The TLDR: The US President tested positive for Covid, was rushed to the hospital and has now returned to the White House. And the entire melodrama—unfolding 28 days before the presidential election—is rife with bad information and usual Trump theatrics. We look at the evidence about his disease, and the implications it has for election day.

First, a quick (fuzzy) timeline

The test: 

• According to the latest report, he took a rapid Covid test on Thursday, October 1, which came up positive. 
• He then did an interview on Fox News—where he only admitted he’d taken the second proper, more conclusive Covid test: “I’ll get my test back either tonight or tomorrow morning.”
• The same day, he also attended a fundraiser in New Jersey—no one knows if he’d taken that first rapid test by then. But guests say he looked “lethargic.”
• On Friday, at 1am, Trump announced he and Melania had tested positive (presumably based on the second test results).
• Point to note: rapid tests often throw up false ‘negative’ results. It is far rarer to get a false positive.

The hospital visit:

• Trump started to deteriorate fairly quickly. His oxygen levels dipped on Friday morning below 94%—which is the lower end of normal. 
• He was taken to the Walter Reed hospital that evening. 
• On Saturday, his oxygen levels dipped again. Point to note: “Many medical experts consider patients to have severe Covid-19 if their oxygen levels drop below 94 percent.”
• But by Sunday, everything seemed to have rebounded—and his team indicated that Trump will be discharged soon. 
• Trump also jumped in a sealed car with his Secret Service personnel for a drive-by visit to his supporters outside the hospital—a highly irresponsible move which made doctors furious.
• On Monday morning, his doctors declared that Trump had been fever-free for 72 hours and his oxygen levels were back to normal.
• Monday evening, Trump was back at the White House—where he stood at a balcony to pose for photos… and promptly removed his mask.

This is confusing… how ill is he?

The statements made by Trump, White House and his doctors have been contradictory and confusing. But the overall intent is to downplay his illness—and insist all is well. Medical experts and media have instead looked at his treatment for clues.

The treatment: The doctors appear to have used every Covid drug available including:

• Dexamethasone—which is typically given to patients who are severely ill. It is only recommended for patients who are either on the ventilator or receiving some other form of supplemental oxygen.
• A five-day course of Remdesivir that is typically used in conjunction with Dexamethasone. As New York Times notes, the drug “tamps down the body’s immune response and is given later in the illness, when some patients’ immune systems go into overdrive and attack their vital organs.”
• On Friday, Trump also received an experimental cocktail made by a company called Regeneron—which is still being tested. This, however, is given early in the disease and helps fight its spread.

Theory #1: Trump is very ill as indicated by the use of Dexamethasone and Remdesivir. As one doctor put it, “When I think about people needing dexamethasone, I think about people who are escalating their condition, who are heading closer to I.C.U. level than to home.”

And the fact that he ‘looks’ okay in his hospital videos and photos is misleading. It could be a case of ‘happy hypoxia’—an absence of visible breathlessness accompanied by feelings of euphoria that kicks in when the body is deprived of oxygen (you see this most often in high altitudes). 

Or it may just be the drugs which are “known to affect mood, causing euphoria or a general happiness.”

Point to note: One medical expert told ABC News:

“[I]t is unusual for someone to go on oxygen for a few hours with this disease and then come right off… The patients that I have seen, once they fall, they stay low for a while—they don't just bounce down and come right back up.”

Theory #2: This is a classic case of ‘VIP treatment’—when doctors tend to over-treat a celeb or are overly deferential to his demands for the ‘best’ available treatment. And the stakes are far higher when the life of a president is at stake:

“‘When a patient is high profile, there's a temptation to break away from the standard medical care that you would give to any other patient—and sometimes to the disadvantage to the patient, the VIP,’ said Dr. Mark Siegel, a Yale academic and physician. Siegel said the president's aggressive treatment plan may reflect an effort by his medical staff ‘to do more rather than pull back, for fear of being criticized.’”

Ok, so what happens now?

The recovery: Trump’s quickie discharge tells us very little about his condition—especially since the White House can be turned into a hospital environment for the President. And the road to Covid recovery—especially for older patients—is rarely a straight one. As StatNews points out: 

“This is a disease that can and often does confound, with many people experiencing no or very mild symptoms and others progressing to prolonged, debilitating bouts of illness that, in some cases, can lead to death. It’s also a disease that can take its time: People who appear to be recovering can take a turn for the worse at a point where, with other respiratory infections like influenza or colds, one would be expected to be starting to recover.”

Point to note: The next 8-12 days are the critical window that will determine whether he bounces back or deteriorates.

Sounds like a recipe for disaster…

Yes, there are many perils ahead if Trump does not recover soon. 

A loose, drugged up cannon: The most obvious risk to White House team is a Covid-sick president who refuses to follow the rules of quarantine. But the more serious risk to Americans is a president who is unfit. StatNews notes: 

“One of the common early symptoms among elderly Covid patients is a drop in mental acuity or periods of mild confusion—which would be a disconcerting turn of events, if it were to happen to a sitting president.”

Known side-effects of steroids also include “psychiatric effects, leading to feelings of grandiosity and mania, or even delirium and psychosis.” According to one expert on steroid use: “The thing about steroids is they can have psychiatric side effects at almost any dose...it is necessary to notice if the use of these drugs causes changes in mood or thinking or sleep.”

Point to note: Vice President Mike Pence will take over if Trump becomes seriously incapacitated—but that requires the president’s “cooperation.” Removing him forcibly from office requires Pence and a majority of cabinet members to inform Congress that the president is unfit—which will not go down well with his supporters. And if Trump contests that assessment, it requires a two-thirds vote in both houses of Congress to remove him from office.

A death in the White House: The risk of death in Trump’s age group is 90 times higher than people in the 18-29 age group. He is also overweight and isn’t in the rosiest of health. If Trump dies, we can expect even greater chaos with the election looming in the horizon. The Republican National Committee will have to vote to nominate a replacement in a mini-convention—who will then be voted in by the electoral college if s/he wins. 

Point to note: A sympathy vote, btw, may be the best shot the Republicans have at retaining the White House. As The Conversation points out:

“History tells us sick presidential candidates often win the ensuing election—Ronald Reagan nearly died from an assassin’s bullet in 1981 but won big in 1984—or that their party will. When Warren G. Harding died in office (in 1923), his Republican party stayed in the White House for another ten years.”

The bottomline: So far Trump’s illness has not triggered any wave of sympathy or support—except among his die-hard supporters. Biden has opened his widest lead—ten points—in the most recent opinion poll. Also this: 65% agreed that “if President Trump had taken coronavirus more seriously, he probably would not have been infected.” In other words, karma is a b**ch, Mr President.

Reading list

New York Times has the best reporting on Donald Trump’s treatment. StatNews has the best analysis of what to expect in terms of his recovery. Bloomberg News via Mint details the White House arrangements to accommodate a sick Trump. Vox and The Conversation looks at the pluses and minuses of his illness on his election prospects. The Atlantic and Politico assess the risk of Biden being infected (he still isn’t out of the woods). New York magazine and Associated Press look at what happens if Trump becomes incapacitated or dies.