophen or ibuprofen. “It’ll be interesting to see if they try to do something more experimental,” Wachter says. “The treatments that have been demonstrated to be beneficial in patients that are sicker, it wouldn’t be shocking to think they’d be considered in this particular case.”

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It’s not a sure thing that the president will get sick at all, of course. The White House doctor said that the president will continue to perform his duties. Even so, people who end up hospitalized, needing oxygen or assisted breathing, do have some treatment options. Hydroxychloroquine likely won’t be one; for months Trump touted the preventative and curative properties of the drug, but major studies eventually found it didn’t help. Physicians might administer convalescent plasma, basically the immunological components of the blood of recovered Covid-19 patients. It, too, hasn’t been shown definitively to help, but it has proven safe in use so far and has a history of benefits in other pandemics. An antiviral drug, remdesivir, seems to reduce the length of hospital stays, and it’s commonly administered now.

The only drug to have been shown, cleanly, to reduce overall mortality is a corticosteroid called dexamethasone, but doctors don’t use steroids in the early phase of the disease. “Starting that early would be absolutely wrong,” Wachter says. Steroids suppress the immune system, and “if you’re mucking around with your body’s effort to mount an immune response early in an infection, that’s a bad thing to do.” But severe Covid-19 can involve a second phase in which a person’s immune system gets overactive and starts to damage the body. That’s where steroids have helped.

One possible therapy that hasn’t been completely tested yet but shows enough promise that a president’s doctors might consider it is the use monoclonal antibodies. These are engineered proteins designed to specifically prevent SARS-CoV-2, the virus that causes Covid-19, from attaching to and entering a person’s cells. At least two companies have monoclonal antibodies, or mAbs, in phase 3 clinical trials, and early results at least hint at safety and maybe even efficacy. If the situation was dire enough and the patient was getting all possible care, it’s possible to imagine doctors using the experimental therapy as a Hail Mary. “I have to assume that they will consider that. It’s not far enough along to be approved for widespread use,” Wachter says, “but in this particular case, almost ironically, they will be looking at all the scientific evidence.”

Really, though, the options for a person with Covid-19, whether it’s mild to severe, don’t vary much whether that person is a president or not. “It’s not like there’s a magic treatment where we unlock the box and give it to him,” Wachter says. “The magic treatments are the ones where we don’t know if they work.” The hope, of course, is that neither the president nor his wife will need magic, or even science—that simple rest and care will see them through.


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