President Trump has COVID-19. In some ways, that seems inevitable — the campaign trail is a high-contact sport, and the president was cavalier about public health guidelines. But what comes next is anything but certain. And it depends on who the president is, not just what he does.
Though Trump is in overall good health according to his publicly released annual physicals (which, it’s worth noting, only includes details at the discretion of the president’s doctor), he has a few risk factors that increase the odds of a severe infection, hospitalization, and death. He is 74 years old, male, and obese — at 6 feet, 3 inches tall and 244 pounds, his body mass index is 30.5, just over the line for the definition of obesity. While Trump doesn’t have hypertension, his latest physical said his blood pressure is 121 over 79, which is considered “elevated.” But just how risky are these factors?
Let’s start with age. When it comes to COVID-19, the older you are, the more elevated your risk of severe illness, hospitalization, ventilation and death. Underlying issues like high blood pressure and diabetes increase risk, too, and are often associated with age, but the riskiest comorbidity is just how long you’ve been alive.
“Even when controlling for a huge number of comorbidities, age is still the most important predictor of death,” said Marm Kilpatrick, an infectious disease biologist at the University of California, Santa Cruz.
This has been documented in lots of studies over the last few months, but one of the most comprehensive was published in Nature in July. Researchers from Oxford and the London School of Hygiene and Tropical Medicine looked at the medical records of more than 17 million adult patients in the U.K. (some of whom tested positive for COVID-19 and some of whom did not) and found that the risk of death from COVID-19 increased with age, even when adjusting for all other risk factors. Patients aged 70-79 were 6.07 times more likely to die of COVID-19 than those 50-59, and patients over 80 were 20.6 times more likely to die compared to the 50-somethings.
In the U.S., 8 out of 10 COVID-19-related deaths have been in adults age 65 and older, according to the Centers for Disease Control and Prevention, and patients aged 65-74 were 5 times more likely to be hospitalized and 90 times more likely to die from COVID-19 when compared to those aged 18-29. Why? Older people tend to have a higher prevalence of underlying illnesses that we know increase risk, along with declining immune responses.
Being a man also puts Trump at a higher risk of adverse effects than the first lady, who also tested positive for COVID-19. Again, multiple studies have documented the correlation between sex and more severe outcomes for a COVID-19 infection, though the precise numbers vary. In the U.S., nearly 1.5 times more men than women in Trump’s age cohort have died because of COVID-19. Part of this sex difference is still a mystery to researchers, but a new paper published last week in Science found that a genetic predisposition to certain immune responses was more prevalent in men, which could partially explain the gap.
Lastly, we know that the president’s weight also likely puts him at a greater risk of a severe or deadly bout of COVID-19. One meta-analysis of research published in August found that, when compared to patients of a healthy weight, people with obesity who contracted COVID-19 were 113 percent more likely to be hospitalized, 74 percent more likely to be admitted to an ICU, and 48 percent more likely to die. The CDC has stated that obesity could triple the risk of hospitalization due to COVID-19. And similar to age, obesity is one factor that can increase a person’s risk of adverse effects independent of other factors — even young, otherwise healthy patients are at a greater risk of severe infection, hospitalization, and death if they’re obese, according to Dr. Nitin Mohan, an infectious disease specialist at Western University in Canada.
“It’s one of those risk factors that, regardless of age, it’s a serious risk to have with COVID,” Mohan said. “When the body goes through any kind of disease process, your immune system is taxed and it works quite hard. The healthier you are, the better chance you have.”
Though Trump is on the cusp of obesity, being overweight is a risk factor as well, so his weight is still a concern even if he’s dropped a few pounds since his last physical. That said, there is at least some dispute among the scientific community about how big a role weight plays as a risk factor in COVID-19: A recent study of 88, 747 veterans in the U.S. found obesity was not a statistically significant risk factor for death.
But the president is, well, the president. And while his biology may be putting him in a riskier category, his social status is working in his favor. Being wealthy, white and in possession of a college degree all make you less vulnerable to hospitalization for COVID-19. Why? Basically because of the way our economy works. Being a person of color, or a part of a lower socioeconomic class, or not having a college degree — all of those things are associated with both a lack of access to health care (both after a COVID-19 diagnosis and throughout their earlier lives) and a higher likelihood of working in the service industry or a similar field where exposure risk is high. And even though there hasn’t been a lot of research into differential outcomes between the kind of health care an average rich white man might get and the kind of health care available to Trump right now, his political status probably doesn’t hurt.
“If anyone has better odds of surviving than any other 74-year-old with his characteristics, it’s probably the president of the United States,” said Andrew Azman, an infectious disease epidemiologist at Johns Hopkins University.
Right now, the president reportedly has only mild symptoms and we can assume he is under constant, high-quality medical care. Those are things that could indicate a milder course of the disease, Azman said. And while comparing to his demographic cohort is far from a crystal ball predictor of exactly how Trump will fare, it’s our best indicator of the likelihood he could face more severe outcomes.
“Our best guess is the population average for people that look like him,” Azman said. “But we know that he is not the average person.”