Early on Friday morning, America learned the news that President Trump and first lady Melania have tested positive for the coronavirus.
Like most Americans, my thoughts are with the president, first lady and their family, as well as all others infected with and affected by the coronavirus.
The president’s infection is a sobering reminder that COVID-19 is an ongoing threat to our country. His infection shows that, sadly, COVID is real, still with us, and can happen to anyone. No one is safe – not even heads of state – until everyone is safe. Here are six key observations.
The first question most people ask their doctors when faced with a new illness is: What are my chances for survival? The risk of severe illness and death from COVID-19 increases steadily with age and age is by far the strongest risk factor for death – 50 to 100 times higher than the risk of younger adults.
Based on what we know right now, a 74-year-old with this infection has approximately a 3% chance of death.
The risk is higher in males than in females and higher in people who are overweight and obese than in those of normal weight. There are about 4-5 people hospitalized for every person who dies – there’s about a 10-15% chance of severe illness in this age group. That means that 85-90% of those who are infected in their 70’s will have no, mild, or minor illness.
People who get prompt and high-quality medical care likely have better outcomes. The proportion of patients who experience serious long-term effects (so-called “long-haulers”) is unknown, and there’s still a great deal we don’t know about these effects.
The second question most people ask is: What can I do to improve my chances for survival? Tracking how much oxygen the body is getting is an important measure of how sick someone is and providing supplemental oxygen early is likely to be helpful.
The president’s infection is a sobering reminder that COVID-19 is an ongoing threat to our country. His infection shows that, sadly, COVID is real, still with us, and can happen to anyone.
There is some evidence that the medication Remdesivir may reduce the duration of illness, although it is not generally recommended for people who do not require hospitalization, in part because of insufficient supplies. The data on convalescent plasma is contradictory.
Some people may benefit from serum that has strong antibodies in it, but this is not yet well characterized. Monoclonal antibodies created in the laboratory are a promising treatment, but also unproven.
The third question often asked is: What is the range of harms this virus causes? Although known for its effects on the lungs, it’s now clear that the virus that causes COVID can damage the heart, brain, and other parts of the body. It’s not clear how often this happens, or what the implications are.
We still have been learning for less than a year learning about this new virus, with lots more to learn.
Fourth, we need to find out: How did the infection occur? This requires medical detective work, which can be aided by fingerprinting the genetic material of the virus to see the source. This isn’t done routinely and may not have immediate implications. In many cases, the source of infection is clear, but in many, there are so many potential sources that it’s not known. The fact that a close adviser was ill several days earlier is obviously a leading hypothesis – but only a hypothesis.
It’s a plain truth that face masks protect others, and almost certainly protect yourself as well. The more people who wear masks when we’re near others, the safer we’ll all be.
Fifth, we need to ask: Who was exposed? This depends on when the president was first infected. We can’t know this until we have more information about when his last negative test was, and when and what his first positive test was. While respecting patient privacy, transparency is important – about when the president has been tested, how the tests have been done, what the exact results are, and on his health.
Some people have asked if Vice President Biden could be at risk from the debate. This is possible, particularly because the louder someone talks, the more chance there is that virus will spread. As of Friday, Biden had tested negative for coronavirus.
Finally, What does this tell us about the pandemic? Testing, although an important part of our response, does not in and of itself reduce the risk of COVID.
Testing is only useful as part of a comprehensive strategy, and there is the risk that businesses, universities and other places that test regularly may let down their guard and allow infection to spread.
What’s important isn’t how many people are tested or how often, but what is done with testing to reduce risk. Testing doesn’t replace other safety measures such as wearing a mask, watching your distance from other people, and washing your hands.
Every person infected with COVID is a step backward in our effort to slow the pandemic and reopen society.
We are nowhere near herd immunity, and getting there without a vaccine would cost hundreds of thousands of lives and millions of jobs.
As we hope for the speedy and full recovery of the president and his family and all others suffering from our common enemy of this new virus, we must better prevent and treat it.
We’re all in this together, and the better we prevent and fight the virus, the more lives we can save and the sooner and safer we can get to the new normal.