What Is ‘Long Haul’ COVID-19 and Is Trump at High Risk?
- President Donald Trump is back in the White House after being hospitalized for COVID-19.
- While some of his symptoms may be waning, his physicians have said he’s not yet out of the woods.
- He may also be at risk for post-COVID-19 syndrome, or “long-haul” COVID-19.
On Oct. 1, Dr. Sean Conley, the president’s physician, confirmed that Donald Trump had tested positive for COVID-19.
The next day, he was moved to Walter Reed Medical Center for treatment after he reportedly had a drop in oxygen levels and a fever.
In recent days, the president has said he feels better and he returned to the White House. But it’s unclear whether a steroid treatment may be the reason he feels he has improved.
His age and underlying health conditions put him at higher risk for severe COVID-19, but even if he recovers quickly, he could be at risk for post-COVID-19 syndrome, or “long-haul” COVID-19.
And even if he recovers from his active infection, many people with COVID-19 report symptoms months after the virus has cleared.
10-day critical time period
At a press conference on Sunday, Dr. Brian Garibaldi, a pulmonary physician involved in Trump’s care, said the president had received a second dose of remdesivir and has experienced no side effects from the drug so far.
Garibaldi also said the president is receiving dexamethasone (a steroid medication) as part of his treatment for COVID-19.
“Typically, individuals diagnosed with SARS-CoV-2 are placed in isolation for 10 days, after which they are no longer considered contagious or infectious,” Dr. Geoffrey Leung, EdM, ambulatory medical director and chair of family medicine at Riverside University Health System in California, told Healthline.
“However, even after isolation, individuals previously diagnosed with SARS-CoV-2 may experience aftereffects, such as fatigue and shortness of breath, that are not related to active infection,” he continued.
Leung also cautioned that the first 7 days of infection are “most critical,” and individuals who have passed this window, and appear to be improving, are “unlikely to develop more severe illness.”
He also said the president has known risk factors, such as his age and weight, that put him at higher risk for severe symptoms overall.
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“Nevertheless, given that the president’s symptoms have been mild to date, consisting only of cough, fever, and fatigue, there is a good chance that he will recover well,” Leung said.
The risk of ‘long-haul’ COVID-19
Regardless of whether Trump overcomes the disease, there are reports that increasing numbers of COVID-19 survivors experience persistent aftereffects that can last months.
These symptoms are now dubbed “post-COVID-19 syndrome” and can include brain fog, fatigue, shortness of breath, joint pain, and chest pain.
“Long-haulers syndrome is a set of self-described chronic symptoms, including fatigue, shortness of breath, and impaired memory and concentration, that presumably occurs in individuals who have survived a prior SARS-CoV-2 infection,” Leung said.
But Leung said it’s unclear whether Trump has a significant risk for developing long-haulers syndrome given “that we are still learning about the science behind this condition.”
Leung said current evidence suggests that many long-haulers are in a different demographic group than the president.
“Self-reported long-haulers are more likely to be women, previously fit and healthy, and middle-aged rather than elderly individuals with preexisting comorbidities,” he said.
Presidents have ceded authority due to health issues
Some people have experienced long-haulers syndrome even when they had no other COVID-19 symptoms.
But what we don’t know is whether Trump is at higher risk for it due to his age and physical condition.
Dr. Charles C. Bailey, medical director for infection prevention at St. Joseph Hospital and Mission Hospital in Southern California, said there’s not enough solid data on these patients.
However, according to Bailey, “to the extent it may be a smoldering immune response to the COVID-19 virus, the early use of antiviral medications, as in the case of the president,” may decrease the risk, since the period of viral activity to trigger it would be shortened by early treatment.
The 25th amendment was ratified by the states in response to the death of President John F. Kennedy, and outlines procedures for replacing the president or vice president in the event of death, removal, resignation, or incapacitation.
If President Trump is affected by COVID-19 to the degree that he’s incapacitated, then this amendment provides clear instructions to maintain the continuity of the U.S. government.
Should this occur, he’ll only be the third president to cede authority due to health reasons.
The first time was when President Ronald Reagan ceded his authority to Vice President George H.W. Bush when he underwent surgery for colon cancer.
The second time was in 2002, when President George W. Bush underwent a colonoscopy, which he described as a “routine medical procedure.”
He again briefly ceded authority to his vice president, Dick Cheney, in 2007 for another medical procedure.
When will Trump’s quarantine end?
According to Bailey, for President Trump to meet the criteria of coming out of isolation, the CDC’s current guidelines for symptomatic COVID-19 cases require the following:
- Improved symptoms, but not necessarily resolved.
- No fever for at least 24 hours, without the use of any fever-reducing medications.
- Be at least 10 days from onset of symptoms if illness has been mild to moderate (a condition Bailey said Trump meets according to reports), or up to 20 days from symptom onset for a more severe illness.
Bailey emphasized that repeat negative COVID-19 tests are not part of these criteria because they don’t measure infectious virus, “only the nucleic acid ‘footprint’ of the virus, which may include viable intact virus as well as nonviable, noninfectious viral fragments,” he said.
He explained that the polymerase chain reactive (PCR) test used to diagnose COVID-19 could even remain intermittently positive for months beyond the point where a number of studies using viral cultures show no further risk of spread.
Tests that rely on viral cultures aren’t yet commercially available, Bailey said, “but ultimately will be the gold standard to gauge infectiousness.”
The bottom line
President Donald Trump has recently tested positive for COVID-19 and is being treated with antiviral and steroid medications.
While he may be recovering, a significant number of people with COVID-19 have experienced aftereffects that include mental impairment, breathlessness, and exhaustion, also called “long-haulers syndrome.”
Experts say early treatment may reduce the president’s risk for long-haulers syndrome.
However, if Trump is incapacitated by COVID-19 or its aftereffects, the U.S. constitution allows his authority to be assumed by the vice president.
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