It’s almost hard to remember that it was just a few short weeks ago that we were waking one another up in the middle of the night with the news that President Donald Trump had the coronavirus. Things moved fast from there: Trump was helicoptered to the hospital, given multiple experimental drugs, driven around while infectious in a sealed car, and then dispensed back to the White House, where he was captured on video gasping for air.
And then, he was apparently fine.
We still don’t know the true severity of Trump’s illness or the possible aftereffects. He could be one of the 10 percent of people who have strange, lingering symptoms for months or more to come; he and his doctor have proved capable of obfuscating even the simplest parts of his disease, so it seems unlikely they would let the American people know if our president were a COVID-19 long-hauler. But it also seems likely that Trump really did make it through his illness without much trouble. All in all, he did not spend much time in the hospital. If his health took a dip in the 7-to-10-day window that doctors worry about with COVID-19 patients (that window probably happened two weekends ago), it wasn’t a very dramatic one. Trump is back to his usual self, which is to say campaigning in front of non–socially distanced crowds. The worst thing anyone could say about his health is that at his first rally post-COVID, he sounded a little hoarse. Though his return to the trail so soon was dubious, at this point Anthony Fauci himself has concluded that Trump is no longer contagious.
How could an elderly man who mocks the very idea of exercise handle COVID so well? On the one hand, from the get-go of his illness, Trump had extensive, excellent medical care. Unlike pretty much everyone else, he lives in a dwelling with its own medical unit and has a personal suite at a local hospital. Any of the smaller stresses of having COVID-19—from access to prepared meals to what symptoms warrant checking in with a doctor—are nonexistent for a president. Some of the bigger ones are taken care of, too: Trump didn’t have to worry about what his insurance plan was going to cover, or if, should he need it, he’d have access to a ventilator. On the other hand, after Trump’s physician detailed the slew of meds he was on, many experts observed that Trump’s unprecedented aggressive treatment might not be driven primarily by science, but by his status—what’s known as VIP syndrome. Piling drugs on drugs—even promising ones—isn’t more effective or healthy, unless those drugs have been tested and shown to be effective and safe together. “He’s a presidential guinea pig,” physician Esther Choo told me in an interview.
But the upshot seems to be that Trump made it through just fine. Is that in spite of the intense medical treatment he received, or because of it? The bizarre thing is that we still don’t really know what causes a person, any person, to survive the coronavirus. At the end of last week, the World Health Organization posted a draft of the results of a huge trial on COVID-19 treatments to a preprint server. The trial included remdesivir, the one drug the Food and Drug Administration has approved for use in COVID-19 patients (on an emergency basis), and one of the drugs Trump took. None of the drugs in the WHO trial reduced mortality or time spent at the hospital, the study found. This doesn’t mean that remdesivir is useless; experts disagree on how definitive the WHO trial is, in part because other data, published in the New England Journal of Medicine (and sponsored by the drug’s maker) suggest that it does shorten recovery time. The WHO trial doesn’t specify when patients were given the drug, so it’s possible that some were simply too sick to benefit from it.
There’s some evidence that the other stuff that Trump took could have helped him, depending on the nature of his illness. Steroids have been shown to reduce mortality in severely ill patients by keeping the immune system from flying off the rails. But these are hardly a guarantee: In a meta-analysis of almost 2,000 patients published in JAMA, a third who received steroids still died, compared with 40 percent of those who received steroids and survived. Regeneron’s antibody cocktail, which Trump also received, has shown promising results … according to presentation slides from a smallish company-sponsored trial. That evidence was sparse enough that one doctor deemed dispensing it to Trump “bad science, bad medicine, and bad ethics.”
What all this means is that, while there are more tools on hand for doctors to try with patients than there were at the beginning of the pandemic, we are still witnessing an ongoing science experiment in which researchers try to figure out what really does and does not give people a better shot at getting well when they are sick with COVID-19. There is certainly no drug that guarantees recovery. It’s possible that in the coming months, and years, as the truth comes out about Trump’s week with COVID, and research tells us more about the drugs he received, we’ll come to understand that the steroid, or the antibody cocktail, or the choice to pile them all together is likely what helped him. But even in high-risk groups, many people get only mildly sick with COVID-19. To spread successfully, a virus actually needs to not kill everyone it infects. No matter where the facts end up, it seems that Donald Trump survived COVID-19 for the same reason that anyone ultimately does in 2020: He got lucky.