COVID And The President: What We Can Expect

The news early this morning that the President and the First Lady have both been diagnosed with COVID-19 infections has been devastating. And for the next two weeks or so, although we pray otherwise, the journey may be difficult. We just don’t know.

Many of us are now asking what those two weeks might bring. Unfortunately, there is no clear answer. No matter the fact that everyone will have their “take” on what is going to happen, the reality is that no one knows.

I have learned from a lot of experience commenting in the public space about illnesses and deaths of famous people that is always risky to speculate when one does not know all the details of an illness. However, I also have found it helpful to share some more generic perspectives to provide a context and a learning opportunity so that hopefully others will be more informed. 

So here are some of my early thoughts:

• This is serious. We hope that the President and the First Lady do well. However the President has some very real risk factors, notwithstanding the fact that we really don’t have great insight into his true health status.

What do we know? He is 74 years old. He is overweight/obese. We are not aware that he exercises with regularity, although he certainly gets plenty of movement around the country these days as part of campaigning (and I don’t say that in jest). No matter the bravado, he is at serious risk of complications from this infection. 

I can say this from some personal authority: The President and I are almost exactly the same age. We are close to the same height and the same weight. A key difference is that I do exercise daily and reasonably vigorously. And for the past seven months I have done everything that I can do to be cautious to the point of consistent isolation and following all precautions carefully. I do that because my wife and I both recognize that if I became infected the consequences—including death—could be real. 

The President of the United States doesn’t have that option, plain and simple.Right now—whether or not we condone his behavior—he must be campaigning. We can get into the controversies over how that campaigning is done, however campaign he must. He must also run the country, again without any option of not engaging regularly in the affairs of state. It is his job, his responsibility. So he didn’t have the luxury that I have of remaining isolated most of the time.

• We know that the President may not have followed the suggested behaviors to reduce the risk of catching corona virus infection, however we don’t know what he did in his personal moments. We can guess, but we don’t know. Furthermore—and this may be the most important lesson of this entire situation—we do know that his medical team put a testing regimen in place around him to try and prevent anyone from COVID infection from coming near to him. Unfortunately and sadly, it failed. 

The lesson is clear: even for someone who has access to the best medical care and prevention strategies available, there are always opportunities for the corona virus to evade the circle of protection. Period. 

Simply stated, the virus is obviously smarter than we are, exposure risks are real and I would be willing to bet that no one who was symptomatic got anywhere near the President, emphasizing the fact that asymptomatic carriage of this virus is perhaps its biggest threat. It is stealthy beyond our ability to cope, even under the most stringent of circumstances.

• I reluctantly bring this up, because it veers into the political space: we don’t know if or when the President may have started taking hydroxychloroquine (HCQ) as a preventive measure on this occasion. We do know he took it back in May, likely as a result of a possible exposure. 

So it is a legitimate question to ask: when the President was known to be at risk of exposure—if in fact such risk could have even been known, since the probability is that the primary (“proband”) exposure wasn’t even known to the person who did the exposing since they likely had no symptoms—did the President start taking HCQ? Is he taking it now? And if he does well, will he continue to tout its benefits? And if he doesn’t do well what message will that send?

Evidence presented just this week showed that HCQ did not have benefit in preventing COVID infections in people at high risk. Other reports show that when HCQ is used early in infections it had no benefit. 

So whether or not the President stays well, it is immaterial to our understanding. It is what we call a “case of one,” an anecdote of no probative value in helping us understand the value of this medicine in the prevention or treatment of COVID infection. It will make no difference to the science.

• The President and the first lady are down for the 14 day count. And they will be (or at least very strongly should be) truly isolated. 

For most, that means isolation from friends, families and caregivers. Those coming into c contact with the President and First Lady will wear effective protective gear, so they won’t be left taking their meals left at the doorstep outside their room as is the case for most who have to be isolated with infection. 

But it does mean campaigning is on hold, at least the in person kind. We can expect a lot of statements, tweets, telephone and even television interviews (remember Chris Cuomo from CNN broadcasting from his basement every night as he endured his COVID infection?). That is not going to stop, it can’t stop in the midst of an election. So as long as the President is physically capable of sharing his thoughts we should have no doubt he will find the opportunities to do so.

So campaigning won’t go on hold—assuming that the President’s symptoms are bearable. Sometimes they are not, and frequently in people of this age there are symptoms. Not always, but that is going to be a concern watched closely by many.

• This may not be a “one and done” in the sense that once the period of greatest danger has passed then the patient quickly recovers and goes back to a normal lifestyle. 

Increasingly we are seeing reports of what has been termed “long hauler” syndrome, where various problems persist well after an infection. These may be of various types involving the lung, the brain, and the heart among other body systems. 

Even as recently as this week articles were published talking about a particular form of heart failure related to COVID where the virus infects the heart muscle and has long lasting impact. How long lasting we don’t know, but the impact is real. And remember this is a man whose underlying condition isn’t exactly the best, notwithstanding some comments to the contrary.

Again, I can personally attest to this: although the virus wasn’t COVID I suffered moderately serious heart damage from a serious viral infection a couple of years ago, ending up in the emergency department. Fortunately, I recovered. With COVID, apparently not everyone does.

• Here is the most difficult question, one which many are thinking and few will say out loud: Could the President become seriously ill? Could he—heaven forbid—die? 

Over 200,000 people have died in the United States as a result of this pandemic. Many of those have been older; many have had what we doctors call “co-morbid conditions.” 

I mentioned earlier about our family’s concern about my own personal health and what that would mean for my own risk if I became infected. I am in reasonably good condition. But I am overweight; I have high blood pressure; I have elevated cholesterol; I do exercise regularly. All of those factors—except the weight—are under excellent control and would suggest that I am OK.  However the reality is that I am still quite vulnerable to serious illness and death if I become infected. 

I would think when it comes to risks, the President and I are pretty much on the same page in that regard. So there is cause for concern.

Then there is the question of what and when we could expect to see problems. 

Hopefully, we won’t see any. However it is a possibility and the next two weeks are going to be difficult for the President, the First Lady, and the nation, not to forget his family, his medical team, his friends and especially for his supporters. He could do fine; he may not. He may deteriorate and require hospital care; he may require intensive care. We simply don’t know, so we pray.

The good news on this front is that we have made considerable progress during this pandemic in understanding how to better care for patients who do become seriously ill: we know some medications do work to reduce the impact of the disease; we do know better how to manage the breathing problems that occur; we do know that in very serious illnesses we can maneuver the position of patients to help them breathe better; we have seen the reports of people who have been critically ill for months and recovered to leave the hospital. 

All of those are true, however all of them belie the fact that this illness can turn on a dime and be deadly. We can’t forget that even with all the finest medical care and the best medical science there is still much we don’t know and can’t do. This may be an uneventful episode however it also may not be a “walk in the park.” This can be serious—deadly serious. Once again, we simply don’t know.

So that is what I can offer as a quick summary of where I see the issues as of this morning. However one other question will loom over these events: Will this be the turning point for the country when it comes to understanding the seriousness of this illness?

Try as I may I haven’t been able to understand why this illness has become so political—but it has. And far from me to take this moment to speculate on how the country is going to interpret these events, especially with respect to how folks are going to react online and in the media over the next two weeks.

We have suffered devastating tragedy these past several months: too many have been impacted, too many have minimized this disease yet too many have chosen a different path when it comes to taking precautions. 

We are now in a phase of COVID weariness from all the restrictions, and we are “breaking out.” That’s the reality and notwithstanding the President’s illness we are finding ourselves in some parts of the country experiencing a significant rise in infections and hospitalizations. That process is already underway, and is likely to get worse no matter whether the President became ill. 

If something good comes from this, maybe it will be that a clear message will be sent about the importance of prevention and taking this virus seriously. We need some kind of wake up call to get this back under control. I can’t imagine a more pronounced call than seeing the President quarantined with infection. And if he becomes symptomatic, well…

One final point: As I mentioned earlier in this message, it is always important to avoid speculation when dealing with the illness of people in the public eye. There are always some things we know, and lots we don’t. 

Over the next two weeks and perhaps longer we are going to be flooded with various opinions and commentaries, many of which will be speculative and not based on accurate information and facts. The medical team and those closest to the President will always know much more than we will. No matter who does the speculating, we must remember they are speculating. We must put on our knowledge filters the way we put on our masks, trying to sort the accurate and known from the “I think” or “Perhaps.” 

My fervent wish is that the medical team be allowed to do what they need to do, that they release accurate information about the President’s status, and that for once we put the games aside. The body politic can deal with the truth, and we can deal with the facts so long as the facts are the facts. I recently wrote about the realities of “Covid Truth.” Never has the real truth been so much more important now than what we have experienced since the beginning of this pandemic.

To do otherwise will make a difficult and frightening situation even moreso. Please—and I beg you—take us down the path of truth. We have never needed truth more than we need it right now, for all of our sakes. 

Please trust us with the truth.