3 Factors That Put Trump at High Risk for Severe Covid-19 Outcomes
Age, gender and obesity don’t predict any given outcome, but they raise the risk
Based on the science and statistics, President Donald Trump is at higher risk of severe outcomes from Covid-19 because he is older, male and obese. While none of these three factors predict the course of the disease in any given person — even centenarians have survived Covid and people of all ages have survived the disease with mild symptoms — here’s what we know about the relative prospects of a typical patient in this situation.
Trump, said to be experiencing mild cold-like symptoms Friday, is 74 years old. Though people of all ages are at risk of severe outcomes and death, about 79% of U.S. Covid-19 deaths are among people 65 and older, and 22% are ages 65 to 74.
Put another way, people ages 65 to 74 are 28 times more likely to die from Covid-19 as people ages 25 to 34.
The risk grows with age in part because the human immune system weakens as we get older. Our immune system has two primary aspects: innate and adaptive. The innate system involves cells that work generally to destroy invading pathogens but is not ideal for any specific germ. The adaptive immune system, which creates disease-fighting proteins called antibodies that react to fight a specific disease.
“Low-grade chronic inflammation in individuals that commonly occurs during aging can also dull the ability of the innate and adaptive immune responses to react to pathogens,” writes Brian Geiss, PhD, an associate professor of microbiology, immunology and pathology at Colorado State University. “It’s similar to becoming used to an annoying sound over time. As you age, the reduced ‘attention span’ of your innate and adaptive immune responses make it harder for the body to respond to viral infection, giving the virus the upper hand.”
At 6-foot-3 and 244 pounds, Trump has a body mass index (BMI) of 30.5, just above the threshold for obesity of 30.0. Obesity, along with diabetes and heart disease, are key factors called comorbidities that raise the risk of severe outcomes from Covid-19 infections.
People with Covid-19 who are obese are 113% more likely to end up in the hospital, 74% more likely to be admitted to the ICU, and 48% more likely to die, according to a review of studies on the topic. While obese people often have other diseases that worsen Covid outcomes, obesity by itself has been shown to be a risk factor.
Men are also at greater risk of severe outcomes and death from Covid-19 than women. Gender-based risk varies by age group, but among older people, men who contract Covid-19 are more than twice as likely to die as similarly-aged women, and the gap grows larger in the oldest age groups.
Among people diagnosed with Covid-19, men are also more likely than women to be hospitalized, which means even if they survive, men tend to suffer worse outcomes. It’s not clear why, but scientists have several ideas, from biological to social.
“Women typically have a more rapid and robust immune response to viruses than men,” Sabra Klein, PhD, a biologist and immunologist at the Johns Hopkins Center for Global Health, said in June. “This may be one factor contributing to female-biased protection against SARS-CoV-2, the virus that causes COVID-19.”
The increased risk for men likely has to do with other factors that may not apply to all men, including their relatively higher rates of comorbidities like diabetes and heart disease, more smoking and drinking, and perhaps a lower propensity to seek medical care when they do become sick, experts say.
Severe Covid-19 symptoms, should they occur in a given person, can start anywhere from a few days to a few weeks after catching the virus.
Meanwhile, given we’re only months into this pandemic, nobody can say whether some people who recover initially might suffer life-long effects from Covid-19. Thousands of people have reported long-haul effects that persist months after the initial infection clears, from ongoing fatigue to breathing problems and difficulty concentrating or focusing.
None of the known Covid-19 risk factors dictate outcomes entirely, and scientists don’t know exactly why the coronavirus affects any one person more than another.
“Covid’s like playing Russian roulette,” Brian Oliver, an expert in respiratory diseases at the University of Technology Sydney, tells Bloomberg. “It can affect anyone really badly, but we know that when people are older and when they’ve got more pre-existing comorbidities, the chances of being affected and having a more severe reaction are much worse.”