Pittsburgh doctors discuss Trump's covid risk factors

Pittsburgh-based infectious disease experts say President Donald Trump’s age and other health factors could make him especially vulnerable to covid-19.

“Age is the most important factor in how well people do – or how well people don’t do – with covid-19,” said Dr. Graham Snyder, UPMC’s medical director of infection prevention and hospital epidemiology.

“We know that if you’re older, you’re more likely to have complications, including hospitalization and death,” he said Friday.

Trump is 74. He revealed early Friday that he and his wife Melania Trump have tested positive for the coronavirus.

Obesity is another factor, Snyder said, a concern echoed by Dr. Amesh Adalja, an infectious disease and critical care physician.

While age is one of the top vulnerabilities, he said, obesity can and does raise the risk of complications from the virus. He said symptoms can evolve over the course of a few days and, unless the president is hospitalized, there is not much to be done in the way of treatment.

“Most treatments are in hospitalized patients,” said Adalja, who is a senior scholar at the Johns Hopkins Center for Health Security. For those who are not hospitalized, treatment consists mostly of supportive care. He noted there are clinical trials happening but as a whole, there is no standard of care for the virus.

Snyder said the president’s medical team will likely be monitoring his respiratory status, watching for shortness of breath or coughing. They may also measure his respiratory rate, the rate at which a person inhales and exhales.

“They’ll also, no doubt, be monitoring his oxygen, the amount of oxygen circulating in the blood,” Snyder said, noting that oxygen levels at 95% and higher are healthy. “If oxygen drops below that, it can indicate the lungs are having a difficult time.”

He said that Trump could have other health issues not disclosed to the public that could make him more vulnerable.

Regardless of symptoms, he said, the president could have been spreading the virus to anyone with whom he was in close contact. He said contact tracing should force anyone who was within six feet of the president for more than 15 minutes into quarantine.

Adalja said the chance is low that former Vice President Joe Biden was exposed to the virus during the Sept. 29 presidential debate, but it’s difficult to calculate with so many unknowns.

“I don’t have enough information on the timeline of who was infected when and whose tests were positive when,” he said.

He noted that precautions were taken with the debate, and the candidates were kept at a distance.

“I think the fact that the debate was conducted in a socially distant manner without physical contact between the two candidates minimizes the risk,” Adalja said. “I do think this is something that will need to be looked at in detail.”

Snyder said he’s not surprised that the White House’s covid-19 mitigation strategy didn’t protect the president.

The White House seemed to be relying strictly on frequent testing, Snyder said. While frequent testing can help in identifying and isolating those with the virus, it doesn’t necessarily stop transmission and it’s not 100% accurate.

“There is the possibility of false negative tests while the virus is incubating — and potentially when a person is contagious, there could be a false negative test,” he explained. “The testing strategy alone isn’t adequate to prevent transmission.”

Physical distancing and mask wearing are widely emphasized as mitigation strategies. Snyder said it’s unclear how strictly those policies are followed at the White House.

Adalja said that regardless of how exactly the president caught the virus, it should be a warning to take the transmission of it seriously.

“I don’t know the mechanism of how the president and first lady were infected but in general, this is a reinforcement that the more social interactions you have, the more likely you are to be exposed to the virus,” he said.