Infection Control Problems Persist in Nursing Homes During COVID


The new analysis draws on self-reported data from nursing homes collected by the federal government over four weeks from late August to late September. While some states fared much worse than others, all 50 states and the District of Columbia had one or more nursing homes that reported inadequate PPE supply, staff shortages, staff infections and resident cases. Forty-seven states reported at least one COVID-19 death among residents.

The analysis found that more than 28,000 residents tested positive for COVID-19 during the four-week reporting period, and more than 5,200 residents died, showing that the virus is still raging in nursing homes. More than 84,000 long-term care residents and staff have died since January, and more than 500,000 residents and staff have contracted the disease, according to the Kaiser Family Foundation’s tally, accounting for roughly 40 percent of the national death toll. Long-term care providers include assisted living, adult day care centers and more, while AARP’s new analysis features just nursing home data.

“This is a nationwide crisis, and no state is doing a good job,” says Bill Sweeney, AARP’s senior vice president of government affairs, adding that the results of AARP’s analysis are “profoundly disappointing.”

“While the pandemic has been unexpected to all of us, basic infection control should have been going on in nursing homes for a long time,” he says. “These are places where people are vulnerable to infection, whether it’s COVID or something else, so for these facilities to still not have basic PPE, even now, with a deadly virus in the air, is outrageous and unacceptable.”

Staff infections nearly match resident infections

For months, providing adequate PPE and developing plans to mitigate staffing shortages have been “core principles” set out by the Centers for Disease Control and Prevention (CDC), for COVID-19 infection control in nursing homes, which generally house older adults with underlying conditions who are at increased risk of infection and severe illness from the disease. PPE stops the transfer of infectious droplets through the air, while adequate staffing ratios mean better care and less person-to-person contact.

Yet in 18 states, more than 30 percent of all nursing homes reported PPE shortages, and in 26 states and the District of Columbia, more than 30 percent of nursing homes are experiencing staff shortages. N95 respirators were the most in-demand PPE item across the country, with 11 percent of all nursing homes reporting shortages. And nursing home aides (certified nursing assistants, nurse aides, medication aides and medication technicians) were the most in-demand staff, with 27 percent of all nursing homes reporting shortages.


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25-year-old had life-threatening heart infection

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Marian University’s Ramya Yeleti was sick with COVID-19 in April. The virus infected her heart, requiring open-heart surgery a month later.

Indianapolis Star

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The last thing that Ramya Yeleti remembers thinking before she passed out in the emergency room that August day was that she might never wake up again.

The 25-year-old medical student knew something was very wrong with her heart, a suspicion the doctors’ reaction confirmed. Once they took her vitals, they ordered an EKG, whisked her back to a trauma room, and placed shock pads on her chest. They also gave her some medicine to try to bring her heart back into a normal rhythm.

“The doctors were obviously freaking out. Something is really, really wrong,” Yeleti recalled thinking. “Then I passed out. I remember just thinking I hope my family will be OK. … I did think I might die.”

Ramya Yeleti of Carmel looks toward her surgery scar. (Photo: Grace Hollars/IndyStar)

Six days later Yeleti woke up in IU Health Methodist Hospital and slowly started to learn what she had been through over the past week: days on a heart-lung life support machine, having her name added to the heart transplant list, open heart surgery, and a recovery that doctors found nothing short of miraculous.

And, her doctors believe, the whole saga started months earlier when the Carmel resident fell ill with the coronavirus.

Doctors will never know exactly what role, if any, the coronavirus played in Yeleti’s near-death experience. However, they suspect that the virus weakened her immune system, setting her up for disaster when another virus struck some months later and leading to a heart condition known as myocarditis that can be life-threatening.

“This is a very rare event, but it is happening,” said Dr. Cole Beeler, medical director of infection prevention at Indiana University Health University Hospital, who did not treat Yeleti himself. ”We see this with other viral infections, too, where the initial viral infection sets off an issue with the immune system that leads to an attack of various organs. … With COVID, we’re still learning a lot about it. It may be that we even discover a broader set of immune processes and diseases that develop after the infection.”

Is she infected now with the coronavirus?

Some viruses like Coxsackie or influenza in very rare cases have been known to cause damage to the heart similar to what Yeleti sustained. Now, the SARS-Co-V-2 virus also has been shown to cause myocarditis in young adults.

In Yeleti’s case, doctors do not know whether Yeleti was actively infected with the coronavirus. Signals were mixed. During her hospital stay, she tested positive for the coronavirus as well as a different virus. But she also had antibodies to the coronavirus, suggesting she had been infected in the past. The positive coronavirus result may have been a red herring, detecting dead strands of the virus in her system rather than an active infection, doctors say.

Still, just to be sure,

Soaring virus infection puts more French cities on alert

PARIS (AP) — Two more French cities on Sunday joined Paris and Marseille and four others in maximum alert status to fight back the coronavirus, surgical strikes with strict new measures to stop the spread of infections.

The prefecture of Montpellier, in the south, announced a maximum alert status for the city and surrounding towns starting Tuesday. Measures include the closing of cafes and bars. The southwest city of Toulouse was doing likewise after a day of meetings between mayors of surrounding towns and the prefect, the local state authority, the Toulouse newspaper La Depeche reported.

Soaring infections and increased hospitalizations put four other cities on the maximum alert list on Saturday: Lyon, Grenoble and Saint-Etienne in the southeast and Lille in the north.

National health authorities reported on Saturday nearly 26,900 new daily infections in 24 hours. The count dropped to 16,100 on Sunday, but the rate of positive tests climbed to 11.5%. There were nearly 5,100 new hospitalizations over the past week, with 910 people in ICUs. As of Sunday, there were 32,730 COVID-19 deaths, but the actual number is likely higher due to deaths at home and incomplete reporting from hospitals or rest homes.

While France girded itself for a climb in critical numbers, a consultation by the National Order of Nurses published Sunday suggested that a significant number of respondents feel tired and fed up, with 37% saying the coronavirus pandemic is making them want to change jobs.


Nearly 59,400 nurses responded to the Oct. 2-7 internal survey on the impact of the health crisis on their working conditions, out of 350,000 in the Order of Nurses. A spokesman for the order, Adrien de Casabianca, described the survey as a “consultation” without the classic methodology of a poll.

The numbers suggested that French medical facilities may not be keeping pace with the growing need, despite lessons from the height of the virus crisis last spring.

The National Order of Nurses notes that 34,000 nurses’ jobs in France are currently vacant.

Nurses and other health professionals in France and elsewhere have sporadically demonstrated for higher salaries, better working conditions and more personnel. They were given small salary hikes in France starting this fall.

“Today, nurses must deal with a growth in COVID-19 cases and feel unarmed to do so,” the president of the National Order of Nurses, Patrick Chamboredon, said in a statement accompanying the survey.

With nurses “indispensable” to the functioning of the health system, “we cannot accept that,” he said.

The head of the infectious diseases unit at Paris’ Bichat Hospital, a major COVID-19 treatment center, Yazdan Yazdanpaneh, questioned whether so many nurses really want to change jobs because “despite it all, these are people who adore their work.”

“They are tired … it’s stress, it’s tension, it’s lots of work,” he said on BFMTV. “Truly, we must take care of them.”

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Follow AP coverage of the virus outbreak at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

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This story has been corrected to show the National Order

The Health 202: Trump returns to White House as CDC says infection possible with social distance

The CDC officially said the virus can spread through aerosols — underscoring how easily it can be transmitted. 

A CDC Web page now acknowledges sometimes people can still get infected with the virus — even when they’re at least six feet apart.

“There is evidence that under certain conditions, people with COVID-19 seem to have infected others who were more than six feet away,” the updated page states. “These transmissions occurred within enclosed spaces that had inadequate ventilation. Sometimes the infected person was breathing heavily, for example while singing or exercising.

“Under these circumstances,” it says, “scientists believe that the amount of infectious smaller droplet and particles produced by the people with COVID-19 became concentrated enough to spread the virus to other people. The people who were infected were in the same space during the same time or shortly after the person with COVID-19 had left.” 

The latest guidance underscores the risks as Trump returns home – and residence staff tends to two active coronavirus patients. 

Around 6:30 p.m., the president appeared at the doors of the Walter Reed National Military Medical Center after a three-night stay to be treated for his own case of covid-19, clad in a suit and mask as he waved and gave a thumbs-up signal. Shortly after arriving at the White House, Trump tweeted a short video depicting himself exiting the helicopter and climbing up the stairs to pose for pictures. 

A few hours earlier, the president told Americans “dont be afraid” of covid-19:

“Trump’s comments… again downplaying the coronavirus came despite evidence that White House decisions to flout public health guidelines and engage in practices viewed as reckless have had dire consequences in the West Wing,” The Post’s Toluse Olorunnipa and Josh Dawsey write.

More than a dozen White House officials have tested positive in recent days. Trump’s doctor Sean Conley, who said Trump was “not out of the woods yet” said the medical team made “some recommendations for how to keep everything safe down at the White House.” 

“Conley declined to describe what specific steps would be made to ensure a safe environment at a building that doubles as a personal residence and a government office while the president remains contagious, which could be for several more days at least,” Toluse and Josh write. 

White House staff have abandoned the West Wing, but some are already infected.

Press secretary Kayleigh McEnany and two of her deputies reported testing positive for the virus yesterday, prompting a flurry of criticism for briefly removing her mask Sunday while briefing the press. McEnany wrote that she wasn’t in contact long enough with anyone to be considered a “close contact” by the White House Medical Unit. 

CBS News correspondent Weijia Jiang:

Other prominent figures who tested positive include former Trump counselor Kellyanne Conway and Sens. Thom Tillis (R-N.C.) and Mike Lee (R-Utah), all of whom attended a Rose Garden ceremony announcing the nomination of Amy Coney Barrett to the Supreme Court 10 days ago.

Trump takes a brief car ride, ignoring own COVID infection

BETHESDA, Md. (AP) — Infected and contagious, President Donald Trump briefly ventured out in a motorcade on Sunday to salute cheering supporters, a move that disregarded precautions meant to contain the deadly virus that has forced his hospitalization and killed more than 209,000 Americans.

Hours earlier, Trump’s medical team reported that his blood oxygen level dropped suddenly twice in recent days and that they gave him a steroid typically only recommended for the very sick. Still, the doctors said Trump’s health is improving and that he could be discharged as early as Monday.

With one month until Election Day, Trump was eager to project strength despite his illness. The still-infectious president surprised supporters who had gathered outside Walter Reed National Military Medical Center, driving by in a black SUV with the windows rolled up. Secret Service agents inside the vehicle could be seen in masks and other protective gear.

The move capped a weekend of contradictions that fueled confusion about Trump’s health, which has imperiled the leadership of the U.S. government and upended the final stages of the presidential campaign. While Trump’s physician offered a rosy prognosis on his condition, his briefings lacked basic information, including the findings of lung scans, or were quickly muddled by more serious assessments of the president’s health by other officials.

In a short video released by the White House on Sunday, Trump insisted he understood the gravity of the moment. But his actions moments later, by leaving the hospital and sitting inside the SUV with others, suggested otherwise.

“This is insanity,” Dr. James P. Phillips, an attending physician at Walter Reed who is a critic of Trump and his handling of the pandemic. “Every single person in the vehicle during that completely unnecessary presidential ‘drive-by’ just now has to be quarantined for 14 days. They might get sick. They may die.”


“For political theater,” the doctor added. “Commanded by Trump to put their lives at risk for theater.”

White House spokesman Judd Deere said Trump’s trip outside the hospital “was cleared by the medical team as safe to do.” He added that precautions were taken, including using personal protective equipment, to protect Trump as well as White House officials and Secret Service agents.

Joe Biden’s campaign, meanwhile, said the Democratic presidential nominee again tested negative for coronavirus Sunday. The results come five days after Biden spent more than 90 minutes on the debate stage with Trump. Biden, who has taken a far more cautious approach to in-person events, had two negative tests on Friday.

For his part, Trump still faces questions about his health.

His doctors sidestepped questions on Sunday about exactly when Trump’s blood oxygen dropped — an episode they neglected to mention in multiple statements the day before — or whether lung scans showed any damage.

It was the second straight day of obfuscation from a White House already suffering from a credibility crisis. And it raised more doubts about whether the doctors treating the president were sharing accurate, timely information with

What We Do & Don’t Know Right Now About Donald Trump’s Condition After COVID-19 Infection

Win McNamee/Getty Images Donald Trump at Tuesday’s debate

President Donald Trump announced early Friday morning that he and First Lady Melania Trump have tested positive for COVID-19.

Trump, 74, has long sought to downplay the novel coronavirus in the last seven months, contending at times that the highly contagious respiratory illness is a political “hoax” and just last week saying that it “affects virtually nobody.”

Including the president, the novel coronavirus has infected more than 7.3 million people in the U.S. and has killed at least 207,699, according to a New York Times tracker.

“Tonight, @FLOTUS and I tested positive for COVID-19,” Trump tweeted. “We will begin our quarantine and recovery process immediately. We will get through this TOGETHER!”

White House doctor Sean Conley went on to clarify over the weekend that Trump was first diagnosed Thursday evening.

Here’s everything we know so far. This story will be updated.

Joshua Roberts/Getty Images Donald Trump

What Symptoms Has Trump Shown?

Although White House doctor Sean Conley initially said on Friday that the first couple planned on remaining at home as they recovered from COVID-19, later that day Trump was admitted to the Walter Reed National Military Medical Center out of an “abundance of caution.”

“President Trump remains in good spirts, has mild symptoms, and has been working throughout the day,” White House Press Secretary Kayleigh McEnany said Friday afternoon.

Conley offered more details about the president’s symptoms the following day.

During a Saturday press conference, he said Trump had been fever-free for 24 hours and that his other symptoms, which included fatigue “are now resolving and improving.” Conley also noted that the president was not currently receiving oxygen, although he evaded specific questions about Trump’s fever or whether he had ever received supplemental oxygen.

However, a source familiar with the president’s health offered conflicting information. “The president’s vitals over the last 24 hours were very concerning and the next 48 hours will be critical in terms of his care,” the source said, according to a White House pool report. “We’re still not on a clear path to recovery.”

Trump was last seen by reporters on Friday as he departed the White House for Walter Reed hospital and was seen wearing a mask and giving reporters a thumbs-up sign.

What Led to Trump’s Positive Test?

MANDEL NGAN/AFP via Getty President Donald Trump

Trump’s positive result came after the news one of his top aides, Hope Hicks, had tested positive for the virus on Wednesday.

Hicks, a former 31-year-old public relations consultant, had reportedly been in the small group of confidants helping the president prepare for Tuesday’s debate. She also traveled with Trump on Air Force One to-and-from Minnesota on Wednesday evening for a campaign rally.

Several thousands showed up to the president’s outdoor rally, while pool reporters traveling with Trump noted “most” in the crowd did not wear masks. The president also met with local state lawmakers during private fundraising events in the state.

“It’s very, very hard when you

Trump given Remdesivir as treatment for COVID-19 infection

President Trump was given a dose of Remdesivir at Walter Reed National Military Medical Center on Friday as White House doctors recommended the antiviral drug to treat his COVID-19 infection.



a man wearing a suit and tie: Trump given Remdesivir as treatment for COVID-19 infection


© Getty Images
Trump given Remdesivir as treatment for COVID-19 infection

White House physician Sean Conley said in a memo released by the press office that Trump did not require supplemental oxygen as of late Friday, but that doctors opted to initiate Remdesivir therapy.

“This afternoon, in consultation with specialists from Walter Reed and Johns Hopkins University, I recommended movement of the President up to Walter Reed National Military Medical Center for further monitoring,” Conley wrote. “This evening I am happy to report that the President is doing very well. He is not requiring any supplemental oxygen, but in consultation with specialists we have elected to initiate Remdesivir therapy. He has completed his first dose and is resting comfortably.”

The use of Remdesivir means Trump is now on multiple therapeutics to treat his infection. Conley said earlier in the day that the president was given an experimental antibody injection developed by Regeneron. He is also taking zinc, vitamin D, famotidine, melatonin and aspirin.

Video: What we know about President Trump’s treatment for COVID-19 so far (CBS News)

What we know about President Trump’s treatment for COVID-19 so far

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The Trump administration issued an emergency use authorization for Remdesivir earlier this year after the drug showed moderate effectiveness in improving outcomes for patients who were hospitalized with the coronavirus. Hospitalized patients with advanced COVID-19 who received the drug recovered in 11 days compared to 15 days for patients on a placebo.

Trump was taken to Walter Reed earlier Friday evening, less than 24 hours after he shared that he and first lady Melania Trump had tested positive for COVID-19. Aides said he was experiencing mild symptoms, including fatigue, and that he is expected to spend at least a few days at the military hospital. Trump is also said to have had a slight fever.

“Going well, I think! Thank you to all. LOVE!!!” Trump tweeted on Friday night.

Trump, who is 74 and overweight, falls into a high-risk category for the coronavirus, which has been particularly lethal for seniors and people with co-morbidities.

The president tested positive for the virus after one of his top aides, Hope Hicks, did so Thursday. Since then, several others close to the president have tested positive, including several people who attended a Rose Garden event last Saturday. Among them are Sens. Mike Lee (R-Utah) and Thom Tillis (R-N.C.), and former White House counselor Kellyanne Conway.

Updated: 11:59 p.m.

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Charting a Coronavirus Infection – The New York Times

After months of downplaying the threat of the Covid-19 pandemic, President Trump announced early Friday morning that he and First Lady Melania Trump had tested positive for the coronavirus. He is now hospitalized at the Walter Reed National Military Medical Center, with what people close to him said on Friday were mild symptoms, including a fever, cough and congestion.

It’s too soon to tell whether his illness will follow a typical course, or how severe his symptoms may become. And with millions of people sickened worldwide, no single timeline can encompass the range of Covid cases. But months of data have helped scientists home in on the general portrait of a symptomatic coronavirus case.

Exposure and incubation

The time between initial exposure to the virus and the appearance of symptoms is known as the incubation period. This period is typically four to five days, although it can last up to 14 days, or perhaps even longer in rare cases.







It remains unclear who infected Mr. Trump, although there are many potential candidates, several of whom gathered with the president during events last weekend and have traveled with him to crowded campaign rallies.

Symptoms and recovery

Most people who come down with Covid recover within a couple weeks and do not require hospitalization. Mr. Trump has reportedly experienced only mild symptoms so far.

Severe cases, however, may take far longer to resolve. And a growing cohort of coronavirus survivors, called long-haulers, has reported symptoms and side effects — including fatigue, impaired memory and heart problems — that can linger for months.







People who develop severe cases of Covid tend to be hospitalized within two weeks or so of the emergence of symptoms. But many of the factors that catapult certain people toward severe forms of the disease remain a scientific mystery. Scientists know that people who are male, older and obese — all descriptors of President Trump — are at higher risk for more serious effects of Covid.

Viral load

After an initial exposure, the number of virus particles in a person’s body, or viral load, takes time to build up as the pathogen infiltrates cells and copies itself repeatedly. Mathematical models indicate that the viral load tends to peak before symptoms appear, if they appear at all, and starts to decline rather quickly in the days following the first signs of illness.







Experts have said that people are more likely to be contagious when their viral loads are high. If so, the window of peak infectiousness might be only a few days long, beginning a day or two before symptoms appear, and closing within a week thereafter.







This also means that people can be highly contagious during the so-called presymptomatic stage, in the days before they develop symptoms. Separately, asymptomatic carriers of the coronavirus have also been repeatedly pinpointed as the source of transmission events, although how the virus behaves in the bodies of such people is less understood.

If Mr. Trump’s symptoms appeared on Wednesday or Thursday,

Trump’s infection is part of an ominous national trend as cases rise in most states

New Jersey and Delaware have experienced rising numbers, as has Texas, which just recently endured a midsummer surge. Wisconsin, a critical swing state in the presidential election, has been hammered. It had logged record highs in case counts for 20 straight days as of Thursday, and recorded more than 17,000 new confirmed infections in a single week.

Among the latest data points in the early-autumn surge: President Trump’s coronavirus diagnosis Friday, which instantly rocked the presidential campaign, became the biggest news story on the planet and provided a reminder, if any were needed, that this pandemic shows no signs of diminishing.

Covid-19, the disease caused by the novel coronavirus, has killed at least 207,000 people in the United States and is continuing to spread easily through many regions of the country. Infectious-disease experts had hoped transmission could be driven to low levels before cold weather arrived. That hasn’t happened, and Trump and first lady Melania Trump on Friday became part of ominous daily case counts that alarm the nation’s top doctors.

“I’m concerned we are going into the fall and ultimately the winter season, when the weather changes, [and] we are stuck at this baseline of 40,000 new infections every day,” Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an interview before Friday’s news about the president’s infection.

On Thursday, Wisconsin Gov. Tony Evers (D) delivered a radio address pleading with residents to do anything and everything to slow the startling rate of infections in the state.

“Folks, if we are going to get this virus under control, then wearing a mask is the absolute least we need you to do,” said Evers, whose own statewide mask mandate is facing a legal challenge and attacks from Republicans. “We have got to put the brakes on this pandemic to keep our friends, family, employees and co-workers, and neighbors safe.”

Places west of the Mississippi River are also struggling. Montana has set highs in case counts for 16 straight days. Kansas, Nebraska and Utah are reporting spikes in infections. And although deaths and hospitalizations have dropped in recent weeks in populous states such as California and Florida, that progress has been offset by increased transmission elsewhere.

Colder weather historically gives a boost to respiratory viruses. People spend more time indoors. Dry indoor air helps viruses remain viable and dries out nasal passages, potentially facilitating infections. People who are exposed to less sunlight can experience lowered immune responses. The coronavirus is different from the seasonal flu, but like the flu, it may show some seasonal variation.

Fauci and other infectious-disease experts say a cold-weather surge is not inevitable. They urge people to adhere to simple public health guidelines that are effective in limiting transmission — wearing a mask, maintaining physical distance, avoiding crowds, interacting with people outside rather than inside if possible, and frequent hand-washing.

But many Americans continue to not take the pandemic seriously, or to miscalculate the risk factors. “We’re starting to see

Trump at risk for serious COVID-19 infection but also has advantages

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President Donald Trump and first lady Melania Trump have tested positive for COVID-19 and “will begin our quarantine and recovery process immediately.”

USA TODAY

Just how serious can COVID-19 be for someone of President Trump’s age and condition?

Everyone reacts differently to the coronavirus that causes COVID-19, from no symptoms at all to life-threatening illness.

“What we’ve learned for sure is that the spectrum of illness from COVID-19 is tremendous,” said Dr. David Banach, an infectious diseases physician at UConn Health and hospital epidemiologist at the UConn John Dempsey Hospital.

President Trump has several risk factors that put him on the more worrisome end of the spectrum, but others that counterbalance the risk.

His age, weight and gender all add to his vulnerability.

Trump turned 74 in June, putting him at five-times higher risk of hospitalization and 90-times higher risk of death than someone in their 20s, according to data from the U.S. Centers for Disease Control and Prevention. Just a year older, and he’d be at eight-times higher risk of hospitalization and 220-times higher risk of death.

The President’s weight-to-height ratio bumps him just over the boundaries of what’s considered obese, putting him at three-times higher risk of a serious infection compared to someone at a healthier weight, according to the CDC.

Being male also puts Trump at higher risk. Just over 54% of Americans who have died of COVID-19 have been male, while 46% have been female; in Trump’s age group, 61% of the deaths have been among men.

The First Lady, who also tested positive for COVID-19, has none of these added risks, and so is likely to have a mild case of the disease.

President Donald Trump and first lady Melania Trump have tested positive for COVID-19 and “will begin our quarantine and recovery process immediately.” (Photo: Getty)

The President also has a number of strengths to counteract his risks.

First, he’s healthy and very active.

He keeps a busy schedule for someone of his age, and his health does not appear to interfere with the activities of his daily life. Risk of serious COVID-19 illness is known to increase as medical conditions mount, with the highest risk among those who have three or more comorbidities, such as asthma, obesity, diabetes, chronic kidney disease, severe obesity, coronary artery disease, history of stroke, and a lung condition called chronic obstructive pulmonary disease or COPD.

Trump also has access to the best possible medical care, potentially including some therapies that could reduce his risk of having a bad case of COVID-19.

Although no therapies have yet been approved, there are several under development that can be given after exposure to the virus and are likely to be safe and limit symptoms. It’s not clear whether Trump has received or will receive any of these.

Monoclonal antibodies, for instance, are proteins that help the immune system fight off a specific invader, and can be used to prevent, protect or treat many diseases. Several companies have been developing monoclonal