What we know—and don’t know—about the president’s coronavirus diagnosis so far

President Donald Trump shared that he and first lady Melania Trump have tested positive for coronavirus on early Friday morning, leading to a slew of questions in the medical community about when, where and how he could have contracted the disease. 

The diagnosis has come as a surprise to some public health experts, given the steps that the White House took to keep the president and his inner circle safe, including regular testing and access to doctors. Press secretary Kayleigh McEnany previously described the president as the “most tested man in America.”

As former U.S. Food and Drug Administration commissioner Dr. Scott Gottlieb noted this morning on CNBC: “They created a bubble around the president and yet he still became vulnerable.” 

So how did it happen? We asked public health experts and doctors for their take on the timeline of when the president could have been exposed, how long he might experience symptoms, and where we go from here. 

At this stage, it’s all speculation. It’s extremely challenging, given the limited data available, to make any hard and fast conclusions. As public health experts explain, it depends on how frequently the president was tested, the type of test he received and the timeline around when he started experiencing symptoms. 

There’s also still some unknowns about the “early time course” of the disease, said Carl Bergstrom, a biologist and professor at the University of Washington. So even once this information becomes clearer, it may still be a challenge to map out exactly when Trump was exposed. 

Of course, there are a few theories that have been thrown out there. 

Chief among them, that the president got exposed during the Supreme Court nominee announcement at the White House on Saturday. According to news reports, Notre Dame President Rev. John Jenkins, who was in attendance, later tested positive for Covid-19. Jenkins apologized earlier this week to the campus community for not wearing a mask or social distancing at the event. Moreover, many of the guests, including top Trump administration officials, were photographed without masks. 

Another potential clue is that Hope Hicks, a close adviser to the president who traveled with him on board Air Force One several times this week, has also tested positive. But Dr. Megan Ranney, an emergency medicine physician and an associate professor at Brown University, doesn’t think it’s likely that there was a transmission chain through Hicks, given that she tested positive just hours before the president. “It makes far more sense, they were exposed to a common vector, but really it’s impossible to know.”

Again, there are no clear answers at this stage, public health experts stress. 

“I suspect the president could have been infected anytime in the past week,” said Dr. Jeremy Faust, an attending physician in the Brigham and Women’s Hospital Department of Emergency Medicine. “This virus is really hard to track.”

The results may be affected by the timing of the test. If the president was tested on the day he was infected, the result would likely come back negative. That’s because there might not be enough viral particles in the nose or saliva. 

Oftentimes, it takes a few days after a person is initially infected — or after they develop symptoms — to get a positive result. Both Trump and the first lady have shared that they’re now experiencing mild symptoms, but it’s unclear when that started. 

“It’s usually about 48 hours, although there are cases where people were exposed to the virus and more quickly converted to a positive,” said Dr. Faust. 

In the 48 hours before he tested positive, and potentially could have been contagious, the president traveled to Ohio, Minnesota and New Jersey, while accompanied by staff that did not wear masks. 

During those events, he may have also been in close contact with supporters who did not wear masks. 

On Wednesday, he travelled to a rally in Minnesota, where Hicks started to first experience symptoms. As the New York Times has reported, Trump fell asleep on Air Force One on his way back, at which point it became clear that something might be up. Several staffers started wearing masks by Thursday. 

Democratic nominee Joe Biden has announced that he’s now tested negative for coronavirus, after standing in close proximity to the president for about two hours at the debates on Tuesday night. 

Still, that doesn’t mean Biden is in the free and clear. 

“If you told me you were at a concert and 12 feet away from someone who later tested positive for several hours, I’d tell you to quarantine,” said Dr. Ranney, the emergency physician. Ranney said Biden will likely be advised by his medical staff to take precautions, particularly if he starts experiencing any symptoms. 

“The guidelines are fairly clear,” said Dr. Faust. “If you have an exposure, you have to quarantine 10 to 14 days, but it’s less clear if after 7 to 10 days of negative testing, if you can call it off.”

What’s not yet known is if Trump could have been infected prior to the debates. The CDC has reported that it’s possible for a person infected with Covid-19 to spread the virus for at least a day or two before experiencing any symptoms.

But Trump has implied that he was tested before the event. Still, Chris Wallace, who moderated the debate, said in an interview with Fox anchor Bill Hemmer that the president arrived too late in Cleveland on Tuesday to get a Covid-19 test. 

“We don’t think it’s likely you can be contagious with a negative test, although it’s always possible that a test was inaccurate,” said Dr. Faust. 

The president tweeted that he and his wife Melania will quarantine as they recover. Thus far, both have shared that their symptoms are mild, although that could change over time. 

On Friday afternoon, White House physician, Dr. Sean Conley, said Trump was “fatigued but in good spirits,” while the first lady had a mild cough and headache.

Trump received a single 8-gram dose of Regeneron’s experimental antibody cocktail as “a precautionary measure,”  Dr. Conley said.

Trump also left the White House for Walter Reed hospital “out of an abundance of caution, and at the recommendation of his physician and medical experts. The White House said the President will be working from the presidential offices at the medical center. 

Conley added that the first family has tested negative for the virus Friday. 

Even if Trump were to test negative in subsequent days, he should still continue to isolate, public health experts note. How long he isolates might depend on the severity of his symptoms. The 74-year-old president has several risk factors that could increase the likelihood that he’ll be hospitalized or experience severe illness, including his age, gender and weight.

The latest public health guidelines suggest that people with mild to moderate Covid-19 symptoms are infectious for up to 10 days after the onset of symptoms. Those with more severe illness or those who are severely immunocompromised can remain infectious for 20 days. 

The CDC recommends those who are able to recover at home, should only stop isolating if: 

• At least 10 days have passed since symptom onset (unless illness is severe)
• At least 24 hours have passed since resolution of fever without the use of fever-reducing medications and
• Other symptoms have improved

“So really we’re looking at a minimum of 10 days,” said Dr. Ranney.