How sick is the president? Trump latest commander-in-chief to downplay medical troubles

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American presidents have a long history of downplaying, or even hiding, the severity of their illnesses. But presidential historians say President Donald Trump’s handling of his COVID-19 infection has become downright dangerous because he’s providing misleading information during a deadly pandemic and is not being transparent about his health as Americans are already deciding whether to reelect him.

The White House has been unclear on the timeline leading to Trump’s COVID-19 diagnosis, and officials have given mixed stories about his treatment. Aidesin recent days have portrayed an image of business as usual despite lingering uncertainty over the severity of his case even after Trump left the hospital Monday to return to the White House. 

“We vote for and support people we trust,” said Peter Loge, an associate professor of media and public affairs at George Washington Universityin Washington, D.C. “If we can’t get a straight answer out of the White House about how sick the president is, we just lose credibility and it makes it hard to trust them.”

Scholars who have studied the presidency say the optimism coming from the White House is not unprecedented.

President Donald Trump returns to the White House Monday, Oct. 5, 2020, in Washington, after leaving Walter Reed National Military Medical Center, in Bethesda, Md. Trump announced he tested positive for COVID-19 on Oct. 2.

“As a rule of thumb, in any presidential health crisis, you are going to get a much more optimistic report than generally is warranted,” said Ross K. Baker, professor of political science at Rutgers University in New Jersey.

As he left Walter Reed National Military Medical Center Monday night, Trump wore a mask and gave several thumbs up and celebratory fist shakes for the cameras gathered outside the building.

The president suffered in recent days a high fever and low blood oxygen levels. He received a steroid, antiviral medication, an experimental antibody cocktail and supplemental oxygen while under care. Trump’s weight and age increase the risk of severe illness from COVID-19, according to the Centers for Disease Control and Prevention. 

President Trump waves from the back of a car in a motorcade outside of Walter Reed Medical Center in Bethesda, Maryland on October 4, 2020.

News of the coronavirus infiltrating the administration did not come from the White House — it was revealed by a Bloomberg News reporter who confirmed Thursday that presidential advisor Hope Hicks had tested positive.  Trump, first lady Melania Trump, three Republican senators, press secretary Kayleigh McEnany and others close to the Trump administration were later revealed to also have COVID-19.

After Trump was flown last week to Walter Reed, his doctors gave conflicting accounts of his health. Dr. Sean Conley, the president’s physician, was evasive when he was initially asked Saturday whether the president was receiving oxygen, later saying he was “not necessarily” intending to mislead the public but trying to paint an “optimistic” picture instead. White House chief of staff Mark Meadows muddied the assessment even further when he followed Conley’s upbeat press conference by telling reporters he was “very concerned” about the president’s condition. 

The White House later released photos of Trump “hard at work” in the hospital where he appeared to sign a blank piece of paper while sitting at a boardroom table and dressed in business jacket.

On Sunday, Trump ventured outside Walter Reed Medical Center, where he has been under treatment, to wave at supporters from an SUV. Doctors and critics called the move “reckless” and accused him of endangering the Secret Service members riding in the vehicle with him.

A day later, hours before leaving Walter Reed, the president said he was feeling better. “Don’t let it dominate your life,” he wrote on Twitter about COVID-19. “We have developed, under the Trump Administration, some really great drugs & knowledge. I feel better than I did 20 years ago!”

All this comes after seven months of Trump downplaying the virus and telling Americans COVID-19 was no worse than the flu and that it would disappear “like a miracle.” 

President Donald Trump says he's "starting to feel good" as he fights COVID-19.

Trump is hardly the first president to project an image of good health and resilience.

President John F. Kennedy tried to portray an image of vigorous health despite debilitating back pain and suffering from Addison’s disease, a disorder that leads to constant pain-relieving injections, Baker said.

President James Garfield was shot in the back in 1881 by a lawyer at a railway station in Washington, D.C. Doctors were unable to remove the bullet. After two months of suffering through various medical procedures, he was taken to a cottage in Long Branch, New Jersey. He was clearly dying, Baker said. Yet physicians kept sending out messages saying he was fine.

Nobody wants to be the bearer of bad tidings when it comes to the president’s health. For Trump, this is further complicated by the fact that the president is the commander-in-chief and his doctors at Walter Reed answer to him.

“This is politicized medicine,” Baker said. “Medical reports are issued for the political purpose of convincing people the president is in better shape than the actual medical condition would allow.”

The positive spin can become a coverup in some cases.

Supporters of President Donald Trump look on as he departs from Walter Reed National Military Medical Center aboard Marine One on Oct 5, 2020.

President Woodrow Wilson traversed the country in September 1919, exhausting himself as he tried to build support for a coalition of nations following World War I. He collapsed after a speech in Pueblo, Colorado, on September 25, and suffered a severe stroke the next month that left him partially paralyzed on the left side.

But the stroke was not made public while Wilson remained in office. Neither was a urinary infection that “nearly killed him,” according to John Milton Cooper, professor emeritus at the University of Wisconsin-Madison who wrote “Woodrow Wilson: A Biography.”

Wilson’s wife, Edith Wilson, hid the extent of Wilson’s condition and practically took over the role of president for the final 17 months of his presidency. Cooper said the first lady screened all incoming requests and correspondence, and while she consulted with Wilson on major decisions, she often made the decision herself by “reading his mind” and taking actions that she felt he would have supported.

“It was a terrible coverup,” Cooper said.

people positive around trump

Two decades later, in 1944, a similar scene played out when President Franklin Delano Roosevelt was diagnosed with “acute congestive heart failure” that forced him into seclusion for months. In that case, historians say a bit of subterfuge was understandable given that the country was in the midst of World War II and the U.S. military was in the final stages of preparing for the D-Day invasion that opened the second front in the war.

“I can understand why the White House didn’t want to tell Adolf Hitler and the world whether the president was ill,” said Timothy Naftali, a presidential historian at New York University.

But a presidential election was also on the calendar that year, meaning FDR withheld critical information about his health condition to voters. After winning that election, FDR died three months into his fourth and final term.

“We were electing a dying man,” Cooper said.

President Franklin Delano Roosevelt (left) and his wife, Eleanor Roosevelt, hid the severity of his heart condition from the U.S. public before his reelection in 1944. He died less than three months into that term.

Sometimes, Americans have been left completely in the darkabout their leaders’ health.

President Grover Cleveland, in his second term in the summer of 1893, was secretly taken to a friend’s yacht to have a cancerous tumor removed from the roof of his mouth. The public wouldn’t learn the truth until nine years after Cleveland died in 1917.

Naftali, the New York University historian, worries that Trump is wasting what could be a “teachable moment” for the American people.

To date, COVID-19, the highly infectious respiratory disease caused by the new coronavirus, has infected more than 7.5 million people in the U.S. and killed more than 210,000. Yet Trump hasrepeatedly mocked his rival, Vice President Joe Biden, for wearing a mask, and has downplayed the severity of the virus. 

Historians say such actions run contrary to the role of the president, who should be using his position to promote preventive health measures, especially during a global pandemic.

Naftali pointed to President Ronald Regan, who was diagnosed with colon cancer while in office, and first lady Nancy Reagan, who was diagnosed with breast cancer. In each case, they shared their diagnosis and the procedures that they underwent. That helped educate the public about those diseases, Naftali said, leading to more women getting mammograms and more adults getting their colons checked.

While Trump has tried to remain in the public eye since his COVID-19 diagnosis, Naftali said his actions over the weekend have undermined his ability to use his experience as an instructive example. Naftali questioned Trump’s decisions to retweet a video showing unmasked supporters lined up outside Walter Reed Medical Center. He questioned Trump’s decision to expose Secret Service agents to the virus during his ride in an SUV to greet those supporters. And he questioned the president’s tweet on Monday about leaving Walter Reed, where the president also declared: “Don’t be afraid of Covid.”

“The tweet was the worst messaging on public health ever,” Naftali said. “The president has an opportunity to lead the discussion toward a better public health approach. That might’ve been an opportunity to tell his supporters, ‘I want you to stay safe, wear a mask.’ But he didn’t.”

From a marketing perspective, presidents are “all about protecting their brand,” said Randy Sparks, professor of marketing at the University of Dayton School of Business Administrationin Ohio. 

“The Trump campaign is doing exactly what it should be doing to protect their brand,” said Sparks, who has studied campaign rhetoric and its effects on persuasion.

Sparks said people will have different “ethical lines” on how much should be revealed about a president’s health. 

For instance, some presidential advisers may feel it’s in the interest of national security to not reveal the whole story about a president’s health. Anti-American countries or terrorist groups could view a presidential illness or incapacitation as a moment to strike. 

On the other hand, there is the argument that Americans have a right to the truth about a president’s medical condition, especially as many Americans prepare to vote this week ahead of the November election, he said. 

“It is a very fine line that you have to walk because there are a whole variety of competing interests,” he said.

William Howell, a political science professor at the University of Chicago, said the United States is polarized with people having deep concerns about the health of democracy. They are divided, distrustful and angry.

 “The lack of clarity associated with his health adds volatility and more uncertainty,” he said. 

Follow the reporters on Twitter @anneryman and @alangomez.

USA TODAY reporters Elinor Aspegren and Savannah Behrmann contributed to this story.

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