Donald Trump’s stay at Walter Reed was an absolute nightmare for public health. The COVID-19-stricken president spent part of his time there breathing maskless in rooms with a photographer and chief of staff Mark Meadows. On Sunday evening, wearing just a cloth face mask, he and a few Secret Service agents went for an unannounced joyride in his armored car outside the hospital, where Trump waved to supporters stationed nearby.
Both activities, which unnecessarily exposed healthy staff members to the novel coronavirus, were undertaken for two purposes only: shoring up the president’s image as a tough guy and making him feel loved. According to guidelines from the Centers for Disease Control and Prevention, the photographer, Meadows, and everyone who accompanied him in the car should all quarantine for 14 days, though no one from the White House has suggested they will. As James Phillips, an attending physician at Walter Reed National Military Medical Center, tweeted on Sunday, the staffers were “commanded by Trump to put their lives at risk for theater.” He called the behavior “insanity.”
Since Trump announced early Friday morning that he’d tested positive for COVID-19, many observers have noted that he has received far better care, and far more freedom, than any of the 210,000-and-counting Americans who’ve died of the illness, or the millions more who’ve survived it. In a video posted Sunday, Trump claimed he’d met some “soldiers and first responders” around the hospital, implying that he’d encountered even more people incidental to his medical care than those who took part in his photo shoots and motorcade. Meanwhile, COVID-19 patients who’ve spent weeks in the hospital have been forbidden from having family members visit. Thousands of patients have died with only a video call, if that, to connect them to loved ones for a final goodbye. These severe restrictions were put in place to prevent further spread of the deadly virus—not just to hospital visitors, but to others outside the hospital with whom those visitors might come into contact. But in the span of just a few days with the illness, and with access to the best, most luxurious health care in the world, Trump has been deliberately multiplying the reach of his germs.
This is nothing new for the president, who has been flouting public health guidelines ever since the pandemic began. On March 13, during the press conference at which he declared the pandemic a national emergency, he showily shook the hands of several CEOS, defying health experts’ guidance to avoid handshakes. Back then, the risk of coronavirus transmission to and from the president was largely theoretical; no one on that stage was known to have had COVID-19 or been exposed to someone who had (though the handshakes were still irresponsible, due to both the actual risk and the public modeling of inappropriate behavior). By ignoring safety guidelines that would have required him to admit a standard amount of physical vulnerability, Trump was attempting to protect his own fragile masculinity and project an image of strength, a picture of a man bigger and badder than any puny virus. But, I wrote at the time, “a man who scoffs at public health recommendations and keeps shaking hands—and evading quarantine—through the first stages of a pandemic is not going to be able to shield himself, nor his friends, from its worst effects. The coronavirus won’t be fooled by foolish bravado. It’ll thrive in it.”
Lo and behold, it did! Now the risks of being near Trump are definite and knowable. He is sick and contagious. Still, the president continues to prioritize his own image over other people’s lives by taking unnecessary risks for photo-ops. But there is one major difference between Trump’s pre-COVID and post-COVID bluster: Now, his posturing is even more likely to result in worse health outcomes not just for the people around him, but for himself. Afraid of giving an impression of sickliness, Trump reportedly resisted advisers who told him he should be helicoptered to Walter Reed on Friday, before eventually giving in. Two sources told CNN’s Jim Acosta that Trump demanded to be released from the hospital on Monday, after medical authorities rebuffed his request to be discharged on Sunday. One source said the president feared that being hospitalized “makes him look weak.” It seems likely that Trump has pressured his doctors—the chief one of whom, Sean Conley, has been spewing sycophantic claptrap to keep Trump happy—into putting on a show of lightning-quick recovery at the expense of necessary medical observation and care. Multiple Trump aides told the New York Times that they worried “he would pressure Dr. Conley into releasing him by claiming to feel better than he actually does.”
For his part, Conley has already admitted to hiding information about the president’s care, including that he’d been given supplemental oxygen, because Conley wanted to maintain an “upbeat attitude” for the president. This is not a man who appears ready to deliver tough news to a demanding patient or recommend precautions that could inflame a bully. As it is, a doctor cannot force a patient to receive treatment against his will, and in this case, as an officer in the Navy, Conley cannot disobey the commander in chief. Here, he has a patient who thrives on dominating others (such as those who tell him he’s very sick) and defying norms (such as those that urge vigilance when a deadly, incurable virus is afoot). Trump also has a notorious lack of respect for experts, science, and people who disagree with him—he’s purged all three from his inner circle, leaving no one capable of steering him toward caution. Even now, with his life on the line, Trump’s impulse toward short-term ego and image maintenance is his top priority.
It seems possible that Trump’s narcissism may end up overriding his survival instinct. Conley will not reveal whether Trump’s lung scans are worrying or whether the president has pneumonia—a bad sign, since Conley has revealed other details!—but considering that Trump has already had to be hospitalized, experienced multiple drops in his oxygen levels, and is being treated with a steroid typically reserved for severe COVID-19 cases, it may be that the president’s illness is more severe than the administration’s optimistic updates would indicate. Experts have also warned of “VIP syndrome,” wherein high-profile people get overaggressive treatment from doctors who don’t want to mess up an important case or are browbeaten by patients who demand the most care, rather than the best care. Unnecessary procedures or interactions between too many medications can lead to worse outcomes than just receiving normal care might yield. The president is a perfect candidate for such a syndrome: Whether due to his own commands or Conley’s zeal, Trump has received an experimental antibody cocktail that hasn’t been reviewed by the Food and Drug Administration and an antiviral drug that isn’t yet FDA-approved. It’s not clear how these medications, plus the steroid, will interact with one another. “I didn’t want to hold anything back,” Conley said at his Saturday press briefing. “If there was any possibility that it would add value to his care and expedite his return, I wanted to take it.” On Monday, Conley said the medical staff was “in a bit of unchartered territory” because no other patient has ever received the multiple treatments the president did so soon after his onset of symptoms.
Trump returned to the White House on Monday night, on the heels of a tweet that claimed he feels “better than I did 20 years ago” and urged Americans not to fear COVID-19 or “let it dominate your life.” Republicans responded with tweets boasting that the president had beaten the disease with his superior grit and strength. When the president arrived home, he stood outside his residence, took off his mask for the cameras, and visibly struggled to breathe.
We now face two possible futures. In one, Trump recovers fully and speedily, then uses his own comeback as proof that COVID-19 is no worse than a cold, but also, paradoxically, as proof that he is tougher and more virile than all the weaklings who perished from the virus due to his negligence. In the other scenario, Trump’s well-developed hubris will compromise his road to recovery, he’ll get sicker, and he may have to be readmitted to Walter Reed (if his medical team can’t retrofit the White House into a full-on hospital facility). The second would seem to check all the boxes necessary for a poetic justice/Icarus/pride-before-fall situation. We’ll have to wait and see if the best health care available to anyone in the country is enough to prevent one.
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