Presidents hate to look sick. Trump has never needed to appear strong more.

It’s not unusual for American presidents to keep their health under wraps, but the Trump administration is handling it a little differently.

It has been five days since White House physician Sean Conley said that President Donald Trump tested negative for the novel coronavirus, an impressive recovery time for a patient who was airlifted to a hospital, received supplemental oxygen, and underwent experimental Covid treatments. As president, Trump didn’t receive the typical care that the average American would, but his speedy return to the White House has prompted questions and scrutiny among reporters, health experts, and the American public.

Trump wants the average American voter to know that he is “feeling great,” and he’s determined — now that we are in the home stretch of his reelection campaign — to appear healthy, vigorous, and strong. He tells supporters he has “dominated” the coronavirus. He feels “so powerful.” He wants to “kiss everyone” at his rallies.

Science, and public health, have proven not to be pressing concerns for President Trump, who holds the medically inaccurate belief that he is “immune” to the coronavirus and “can’t give it” to others. What matters to Trump is how he appears to the American people. And with the election in less than 30 days, his team has scheduled back-to-back campaign events for Trump to deliver booming speeches to tightly packed crowds (who, themselves, may or may not be masked). But these high-profile appearances, coupled with persistent questions around his health, have the American people examining him intently for signs of illness.

Appearances are crucial in politics, especially when the two presidential candidates are faced with questions regarding their age and mental acuity. For someone like Trump, who has spent his entire political career performing a sort of hyper-aggressive masculinity, he can’t give up that facade just yet — not even with sickness coloring the picture. It’s not unusual for presidents to hide their physical ailments, but Trump’s sudden show of strength — in the form of frenzied campaigning — is an extreme deviation from the presidential norm and a sign that he’s worried about slipping in the polls.

But no one can say for sure, not even Trump and his cadre of doctors, that he has emerged from the virus scot-free. The coronavirus is a precarious and persistent disease, sometimes triggering immune overreactions or long-term deficiencies. Perhaps the president’s aversion to illness is rooted in the belief that the sick are weak, and that the healthy are strong.

Weakness is not a suitable trait for any American president, not just Trump. Franklin Roosevelt, John F. Kennedy, and Ronald Reagan, to name a few, have either undergone significant surgeries or battled chronic illnesses in office.

Trump is the first president to be hospitalized (that we know of) since Reagan as an inpatient, and he knows that the specter of a sick president is concerning, no matter how the White House tries to spin it. It’s unsurprising, then, that the proper timeline of Trump’s illness and recovery has not been made clear to the press.

“Powerful leaders are not exempted from illness by virtue of their position or influence … A leader’s illness and demise can affect the lives of many others in decisive ways,” wrote Rose McDermott, a Brown University professor in her 2008 book Presidential Leadership, Illness, and Decision Making.

The state of a president’s health, when faced with a potentially severe illness, has historically been kept under wraps. “This is a playbook used by almost every presidential physician. They’re perfectly happy to share information when the president is doing great, but tend to obfuscate anything that suggests he’s weak or impaired,” McDermott told me. “No president wants to appear weak, out of control, or raise any questions about their ability to be in command, so they hide behind their doctors to say they’re capable.”

Hiding is more complicated for Trump, who thrives off of attention. But even with social media and a hyperactive news cycle, a veneer of secrecy still surrounds the president’s health. “What’s really telling is that, last fall, Trump was rushed to Walter Reed in the middle of the night,” McDermott added. “We still don’t know what happened, even if their response was that he was just having a physical done.”

The White House’s lack of transparency, however, seems to be fueling more scrutiny this time, not only among reporters, but by citizens online. While previous presidents have successfully concealed their health records, many reporters are hyper-skeptical of this administration’s mixed messaging. At Thursday night’s town hall, Trump evaded NBC journalist Savannah Guthrie’s question as to when he last tested negative for Covid-19. Conley, his physician, also dodged that question on Monday, saying “I don’t want to go backwards” on discussing the president’s test results.

Yet Trump is not one to simply use his doctors as a shield. Performance and flair are integral aspects to his life and presidency, so even in the depths of his illness, the cameras kept rolling for America’s reality TV president. His team staged photo-ops, while the president tweeted, took his presidential motorcade out for a dangerous joyride, and dramatically returned to the White House via Air Force One — an Evita-inspired scene that ends with the president tearing off his mask on his balcony and saluting to an empty lawn.

His latest string of public appearances reveals what we already know about the president: He’s a showman who revels in the limelight at pro-MAGA events. He is, once again, delivering hour-long speeches and dancing at his rallies.

Trump appears to be more fixated on the illusion of control and strength than any ailing US president; he also is, perhaps, the most-watched president in history. It would’ve been difficult for him to quietly fall ill, as Woodrow Wilson did in 1918 with the Spanish flu, in which he later suffered from a debilitating stroke that left him partly paralyzed. Videos of Trump speaking and photos from the press pool and MAGA rally attendees frequently circulate online, and the scrutiny towards the president’s appearance reached a zenith during the first week of his public diagnosis. (During the vice presidential debate, many also harped on Mike Pence’s pink-looking eye.)

Viewers, too, are focused on Joe Biden, who has been more transparent about his health records. The Biden campaign has sought to juxtapose its internal Covid-19 response to Trump’s; when two people associated with Sen. Kamala Harris’s team tested positive, the campaign publicized the candidates’ last testing results and medical explanations as to why it’s still safe for Biden to travel.

Instead, Trump scorns these precautions. “I don’t wear a mask like him,” the president said at the October 2 presidential debate, in reference to Biden’s mask-wearing habits. “He could be speaking 200 feet away and he’ll show up with the biggest mask I’ve ever seen.”

To Trump, the virus seems to be “a dare, a slight against the power and health he has tried to project,” wrote Vox’s Alex Abad-Santos. “Now he’s chosen to double down and prove his virility through risk with no real reward— particularly when it comes to eschewing the face mask, an item he considers weak.”

Axios reported on Monday that Trump asked to be put on the road every single day until November 3, despite concerns from some advisers. Trump appears eager to overcompensate for myriad reasons — as a flex against Democratic rival Joe Biden and to downplay the severity of Covid-19 in a “if I get over it, so can you” manner. It’s as if he was not sick in the first place.

On paper, the coronavirus diagnosis didn’t look good for him. The president falls in the “high risk” category of people for whom Covid-19 could be — if not fatal — severely damaging. He is 74 and overweight, maintaining his lifestyle with an indulgent diet of junk and fast food. He doesn’t believe in exercise. According to those in Trump’s orbit, he’s also a germaphobe (despite his commitment to keep shaking hands during the pandemic).

“His presentation with himself is at odds with what’s completely obvious,” said McDermott, who added that the president’s elevated mood and behavior could be a side effect of steroids. “He’s not as in good shape, even without Covid, as he claims. He’s certainly aware of the impression he makes because all he does is watch television.”

There was a moment in Walter Reed, though, in which Trump briefly came to terms with his own mortality, reported New York magazine’s Olivia Nuzzi. “I could be one of the diers,” he had said.

For previous presidents, this kind of brush with death has changed them, and they’ve merged from their illness as more empathetic leaders.

“Roosevelt is the best example as someone who was patrician, elitist, and not somebody people connected with before he got polio,” McDermott said. “Polio changed his notion of how illness affects someone’s quality of life, and it turned him into one of the most progressive presidents the US has ever seen.”

But as of mid-October, the president appears to be very much alive, having emerged from the experience as callously cavalier as he was before his diagnosis. He even planned a stunt to appear initially frail during his hospital discharge, the New York Times reported, which would end with him revealing a Superman T-shirt underneath his button-down. Trump, it seems, has interpreted his recovery as a boon that’ll help him in the polls, despite sagging numbers.

“We’re going back to work. We’re going to be out front. As your leader, I had to do that,” Trump told Americans in a Twitter video shortly after his White House return. The subtext of the message was odd, like he was implying that as president, he contracted the virus on America’s behalf. He closed the video, saying: “Don’t let it dominate your lives.”

Trump is determined to not allow the coronavirus — his own illness or his administration’s handling of the pandemic — to dictate his narrative, even if it puts him in danger. “He’s going to kill himself,” one adviser told Axios of his campaign schedule. It’s likely that the president is overexerting himself to keep up appearances for his base, to build upon the myth that he is a strong, invincible leader. Previous presidents, like Kennedy (who was chronically ill and constantly in pain), have similarly relied on this specter of health and vigor to attract voters.

In 2016, a portion of the American electorate bought into Trump’s myth — a story of a clever businessman who understood the art of the deal and promised to advocate for all Americans. At the tail-end of a year full of inconsolable loss and mass death, it’s hard to say whether voters will buy into Trump’s last-ditch distraction, a false show of strength from a very bronzed man atop a very tall podium who has claimed, for the past four years, that he will make America great again.

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