Oct. 8 marked a major milestone in what we know about the efficacy of remdesivir, the experimental antiviral medication that was the first therapy drug to be issued an emergency use authorization for COVID-19 in the United States. On that day, the results of a major medical trial — double-blind, placebo-controlled and involving more than 1,000 patients — were finally published in the New England Journal of Medicine. The study found that the drug really does seem to shorten the number of days it takes to recover from COVID-19, and it even had fewer serious side effects than the placebo control. However, researchers also showed the drug was not exactly a game-changer. It didn’t significantly reduce mortality, for example. Overall, though, the study was good news.
One day earlier, a 74-year-old COVID-19 patient who took remdesivir returned to work in his regular office. That bit was probably good personal news for one man, but if you want to know how well remdesivir works — and what it means for you, if you were to get the coronavirus — the former matters a lot more than the latter. Even if that man is the leader of the free world.
He may have taken a combination of experimental drugs, but President Trump’s hospital stay was not an experiment. We have learned nothing about COVID-19 or its treatments by watching what happened to him. That’s true whether you’re tempted to look at his experience for proof that COVID-19 isn’t that big of a deal, or if you’re hunting Twitter for evidence that the drugs he took are having an outsized impact on his mental state.
From the moment the president inhaled particles of virus, his illness carried not just a physical risk to himself, but also a moral hazard to a country desperate for solid answers about an infectious disease that has been resolutely hard to pin down for over seven months. COVID-19 has presented us with one liminal space after another. It’s been nearly impossible to neatly chart the probable course of the pandemic, prevent the virus’s spread and even count the number of Americans who have died without a pile of asterisks and qualifications. So when the president of the United States became one of the infected, it seemed like there was, at the least, an opportunity to offer a little bit of clarity — to pin one thing down in the public conversation over the coronavirus and get everybody on the same page about the seriousness of the disease and its risks.
But that didn’t happen.
Understanding one person’s case was never going to help us understand the disease as a whole, but we can barely even do that. The White House’s lack of transparency about what exactly has happened — and when — has left the country unable to agree on what really happened. It’s still unclear when the president first tested positive. There appears to have been no contact tracing and reporting of the president’s contacts who may have contracted the virus; if there’s been any, it’s been left to the media and private citizens. It’s difficult to untangle how sick he actually was from rosy public statements — that his doctor admitted were deliberately spun to be positive and upbeat.
Trump is not the first president to be cagey about his physical health. (Although, one would think there is a little more reason to be transparent when the disease in question is contagious. President Kennedy wasn’t spreading Addison’s Disease around the Rose Garden.) In this case, though, the lack of clarity from the White House has tangled up with the lack of clarity about the virus itself. If you were confused about whether the president tested negative before his first post-hospitalization rally, wait until you find out that’s not really the right question to ask.
Partly, though, the problem with expecting Trump’s illness to clarify the murky waters of COVID-19 is expecting any one person’s illness to cut through the muck. That is just not how science works. As the CEO of Regeneron — the manufacturer of the experimental antibodies Trump also took — put it on Face the Nation last weekend: “The president’s case is a case of one, and that’s what we call a case report, and it is evidence of what’s happening, but it’s kind of the weakest evidence that you can get.”
That evidence is weak because medical science doesn’t work the same way as our system of government — you can’t just pick individuals to represent the biology of society as a whole. Our bodies are all a little bit different. Our circumstances are all a little bit different. If a patient takes a drug and recovers, how do you tell whether the medicine actually works, or you just tried it on someone who would have recovered anyway? How do you tell whether the medicine is safe, or the patient is just more tolerant of its effects than the average person?
The answer is that you run the test again and again, on more and more people. And you make sure that some of them are told they got the drug even though they really didn’t, so we can also distinguish between the benefits of the medication and the power of our own bodies under suggestion. That’s how science weeds out the outliers and comes to know, as best it can, whether a medicine truly works. It’s not perfect, but it’s better than the alternative. This research isn’t about a strong leader, it’s about the community.
But the president of the United States is kind of the ultimate outlier. Even among older white men, he is not typical. He is far wealthier. He has access to much better health care. He has handlers and on-call physicians and a literal hospital suite made just for him. And this particular president is probably not even all that representative — in temperament, habits and life history — of even your average older white male president. If he were, he might not have contracted the virus at all. What happens to him is never going to tell us what a run-in with COVID-19 is likely to look like. What happens to him is never going to tell us whether a medicine worked. What happens to him is never going to tell us about the side effects of remdesivir, the Regeneron antibody cocktail or dexamethasone.
And all that is especially true when we’re talking about a virus that can tear through a family with seemingly random abandon — killing some, hospitalizing others and barely registering as an illness with others.
No politician can be our figurehead here. Demagoguery doesn’t work for the study of infectious disease.