Most people returning home from a stay in the hospital — especially people struggling with Covid-19 — use the time to rest and recuperate.
But if Tuesday was any indication, President Trump plans no such thing. The day was a blur of tweets and retweets (25 by dinnertime): attacks, major policy pronouncements and assurances to his followers that he was “FEELING GREAT!”
He ordered his aides to cut off negotiations with Democrats in Congress on the emergency rescue package for an economy pummeled by Covid-19 and urged Senator Mitch McConnell, the majority leader, to push ahead with his nomination of Amy Coney Barrett to the Supreme Court. He mocked “Fake Polls” that showed former Vice President Joseph R. Biden Jr. leading him in Pennsylvania, and belittled “Crazy Nancy Pelosi and the Radical Left Democrats.”
From the moment Mr. Trump decided to leave Walter Reed National Military Center, he has done everything he could to show that he is as active and engaged a president — and presidential candidate — as he was before the diagnosis. He said he wanted to go ahead with his debate on Oct. 15 in Miami with Mr. Biden, and that he was ready to return to the campaign trail.
His decision to press for the confirmation hearings of Ms. Barrett — complicated by three senators having come down with the virus — and his move to end negotiations for another economic rescue plan seemed intended to send one clear message to Washington: Mr. Trump remains in charge.
Mr. Trump’s doctors said that they will know by Monday if Mr. Trump has gone through the worst of the disease, or if this was just a lull, which would not be out of character for the course of Covid-19.
But his eagerness to put his bout with the virus behind him and resume business as usual is understandable. The election is barely a month away, and another battery of polls on Tuesday showed Mr. Trump trailing. Time is running out.
In a memo titled “Precautions and POTUS Interactions” sent around the White House this week, staff members were warned about what to do when interacting with the president, including acquiring personal protective equipment from an “Isolation Cart.”
Staff members are to go to the Oval Office or the residence on the second floor, where the first family lives, only if they are requested to go and expected to be there. If staff members are not in close contact with President Trump, meaning they’re more than six feet away from him, only a “surgical mask” and hand sanitizer are required, according to the memo from the White House Management Office, which was reviewed by a New York Times reporter.
But within six feet, people must use sanitizer and “remove any outer garments,” according to the memo. “Ensure you are wearing the following Personal Protective Equipment (PPE). PPE is provided in the Isolation Cart” that’s located “in the foyer area of the second floor residence and the outer Oval Office,” the memo stated.
The memo listed the types of equipment, including, “Yellow gown,” “Surgical mask,” “Protective eye wear” and “Gloves.”
Upon exiting, people are instructed to remove gowns and gloves and put them in a trash receptacle next to the cart, clean the eye shields with wipes that are provided and save them for future use, and then wash hands or use sanitizer after leaving.
An incumbent president has a terrible first debate.
His running mate steps up to deliver a solid performance in the vice-presidential debate to put the ticket back on track.
The president, buoyed, wins his second debate. Victory ensues.
This is pretty much the scenario President Trump has in mind on the eve of Vice President Mike Pence’s consequential face-off against Senator Kamala Harris on Wednesday. And it was the animating motive behind his decision Tuesday to announce he would debate former Vice President Joseph R. Biden Jr. in Miami, even though Mr. Trump might still be sick and contagious.
It also happens to be exactly what happened in 2012 when President Barack Obama — Mr. Trump’s forever foil — rebounded from his low-energy first debate against Mitt Romney after Mr. Biden held the line during his sparring match with Paul Ryan.
If the current president’s to-do list is identical to Mr. Obama’s, he has dug himself a much deeper hole, and this was before contracting an unpredictable, disruptive and dangerous virus.
Mr. Obama came into the 2012 campaign facing a similar political situation as Mr. Trump was before the pandemic. Both men are what operatives call a “high-floor, low-ceiling” candidate, with a bedrock of support in the 42 percent to 46 percent range, and opposition frozen at roughly the same level.
Their similarities end there.
Mr. Pence, a Republican veteran who has prepared for his debate (unlike Mr. Trump), is perhaps the most predictable factor on the president’s side, but nearly everything else is up in the air.
Mr. Obama faced the serious headwinds of a sluggish economic recovery — and the tempest of the Tea Party uprising — but his troubles were dwarfed by the coronavirus crisis and the popular backlash against his management of the federal response.
The polls tightened in 2012 after Mr. Obama’s lackluster showing at the first debate that year in Denver, but he held on to his narrow edge even on the eve of a much better second debate. Mr. Trump has been tanking in recent national polls since his disastrous first debate, and has been heading in one direction since the debates in the battleground states: down.
Still, one of the fundamental differences between the two men is the way they relate to the people around them.
Mr. Obama could be aloof and snippy with his staff, but he was ultimately coachable. His former press secretary, Robert Gibbs, was brought back into the fold during the debates, in part, because he did not mind telling the president he had done a lousy job, and Mr. Obama eventually internalized his team’s critiques.
Mr. Trump is a very different kind of manager. In any case, nearly all of his top advisers have now contracted the virus and will not be in his immediate presence for the foreseeable future.
Late Tuesday, came the news that Stephen Miller, a speechwriter and immigration hard-liner — the aide who best channels Mr. Trump in prose and policy, tested positive for Covid-19.
As a buoyant President Trump emerged from Walter Reed National Military Medical Center this week, appeared on a balcony at the White House, and proclaimed on Twitter that the public should have no fear of the coronavirus, many Americans saw few parallels between Mr. Trump’s experience with the virus and their own.
A woman in Brooklyn was reminded of the $4,000 she was charged for medication for her father, who eventually died from the coronavirus.
One man in Texas said he understood why the president of the United States would have top-flight doctors, but could not help comparing the place where Mr. Trump was treated with the facility where his 87-year-old mother became sick and died.
Nothing about the medical care that presidents receive is ever typical, and the coronavirus is no different: Mr. Trump so far seems to have benefited not only from power, money and access to first-class medical treatment, but also from the timing of his illness. He caught the virus seven months into the pandemic, after the country built up supplies and doctors honed their understanding of the disease.
One of his treatments, the steroid dexamethasone, was not used widely to treat patients at the beginning of the pandemic and was not adopted by some hospital officials in the United States until this summer.
Prudencio Matias Mendoza’s brother, Mariano, died from the coronavirus in late July, and in the past week, Mr. Matias Mendoza, 38, has been following Mr. Trump’s bout with the virus.
He supports some of the president’s policies. But he could not help but feel angry to see Mr. Trump and other officials ignoring social distancing and mask-wearing mandates.
“The president is not a god,” Mr. Matias Mendoza said. “Everyone has to do their part. This is a virus that comes to kill.”
The White House physician, Dr. Sean P. Conley, said on Tuesday that President Trump was experiencing no symptoms of Covid-19 and doing “extremely well” on his first full day at home since a three-night stay in the hospital.
But outside doctors and medical experts in Covid-19 and lung disease said they were struggling to piece together an accurate picture of Mr. Trump’s health. Far from having vanquished Covid-19, the outside experts said, Mr. Trump is most likely still struggling with it, and possibly entering a pivotal phase in which he could take a turn for the worse.
Dr. Conley said on Monday that Mr. Trump had been prescribed dexamethasone, which some experts saw as a sign that the president could be dealing with pulmonary issues since it is recommended only for Covid-19 patients who have severe or critical forms of the disease.
“Does he have lung involvement? My guess is yes, because they did give him a lot of medications that they would only give to someone who did,” said Dr. Mangala Narasimhan, a pulmonologist and director of critical care services at Northwell Health in New York.
In a televised event on Monday that some of the president’s Republican allies tried to frame as a quick recovery from the virus, Mr. Trump was flown from Walter Reed National Military Medical Center to the White House. After leaving his helicopter, he crossed the lawn, walked up a set of stairs and removed his mask.
“As a pulmonologist, he did two things for me: He did a walk test, and he did a stair-climbing test,” said Dr. Talmadge E. King Jr., a specialist in pulmonary critical care and the dean of the UCSF School of Medicine. He added that lung doctors still rely on tests like these “to just get a picture of how the patient’s doing.”
He and others said that at the top of the stairs, Mr. Trump used his neck muscles to help him breathe — a classic sign that someone’s lungs are not taking in enough oxygen.
Dr. Ilan Schwartz, an infectious disease doctor and assistant professor at the University of Alberta, agreed. “As a physician, I would refrain from commenting on somebody whom I haven’t examined,” he said. “But in this case, the clinical signs are so obvious that it can be seen from a distance, even on a short two- or three-second clip.”