How severe could Trump’s Covid-19 case be? Here are his risk factors — and advantages.

President Trump and first lady Melania Trump tested positive for Covid-19, which has killed more than 207,000 Americans, a month before the election.

This naturally raises many questions about what could possibly happen next in 2020. How will the diagnosis impact the election? Were former Vice President Joe Biden or any others infected at Tuesday’s presidential debate? Is there a larger cluster of cases in the White House?

Of course, there’s also the question of how the 74-year-old president will fare with a Covid-19 infection.

Although Trump has spent months downplaying the danger of the virus for himself and Americans, and frequently refuses to wear a mask, he falls squarely into several higher-risk buckets — being over 70 years old, being male, and having obesity. These factors may raise his odds of severe disease and death from the coronavirus.

On the other hand, Trump has several advantages that may protect him. He caught the virus at a time when even people who are high-risk have a better chance of survival, because doctors are getting better at treating the disease. He also has access to good health care — a benefit many Americans don’t share. And we know that many people who get Covid-19 experience no symptoms or mild disease; it’s possible Trump will be one of them.

While no one can predict how Trump will fare — we don’t have his full health record, and don’t know anything of the genetic mutations he carries that could affect his prognosis — it’s important to understand the known and unknown risks he carries. Let’s walk through them.

Since the start of the pandemic, it’s been clear that one of the biggest risk factors for hospitalization and death from Covid-19 is older age: Study after study has shown that with every passing decade, a person’s chances of dying from the disease increase.

In a late February report from China’s Center for Disease Control and Prevention, researchers looked at the first 72,314 patients with confirmed or suspected Covid-19 and discovered a huge variation in the case fatality rate by age group:

In Italy, a country with one of the world’s oldest populations, a March 4 analysis by the national health institute found that of the 105 patients who died from the virus, the average age was 81. This put a 20-year gap between the average age of people who tested positive for the virus and the deceased, the institute said.

That trend has held up over time. In an August analysis of Covid-19 mortality data, reported in Nature, “For every 1,000 people infected with the coronavirus who are under the age of 50, almost none will die.” That number climbs to nearly five for people in their 50s and early 60s. Then, “For every 1,000 people in their mid-seventies or older who are infected, around 116 will die.”

So far, Trump is experiencing “mild symptoms,” Mark Meadows, the White House chief of staff, said. Earlier in the day, White House physician Sean Conley stated in a memo that “the President and First Lady are both well at this time, and they plan to remain at home within the White House during their convalescence.” If Trump’s condition worsens, his age alone makes him higher risk.

Age doesn’t give the full picture of Trump’s potential prognosis, however. Since the beginning of the pandemic, we’ve seen gender play a pretty consistent role, too. Specifically, men appear to be at a greater risk of complications and death from the coronavirus than women.

According to a recent study looking at more than 61,000 people in Spain, published as a preprint on medrxiv.org (which means it hasn’t yet been peer-reviewed), men faced twice the risk of death from Covid-19 compared to women — and that risk increases with age. For example, the infection fatality risk (or proportion of deaths among all infected individuals) for men age 80 and over is between 12 and 16 percent; for women in that same age group, it’s 5 to 6 percent.

Research from many other — but not all — localities has uncovered the same trend. Sixty percent of the deaths in New York state, as of May 5, were men. An earlier study from China found that men were 2.4 times more likely to die than women, as Vox reported.

It’s not clear why men seem to generally experience more severe disease than women, but some guess biological differences may play a role: Women may mount a stronger and faster immune response, for example. The gender gap may also be explained by non-biological factors. Men are likelier to have health behaviors that put them at greater risk of complications, such as smoking.

According to a June report from Trump’s physician, the president is 6 feet 3 inches tall and weighs 244 pounds. That makes his body mass index 30.5 — which classifies Trump as obese.

BMI is not a perfect health metric; there’s lots of variation in how body weight affects health. But, to date, a higher BMI has been linked to worse Covid-19 outcomes. In an August analysis of data from 399,000 patients around the world, published in the journal Obesity Reviews, researchers found that people with obesity were 113 percent more likely than people of a normal weight to end up in the hospital, 74 percent more likely to be admitted to the ICU, and 48 percent more likely to die.

Like the gender finding, the link between obesity and poor Covid-19 health outcomes is not well understood. Some have theorized that there may be physiological factors at play, including “impaired immunity, chronic inflammation, and blood that’s prone to clot, all of which can worsen COVID-19,” according to a report in Science magazine.

We also know that people with obesity are more likely to have low socioeconomic status and other health problems, such as diabetes, also linked with more intense Covid-19 disease. Maybe they’re more likely to show up at a hospital late and receive inadequate health care due to the well-known weight stigma in health care, as obesity doctor Yoni Freedhoff has pointed out. But for now, we know the risk of complications and death from the coronavirus is heightened in people with a higher BMI.

At the same time, Trump has many advantages that may protect him from severe Covid-19, despite his various risks.

Over time, this pandemic has revealed how unjustly the burden of the virus is distributed throughout society. People who are part of minority groups are at greater risk — not because of any higher genetic susceptibility but because of systemic racism and other socioeconomic factors. As my colleague Dylan Scott reported this week, 1 in 1,000 Black Americans have died in the Covid-19 pandemic. Overall, Black people are 3.5 times more likely to die from Covid-19 than white people.

Lower-income people and those with patchy or no access to health care are also part of groups that experience the worst health outcomes.

Trump is white and wealthy. He has access to top-tier health care. He also won’t lose his job or housing, as many Americans have during the pandemic. So even if he falls into several high-risk categories, his life of privilege may be his best health protection of all.