COVID-19 Resource Center

COVID-19 Resource Center


Healio Interviews

Disclosures: Adalja reports no relevant financial disclosures. Shahpar is employed by Resolve to Save Lives, an initiative of Vital Strategies.
October 02, 2020
4 min read

Trump, a ‘high-risk’ patient, tests positive for coronavirus


Healio Interviews

Disclosures: Adalja reports no relevant financial disclosures. Shahpar is employed by Resolve to Save Lives, an initiative of Vital Strategies.
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President Donald J. Trump announced that he and First Lady Melania Trump tested positive for SARS-CoV-2.

“Tonight, @FLOTUS and I tested positive for COVID-19,” the president tweeted. “We will begin our quarantine and recovery process immediately. We will get through this TOGETHER!”

Adalja Trump and COVID infographic

A presidential aide, Hope Hicks, has also tested positive for the coronavirus. Vice President Mike Pence has tested negative, according to a spokesman. Former Vice President Joe Biden, who shared a stage with Trump during Tuesday’s presidential debate, said Friday he has thus far tested negative.

We asked Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, and Cyrus Shahpar, MD, MPH, COVID-19 chief science officer and head of the epidemic intelligence unit at Resolve to Save Lives, about the clinical implications of the president’s infection.

Question: How high risk is the president for a severe infection?

Adalja: The president is in a high-risk category because he is older than the age of 60 and has a comorbid condition, obesity. There’s no specific treatment for an asymptomatic individual. If he were to develop symptoms, it would depend on the severity of symptoms. Many people with symptoms are treated outside of the hospital with over-the-counter fever reducers like ibuprofen or acetaminophen. That all changes, obviously, if someone requires hospitalization.

Shahpar: The president is at higher risk for severe infection. The biggest risk factor for severe illness is age, and based on that alone, he has an approximately 3% risk of death.

Q: Will he be treated if he does not show symptoms?

Shahpar: No. He shouldn’t be.

Q: What is the risk to others in the White House, given that the president, first lady and at least one aide have just tested positive?

Adalja: Well, there have been multiple cases in the White House over the period of this pandemic. [National Security Advisor Robert C. O’Brien] also was positive, people forget. Multiple Secret Service agents have tested positive, as well as one of the stewards for the president. The risk is going to depend upon what precautions the White House has in place and which individuals the president, first lady and Hope Hicks interacted with who are deemed significant exposures. It’s impossible to know that from the outside if you are not a case investigator or contact tracer who is going through that data with the individual and know the protocols that are completely in place.

Shahpar: There is a higher risk in indoor settings, for those with prolonged exposure, those who are not masked and those who are using a shared space.

Q: What is the risk to Biden and anyone else at the presidential debate on Tuesday night?

Adalja: The risk is going to be stratified by who was within 6 feet of the president and if the president at that time was contagious, and we don’t have the timeline nailed down for when the president would be presumed to be infectious. I suspect he was tested before the debate. I don’t know the interval between the last negative test and the positive test.

Within 6 feet is where the significant exposure line is primarily drawn. As for former Vice President Biden, it depends upon whether or not he was within 6 feet of the president and how well all the social distancing protocols were followed. There wasn’t contact between the candidates for president at the debate. That minimizes the risk, but, again, it all depends upon when the president was deemed to be infectious and that’s going to be based upon that test and the timing of that test and the timing of the prior negative test.

Shahpar: The fact that the debate was indoors means there was a higher risk. Also, increased voice can create smaller particles that linger — for example, in choir outbreaks. Distancing is good if it was consistent. I’m uncertain about the level of ventilation. If the president was infectious at the time, I would expect Biden to be symptomatic — if he is infected and develops symptoms — later in the weekend. But he can get serial testing. I’m uncertain about “close contact” — 6 feet for 15 minutes — exposure throughout event, but Biden should be considered exposed.

Q: What about the risk to others? Trump held a rally in between the debate and testing positive.

Shahpar: Yes, there is a risk, higher if he wasn’t masked, was indoors, was with them for a period of time. Typically, people are infectious up to 2 days before symptom onset. It is unclear if Trump has symptoms.

Q: How long will the president have to isolate? When could he resume campaign activities?

Adalja: At least 10 days. I would suspect they are going to do things virtually.

Q: Could this be a false-positive test result?

Adalja: I think it would be unlikely to be a false-positive result, given that his wife is also positive, and they have a contact who was positive before that. There is likely a significant exposure that prompted this test, and now you have two individuals who were in contact with Hope Hicks, if that was the exposure, who are now positive.

Shahpar: It’s possible, but they have access to rapid PCR, not just antigen testing.

Q: Provided he tests negative, is it safe for Biden to resume campaign activities?

Shahpar: It depends on the nature of their interaction during the debate. Also, whether he interacted with others who may test positive that we don’t know about yet. The safest thing is to quarantine. He should consider wearing a mask, washing his hands and social distancing.