The US President, Donald Trump, as announced that he and his wife Melania have tested positive for COVID-19, and have started self isolation.
Dr Stephen Griffin, Associate Professor, School of Medicine, University of Leeds, said:
“It is sad to hear that President Trump, the First Lady and other members of their team have tested positive for SARS-CoV2 infection. Whilst we obviously wish them all the best and hope for a mild course of disease, it is a concern that President Trump has – I believe – a past history of heart conditions and is also in a higher risk age category for severe COVID-19.
“However, it is perhaps unsurprising that this has happened given that Trump has failed to observe basic precautions against the risks of SARS-CoV2 transmission. Most notably, these positive tests means that there is considerable risk that members of the Trump delegation present at the recent debate may have been infectious, compounded by the removal of facemasks when taking their seats; I would hope that due diligence is being applied by relevant authorities in this regard and other delegation members are being tested.
“The Presidential entourage no doubt take great care to regularly test close contacts, yet the fact that several members of staff are either positive or currently self-isolating illustrates the issues around aerosolised/droplet, or indeed other forms of SARS-CoV2 transmission, and the importance of basic preventative measures that have been largely minimised by the Trump administration, for example during various public rallies.”
Dr David Strain, Clinical senior lecturer and honorary consultant, University of Exeter Medical School, said:
“The President has repeatedly ignored the recommendations of medical experts by regularly not wearing a mask in situations where one is suggested, not physical distancing and ignoring recommendations regarding hand hygiene, as shown by his hand shaking at rallies without any discernible sanitisation, therefore the exact source of contraction is difficult to ascertain, however, it is most likely to have come from Hope Hicks, his aide who tested positive on Thursday, and with whom he was in Air Force One, only the day before.
“As such he is likely early in the disease, Assuming he contracted the virus recently, he is likely to have few symptoms over the next 4-5 days, possibly losing his sense of smell early next week. The classic respiratory symptoms would occur midway through next week. His age and obesity, in addition to being a man, place him at an increased risk of a poor outcome from this stage, which also means he would be more susceptible to co-infections. Over this period he will hopefully make a recovery, however his physicians will be aware of the risk that a crash, similar to that of our own Prime Minister experienced at around day 10, may occur. Should this occur at his age, he would need to be hospitalised and we would be concerned for his survival.
“Whilst the President will undoubtedly have the best care in the world, COVID-19 remains a virus that has no effective cure, and he is part of a high-risk demographic. The next few weeks will be a very difficult time for the American administration.”
Dr Julian Tang, Honorary Associate Professor, Respiratory Sciences, University of Leicester, said:
“It’s not so surprising that the US President Trump has now tested positive for COVID-19 – just like the UK Prime Minister Johnson (who was also infected several months ago), they have multiple daily contacts during their everyday duties.
“But with a single (presumably PCR) positive result , it is difficult to say exactly where he is in his infection and when he was infected.
“Some articles mention that the White House staff are screened routinely for COVID-19 – if this is done weekly, and if his last test was PCR negative 7 days ago, for example, then studies suggest that he would still be shedding live virus now – but we don’t know exactly when he started becoming infectious if he was just sampled within the last 24 hours.
“He also seems relatively asymptomatic. We know that asymptomatic COVID-19 cases can shed live virus and spread infection but from a single PCR positive test result, we can’t say exactly when this infectious period started. So it would be useful to know when he was last tested (and the result) and what his symptoms are and when they started – if any.
“COVID-19 patients can be PCR positive for 20-30 days or longer but we think that they remain infectious for up to the first 10-14 days of this period and only.
“The COVID-19 incubation period is around 5 days during which you would be PCR negative – so you could test negative on a Monday, then test positive the following Friday, if you were exposed on the previous Friday, for example.
“Most studies suggest that those with symptomatic COVID-19 infections could remain outside hospital during the first 5-7 days of the illness but thereafter it may become more serious requiring hospitalisation – or they start to recover by themselves.
“Apart from age and obesity, other existing medical conditions like diabetes, hypertension, other chronic heart and lung disease can lead to serious COVID-19 disease. So all these factors could contribute to worse outcomes in any patient with COVID-19.
“Given all the above, and without knowing the nature of the ventilation and the air exchange rates in the venue, it’s difficult to say if President Trump posed an infection risk to others during the recent Trump-Biden debate – but at least, their social distancing seemed adequate (>2 m) from the televised images. Clearly neither were able to wear masks during the debate.”
Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:
“Donald Trump has some risk factors such as being male, older (still strongest risk factor) and overweight but if he has no chronic conditions and is reasonably active (it seems likely so as he plays lots of golf and appears to walk quickly) then these may offset or attenuate his risks so that he may recover swiftly from the infection. The risk of serious disease and death depends on many factors – some unmeasurable, so there is always uncertainty – and it is not so simple as to make inferences from one or two alone.”
Prof Trish Greenhalgh FMedSci, Professor of Primary Health Care Services, University of Oxford, said:
“The President and his wife appear to have tested positive on the same day, the day after Hope Hicks. This raises questions about whether Hicks was the source or whether all may have been infected simultaneously by another source. The chain of infection is important because it will influence the likelihood that Mr Trump could have infected Mr Biden and others during Tuesday’s Presidential debate. There is strong evidence from many sources that the SARS-CoV-2 virus is transmitted via shared air as well as by droplets and direct contact (i.e. people in the same room, even if more than 2 metres apart, are at risk because eventually the airborne virus reaches all parts of the room).
“Risk factors which may be relevant in Mr Trump’s infection include associating closely with a large group of people who rarely wore face coverings; spending long periods of time indoors with large numbers of people; high vocalisation (in many Trump gatherings such as rallies, people were encouraged to shout and chant); and whether the rooms were adequately ventilated.
“Early reports are that the live audience for the Presidential debate included Republicans (who mostly did not wear masks) and Democrats (many but not all of whom did). In an unlikely but not impossible worst-case scenario (one in which Mr Trump was contagious when he vocalised loudly during the 90-minute debate), this could turn out to be an interesting natural experiment in airborne transmission and the contested role of masks in protecting the wearer.”
Prof Rowland Kao, Professor of Veterinary Epidemiology and Data Science, University of Edinburgh, said:
“That Donald Trump became infected was not an inevitability, but is consistent with him being a high risk candidate for infection – both because of his apparent attitudes towards personal protective measures (such as maintaining physical distance and towards face masks), but also because, as a public figure, he would be in contact with many people in many different places, including this being frequently at close quarters. Also of concern is that those very same conditions make him more likely to infect others when infectious, and so his actions now have great importance in terms of reducing that risk of creating new outbreaks, but perhaps most importantly as an example to others – whether that is for better or worse is up to him.”
Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:
“The President’s profile would classify him as vulnerable. He is aged 74, and reportedly overweight. Many people in their 70s will also have further co-morbidities that increase the risks of a more severe illness.
“It appears that at least one of his close aides has COVID-19, so it is plausible that was the mode of transmission here. However, he has also attended large scale indoor meetings, where good infection control practice was not in evidence. This includes the lack of wearing of face masks among those attending. These are all risk factors for transmission that could be relatively easily reduced to increase safety of the participants, and can support lowering transmission onto high-risk groups.”
All our previous output on this subject can be seen at this weblink:
Dr Stephen Griffiths: No COIs
Prof Naveed Sattar: No COI
None others received.