Trump at higher risk for serious infection

President Trump’s coronavirus diagnosis, confirmed in a test on Thursday, threatens to throw into turmoil October’s critical run-up to the election.

It is a head- spinning turn of events for Trump — at elevated risk of disease progression due to his age, weight and other factors — who now faces the grinding reality of being a COVID-19 patient.

The next one to two weeks will reveal whether he emerges unscathed or suffers profound illness, potentially death.

“If he remains well or mildly sick for 10 days, he is out of the woods for severe disease,” said UC San Francisco infectious disease expert and professor of medicine Dr. Monica Gandhi.

The next presidential debate — planned as a “town meeting” in which local residents ask questions of the candidates — is scheduled in Miami for Oct. 15. The final debate to be held on Oct. 22. There are 32 days until Election Day.

The president has canceled upcoming campaign events.

If treating Trump, “I would be moderately to very worried, due to his age and co-morbidities,” said infectious disease specialist Dr. Peter Chin-Hong, a UCSF professor of medicine.

Calling this “the waiting phase,” Chin-Hong said there is no current treatment for newlyinfected patients. “You watch,” he said.

Treatment is only available for patients with severe disease who require hospitalization, said ChinHong and Gandhi.

According to clinicians and the U. S. Centers for Disease Control and Prevention, patients with risk factors for severe illness must be closely monitored for the possible risk of progression to severe illness — especially in the second week after symptom onset.

On average, it takes four to five days from exposure to onset of symptoms. While many people remain asymptomatic, clinical symptoms appear in 69% of infections in people aged over 70 years. Trump is 74 years old.

White House chief of staff Mark Meadows said President Trump is experiencing mild symptoms, but continues to work from the White House residence as he iso-

lates. In a Friday morning tweet, First lady Melania Trump says she is experiencing “mild symptoms but overall feeling good.”

If the disease does not progress, people with mild symptoms typically recover quickly, said UCSF’s Gandhi.

More moderate symptoms, such as shortness of breath due to low oxygen levels, appear five to eight days after onset of illness, on average. For Trump, that could be Oct. 6 through Oct. 9.

“Two signs — shortness of breath and loss of taste and smell — are warnings that things are progressing,” said Chin-Hong.

Shortness of breath can be recognized during exertion, such as walking up stairs. Trump is likely being monitored with a small device called a pulse oximeter, which measures the saturation of oxygen in red blood cells by shining a light through the fingertip to detect how much oxygen is absorbed.

Loss of taste and smell can be detected during breakfast, such as drinking a morning cup of coffee, said Chin-Hong.

Trump’s threat of more severe illness, called acute respiratory distress syndrome (ARDS), is greatest between eight to 12 days after the onset of illness. That would Oct. 9 through Oct. 13.

Treatment is available once patients are hospitalized for severe illness. The drug remdesivir, which stops replication of the virus, is available for people sick enough to require oxygenation, said Chin-Hong. The drug dexamethasone, which eases the body’s angry immune response, is offered if illness progresses.

The median length of hospitalization among survivors is 10 to 13 days.

Even after recovery from severe symptoms, illness can linger. While the majority of patients with mild or moderate COVID-19 recover promptly, survivors of more severe illness complain of intermittent chest tightness, cough, fatigue, joint pain, cognitive problems and persistent problems with their senses of taste and smell — weeks, even months, after the virus has vanished.

Several factors elevate Trump’s risk of progressing to more severe disease.

One is his age. Of Americans with COVID-19 aged 65 to 84 years, 3% to 11% died. With age, our immune systems are less well regulated, said Chin-Hong.

Obesity, defined as a body mass index (BMI) of 30 or above, also elevates his risk. Trump’s physician Dr. Sean Conley reported in June that the president is 6 feet, 3 inches tall and weighs 244 pounds. That means his body mass index, or BMI, is 30.5, just over the threshold for obesity.

Men have a 30- 50% higher risk of severe outcomes than women.

Two other things could increase risk, added UCSF’s Gandhi.

One is his lack of routine masking. It’s likely that face masks, by blocking some of the virus-carrying droplets that are inhaled, can reduce your risk of falling seriously ill, she said.

“The more virus you get into your body, the more sick you are likely to get,” she said.

The second is his potential exposure to large amounts of virus, called inoculum. Hope Hicks, a senior aide and the closest known person to the president to have contracted the virus, traveled with the president aboard Air Force One — and she was ill enough to fly back early from a campaign event on Wednesday.

There is increasing evidence that people with symptoms spew more virus than people who are not sick, said Gandhi.

“For now, the one thing for him to do is absolutely keep away from others — to stay isolated,” she said.

“There is nothing to be done but watch closely for symptoms.”