Early in the morning on October 2, President Donald Trump tweeted that he had tested positive for COVID-19. Only 33 days away from a highly contentious election, the diagnosis plunged the nation into uncertainty. Doctors, scientists and pundits quickly began speculating on what will happen to the president, and the White House has been both tight-lipped and prone to giving conflicting information about the VIP patient.
But in general, the course of this disease is no longer a complete black box to medicine. Trump will be at a fork in the road during the latter half of this week, say infections disease and critical care physicians who spoke with Scientific American. He could be heading for a bad stretch in a prolonged illness or he could be on an upward swing to recovery. Doctors sadly have the experience of treating more than 36 million COVID-19 patients worldwide and more than 7.5 million in the U.S. Using this clinical history, many now divide the disease into several stages, each with distinct symptoms and treatments. Based on when he first reported symptoms, Trump appears to be at the end of one phase and the verge of the next. Here is the sequence that physicians usually see and how it applies to the president.
Exposure and incubation
A COVID-19 infection begins when the SARS-CoV-2 virus enters cells in the body and begins to replicate. This period of time, after infection but before symptoms start, is called the incubation period—and it occurs between two and 14 days after contracting the virus. While people may not know they are sick, they often become contagious two or three days before symptoms begin.
Symptoms start by the fifth day after infection for most people, and they include fever, cough, sore throat, fatigue, aches, pains, gastrointestinal issues, and loss of smell or taste. Taison Bell, a pulmonary and critical care physician at the University of Virginia, says that when symptoms arise, this change signals a person is at “peak infectivity,” which means they are shedding lots of virus particles into the air, putting nearby people at risk.
This timing has big implications for the president and those around him, Bell says: “The most famous person in the world right now has COVID-19, and one could assume, based on the time line, that he could have been infectious during the presidential debate.” The televised argument with challenger Joe Biden took place last Tuesday, and Trump began showing symptoms on the following Thursday. “He is still infectious now and was when he took his joyride,” says Bell, referring to short trip Trump took in a car with Secret Service agents on Sunday. The vehicle traveled around and just outside the Walter Reed National Military Medical Center, where he was being treated.
At this early stage of the disease, most people do not receive aggressive treatment, but Trump was given two experimental drugs: the antiviral medication remdesivir and an infusion of monoclonal antibodies. He also received an established