President Trump has been diagnosed with Covid-19 and is being treated at Walter Reed National Military Medical Center.
Those are two of the few certainties in this situation right now, a fast-moving national predicament and one in which clear answers are not always being provided to the public.
Below, STAT outlines eight of the crucial unknowns about the president and the course of his illness, and how it could shape broader the political and public health spheres.
What is Trump’s condition?
This is the key question, and the answer only got fuzzier on Saturday.
The president’s case has generally been described as “mild” by the White House but people can still feel quite sick with a mild illness. He was taken to Walter Reed Friday out of what was initially described as an abundance of caution, but multiple news outlets reported Saturday that Trump in fact had trouble breathing Friday and was given supplemental oxygen to boost his oxygen levels before being flown from the White House to Walter Reed.
At a briefing outside Walter Reed Saturday, Trump’s medical team cast a rosy image of Trump that morning, saying he had not had a fever in 24 hours, his other symptoms were resolving, and his oxygen levels were at a healthy 96%. But they conspicuously dodged questions about his condition at other points during his illness and about whether he had ever received supplemental oxygen. They didn’t say, for example, what level his fever reached or what his oxygen levels were at other times — possible indicators for how sick the president really is.
Soon after the doctors’ briefing, White House chief of staff Mark Meadows said Trump had gone through a “very concerning” stretch on Friday, the Associated Press reported.
When was the president diagnosed with Covid-19?
After some confusion Saturday, this appears to have been resolved.
Trump announced his diagnosis in the early hours of Friday after saying he had been tested Thursday night. But during the briefing Saturday, Sean Conley, the president’s physician, said it had been 72 hours since Trump was diagnosed.
Conley, in a statement issued by the White House a few hours later, said he had misspoken during the briefing and clarified that Trump’s positive test indeed came on Thursday night.
Where did he contract the virus?
Trump has been to a lot of events and had contact with a lot of people in the past week or so, typically without taking recommended precautions. It could make determining where Trump got Covid-19 all but impossible.
But you can still sketch out a rough timeline of when the president might have contracted the coronavirus, called SARS-CoV-2. Most people who develop symptoms do so about five days after the initial exposure. Trump started feeling ill Thursday, doctors have said. Five days earlier, Trump was announcing the nomination of Amy Coney Barrett to the Supreme Court at the White House. Multiple other attendees at the event now have confirmed Covid-19 cases as well.
Then again, if Trump’s symptoms were becoming serious enough by Friday for him to need supplemental oxygen — a point that typically takes longer to reach in the disease course — his infection could have happened earlier than last weekend.
What were Trump’s interactions like between when he contracted the virus and when he started quarantining?
Trump, on both Fox News and Twitter, said Thursday night that he had just learned that his close aide Hope Hicks had been diagnosed with Covid-19 and that he was going to start quarantining while awaiting his own test results. Hicks reportedly started feeling sick Wednesday during a trip with the president to Minnesota.
People typically become infectious a few days after they contract the virus and before they start showing symptoms, a period of infectiousness that builds over a few days and then wanes. If Trump caught SARS-2 over the weekend or in the days before, he might have been contagious on Tuesday, the day of his debate with former Vice President Joe Biden. During the Trump team’s preparations that day, no one was wearing a mask, said former New Jersey Gov. Chris Christie, who was there and has since developed Covid-19 himself.
On Wednesday, Trump traveled to Minnesota for a rally and fundraiser, and on Thursday, he met with supporters and had another fundraiser in New Jersey.
It’s not clear what Trump’s interactions were like at some of those events, or in his time at the White House — how close he was to others, for how long, what precautions were taken. But White House officials have indicated they expect more cases to emerge over the coming days. It can take several days after a person contracts the virus for the viral levels to reach a point that they can be detected by a test.
What will the next week be like for the president?
People who develop severe cases of Covid-19 can appear fine for a few days, and then take a turn for the worse. Doctors have said that the crucial time to know if Trump avoids a more serious illness won’t come for perhaps another week, a point echoed by Conley. At the briefing, Conley said that despite the positive signs on Saturday, “the first week of Covid, and in particular days seven to 10, are the most critical in determining the likely course of this illness.”
Such a disease course is likely influencing the medical team’s decision to keep Trump at Walter Reed even if, as they say, he is doing fine for now. Trump, as a 74-year-old obese man, also fits into several categories that increase his risk for more severe disease.
Why treat him with both Regeneron’s monoclonal antibody cocktail and Gilead’s remdesivir?
When the president’s doctor said Friday that Trump had been treated with both an experimental cocktail of monoclonal antibodies and Gilead Sciences’ antiviral remdesivir, some people reacted with alarm. If the president was getting the therapies — including an experimental one — he must be really sick.
Conley pointed to a simpler reason at the briefing Saturday: “It’s the president. I didn’t want to hold anything back.”
Regeneron Pharmaceuticals’ cocktail, which remains in trials and hasn’t been authorized by regulators, comprises monoclonal antibodies that are meant to mimic the infection fighters the body produces on its own in response to a pathogen. Remdesivir works differently, by interfering with the process the virus uses to make copies of itself. It is authorized by the Food and Drug Administration for patients hospitalized with Covid-19 and was shown in clinical trials to reduce their time to recovery.
Because of the way the treatments work, it’s thought that they are most effective if given earlier in the course of the illness — before the infection really takes hold. Severe illness often occurs when the body’s immune system overreacts to the infection and goes haywire; these therapies might not be able to help much once that process starts.
How will Trump’s diagnosis affect how Americans view the pandemic?
One of the reasons the U.S. has had such a difficult time controlling its epidemic is because so many people have dismissed the threat of the coronavirus and flouted public health recommendations. Many of those people have looked to Trump as he’s mocked masks and downplayed how dangerous of an infection Covid-19 is.
It’s possible then that how Trump fares could reshape the signal he’s sent to his supporters about the seriousness of the public health crisis.
“If our president doesn’t do well in this infection, it might cause a lot of people who are thinking that it’s a hoax to think twice,” Michael Mina, an epidemiologist at Harvard’s T.H. Chan School of Public Health, said Friday, before Trump went to Walter Reed. “If he sails through it … then it could potentially create more fuel for somebody who’s already disregarded this virus as not important to continue doing so and to have many people who listen quite dogmatically to him think the same.”
What does this mean for the campaign?
We here at STAT are health and science reporters, not political journalists. We’ll leave the crystal-ball gazing and electoral insights to others. Still, a number of infections have been confirmed among people who were at the White House’s Barrett event and who were involved in the Trump team’s debate preparation. With a month before the election, debates scheduled, and a campaign that was already hinging on the coronavirus pandemic, we’ll just say that, yep, Trump’s Covid-19 could have an impact.