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Trump’s case should not change how we think about covid-19

The very real risks in generalizing from the president’s illness.

President Trump and first lady Melania Trump arrive at Cleveland Hopkins International Airport before the first presidential debate on Tuesday. Both have since tested positive for the coronavirus and have symptoms of covid-19. (Mandel Ngan/AFP)

With President Trump’s positive coronavirus diagnosis, we’re in the early stages of what will surely be one of the most highly publicized medical cases in history. The health of the president and the first lady — who also tested positive — should be our chief concern, as observers.

Yet the course his case takes could also influence what people think about covid-19, the disease caused by the novel coronavirus, in general — particularly people who have doubts about the seriousness of the disease. And here there are potential pitfalls. The president’s case, whatever its course, should not be treated as a referendum on how this particular illness “really” plays out — because every case will be different. If Trump should have a mild case, for example — as we should hope — that in no way would refute the idea that the virus can be deadly. Conversely, we should not overgeneralize if the outcome turns grim: There are many people, even in their 70s and older, who survive.

Unfortunately, generalization about a mild case seems like the greater danger, given rampant skepticism about covid-19, some of it fueled by this administration.

As a physician who has cared for countless patients with covid-19, I have seen the full range of outcomes, which range from no symptoms at all to organ failure and death. Yet outside the hospital, I still encounter skeptics — even among my friends — who maintain that it is no worse than the flu (this is false) or who wonder whether the disease is real, since they don’t know anyone who has been ill. While it is regrettable that the president himself has downplayed the virus and confused the public about the best practices to combat it, I am hopeful that this moment serves as an opportunity for him to focus our nation’s efforts where they need to be, including on mask-wearing and physical distancing, especially indoors.

In addition to the basic observation that one case cannot give us a full picture of an illness, there are particular reasons the president’s situation is unique. First, he will be getting the best clinical care available; unfortunately, that’s not reflective of what is always available to the average American, although our ability to treat this virus has significantly improved since February. He will have immediate access to our nation’s best infectious-disease doctors, nurses and other clinical personnel — and the finest diagnostic and monitoring technology. The president and his wife will also have access to the best available clinical therapies. (At this stage, that might mean the antiviral medication remdesivir, especially if they need oxygen support.) If their cases become more severe, they would probably be given the steroid dexamethasone. Of course, the Trumps would have access to any experimental therapies their doctors deem worth trying, if they were more severely sick.

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It’s important to remember that even within similar patient populations, clinical outcomes vary. Trump’s main risk factors for covid-19 mortality are his age (74), his gender (men have disproportionately poor outcomes) and his excess weight (obesity increases the risk of being hospitalized for covid-19 threefold). In general, the infection fatality rate for people in their 70s has varied around the world, from 5 to 11 percent, according to recent data — but these numbers are affected by access to health care, comorbidities and other factors. And as every doctor knows, anything could happen to any patient. Whether the president were to tragically succumb to the disease, or if he were to walk away unscathed after a few days with a cough, the risk to the average American remains exactly the same as before.

A seemingly mild — or even moderately severe — illness might not be the end of the story, either. It’s become increasingly clear that patients who avoid death or hospitalization are often not out of the woods. Clinically, we are seeing patients having ongoing issues, including difficulty thinking clearly, continuing challenges with breathing and chronic fatigue, among other debilitating symptoms — for weeks to months afterward. Even if the Trumps recover quickly from the initial bout with the virus, it will take time to know whether they have problems like these.

Ultimately, the severity of Trump’s individual case will probably tell us nothing about the danger of covid-19 more generally. Partisans may try to draw conclusions based on how he fares — and apply it to the broader health debate — but that will have nothing to do with science, and the tendency should be resisted.

In rare situations, we have seen young patients who have died of covid-19, and we have seen elderly patients, such as 113-year-old Maria Branyas, in northeastern Spain, unexpectedly survive. No single case can define an entire disease — especially when the patient is the president.