At 74 years old and overweight, President Trump fits the profile of someone at higher risk of complications from COVID-19, but the decision to send him to Walter Reed National Military Medical Center Friday night could reflect a number of possibilities, doctors say.
It could be a precautionary move, as the White House said in announcing the hospitalization. News reports said the president had a low-grade fever, a cough, and nasal congestion.
Alternatively, said Dr. Joshua Barocas, an infectious diseases specialist at Boston Medical Center, it could mean that the president is still feeling relatively well but results of tests conducted at the White House indicate concerning trends. A third possibility, he said, is that the president has gotten sicker, too sick to be cared for at the White House.
Dr. Daniel R. Kuritzkes, chief of the Division of Infectious Diseases at Brigham and Women’s Hospital, said the trip to the hospital doesn’t necessarily mean the president’s health has taken a turn for the worse. There are at least two other, less troubling reasons, he said.
One would be a desire to monitor him closely “to see which way his clinical condition is going and to be able to intervene rapidly and more aggressively if needed ... rather than having to transport him from the White House on an emergent basis," Kuritzkes said.
Another possibility, he said, is that doctors want to watch for reactions to an experimental drug they have given him.
On Friday, Trump received a single dose of an “antibody cocktail” made by Regeneron. The drug isn’t available outside of medical studies and its effectiveness remains unproven. But White House doctor Sean Conley, like other doctors treating COVID-19 outside the hospital, had little at his disposal to offer outpatients, since the medications developed so far are intended for hospital patients.
Regeneron stirred some optimism this week with a press release saying that, in a small study, outpatients who took the drug saw their viral levels decrease more rapidly than in those who took a placebo.
Regeneron is one of several companies studying monoclonal antibodies, which are manufactured copies of the antibodies that fight off disease, taken from people who recovered, Kuritzkes said. The Regeneron drug combines two antibodies.
These antibodies have been shown to kill the virus in laboratory dishes, and generally monoclonal antibodies are thought to be safe, Kuritzkes said. But, he said, “We really don’t know if there’s a clinical benefit.” Large-scale studies are only just beginning.
After the president was hospitalized, Conley revealed late Friday that Trump was receiving an antiviral medication, remdesivir. Unlike the monoclonal antibodies, remdesivir is available to other patients, if they are in the hospital. The US Food and Drug Administration allowed remdesivir under an emergency use authorization after a study found that severely ill patients who received it spent fewer days in the hospital.
The president’s doctor may have been eager to try an experimental treatment because Trump’s age and weight put him at high risk for complications from COVID-19.
“Given his age and obesity, the next few days are going to be really key," Dr. David Hamer, an infectious disease specialist at Boston Medical Center, said Friday morning, before the president’s hospital visit was announced.
To illustrate the insidious nature of the virus, Hamer pointed to the experience of another world leader. British Prime Minister Boris Johnson, 55, was hospitalized 10 days after testing positive in April and spent three days in the ICU battling the disease. Johnson’s symptoms were very mild to start.
Experts have long warned the virus that causes COVID-19 is a particular threat to those in their 70s or older, as well as those with preexisting health conditions, and people who do not exercise.
In June, the White House released limited results from Trump’s annual physical, which noted he weighed 244 pounds and showed he has a body mass index of 30.5, meaning he is technically obese, although at 6 foot 3 inches, just barely.
Excess weight tends to go hand in hand with other medical conditions, like high blood pressure and diabetes, which may by themselves make it harder to fight COVID-19.
In a report published in late August, researchers found that infected people with obesity were more than twice as likely to end up in the hospital and nearly 50 percent more likely to die of COVID-19. Another study, which has not yet been peer-reviewed, showed that among nearly 17,000 hospitalized COVID-19 patients in the United States, more than 77 percent had excess weight or obesity.
Meanwhile, Trump’s age and gender also make him susceptible to severe disease. An estimated 5.4 percent of people over the age of 70 who are infected die from COVID-19. People who test positive for COVID-19 between ages 65 and 74 are five times more likely to be hospitalized and 90 times more likely to die, compared with patients between 18 and 29, according to the CDC.
But the vast majority of elderly people who get COVID-19 do survive. Consider a recent study of British people, which showed that 3.1 percent of infected people in their 60s died, while the death rate nearly quadrupled to 11.6 percent in those age 75 or older. But looked another way, that means more than 88 percent of very old people survived.
Men and women are about equally likely to be infected with the coronavirus, but researchers have observed that men often experience more debilitating and deadly symptoms. In Italy, men in nearly every age group were twice as likely as women to die of the disease. That pattern has repeated itself around the globe. A study published in July by the CDC reported that COVID-19 deaths in men outnumbered deaths in women in 41 out of 47 countries assessed. It also said that the case fatality ratio — the proportion of people with confirmed cases of COVID-19 who die of it — was more than twice as high for men as for women.
The gender gap could be attributed to both behavioral and biological differences. Men are more likely to be smokers, which makes patients more susceptible to the worst effects of COVID-19. Trump does not smoke, nor drink alcohol.
But experiments in mice also suggest that estrogen protects females from the worst effects of the coronaviruses that cause severe acute respiratory syndrome and Middle East Respiratory Syndrome. The same may apply to the coronavirus. Some scientists also suspect that male hormones called androgens, such as testosterone, may be to blame for men’s poorer outcomes.