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What we know about Trump’s COVID-19 illness

Since President Donald Trump announced in the early hours of Friday, Oct. 1, that he and first lady Melania Trump tested positive for COVID-19, White House officials and physicians alike have offered a whirlwind of conflicting statements about his prognosis and what the path forward looks like for a return to the Oval Office and the final weeks of his reelection campaign.

While some details of his condition are known — including experimental treatments usually reserved for severe cases, administered during a stay at Walter Reed National Military Medical Center — it’s unclear how the president contracted the virus and when he first started to experience symptoms or become contagious. Reports also suggest that efforts to discover who else in the president’s orbit may be infected have been limited so far.

It can take up to 14 days to show symptoms after being infected, but most tend to experience them between days three and five. Those with the virus can pass it to others between 48 to 72 hours before symptoms develop, unless they are asymptomatic. White House chief of staff Mark Meadows confirmed that Trump was experiencing “mild symptoms” on Friday afternoon, which suggests that those he came into contact with between Tuesday and Wednesday — including Democratic presidential nominee Joe Biden, who shared a debate stage with the president Tuesday night but has tested negative in days since — could be at risk of infection.

In news conferences over the weekend and on Monday, White House physician Dr. Sean Conley clarified some aspects of the president’s health, but failed to answer a series of key questions: On what day did the president receive his last negative test before testing positive? How will he safely quarantine in the White House to reduce exposure to staffers and other personnel who work there? What did medical scans of his lungs show in terms of any potential damage the virus may have done? What are his and other physicians’ primary concerns regarding what could happen over the next several days of Trump’s illness?

Though he has projected optimism regarding Trump’s recovery, Conley also noted that because the president received a series of therapies that are typically reserved for patients who are later in the course of their illness at an earlier point in his own, Trump and his physicians are “in a bit of uncharted territory.”

Here’s what we do know about what the president’s spokespeople have said about his illness, the therapies he has been given so far and what his return to the Oval Office may look like.

What have doctors and aides said about the president’s illness?

Along with Conley’s news conferences, there have been a number of other statements from the White House about the president’s health. Here are some of the big takeaways:

Saturday, Oct. 3

  • A day after Trump arrived at Walter Reed, Conley said that the president was “fever-free” and “up and moving about” without difficulty. He noted that the president’s symptoms included a mild cough, nasal congestion and fatigue, but that they were improving. He would not confirm reporters’ inquiries about whether Trump had been given supplemental oxygen. Though a source “familiar with the president’s condition” said that Trump had been given oxygen on Friday morning at the White House, before traveling to Walter Reed National Military Medical Center, according to the Associated Press. There was also confusion when Conley stated that Trump was “72 hours into the diagnosis,” which would have meant Trump had tested positive on Wednesday. The doctor later issued a statement saying he had misspoken.
  • In contrast to Conley’s statements, Meadows told reporters that the president’s vitals were “very concerning,” and said that the next 48 hours would be “critical.” He added: “We’re still not on a clear path to a full recovery.”
  • Trump released a four-minute video on his Twitter account, saying that he wasn’t “feeling so well,” when he arrived at the military hospital, but felt “much better now.”

Sunday, Oct. 4

  • Conley was more forthcoming about whether Trump had received supplemental oxygen, saying it was administered at the White House before the president was transported to Walter Reed. He noted that the president had experienced two episodes where his blood oxygen level had dropped, and that the medical team decided to administer the steroid Dexamethasone after those episodes. Conley also said that the day before, he had presented a rosier picture of the president’s condition. “In doing so, [it] came off like we’re trying to hide something, which wasn’t necessarily true. The fact of the matter is that he’s doing really well,” he said.
  • Another member of the president’s medical team, Dr. Sean Dooley, said that Trump had not had a fever since Friday morning and that his vitals were stable. Dooley added that the president was not showing any significant respiratory symptoms, such as shortness of breath.
  • Trump tweeted a message thanking doctors and nurses at Walter Reed, and that he had “learned a lot about COVID,” before leaving the hospital briefly to drive around in an SUV with members of the Secret Service to greet supporters.

Monday, Oct. 5

  • The president tweeted in the afternoon that he would be leaving Walter Reed at 6:30 p.m., saying that he was “feeling good” and encouraging people to not be “afraid” of the novel coronavirus.
  • Conley told reporters that the president would return to the White House, after another infusion of the antiviral medication Remdesivir; Trump received a third dose of Remdesivir on Sunday. Conley would not comment on what results of scans of the president’s lungs have showed. The doctor also said that while Trump may not be “out of the woods,” his oxygen saturation levels and breathing were “all normal.”

Tuesday, Oct. 6

  • The morning after Trump returned to the White House, Conley released a statement saying that the president “had a restful first night at home, and today he reports no symptoms.” He noted that Trump’s vital signs were stable.
  • Trump tweeted that he was “FEELING GREAT!” and that he was looking forward to the presidential debate on Oct. 15 in Miami. In a separate tweet, the president compared the virus to the flu, but Twitter hid the message for “spreading misleading and potentially harmful information related to COVID-19.”

Wednesday, Oct. 7

  • On Wednesday morning, Conley released a statement saying that the president’s physical exam and vital signs, including his oxygen saturation and respiratory rate, “all remain stable and in normal range.” Conley added that Trump has not required supplemental oxygen since his initial hospitalization, and that he’s been fever-free for more than four days and symptom-free for more than 24 hours. Trump’s recent labs, drawn Monday, “demonstrated detectable levels of SARS-CoV-2 IgG antibodies,” which were not detectable in an initial lab drawn Thursday, Oct. 1.
  • White House spokesman Brian Morgenstern confirmed Wednesday afternoon that the president has resumed work in the Oval Office for the first time since he was diagnosed with COVID-19. Trump is likely still infectious, and the White House has said that it has taken precautions, including the use of personal protective equipment to protect staff members who interact with him.
  • In a video posted to Twitter later in the day, Trump touted the experimental monoclonal antibody cocktail developed by the company Regeneron that he was given last week and voiced his desire to make that treatment and others like it more widely available to COVID-19 patients, although he does not have the authority to make that happen unilaterally.

Thursday, Oct.8

  • The president’s physician announced Thursday evening that he fully anticipated “the President’s safe return to public engagements” on Saturday, which he said would be 10 days since the initial diagnosis. Conley wrote in a statement that “his physical exam has remained stable” and that there was no indication suggested his illness was progressing.

Saturday, Oct. 10

  • Conley released a statement Saturday stating that a PCR test, one of the most accurate ways of testing for COVID-19, demonstrated that the president was “no longer considered a transmission risk to others.” Given that Trump was fever-free for over 24 hours and 10 days out from the initial onset of his symptoms, all of which had improved by Saturday, Conley said that there was “no longer evidence of actively replicating virus” in his system. Conley added that he will continue to monitor the president “as he returns to an active schedule.”

Monday, Oct. 12

  • Conley announced Monday that the president had tested negative for the coronavirus “on consecutive days” while using the AbbottBinaxNOW antigen card, which delivers rapid results. Conley noted that “repeatedly negative antigen tests, taken in context with additional clinical and laboratory data” in addition to “ongoing assessment of viral culture data” all point to “a lack of detectable viral replication.” He again emphasized that this data informed Trump’s medical team’s determination that he is no longer contagious.

What treatments has the president received so far?

The president has received a range of treatments, both established and experimental, since testing positive for COVID-19, some of which are generally reserved for patients with more serious cases of the disease:

An “antibody cocktail” manufactured by Regeneron. The company has stated that this “cocktail” has been shown to reduce “viral loads and symptoms” in nonhospitalized COVID-19 patients. This combination of two neutralizing antibodies, which aim to cover the receptor binding domain of the coronavirus’s spike proteins and prevent it from entering human cells, has not yet been approved for emergency use by the Food and Drug Administration.

Remdesivir. To prevent the virus from infecting and damaging more cells, this antiviral drug disrupts the viral replication process within our cells that the coronavirus uses to make copies of itself. Remdesivir is an experimental treatment, but it has been approved for emergency use by the FDA for all patients hospitalized with COVID-19 “irrespective of their severity of disease.” The National Institutes of Health have stated that there is not enough evidence to suggest whether the drug should be recommended for use in mild or moderately ill COVID-19 patients, but that it can be used for “five days or until hospital discharge” depending on the kind of supplemental oxygen they receive. Not all potential side effects of remdesivir are known because it is still being studied, but allergic reactions and increased levels of liver enzymes have been documented.

Dexamethasone. This corticosteroid has anti-inflammatory and immunosuppressant properties. Dexamethasone was “found to have benefits for critically ill patients” in a British clinical trial, and preliminary results suggest that it reduced mortality by about one-fifth for COVID-19 patients who required oxygen but were never put on ventilators. Patients with severe cases of COVID-19 “can develop a systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction,” according to the National Institutes of Health, and dexamethasone may be able to “prevent or mitigate” those effects. The NIH emphasizes that this treatment is not recommended for use in patients who do not require supplemental oxygen. Possible side effects of corticosteroids like dexamethasone include muscle weakness, changes in mood and blurred vision.

Supplemental oxygen. Also called “oxygen therapy,” supplemental oxygen can be administered through a variety of procedures when a patient’s blood oxygen level drops lower than the normal 95 to 100 percent range, a condition called hypoxemia. Trump’s specific readings are unconfirmed, but his blood oxygen level dropped below 94 percent on two separate occasions since Friday, according to Conley. The NIH recommends that patients who receive supplemental oxygen are closely monitored for “worsening respiratory status.”

READ MORE: Trump is receiving a steroid usually given to patients with severe COVID-19

What are the president’s risk factors?

A person’s risk of severe illness, hospitalization or death as a result of COVID-19 increases with age. At 74, the president is in one of the highest risk age groups compared to those who are between 18 to 29 years of age.

A person’s risk for severe COVID-19 infection, which could lead to hospitalization or death, increases with age, according to the CDC. Graphic by Megan McGrew

Evidence also suggests that men are at a higher risk of dying from the disease compared to women, according to the Centers for Disease Control and Prevention, although it’s still unclear exactly why that’s the case.

A person’s weight is not necessarily reflective of their health and is thus not always a reliable indicator of what their outcomes with COVID-19 will likely be. But the CDC has stated that obesity, which is defined as having a body mass index of 30 or higher, increases one’s “risk of severe illness from COVID-19.” FiveThirtyEight has reported that “at 6 feet, 3 inches tall and 244 pounds,” the president’s body mass index is “just over the line for the [clinical] definition of obesity.”

Who else in the White House has tested positive?

In addition to the president and the first lady, more than 10 White House staff members and other close contacts have contracted COVID-19 in recent days, including:

  • Hope Hicks, White House adviser
  • Kayleigh McEnany, White House press secretary
  • Nicholas Luna, presidential aide
  • Kellyanne Conway, former counselor to the president
  • Bill Stepien, Trump campaign manager
  • Ronna McDaniel, RNC chairwoman
  • Chris Christie, former governor of New Jersey
  • Sen. Mike Lee, R-Utah
  • Sen. Thom Tillis, R-N.C.
  • Sen. Ron Johnson, R-Wisc.
  • Stephen Miller, senior adviser to the president

The Trump administration has said that “a White House medical team” is carrying out contact tracing to determine who else may be at risk after being exposed to those who have tested positive. But The New York Times reported Monday that the White House has chosen not to trace the contacts of those who attended Judge Amy Coney Barret’s nomination ceremony Sept. 26, despite the possibility that positive cases could be tied to that event. At the event, which took place days before the president’s diagnosis, social distancing was not required and many attendees did not wear masks, including during a small indoor reception. Washington Mayor Muriel Bowser said that city officials have tried to connect with the White House to offer support, but have been unsuccessful.

Local jurisdictions have reported they’ve been giving their own guidance to those associated with the president’s events last week, including a rally in Minnesota and a fundraiser in Bedminster, New Jersey. The Minnesota Department of Health has urged anyone involved with the president’s events to get tested — with an additional test recommended 12 days after any negative tests — and that “quarantine for 14 days is necessary regardless of test results.”

The Thursday fundraiser in New Jersey, hours before Trump announced his diagnosis, included both indoor and outdoor events. New Jersey officials complained about incomplete information from the Republican National Committee, which was in charge of the guest list, as well as from the federal government. The Trump administration told CBS News on Sunday night that the White House’s contact tracing efforts for the trip were complete, despite statements from Gov. Phil Murphy on Monday that the investigation was ongoing. Murphy added that his office was exploring whether any state laws on COVID-19 restrictions were violated in holding the event.

What’s next?

Trump returned Monday evening to the White House, where he removed his mask in front of cameras and said, “I feel good.” Earlier in the day, Conley said that the president remains contagious, but said that he could resume normal activities once “there is no evidence of live virus still present.”

Speaking in a video on Twitter that was quickly criticized by Americans who have lost loved ones, Trump downplayed the coronavirus, claiming he was better. “Don’t let it dominate you,” he said. The president has received world-class care since his diagnosis, but the virus has also killed more than 210,000 people in the U.S. since February, and a disproportionate number of fatalities have been people of color, which the CDC has said is due to health and social inequities.

The president tweeted Monday that he will “be back on the campaign trail soon.” It’s unclear when he will no longer be actively infected with coronavirus. At this point in his illness, it’s impossible for the president or anyone to travel without risking the possibility of infecting healthy people around them, and critics pointed to Trump’s ride inside a hermetically sealed vehicle Sunday. Although the Secret Services agents who joined in the car wore eye protection and respirators, and the drive-by was brief, spending any amount of time — especially in an airtight space — with an infected person poses a risk of infection. The White House has not released details regarding protocols that will be put in place to protect employees from being exposed to the president as he returns to work.

Trump has publicly flouted public health guidance, particularly around holding large indoor rallies and wearing masks, though he began to wear one at certain events in July. The White House on Tuesday released a note about the protocols that have already been in place to prevent infections, including requiring the staff of the president’s residence to wear masks at all times, some of whom are also tested daily. “With the recent positive results of the President and First Lady, staff wear full PPE and continue to take all necessary precautions,” the statement concluded. However, the reported precautions did not stop the White House from becoming a coronavirus hot spot. Former first lady Michelle Obama tweeted that her “heart goes out to everyone touched by this virus, from those at the White House, especially the Secret Service and residence staff whose service ought never be taken for granted.”

READ MORE: Trump’s return to the White House sparks fear, anger for residence staff

For Trump’s own safety, many doctors have questioned why he was discharged from the hospital, given indications he was being treated with therapies reserved for the very ill, and the timeline of his infection.

“The times we’re the most concerned about a patient’s course is day seven through 10. So, why is he being discharged home right now, or discharged to the White House right now, when the period that we’re the most concerned about is yet to come?” Dr. Leana Wen of George Washington University told the PBS NewsHour’s Judy Woodruff on Monday.

With its dedicated medical unit, the White House is no ordinary home. Dr. William Lang, former deputy White House physician, told the NewsHour that the president “can be monitored very closely at the White House, just as he would be in the hospital,” and can be quickly transported back to the hospital if necessary.

This post is developing and will be updated.

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