President Trump's COVID-19 diagnosis raises questions about risk factors, exposure

Men and people over 65 have the greatest chance of a serious illness, says UCLA Health infectious disease specialist

If the highest-profile person in America – with the nation’s best security monitoring him 24 hours a day – can contract COVID-19, then just about anyone can.

That’s why infectious disease specialists and public health officials have adamantly advised people to wear masks, wash their hands often and stay at least six feet away from those not part of their household while the pandemic persists.

How President Donald Trump contracted COVID-19 is unclear, but there are certain characteristics of the virus that may have come into play. For one, you don’t have to be standing next to someone showing signs of sickness to be at risk.

An infected person can spread the virus even without showing symptoms, says Annabelle de St Maurice, MD, MPH, co-chief infection prevention officer for UCLA Health.

“We know it happens,” she says. “I think, early on, we thought maybe it doesn’t, because you aren’t coughing and sneezing. But when you are breathing and talking and in close proximity to someone, you’re at risk of spreading it if you’re not wearing a mask and not more than six feet apart.”

Even “super spreaders” — those who carry a particularly high amount of virus — can be asymptomatic, Dr. De St. Maurice says. These people can inadvertently spread disease to many others, particularly if they’re in close contact or without face coverings.

Why do some people contract the virus while others with similar exposure to it don’t? Why do some experience more severe symptoms than others?

There are multiple known risk factors that can lead to more serious illness in those who are infected with the virus, the most significant being one’s age, says Dan Uslan, MD, co-chief infection prevention officer for UCLA Health.

“The older one is, the higher likelihood of severe disease, which would include hospitalization and intensive care — over age 65 in particular,” he says.

Other risk factors include conditions such as diabetes, obesity and problems with the immune system. Men also are at greater risk than women for hospitalization and death, Dr. Uslan says, though researchers have yet to determine why.

“All of those can add up to worse outcomes,” he says. “But people who are completely healthy can also have bad outcomes. It’s just less common. And people who have lots of risk factors can also do just fine. So just because one has risk factors does not necessarily mean one will have a negative outcome.”

About 10% of patients older than 65 with COVID-19 end up in the hospital and the mortality rate among this population is around 3%, Dr. Uslan says.

The U.S. has the highest number of confirmed COVID-19 cases in the world at 7,299,080 as of October 2, and the greatest number of deaths: more than 208,000. Globally, there are more than 34 million cases and more than 1,024,950 deaths.

While testing may prevent outbreaks, it doesn’t prevent new cases, says Dr. de St. Maurice, since a person can be infectious two days prior to a positive test result.

However, testing is effective as part of a comprehensive strategy that includes what Dr. Uslan calls the “three Ws: wearing a mask, watching your distance and washing your hands.”

“You can’t test your way out of this,” he says. “Testing tells you who has it, but the way it’s prevented from being transmitted is through those three Ws.”

While the shock surrounding the president’s diagnosis is new, the strategies for preventing transmission of the virus haven’t changed, Dr. Uslan says.

“We should continue to do what we’ve been doing, which is minimize leaving the house, minimize social interaction with people not in our immediate family, and when we do leave the house, wearing a mask, washing our hands frequently and maintaining our six feet of distance,” he says. “Nothing has changed in terms of our knowledge of what works to prevent transmission.”