Trump is 74, male and obese. All put him at greater risk of severe COVID-19


President Trump steps off Marine One on the South Lawn of the White House on Thursday after attending campaign events in New Jersey. He tested positive for the coronavirus hours later. <span class="copyright">(Saul Loeb / AFP via Getty Images)</span>
President Trump steps off Marine One on the South Lawn of the White House on Thursday after attending campaign events in New Jersey. He tested positive for the coronavirus hours later. (Saul Loeb / AFP via Getty Images)

President Trump may be the leader of the free world, but as far as the coronavirus is concerned, he is a 74-year-old male with obesity.

Each of those three attributes — his age, sex and weight status — increases his risk of developing a severe case of COVID-19.

The president announced on Twitter early Friday that both he and First Lady Melania Trump had tested positive for coronavirus infections. He did not say whether he had experienced any symptoms of COVID-19, the disease the virus causes, but he did note that he and his wife planned to “begin our quarantine and recovery process immediately.”

Although many people who test positive for the coronavirus never develop any outward sign of infection, odds are that the president will experience symptoms of some kind. Roughly half of all COVID-19 patients in the U.S experience a a cough, according to data from the Centers for Disease Control and Prevention. Other common symptoms include headache, muscle pain and shortness of breath.

Should Trump’s infection progress to a case of COVID-19, there are reasons to be concerned about the potential severity of his illness.

The odds of a severe case of COVID-19 — one that requires hospitalization, intensive care or breathing assistance — rise steadily with age, according to the CDC. Compared to young adults between the ages of 18 and 29, a person between the ages of 65 and 74 is five times more likely to be admitted to a hospital and 90 times more likely to die of the disease.

Other CDC data indicate that, among COVID-19 patients in their 70s, the death rate for those who were in good health at the time of their infection was 10%. For those already dealing with a medical condition, the death rate was three times as great: 32%.

Since the early days of the pandemic, researchers have observed that COVID-19 patients who are obese fare worse than those who are not.

According to a report in June from Trump’s physician, Dr. Sean Conley, the president is 6 feet, 3 inches tall and weighs 244 pounds. That means his body mass index, or BMI, is 30.5, just over the threshold for obesity. (He’s got plenty of company: 42.4% of U.S. adults are obese, the CDC says.)

It’s not clear why obesity may make a COVID-19 patient sicker. Doctors suspect that, as a respiratory illness, it may intensify the breathing difficulties common in people with obesity. Another theory is that obesity predisposes a person’s immune system to overreact to the coronavirus, triggering a dangerous “cytokine storm” that destroys tissues without stopping the infection.

Whatever the reason, one study of COVID-19 patients who came to emergency rooms found that those who were under the age of 60 and had a BMI at the low end of the obesity range were twice as likely as non-obese patients to be admitted to the hospital rather than be sent home. They were also 80% more likely to spend time in intensive care.

However, that same study found no association between obesity and COVID-19 severity among patients 65 and older.

Although men and women are about equally likely to be infected with the coronavirus, researchers have observed a consistent gender gap among seriously ill COVID-19 patients. In Italy, one of the first countries to be hit hard by the pandemic, men in nearly every age group were twice as likely as women to die of the disease. That pattern has repeated itself around the globe.

A study published in July by the CDC reported that COVID-19 deaths in men outnumbered deaths in women in 41 out of 47 countries assessed. It also said that the case-fatality ratio — the proportion of people with confirmed cases of COVID-19 who die of it — was more than twice as high for men as for women.

One global data tracker shows that, for every 10 women admitted to intensive care because of COVID-19, there are 18 men requiring such treatment. And for every 10 women killed by the disease, 14 men die of it.

The gender gap could be explained in part by the fact that men are more likely to be smokers, which makes patients more susceptible to the worst effects of COVID-19. Experiments in mice also suggest that estrogen protects females from the worst effects of the coronaviruses that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS); that may be the case with the coronavirus that causes COVID-19, too.

Some researchers have even theorized that men are more vulnerable because their testicles produce ACE2 proteins, which the coronavirus binds with when it gets inside a human body.

Trump does have one thing going for him: his race.

According to the U.S. Census Bureau, 60% of Americans are non-Latino whites. But non-Latino whites account for only 43% of confirmed coronavirus infections in the U.S. and 52% of COVID-19 deaths.

Latino and Black Americans are experiencing a disproportionate amount of both infections and deaths.

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