If Trump has learned anything from getting Covid-19, he’s not showing it

President Donald Trump in the back of a car in a motorcade outside of Walter Reed Medical Center, where he’s getting treatment for Covid-19. | Alex Edelman/AFP via Getty Images

Trump’s drive-by motorcade photo-op is out of the same coronavirus playbook that got America into this mess.

If President Donald Trump has learned anything from getting sick with Covid-19, he’s not showing it.

Since Trump’s diagnosis last Thursday, he and his administration have worked diligently to cover up the president’s disease. They’ve downplayed his symptoms. They’ve suggested he needed to be hospitalized not due to his apparently high fever and low oxygen levels but out of an abundance of caution. They’ve posted videos and photos of the president doing normal things. Even the president’s own doctors have taken to politicized spin, arguing that they were trying to be “upbeat” as they refused to fully and truthfully answer questions about Trump’s health.

On Sunday, it culminated in a photo-op in which Trump was driven outside Walter Reed hospital as he waved at supporters — exposing at least a driver and passenger in Trump’s car to his infection. As James Phillips, attending physician at Walter Reed, tweeted, “That Presidential SUV is not only bulletproof, but hermetically sealed against chemical attack. The risk of COVID19 transmission inside is as high as it gets outside of medical procedures. The irresponsibility is astounding. My thoughts are with the Secret Service forced to play.”

This is all out of the same playbook Trump has used for Covid-19 from day one. It’s an attempt to make everything seem normal, as if the coronavirus isn’t wrecking lives, in a desperate attempt to go back to a better world that could help ensure Trump’s reelection. As Trump told journalist Bob Woodward, “I wanted to always play [the coronavirus] down.”

Trump has stuck to this even as it’s put people in danger again and again, now even after he’s gotten sick himself. He’s called for states to reopen — to “LIBERATE” them — even as experts warned that opening too soon would lead to new cases (and, sure enough, cases spiked over the summer as states opened prematurely). He’s pushed for less testing, arguing more tests pick up more cases and therefore make the US look bad, even as experts said more testing, along with contact tracing, is still needed to slow the outbreak. He’s mocked masks and frequently refused to wear one himself, even as experts and a growing body of research show masks are key to stopping Covid-19.

This obsession with creating a false sense of normalcy seemingly extended to the moment that Trump received a positive coronavirus test. As the Washington Post initially reported, and White House staff confirmed, Trump attended campaign events on Thursday even after he and his staff learned one of Trump’s closest aides, Hope Hicks, was showing symptoms. That continued, based on recent reports, as some staff noticed Trump seemed fatigued and likely sick himself. In doing this, Trump likely exposed his own staff and supporters to Covid-19.

A potential silver lining to Trump getting sick was that maybe this would show him how serious this virus is — that it’s real, that it can make people very ill and kill them. Trump alluded to that in a video on Sunday, claiming, “I learned a lot about Covid. I learned it by really going to school. This is the real school.” Despite that, Trump was back out Sunday for the drive-by photo-op that potentially exposed his staff, at least, to the coronavirus.

This is all ridiculous, of course, because we already know Trump is sick and hospitalized. This is obviously not normal.

And we know the consequences of this act. It’s how the US ended with nearly 210,000 Covid-19 deaths so far — more than any other country in the world. It’s how the US ended up, after accounting for population, at the top 20 percent among developed countries for Covid-19 deaths. (If the US had the same Covid-19 death rate as Canada, more than 125,000 more Americans would likely be alive today.) It’s why America can’t go back to normal, even as countries like Germany, New Zealand, and South Korea open up more, as it faces far too many coronavirus cases — almost 100,000 new cases just since Trump tested positive.

It’s why Trump himself got sick. As he lived his denial, going to ill-advised campaign rallies and events, frequently refusing to wear a mask, Trump exposed himself to the coronavirus again and again.

And it’s all set to continue — as Trump and his staff’s barrage of mistruths and political spin over the weekend proved.

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What we know — and don't know — about Trump's coronavirus treatment

President Donald Trump's coronavirus diagnosis has underscored the unpredictable nature of the disease — and how the oldest elected president in U.S. history, who's just above the CDC threshold for obesity, is still a high-risk patient even with the world class presidential medical care and a battery of drug treatments.

Trump, who arrived at Walter Reed National Military Medical Center on Friday evening and has received two experimental drugs, has access to all the leading treatments, rapid testing and the government's top medical specialists.

Trump was "fever free" and in high spirits on Saturday morning, said White House physician Sean Conley in a Saturday morning press conference that ultimately raised new questions about Trump's condition and the timing of his diagnosis.

Though Conley said Trump is not currently receiving supplemental oxygen, he didn't directly answer whether Trump has been on oxygen since his diagnosis. Multiple news reports afterwards indicated Trump received oxygen Friday morning before being admitted to Walter Reed. Conley also didn't answer a question about whether Trump received steroids, which have been used in more severe Covid-19 cases.

Conley's comments on when Trump was diagnosed immediately threw into question when Trump knew he was infected. He said Trump was "72 hours" into his diagnosis, which suggested Trump received a positive coronavirus well over a day before he publicly disclosed it early Friday morning. But almost two hours after the press conference, Conley in a new memo said he had misspoke, and that Trump was diagnosed Thursday night.

It was previously disclosed that Trump received 8 grams of the drug developed by Regeneron, the highest dose being tested in the company's ongoing late-stage clinical trials. That could signal an aggressive treatment plan, out of an abundance of caution, or worsening symptoms. Conley's Saturday afternoon memo said that Trump first received an experimental antibody treatment Friday morning – and not Thursday morning, as another doctor involved in Trump's treatment indicated during the press conference.

It was previously disclosed that Trump also received an infusion of remdesivir on Friday, one of the few treatments that have been shown to help patients. The drug can reduce the length of hospitalization by a few days, and recent data suggests that it might have a slight benefit in mortality. The FDA authorized emergency use of remdesivir in hospitalized patients in May, and evidence has shown it’s more effective the earlier it’s given in the course of a patient’s infection. Conley said Trump is set to receive a five-day course of the treatment, which is standard.

Conley said the mix of experimental drugs was part of his decision not to "hold back" and to pursue treatments that could expedite Trump's return to work.

"Remdesivir works a little bit differently than the antibodies," Conley said Saturday. "We're maximizing all aspects of his care, attacking this virus with a multi-pronged approach."

The White House, which has been less than forthcoming about Trump's health throughout his presidency, said Trump's visit to Walter Reed was a precautionary measure to monitor him over the next few days. Though Conley said that Trump on Saturday wasn't having trouble breathing or walking around, someone in Trump's orbit immediately afterwards raised concerns about the president's condition.

“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," according to a White House pool report that cites a source "familiar with the president's condition."

What else do we know about Trump's drug regimen?

Regeneron said Trump received its antibody drug through a "compassionate use" program, which allows patients early access to experimental drugs with the FDA's approval. The treatment, known as a monoclonal antibody, is a lab-made version of the antibodies that the immune system makes to ward off the virus. Regeneron said Tuesday that its antibody reduced the amount of virus in patients' bodies in its ongoing trial, and may speed recovery.

Monoclonal antibodies like Regeneron's are thought to work best when given early in the course of infection. This appears to be the situation with Trump, who tested positive Thursday and is showing fatigue, according to a Friday afternoon memo from Conley that was released before Trump left for Walter Reed. The president notably canceled his only scheduled appearance on Friday and has been relatively quiet on Twitter since his diagnosis was announced.

Other drugs and supplements the president is taking include a daily aspirin — often prescribed to bolster heart health — along with zinc, Vitamin D, famotidine and melatonin, each of which has been proposed as a potential Covid-19 treatment. Taken together, the cocktail suggests that Trump's symptoms are mild to moderate, although that could change as his disease progresses.

Famotidine, a heartburn medicine also sold under the brand name Pepcid, is being tested as a coronavirus treatment on the basis of observational studies in China that suggested patients who took the drug for heartburn had a slight survival edge. But there is no direct evidence from randomized, controlled clinical trials — the gold standard for medical research — that the drug benefits people with coronavirus.

Zinc is thought to improve overall body function and protect against infection, and Vitamin D to bolster the immune system, but there is no evidence that either helps prevent or ease Covid-19 infection. Melatonin is often used as a sleep aid, and some clinical trials are investigating whether it can help reduce inflammation in coronavirus patients.

Notably, the president is not taking hydroxychloroquine, despite championing the anti-malarial drug as a Covid-19 treatment and taking it for two weeks in May after a possible virus exposure. Multiple trials have shown it to have no clinical benefit for Covid-19. Trump was closely monitored when he took the drug in spring in case he developed an irregular heart condition, a known side effect, his physician said at the time.

There’s no way to know how long Trump will be sick, or how vigorously he will be able to campaign in final days or weeks before the election. Covid-19 is notorious for its ability to attack multiple parts of the body, which can make the disease look very different from one patient to the next. It sometimes causes long-term health effects that can take months to recover from, and in some cases, can leave lasting damage to vital organs.

Here are some of the big unanswered questions about Trump's case:

When was the president exposed?
It may be impossible to know. The National Institutes of Health says it can take up to two weeks for Covid-19 to be detected, with a median incubation period of four or five days. Speculation has focused on senior adviser Hope Hicks, who was diagnosed with the virus and traveled with Trump to the presidential debate in Cleveland on Tuesday and accompanied him to a campaign rally in Minnesota on Wednesday night. It's possible the exposure could have happened earlier this week, when he campaigned in Pennsylvania, or even before then.

Did the White House have effective safety measures?
The White House hasn't said how it screens staff and visitors, and Trump's campaign has hosted large rallies with packed crowds of largely unmasked people. The rallies have mostly been held outdoors, where the risk of virus spread is lower, but his campaign held an indoor rally in Nevada about three weeks ago in defiance of state restrictions, and another in Duluth, Minn., on Wednesday.

The administration has in the past relied on a rapid test from Abbott Laboratories that can produce results in as soon as 15 minutes. But the test has been shown to have high error rates, and it's likely that the White House confirmed the president and first lady’s infections with additional lab-based testing. The White House declined to comment on testing procedures.

Even the best tests don't catch every case, though. Public health experts say there's no substitute for wearing face coverings and observing social distancing — precautions Trump has frequently flouted.

What other drugs might he take?
The Trump administration has also aggressively promoted the use of antibody-rich blood plasma from coronavirus survivors. It’s been used in the past to treat diseases ranging from Ebola to diphtheria, with mixed results. There’s no clear evidence it helps those ill with Covid-19, and an expert panel advising the government says it should not be considered standard of care. The FDA issued an emergency use authorization for the treatment in late August over the objections of top federal scientists.

A decades-old steroid called dexamethason is another treatment doctors have deployed. U.K. scientists reported in June that it reduced the risk of death for severely ill patients. But the drug, which quiets the immune system, could backfire in mild or moderately ill patients.

Could there be long-term effects?
There’s a growing population of patients who haven’t fully recovered from the coronavirus months after first experiencing symptoms. Many of these “long haulers” had mild or moderate symptoms that sometimes didn’t require hospitalization.

Common symptoms that linger over time include fatigue, a cough, shortness of breath, headaches, joint pain and in some cases, damage to the heart, lungs or brain. The difficulty of predicting outcomes has led scientists to study patients who had related viruses like SARS. The Mayo Clinic notes many who recovered went on to develop chronic fatigue syndrome, a disorder that worsens with physical or mental activity but doesn’t improve with rest.

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President Pelosi? Pence prepares to risk it all for Trump

He’s the GOP’s one line of defense between a hospitalized commander-in-chief and a President Nancy Pelosi, and he’s about to depart Washington on a four-day campaign swing in the middle of his boss’s health crisis.

Vice President Mike Pence will travel to Utah on Monday as he plays the Trump campaign’s lead act for the foreseeable future — the highest-profile surrogate for the president’s reelection at a time when both men can least afford another setback following Donald Trump’s Covid-19 diagnosis.

After months of campaigning in smaller, lower-profile settings — from greeting voters at roadside diners to addressing blue-collar workers deep in the Rust Belt — Pence will step into the spotlight this week for a high-stakes debate against Democratic vice presidential nominee Kamala Harris, a MAGA rally in Arizona and a brief stop in his home state of Indiana to cast an early ballot in the 2020 race.

A month before Election Day, Pence is putting it all on the line in a last-ditch attempt to rescue his ticket.

The vice president himself has presented a positive face about representing the GOP ticket in a moment of crushing uncertainty, despite pressure from White House aides and allies to hunker down in Washington until Trump gets the all-clear. The president remains a patient at Walter Reed National Military Medical Center, where he has been receiving a variety of therapies and drugs to combat the potentially fatal disease.

Despite pressure to stay put, Pence allies insist he was made for a moment like this given his soothing temperament, grasp of the virus and unfailing loyalty to Trump. But other people close to Pence bemoaned his decision to fly halfway across the country while the commander-in-chief remains hospitalized and administration officials are given limited updates on his status, noting that the same protocols that will be used to protect the vice president on the campaign trail failed to shield Trump from exposure to the virus.

“You can no longer say, ‘There’s no way he’s going to catch this,’ because that’s what we told ourselves about the president and it still happened,” said one White House official.

Scott Jennings, an aide to former President George W. Bush who is close to the Trump White House, signaled that Pence should stay in town and be vigilant given his spot in the chain of command. “The president is in the hospital with a disease known to kill people. Mike Pence’s health and security is paramount.”

Although Pence and his wife Karen have repeatedly tested negative since Trump first announced his positive diagnosis early Friday, the vice president was around at least eight people who tested positive for Covid-19 after attending a White House Rose Garden ceremony where Trump unveiled his Supreme Court replacement for the late Justice Ruth Bader Ginsburg.

Among those who contracted the virus and are currently quarantining are first lady Melania Trump, Trump campaign manager Bill Stepien, top Trump aide Hope Hicks, GOP Sens. Mike Lee and Thom Tillis, former White House counselor Kellyanne Conway and former New Jersey Gov. Chris Christie.

Pence has been recognized by people inside and outside the White House as someone taking the virus more seriously than Trump has — even though some say he may not be taking it seriously enough either. The vice president in February took control of the White House’s coronavirus task force and has shaped much of the day-to-day engagement with officials in the Trump administration and governors across the nation. But he’s played two parts in that role: sometimes trying to clean up Trump’s efforts to downplay the virus, and other times painting a rosy portrait and framing the pandemic in the past tense just as Trump has done.

Despite the ongoing risks of exposure, the Trump campaign is eager to deploy Pence as it carries out what it’s calling “Operation MAGA,” a quickly assembled effort to keep the president’s reelection operation afloat for the next 30 days by dispatching the vice president, members of the first family and key allies to virtual and in-person events across the country.

Part of that effort means getting Pence back on the campaign trail as soon as possible for “a very full aggressive schedule,” senior Trump campaign adviser Jason Miller told NBC’s “Meet the Press” on Sunday.

“He’s now the face. He needs to step up starting today,” said a former Trump campaign official, echoing a sentiment shared by current campaign aides who said it’s important for the vice president to be as visible as possible while the president is in recovery to reassure and energize the GOP base.

“We don’t operate in fear,” said Steve Cortes, a senior adviser to the Trump campaign. “The president [has] recovered with terrific progress so far. The vice president is healthy and working nonstop. Continuity of command is well-established. We will not cower or hide, not the country, nor the administration, nor our campaign.”

Pence is expected to postpone a meeting with Utah Republicans when he arrives in Salt Lake City on Monday, according to two people familiar with his plans, one of whom said the vice president will spend the bulk of Monday and Tuesday preparing for his debate on the ground with a close circle of advisers.

“Wednesday is now effectively the next presidential debate,” said the former Trump campaign official.

The Trump campaign also announced on Saturday that Pence would host an event at a tactical gear manufacturer in Peoria, Ariz., on Thursday, the day after the debate. Asked if attendees of the Thursday event would be required to wear protective face masks, Trump campaign communications director Tim Murtaugh said only that masks would be “strongly encouraged” and that temperature checks would be administered prior to entry — suggesting the Trump campaign does not plan to alter its safety protocols moving forward.

“The VP is tested daily and it’s absolutely vital for him to be out on the trail. We’ll campaign digitally, we’ll campaign in person and we’ll keep up the protocols we’ve always had,” said a second Trump campaign official.

A former senior administration official said Pence could assume the duties of the president at any time or place, if he needed, but he should only return to the campaign trail if he doesn’t host large events that lack masks or social distancing.

“The vice president has to weigh his responsibility as successor to the president with the responsibility to simultaneously set an example for our public health response as the head of the task force,” this person said.

In a 20-minute internal conference call on Saturday, an upbeat Pence gave Trump campaign staffers and volunteers across the country a pep talk urging them to forge ahead during the final weeks before the November election.

Despite being closer to the Oval Office than ever before, Pence maintained his characteristic deference to Trump throughout the call — praising the president for acting quickly to combat the novel coronavirus by halting inbound travel from China and putting Pence in charge of the Covid-19 task force.

“You know, I’ve said as I’ve traveled around the country many times in recent days, President Donald Trump has never stopped fighting for us. Now it’s our turn to fight for him,” Pence said, according to audio obtained by POLITICO.

He said at another point in the call that Trump wanted him to tell staffers to do their part to defeat the virus.

“Wash your hands on a regular basis, use hand sanitizer, wear a mask when you can’t socially distance,” he said.

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Trump’s last rally: A catalog of worst pandemic practices

In retrospect, it was an ominous scene — the vapor in Donald Trump’s breath visibly condensing as he spoke at the rally in Duluth, Minn., a wisp of exhalant hanging in the frigid air.

In a region where coronavirus cases are surging, a mask-less Trump stood before several thousand supporters on Wednesday, most of them mask-free themselves, pumping his fists and tossing hats to the tightly packed crowd.

Two days later, Trump would be hospitalized. And Duluth — the site of his last rally before checking into Walter Reed National Military Medical Center — would become mired in a recovery of its own.

The rally was a story of worst practices in a pandemic, with Duluth as the collateral damage. Before Trump’s hospitalization and wall-to-wall coverage of his evolving condition, it was in Duluth that the recklessness of his campaign fell plainly into view — from his scoffing at mask-wearing to his insistence on assembling large crowds.

By the weekend, local public health officials were warning rally attendees about their risk of exposure, and prominent Republicans in the state were in quarantine. Emily Larson, the city’s Democratic mayor, asked anyone who attended the rally to “please get tested, self isolate.”

“Contact tracing President Trump in Minnesota: Who hung out with him for how long?” blared a headline in the St. Paul Pioneer Press. The Duluth News Tribune’s above-the-fold front page read simply, “[Rep. Pete] Stauber traveled with Trump.” No further context was necessary.

Photographs of the Duluth rally appeared on social media with red circles drawn around people standing closest to the lectern — and to Trump. Stauber and two other Republican congressmen who traveled with Trump on Air Force One were pilloried for returning to the state on a Delta Airlines flight on Friday night — apparently flouting airline rules.

The House members’ “stupidity and disregard for the well-being of their fellow passengers is staggering,” Ken Martin, chairman of Minnesota’s Democratic-Farmer-Labor Party, said in a prepared statement.

Gary Anderson, the Democratic president of the Duluth City Council, said Sunday that Trump “took risks with the health of our community, clearly, and I think that’s how our community is worse off in the most direct way.”

Minnesota, a state Trump lost by fewer than 45,000 votes four years ago, wasn’t supposed to end like this for Trump. It was supposed to be where he stunned all the naysayers this year. Appearing at a rally in Duluth in 2018 to campaign for Stauber, Trump pinched his thumb and forefinger together and told the crowd he’d come “this close” to winning the state, something no Republican has done since Richard Nixon in 1972. One more visit, “one more speech,” he said, and he would have. In 2020, Trump said, “It’s going to be really easy I think.”

Duluth is critical to Trump’s ambitions. Though the city itself is a progressive enclave on the tip of Lake Superior, its media market gives Trump a port of entry to the state’s more conservative Iron Range, a blue-collar mining region that, while ancestrally Democratic, has been trending Republican in recent years.

Trump carried the congressional district surrounding Duluth by 15 percentage points in 2016, and he will need to juice turnout there this year to compensate for losses in the Democratic-heavy Twin Cities and their suburbs. In a year marked by little campaign travel, Trump has lavished attention on Northern Minnesota, dispatching family members to Duluth and appearing himself in Bemidji, Minn., in mid-September. Several mayors from the area publicly endorsed him.

One them, Larry Cuffe Jr., a former Democrat and the mayor of small town Virginia, recalled Sunday that Trump’s campaign provided hand sanitizer and distributed masks at the rally in Duluth last week. Cuffe and the people he was with were all wearing masks, he said, and he wasn’t worried about contracting the virus there.

What’s more, Trump looked good to him. Trump’s speech, Cuffe said, “was even more poignant and more to the point” than he had seen at previous events.

“I didn’t see anything that would make it look like he wasn’t at the top of his game,” Cuffe said.

In fact, Trump appeared to be in his element. One day after a chaotic and ineffectual debate, Trump boasted about his performance and derided Joe Biden. He mocked Rep. Ilhan Omar (D-Minn.), a former refugee and Somali-American from the Twin Cities area, and warned Biden would “turn Minnesota into a refugee camp.” (Biden has no such plans.)

He mused about serving “16 more years” as president.

But even as Trump spoke, there were signs that not all was well with his campaign. As in other states, Trump is underperforming his 2016 levels in Minnesota with his base demographic of white voters. The coronavirus, a persistent drag on his public approval rating — and the issue that will now dominate the campaign’s closing weeks — was on an upswing in Northeastern Minnesota when Trump arrived.

Trump spoke for only about 45 minutes, unusually brief for him. “It’s freezing out here,” he said.

The rest of Duluth was left to absorb the fallout.

Following the rally, the Minnesota Department of Health said “community transmission of COVID-19 was high in St. Louis County prior to this week’s rally, and people attending the rally may have been infectious without realizing it.”

Outside Trump’s rally, a Trump supporter in a plaid shirt and gray hair was filmed attacking a photojournalist. After Larson called Trump a “white supremacist,” Trump supporters took to their cars and trucks, parading down the street by her home. Residents unaccustomed to political mischief reported having lawn signs stolen for the first time in their lives.

“I think that we’re living in a political low point, where people feel empowered to behave in ways that we wouldn’t have just four years ago or six years ago or even 20 years ago,” said Jeff Anderson, a former Duluth councilman and aide to former Rep. Rick Nolan (D-Minn.).

Describing a political environment antithetical to Minnesota’s reputation for civility, he said, “I think there’s just been this permission that’s been given to make people feel more comfortable behaving in inappropriate [ways].”

Trump’s medical team said Sunday that Trump could be discharged from Walter Reed medical center as early as Monday. And it’s possible that his rally in Duluth won’t be his last.

But even a brief break will be damaging. Running behind Biden in both national and swing state polls, large rallies are a mainstay of Trump’s campaign, critical to generating media and identifying supporters who aren’t yet registered to vote. In a nod to their significance, Republican National Committee Chairwoman Ronna McDaniel said after the Duluth rally — and before announcing her own positive test for Covid-19 — that 60 percent of rally attendees in Duluth were not Republican and, more important, more than 17 percent did not vote in 2016.

Tim Murtaugh, a spokesman for Trump’s re-election effort, said of the prospect of Trump returning to in-person events that “we’ll leave that to the president’s medical team.”

But he was not apologizing for holding the rally in Duluth. Noting temperature checks and other safety precautions taken there, he said that “if people can protest in the streets by the thousands, then they can gather peacefully under the First Amendment to hear from the president of the United States.”

Nancy Cook contributed to this report.

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Biden still at risk after debating Trump at ‘peak of contagion’

For more than six months, Joe Biden’s team went to extraordinary lengths to keep their candidate safe, fastidiously following medical guidelines that enabled him to campaign while guarding him from a potentially deadly virus.

Now, the Democratic nominee is facing the prospect that the president of the United States himself might have posed the biggest Covid-19 risk to his health since the pandemic began.

It could be days before the 77-year-old Biden will be in the clear, despite recent negative tests. The virus can incubate for up to 14 days.

Donald Trump was quite likely infectious at the Tuesday debate, medical professionals say, considering the severity of the symptoms on Friday, in which he necessitated oxygen before being transported to Walter Reed Military Medical Center.

"A person is at their peak infectiousness in the 48-hour period before they start showing symptoms,” said Leana Wen, a former health commissioner for Baltimore and ER physician. ”If that timeline is correct, then [Trump] would actually be at the peak of contagion on Tuesday night.”

Democrats expressed considerable frustration at the series of events that thrust the ever-so-careful Biden into a risky, maskless environment which ultimately ended up with several Trump staffers and supporters testing positive and Trump himself hospitalized.

"The irony in my estimation is that if there is one person out of 330 million who should have the least amount of risk, it’s the president of the United States and his inner circle," said Ohio Rep. Tim Ryan, who was inside the debate hall and had to undergo a Covid-19 test after learning Trump had tested positive. "And yet, they’re executive-level super spreaders."

During the evening debate, a slew of Trump family members broke guidelines set by the Cleveland Clinic, the academic medical center that hosted the debate, by refusing to wear masks inside the debate hall. It was a far cry from the carefully cultivated events that Biden had organized and attended for months.

Among those inside the debate hall or who traveled with Trump that night who announced positive tests later in the week: former New Jersey Gov. Chris Christie, who had helped Trump with debate prep, First Lady Melania Trump, senior adviser Hope Hicks and Trump campaign manager Bill Stepien.

By contrast, Biden and his team have been vigilant about wearing masks and adhere to the strictest of rules as he travels. There have been no Covid-19 infections on the Biden team so far. Media access has been greatly limited, with only pool reporters allowed to travel with Biden. If a flight is involved, the press always travels in a separate plane. At some events, circles are drawn to mark where exactly attendees can safely sit or stand.

On Friday, after the confirmation of Trump’s diagnosis, Biden continued with his travel plans to Michigan. But he canceled an indoor fundraiser. The team did not find out from Trump or the White House but from news reports.

Asked whether Biden should be quarantining for 14 days, a Biden campaign aide said staff considered the situation and followed medical guidelines.

"Vice President Biden and the president were never within what the CDC considers to be close contact, and we are following CDC guidance. The vice president tested negative twice Friday, our traveling staff tested negative on Friday, the VP tested negative again Sunday, our campaign events are socially distanced and everyone is wearing a mask," campaign spokesman T.J. Ducklo said in a statement. "Given all of those factors, we are comfortable that the vice president can continue to campaign safely.

Overall, concerns within the Biden team that the candidate — or other staff — had been exposed have been blunted by the fact that the campaign has been so devoted to following protocols, including wearing masks inside the hall, and keeping distance from others.

On the night of the debate, the two candidates were standing more than 12-feet apart. Social-distancing guidelines call for at least six feet of space between individuals to avoid exposure to coronavirus, but medical professionals recommend a greater distance of separation for individuals spending longer periods of time next to one another indoors.

Sen. Chris Coons (D-Del.) said after Trump’s diagnosis he thought back to the debate and wondered whether Trump may have exposed Biden that night.

“Did it cross my mind afterward that he spent 90 minutes yelling in relatively close quarters with former vice president Biden and [moderator] Chris Wallace? Yes,” Coons said. “I mean, he was projecting forcefully.”

In a new statement on Sunday, the Cleveland Clinic said the candidates and those traveling with them were required to submit a negative result from a test taken within the prior 72 hours. Both campaigns adhered to the rule, said spokeswoman Angela Kiska. The Biden campaign did not specify when the former vice president was tested but said it was within the 72-hour period allowed by the Cleveland guidelines.

Trump first tested positive for Covid-19 on Thursday through a rapid test, which was later confirmed through a PCR test. Trump made the diagnosis public early Friday.

The Trump campaign referred to the White House a question about whether Trump was tested on the day of the debate. A White House spokesman said Trump was tested “regularly” but would not say if Trump was specifically tested the day of the debate.

"That’s part of the problem, you can’t get a straight answer," said Ryan.

Some inside the debate hall, a facility shared with Case Western Reserve University, noted that Trump was sweating on stage, despite it being relatively cool in the room.

“It was probably around 68 degrees. President Trump was visibly sweating. He looked unwell. He looked agitated, but frankly I hadn’t thought of it at the time. I just took it as an indication he was wound up,” Coons said.

Trump raised his voice at various points during the 90-minute session, increasing the likelihood of sending droplets into the air.

Biden has said he would release the result of every Covid-19 test he takes. On Friday, he said he received a negative result; on Saturday, he said he had not taken a test that day. The campaign has not yet released a result on Sunday.

Medical professionals cautioned that Biden is not yet out of the woods.

“If I was one of his advisers, I would tell him to stay close to home for a couple of weeks just to be sure,” said Georges Benjamin, executive director of the American Public Health Association. “It may not be 14 days, it might be 10 days, that might be rational.”

“The good news is we know that he’s wearing a mask and he's following those good public health measures,” Benjamin added. “But again, I would err on the side of caution. Age and just the political consequences, the physical consequences of him getting sick would be intolerable.”

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