President Trump’s covid-19 diagnosis brings the disease that has killed more than 208,000 Americans to the pinnacle of power. And because health and safety of the head of the executive branch has implications for everything from efficient government decision-making to the ongoing presidential campaign to the military chain of command, members of the public eagerly await prompt, detailed reports of Trump’s condition.
History suggests they will be sorely disappointed.
It’s not only that this president has demonstrated rampant disregard for the truth. Or, more specifically, that he was willing to deceive the nation about the seriousness of the pandemic threat. Or, more specifically yet, that the public learned from a leak — not from any White House announcement — that top Trump aide Hope Hicks had tested positive for the coronavirus, news that White House staff had sought to keep from getting out.
Even in less contentious times under leaders less prone to deny truth and promote falsehoods, presidents and those around them have routinely and often blatantly withheld crucial health information from public view. Their justifications have ranged widely but, whatever the logic, the result usually has been active deception of the American people, the media, Congress and even members of their own administrations.
* * *
It started early in the republic. In 1813, about halfway through James Madison’s time in office, he arranged to have an urgent letter sent to members of Congress with whom he’d intended to meet to inform them that neither could he see them “nor can he at present fix a day when it will be in his power.” But he failed to provide any details about the intestinal ailment and fever that knocked him down and kept him there for the greater part of a month. Madison’s illness became so severe that he couldn’t even read congressional resolutions that a representative had brought to him, but he recovered, and his initial lack of candor about the severity of his sickness had no consequences.
A much more robust effort to mislead the public developed when Grover Cleveland, ironically regarded as a generally honest and forthcoming president, received in June 1893 a diagnosis that the growth on the roof of his mouth was malignant. Doctors urged quick attention, and Cleveland assented. But to avoid public knowledge of the cancer and the attempt to remove it, Cleveland approved a clever but risky plan of denial and deception. No hospital visit could be kept private, so the cabal decided to perform the necessary surgery below deck on a yacht owned by a friend of the president, with the bare minimum of secrecy-sworn doctors, while Cleveland was en route to vacation in the Northeast. Thankfully, the waters remained calm, allowing the doctors to remove not only the tumor but also his entire left upper jaw and part of his soft palate after discovering that the tumor had actually grown through it.
The truth was kept to a very small circle; the doctors and the president’s private secretary would lie to everyone else to cover their tracks and excuse his unwillingness to entertain visitors. “He is suffering from rheumatism,” they said. “No operation has been performed, except that a bad tooth was extracted,” they said. By the time the president returned to the nation’s capital in August, he’d adjusted to his prosthetic jaw and could talk without most anyone seeing or hearing differences. But the president’s men maintained the deception, vilifying the one bold journalist who correctly reported the bulk of the story — who would receive vindication in the new century, after Cleveland had died of a heart attack.
Cleveland’s lies affected few major matters of state, but the deception that surrounded Woodrow Wilson’s stroke and subsequent disability certainly did. After one apparent earlier stroke in September 1919, which Wilson’s doctor labeled “nervous exhaustion” for the press, the president in October collapsed in a White House bathroom, the victim of a massive stroke that left him “helpless” and “a shadow of his former self.”
The doctor’s bulletin called the president “a very sick man” and declared “absolute rest is essential for some time,” but withheld all details. Without consulting with the vice president, the Cabinet or Congress, Wilson’s wife and doctor severely restricted access to the president. Only a trusted few outside of immediate family, a handful of doctors and nurses, and essential White House staff members even heard the truth about his paralysis and disability in those early weeks. Most of the Cabinet, everyone in Congress and the general public could only listen to the rumor mill to guess his actual condition, given the bland and information-bereft statements from the White House.
Most key papers requiring presidential action never received replies; available evidence strongly suggests that the first lady took great liberties with the few decisions that did come down from the residence. Secret Service agent Edmund Starling admitted that Wilson’s wife and doctor “stood between the President and the rest of the world while he was ill. How much they kept from him will never be known.”
Those around Franklin D. Roosevelt, who had lost the ability to walk without leg braces, famously tried to hide from public view the effects of the president’s paralysis. The other medical conditions that beset him in the 1940s and ultimately killed him prompted similar deceptions. By early 1944, examinations revealed a litany of conditions that had developed or grown worse over the years: high blood pressure, congestive heart failure, poor circulation, limited lung capacity, an enlarged heart, an intermittent slack jaw and blank stare and reduced supply of oxygen to the brain. The poor communication between doctors and their important patient — in both directions — allowed FDR to answer the media’s questions about his condition more freely than if he had complete knowledge about his own health. His doctors increasingly deceived the press about what they knew, too. “The President’s health is perfectly okay,” his lead physician wrote in an October statement to the media. “There are absolutely no organic difficulties at all.” Within a few days, when a reporter followed up, the doctor doubled down: “The stories that he is in bad health are understandable enough around election time, but they are not true.” But, of course, they were true, and Roosevelt died in April 1945 after a cerebral hemorrhage.
Some presidents since then have done better than others at communicating health information to the public. Three health scares spurred Dwight D. Eisenhower to make specific arrangements for his vice president, in the event of a severe presidential disability, to “decide upon the devolution of the powers and duties of the Office” and serve as acting president until the inability had ended. More to the point, the letter codifying this intention was made public the following month — and it helped inform debates about the presidential disability provisions of the 25th Amendment, ratified in 1967.
Those around Ronald Reagan didn’t act as smoothly on March 30, 1981, when John Hinckley shot and nearly killed the president. Almost immediately after the attack, Reagan underwent surgery and remained largely unconscious for hours. The obvious thing to do would be to invoke Section 4 of the 25th Amendment — by which the vice president and the majority of the executive departments’ principal officers would transfer power, at least temporarily, to then-Vice President George H.W. Bush — but the responsible Reagan administration officials failed to push consideration of the provision. At least Eisenhower’s example encouraged them to communicate more robustly and effectively about the president’s medical condition with the press and congressional leaders than most previous presidents had done.
* * *
It’s worth recalling that four of Trump’s 43 predecessors died of natural causes while in office, and many more of them faced serious illnesses or other disabling conditions during at least part of their tenure. And even before he tested positive for the coronavirus, uncertainty about this president’s health remains higher than most. Mystery, for example, still surrounds Trump’s unannounced trip to Walter Reed National Military Medical Center in November 2019.
By Friday afternoon, the White House had provided quite limited insight into the president’s physical condition after contracting the virus. The only official statement from his physician declares the president is “well,” and Chief of Staff Mark Meadows has told reporters Trump is experiencing “mild symptoms.” The history of presidential ailments points to a strong possibility that months, even years, will pass before the truth comes out.
That would be unfortunate. The administration’s deep credibility gap leaves reasonable observers skeptical about the president’s symptoms and prognosis and offers ample fodder for conspiracy theorists. If the president fails to appear, even by video from quarantine, for long — or, more dramatically, if he stops tweeting for unusual periods of time — the public will understandably wonder if those around the president are misleading us about his condition.
No matter how much you think the public should know about the commander in chief’s health, especially going into a presidential election, prepare to know less.