How severe could Trump’s Covid-19 case be? Here are his risk factors — and advantages.

While his age, sex, and weight may elevate his risk, his race and privilege may protect him.

President Trump and his wife, Melania Trump, tested positive for the coronavirus, which has killed more than 207,000 Americans, a month before the election.

This naturally raises many questions about what could possibly happen next in 2020. How will the diagnosis impact the election? Were former Vice President Joe Biden or any others infected at Tuesday’s presidential debate? Is there a larger cluster of cases in the White House?

Of course, there’s also the question of how the 74-year-old will fare with a Covid-19 infection.

Though Trump has spent months downplaying the danger of the virus for himself and Americans, and frequently refuses to wear a mask, he also falls squarely into several higher-risk buckets — being over 70 years old, being male, and having obesity. These factors raise his odds of severe disease and death from the coronavirus.

On the other hand, Trump has several advantages that may protect him. He caught the virus at a time when even people who are high risk have a better chance of survival, because doctors are getting better at treating the disease. He has access to good health care — a benefit many Americans don’t share. We also know that many people who get Covid-19 experience no symptoms or mild disease, and it’s possible Trump will be one of them.

While no one can predict how Trump will do — we don’t have his full health record, and don’t know anything of the genetic mutations he may carry that could affect his outcomes — it’s worth understanding the known and unknown risks he carries. Let’s walk through them.

Trump’s age of 74 puts him at higher risk of severe Covid-19

Since the start of the pandemic, it’s been clear that one of the biggest risk factors for hospitalization and death with Covid-19 is older age: Study after study has shown that with every passing decade, a person’s chances of dying from the disease increase.

In a late February report from China’s Center for Disease Control and Prevention, researchers looked at the first 72,314 patients with confirmed or suspected Covid-19 and discovered a huge variation in the case fatality rate by age group:

Christina Animashaun/Vox

That trend has held up over time. In an August analysis of Covid-19 mortality data, reported in Nature, “For every 1,000 people infected with the coronavirus who are under the age of 50, almost none will die.” That number climbs to nearly five for people in their 50s and early 60s. Then, “For every 1,000 people in their mid-seventies or older who are infected, around 116 will die.”

For now, the White House hasn’t reported any symptoms in the president. In a memo, released early Friday, Trump’s physician Sean Conley stated that “the President and First Lady are both well at this time, and they plan to remain at home within the White House during their convalescence.” If Trump does develop symptoms, though, he’s certainly in a higher risk category because of his age alone.

Men with Covid-19 are at a greater risk of death

But age doesn’t give the full picture of Trump’s risk. Since the beginning of the pandemic, we’ve seen gender play a pretty consistent role, too. Specifically, men appear to be at a greater risk of complications and death from the coronavirus than woman are.

According to a recent study looking at more than 61,000 people in Spain, published as a preprint on medrxiv.org (which means it hasn’t yet been peer-reviewed), men faced double the risk of death from Covid-19 compared to women — and that risk gets bigger with age. For example, the infection fatality risk (or proportion of deaths among all infected individuals) for men age 80 and over is between 12 and 16 percent; for women in that same age group, it’s 5 to 6 percent.

This trend has held in many — but not all — studies. It’s not clear why men seem to generally experience more severe disease than women but some guesses include the fact that women may mount a stronger and faster immune response, and men are likelier to have behaviors that put them at greater risk of complications, such as smoking.

Trump has obesity

According to a June report from Trump’s doctor, the president is 6 feet 3 inches tall and weighs 244 pounds. That means his body mass index is 30.5 — meaning Trump is medically obese. BMI is not a perfect health metric — there’s lots of variation in how body weight affects health.

But, to date, a higher BMI has been linked to worse Covid-19 outcomes. In an August analysis of data from 399,000 patients around the world, published in the journal Obesity Reviews, researchers found people with obesity were 113 percent more likely than people of a normal weight to end up in hospital, 74 percent more likely to be admitted to ICU, and 48 percent more likely to die.

Like the gender finding, the link between obesity and poor Covid-19 health outcomes is not well understood. Some have theorized that there may be physiological factors at play, including “impaired immunity, chronic inflammation, and blood that’s prone to clot, all of which can worsen COVID-19,” according to a report in Science Magazine.

We also know people with obesity are more likely to have low socioeconomic status and other health problems — such as diabetes — linked with more intense Covid-19 disease. Maybe they’re more likely to show up at hospital late and to receive inadequate healthcare due to the well-known weight stigma in healthcare, as obesity doctor Yoni Freedhoff has pointed out. But for now, we know the risk of complications and death from the coronavirus is heightened in people with a BMI of 30 or over.

Trump also has advantages that may protect him from severe Covid-19

At the same time, Trump has many advantages that may protect him from severe Covid-19, despite his various risks.

Over time, this pandemic has revealed how unjustly the burden of the virus is distributed throughout society. People who are part of minority groups, people who are poorer, people with patchy or no access to healthcare are the ones who experience the worst health outcomes. As my colleague Dylan Scott reported this week: 1 in 1,000 Black Americans have died in the Covid-19 pandemic. Overall, black people are 3.5 times more likely to die from Covid-19 than white people.

Trump is white. He’s got access to top tier healthcare. He also won’t lose his job or housing as a result of being diagnosed with Covid-19. So even if he falls into several high-risk categories, his life of privilege may be his best protection of all.

https://www.vox.com/2020/3/12/21173783/coronavirus-death-age-covid-19-elderly-seniors