Stephen Miller Tests Positive as White House Outbreak Grows

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Credit…Anna Moneymaker for The New York Times

On Tuesday evening, senior administration officials confirmed that Stephen Miller, Mr. Trump’s top speechwriter and a policy adviser, had tested positive for the coronavirus, joining a growing list of Mr. Trump’s close aides who have the virus.

“Over the last five days I have been working remotely and self-isolating, testing negative every day through yesterday,” Mr. Miller said in a statement. “Today, I tested positive for Covid-19 and am in quarantine.”

Mr. Miller is married to Katie Miller, Vice President Mike Pence’s communications director. A senior administration official said Ms. Miller, who contracted the virus this spring and returned to work in May, was tested Tuesday morning and was negative for any new infection.

On Tuesday, many White House offices were empty as officials stayed home to wait out the infectious period from an outbreak of the coronavirus within the building and among people who had been there.

President Trump was in the White House residence, convalescing, as a number of advisers and other officials stayed home, either because they had contracted the coronavirus or had been near people who did.

The White House communications and press shops were bereft of people. The White House press secretary, Kayleigh McEnany, announced on Monday that she had tested positive. Two other press office aides have also contracted the virus, and two more aides on Tuesday were said to have tested positive, people familiar with the results said.

The outbreak in the White House, which has extended to some lawmakers on Capitol Hill, has raised concerns in the city that surrounds it. Washington, D.C., which has managed to bring infection rates down in recent weeks through preventive laws and high rates of compliance, has almost no control over the federal government.

The city reported 105 new coronavirus cases on Tuesday, the highest number since June 3.

The gathering at the Rose Garden would have violated the city’s mandates limiting the size of gatherings and requiring masks. But because the White House is on federal property, it is exempt from such rules.

City officials said they would be closely monitoring infection trends for several days to see if the Capitol and White House cases affected the city’s overall infection rate.

Credit…Doug Mills/The New York Times

The White House physician, Dr. Sean P. Conley, said on Tuesday that President Trump was experiencing no symptoms of Covid-19 and doing “extremely well” on his first full day at home since a three-night stay in the hospital.

But outside doctors and medical experts in Covid-19 and lung disease said they were struggling to piece together an accurate picture of Mr. Trump’s health. Far from having vanquished Covid-19, the outside experts said, Mr. Trump is most likely still struggling with it, and possibly entering a pivotal phase in which he could take a turn for the worse.

Dr. Conley said on Monday that Mr. Trump had been prescribed dexamethasone, which some experts saw as a sign that the president could be dealing with pulmonary issues since it is recommended only for Covid-19 patients who have severe or critical forms of the disease.

“Does he have lung involvement? My guess is yes, because they did give him a lot of medications that they would only give to someone who did,” said Dr. Mangala Narasimhan, a pulmonologist and director of critical care services at Northwell Health in New York.

In a televised event on Monday that some of the president’s Republican allies tried to frame as a quick recovery from the virus, Mr. Trump was flown from Walter Reed National Military Medical Center to the White House. After leaving his helicopter, he crossed the lawn, walked up a set of stairs and removed his mask.

“As a pulmonologist, he did two things for me: He did a walk test, and he did a stair-climbing test,” said Dr. Talmadge E. King Jr., a specialist in pulmonary critical care and the dean of the UCSF School of Medicine. He added that lung doctors still rely on tests like these “to just get a picture of how the patient’s doing.”

He and others said that at the top of the stairs, Mr. Trump used his neck muscles to help him breathe — a classic sign that someone’s lungs are not taking in enough oxygen.

Dr. Ilan Schwartz, an infectious disease doctor and assistant professor at the University of Alberta, agreed. “As a physician, I would refrain from commenting on somebody whom I haven’t examined,” he said. “But in this case, the clinical signs are so obvious that it can be seen from a distance, even on a short two- or three-second clip.”

Credit…Hilary Swift for The New York Times

President Trump announced on Tuesday that he was planning to attend next week’s debate in Miami against former Vice President Joseph R. Biden Jr. despite his continued struggle with the coronavirus and unresolved questions about the event’s rules.

“I am looking forward to the debate on the evening of Thursday, October 15th in Miami. It will be great!” the president tweeted early Tuesday, the morning after he returned to the White House from Walter Reed National Military Medical Center.

“FEELING GREAT!” he added in a separate tweet, hours before his physician reported that he was feeling well.

Asked later on Tuesday if he would feel safe debating Mr. Trump next week, Mr. Biden said, “Well, I think if he still has Covid, we shouldn’t have a debate.”

Physicians who specialize in infectious diseases quickly warned that Mr. Trump’s optimism might be premature, and could reflect a false sense of security about his condition, reinforced by temporary improvements that could be reversed once he is removed from medications.

People with mild to moderate cases of the illness are likely to “remain infectious no longer than 10 days after symptom onset,” according to guidelines from the Centers for Disease Control and Prevention. But that period could be doubled in cases of more serious illness.

That means Mr. Trump could still be contagious, depending on the severity of his case and when his symptoms began, during the next debate, according to Dr. Krutika Kuppalli, an infectious-disease physician in South Carolina.

“We don’t even know what’s going to happen tomorrow, let alone in a few days,” she said.

Medical details that Mr. Trump’s doctors disclosed over the weekend — including his fluctuating oxygen levels and a decision to begin treatment with a steroid drug — suggested to many infectious-disease experts that he had a more severe case of Covid-19 than the physicians acknowledged.

He has been taking a steroid called dexamethasone — a drug known to buoy feelings of well-being, said Dr. Taison Bell, an emergency medicine physician at the University of Virginia, and patients typically need to demonstrate they can function without medication before being allowed to resume normal activities.

Should Mr. Trump’s condition continue to improve and should he be definitively cleared by physicians to participate in next week’s debate, Dr. Bell added, masking and distancing would remain crucial. “They need to stick with the rules they’ve set,” he said.

If Mr. Trump is able to follow through on his promise, he faces a campaign transformed by an infection that has spread to his top aides, and stakes that have been heightened by a disruptive performance in the first debate that prompted the Commission on Presidential Debates to consider revising its procedures.

Mr. Trump had previously questioned whether he would participate if new rules, including the possibility that his microphone would be muted to discourage interruptions, were enacted. But his illness has upended those calculations, and Republican officials said that he now needed to show that is physically capable of carrying on his campaign.

Debate planners are also trying to keep their events from exacerbating the pandemic. On Monday, the commission decided to install a sheet of plexiglass between Kamala Harris and Mike Pence at the vice-presidential debate on Wednesday amid concerns about transmission during their back-and-forth.

After first objecting to the barriers as unnecessary, aides to Mr. Pence reversed course on Tuesday, saying that if the plexiglass barriers were important to Ms. Harris, then they would accept them for the vice president, according to Frank J. Fahrenkopf Jr., a co-chair of the Commission on Presidential Debates.

It is not clear if the commission will do the same at the town-hall-style presidential debate in Miami, but Democratic officials have pressed for rigorous safety measures, including the expulsion of attendees who refuse to wear masks or decline to observe social distancing protocols.

Credit…T.J. Kirkpatrick for The New York Times

Gen. Mark A. Milley, the chairman of the Joint Chiefs of Staff, and several of the Pentagon’s most senior uniformed leaders are quarantining after being exposed to the coronavirus, a Defense Department official said on Tuesday.

The official said almost the entirety of the Joint Chiefs of Staff, including Gen. James C. McConville, the Army chief of staff, are quarantining after Adm. Charles Ray, the vice commandant of the Coast Guard, tested positive for coronavirus.

“We are aware that Vice Commandant Ray has tested positive for Covid-19 and that he was at the Pentagon last week for meetings with other senior military leaders,” Jonathan Hoffman, the Pentagon spokesman, said in a statement released by his office.

“Out of an abundance of caution, all potential close contacts from these meetings are self-quarantining and have been tested this morning,” he added. “No Pentagon contacts have exhibited symptoms and we have no additional positive tests to report at this time.”

The announcement represents an alarming development — as the virus extends its reach from the highest levels of civilian government to the operational heart of the country’s national security apparatus.

A military official noted that General Milley and the other senior officers have full operational capability from where they are working — most at home — and said that there is no degradation to the country’s national defense.

Admiral Ray was in the Pentagon last week, attending meetings in the secure “Tank” with General Milley and the senior Pentagon uniformed leadership. Defense Department officials said the decision to quarantine complied with Defense Department guidelines established by the Centers for Disease Control.

General Milley, 62, and a number of senior Defense Department officials have also been getting tested frequently since Sept. 27, when many of the Pentagon’s senior leadership attended a White House reception for “Gold Star” families of fallen troops.

Both Mr. Trump and Melania Trump, the first lady, were at that event. Admiral Ray also was at the White House Gold Star gathering, a Defense Department official said.

The reaction at the Pentagon to the possible exposure of senior military leaders to coronavirus stands in contrast to the White House, where Mr. Trump has flouted the same guidelines established by the C.D.C. that the Pentagon is following.

White House officials, citing national security concerns, last weekend told Defense Department officials that they should no longer inform the public or the news media about the coronavirus status of senior Pentagon leaders. But Defense Department officials have questioned the directive.

Credit…Anna Moneymaker for The New York Times

President Trump on Tuesday abruptly ended talks with Democrats on an economic stimulus bill, sending the stock market sliding and dealing a final blow to an intensive set of on-again-off-again negotiations to deliver additional pandemic aid to struggling Americans before the November elections.

Mr. Trump announced that he was pulling the plug on the effort in a series of afternoon tweets in which he accused Speaker Nancy Pelosi of “not negotiating in good faith” and urged Senate Republicans to focus solely on confirming his nominee to the Supreme Court in the coming weeks.

Instead, Mr. Trump said that he had instructed Mr. Mnuchin to stop negotiating, sending the S&P 500 down as much as 1 percent in the immediate aftermath of his tweet. It had been up more than half a percent in the moments before. The index closed down 1.40 percent for the day.

“Our Economy is doing very well,” Mr. Trump tweeted as the market fell. “The Stock Market is at record levels, JOBS and unemployment also coming back in record numbers. We are leading the World in Economic Recovery, and THE BEST IS YET TO COME!”

Ms. Pelosi and Steven Mnuchin, the Treasury secretary, who had previously been scheduled to speak later Tuesday afternoon, briefly spoke after Mr. Trump’s tweet, with Mr. Mnuchin confirming that the president had discontinued talks and the speaker expressing disappointment “in the President’s decision to abandon the economic & health needs of the American people,” according to Drew Hammill, a spokesman for Ms. Pelosi.

Ms. Pelosi had told lawmakers on a private caucus call moments before Mr. Trump’s tweets that Democrats were “waiting for them to approve our language to crush the virus and how we put money in the pockets of the American people,” according to a Democratic aide on the call, who disclosed her remarks on condition of anonymity.

In a statement after the president’s tweets, Ms. Pelosi accused him of showing “his contempt for science, his disdain for our heroes — in health care, first responders, sanitation, transportation, food workers, teachers, teachers, teachers and others.”

“Trump is wedded to his $150 billion tax cut for the wealthiest people in America from the CARES Act, while he refuses to give real help to poor children, the unemployed, and America’s hard working families,” Ms. Pelosi said.

Mr. McConnell, speaking to reporters on Capitol Hill, said he supported the president’s decision, adding, “I think his view was that they were not going to produce a result, and we need to concentrate on what’s achievable.”

As the talks broke apart, more than 40 U.S. senators, along with more than a dozen congressional aides and reporters, have been tested for the coronavirus since late last week, when it became clear the White House was a hot spot for transmission, officials said on Tuesday.

Three Republicans — Mike Lee of Utah, Thom Tillis of North Carolina, and Ron Johnson of Wisconsin — have tested positive in recent days. The other senators who have sought testing — about evenly divided between the two parties — have so far tested negative.

Aides for both Mr. Lee and Mr. Tillis have tested negative, according to spokesmen for the lawmakers.

Credit…Al Drago for The New York Times

Mr. Johnson has said that he would return to the Senate even if he were still ill when Judge Amy Coney Barrett’s nomination to the Supreme Court came to a vote, declaring that he would show up “in a moon suit” if necessary to confirm the president’s Supreme Court nominee before the election.

Senate leaders at war over the confirmation have quickly set aside differences and agreed to adjourn for two weeks beginning Monday. (The House had already been scheduled to be out of session.)

That left the cavernous Capitol — a beehive workplace for 535 legislators and thousands of staff — eerily empty on Tuesday as a frantic investigation was underway to understand the extent of the transmission. Anxiety over the possibility of widespread infection is particularly acute on Capitol Hill, where nearly half of senators are over the age of 65; the House, on average, is not much younger, and thousands of employees have been forced to work amid the pandemic.

Credit…Eve Edelheit for The New York Times

Facebook removed a post from President Trump on Tuesday that violated its policy against sharing misinformation about the virus, one of the few times that the social network has taken down one of his posts.

In Mr. Trump’s message, he falsely claimed that the flu was responsible for more deaths than the coronavirus. More than one million people have died from the coronavirus, with more than 35.5 million cases reported around the world. Mr. Trump’s post is no longer available on Facebook.

“Many people every year, sometimes over 100,000, and despite the Vaccine, die from the flu,” Mr. Trump wrote in the post. “We have learned to live with it, just like we are learning to live with Covid, in most populations far less lethal!!!”

The president’s comments and actions over the past few days — including his Twitter message on late Monday telling Americans: “Don’t be afraid of Covid. Don’t let it dominate your life” — have drawn outrage from scientists, ethicists and doctors, as well as from some people whose relatives and friends have died.

“I am struggling for words — this is crazy,” said Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania. “It is just utterly irresponsible.”

Facebook had previously removed ads and posts by Mr. Trump’s re-election campaign for spreading coronavirus misinformation or for violating policies about hate symbols, and it took down a video Mr. Trump posted in August in which he claimed children were “virtually immune” to the coronavirus. While the Silicon Valley giant has been under intense pressure to deal with Mr. Trump’s spreading of falsehoods on its site, its chief executive, Mark Zuckerberg, has said that he is a proponent of free speech.

This year, Facebook introduced new policies to remove misinformation related to Covid-19 “that could contribute to imminent physical harm.” The company has applied the policy to remove posts that “make false claims about cures, treatments, the availability of essential services or the location and severity of the outbreak.”

“We remove incorrect information about the severity of Covid-19, and have now removed this post,” Facebook said in a statement.

Mr. Trump also tweeted the same message falsely claiming that the flu was responsible for more deaths than the coronavirus. The company added a label to the tweet that hides the message, saying that the post violated its policies by spreading misleading information about Covid-19.

A Twitter spokeswoman said that the label would mean “engagements with the tweet will be significantly limited.”

Credit…Joe Raedle/Getty Images

President Trump’s comparisons of Covid-19 to the flu stand in sharp contrast with months of data gathered by experts, who have repeatedly said that the coronavirus poses a far more serious threat than influenza viruses.

The president tweeted on Tuesday morning:

“Many people every year, sometimes over 100,000, and despite the Vaccine, die from the Flu. Are we going to close down our Country? No, we have learned to live with it, just like we are learning to live with Covid, in most populations far less lethal!!!”

Based on data gathered thus far, most flu viruses are less deadly and less contagious than the coronavirus. And while flu vaccines and federally approved treatments for the flu exist, no such products have been fully cleared by governing bodies for use against the coronavirus.

According to the Centers for Disease Control and Prevention, between 24,000 and 62,000 flu-related deaths occur in the United States each year — substantially fewer than Mr. Trump claimed. In February, Mr. Trump stuck closer to the facts at a White House news conference. “The flu, in our country, kills from 25,000 people to 69,000 people a year. That was shocking to me,” he said at the time. On average, seasonal flu strains kill about 0.1 percent of the people they infect.

The coronavirus, on the other hand, has killed more than 210,000 people in the United States, and more than one million worldwide, since the start of 2020. The virus’s true mortality rate remains unclear, as it is difficult to gather such data while the pandemic rages on. Inadequate testing has also made it hard to pinpoint how many people have been stricken by the virus, which can spread silently from people who never show symptoms.

Still, estimates from experts tend to put the coronavirus’s death rate higher than the flu’s. The virus’s death toll was especially high in late winter and spring, when hospitals were overwhelmed, clinically tested treatments were scarce and masking and distancing were even more intermittent than they are now.

Frequent encounters with past flu strains, in combination with effective vaccines, can also bolster the body’s defenses against new flu viruses. The coronavirus, however, has swept through a defenseless population of unprepared hosts at a dizzying rate.

And deaths also don’t reveal the entire picture. Researchers still don’t fully understand the long-term consequences of coronavirus infections, which have saddled a growing number of people, called long-haulers, with serious and debilitating symptoms that can linger weeks or months.

Twitter appended a note to Mr. Trump’s tweet, saying that it violated the company’s rules about spreading false or misleading information about the virus, and Facebook removed the post for violating its similar policy.

Credit…Erin Schaff/The New York Times

Since President Trump disclosed early Friday that “@FLOTUS and I tested positive for COVID-19,” he has tweeted dozens of times and released four video statements posted on social media accounting for 7 minutes 9 seconds of direct-to-camera communication.

He has instructed Americans to not let the virus “dominate” their lives; compared the impact of the deadly virus to the seasonal flu (in a post that Facebook removed from its platform on Tuesday, citing its rules against spreading misinformation); lavished praise on his supporters and the medical staff who helped him; talked about how fit he was feeling; and declared that he had “learned a lot about Covid” and now “gets it.”

One topic he has scarcely mentioned: the 210,000 people in the United States who have already died of the virus.

In none of the messages does Mr. Trump directly offer condolences to the families of the dead or make explicit reference to the toll that the pandemic has taken on the families of those who contracted the disease or died in the pandemic.

In response to Mr. Trump’s “dominate” remark, Amanda Kloots, the widow of the Broadway actor Nick Cordero — who died of the virus at 41 in July — made an emotional plea to Mr. Trump to express “empathy” in a post and video on her Instagram page.

“Unfortunately it did dominate our lives didn’t it?” she said.

“I guess we ‘let it’ — like it was our choice??” Ms. Kloots continued. “It IS something to be afraid of. After you see the person you love the most die from this disease you would never say what this tweet says. There is no empathy to all the lives lost. He is bragging instead. It is sad. It is hurtful. It is disgraceful.”

Mr. Trump has not avoided the topic entirely, referring in vague terms to the enormous negative impacts of the virus — urging people “to get out there and be careful” in one video, and making passing reference to “the millions of people all over the world” affected by the disease in another.

Mr. Trump has played down the impact of the disease in the months before he came down with the virus, a pattern that has continued since his diagnosis.

Fifteen of the posts were exhortations to supporters, boasting of his accomplishments and urging them to “VOTE!”

He has defined his role as morale booster, rather than emphasizing the steps needed to ameliorate the crisis or offering new approaches based on his personal experience.

“You’re going to beat it,” he said in a message on Monday. “We’re going to be out front. As your leader, I had to do that. I knew there’s danger to it, but I had to do it. I stood out front, and led.”

Twitter appended a note to Mr. Trump’s tweet comparing the coronavirus to the flu, saying that it violated the company’s rules about spreading false or misleading information about the virus, and Facebook removed the post for violating its similar policy.

Credit…Al Drago for The New York Times

Despite almost daily disclosures of new coronavirus infections among President Trump’s close associates, the White House is making little effort to investigate the scope and source of its outbreak.

According to a White House official familiar with the plans, the administration has decided not to trace the contacts of guests and staff members at the Sept. 26 Rose Garden celebration for Judge Amy Coney Barrett, Mr. Trump’s Supreme Court nominee. At least 11 people who attended the event, including the president and the first lady, have since tested positive.

Instead, it has limited its efforts to notifying people who came in close contact with Mr. Trump in the two days before his Covid diagnosis on Thursday evening. The White House official, who declined to be identified because he was not authorized to speak about the matter, said that the administration was following guidelines from the C.D.C.

The contact tracing efforts have consisted mostly of emails notifying people of potential exposure, rather than the detailed phone conversations necessary to trace all contacts of people who have been exposed. These efforts, typically conducted by the C.D.C., are being run by the White House Medical Unit, a group of about 30 doctors, nurses and physician assistants, headed by Dr. Sean P. Conley, the White House physician.

“This is a total abdication of responsibility by the Trump administration,” said Dr. Joshua Barocas, a public health expert at Boston University, who has advised the city of Boston on contact tracing. “The idea that we’re not involving the C.D.C. to do contact tracing at this point seems like a massive public health threat.”

Credit…Doug Mills/The New York Times

For more than a century, Secret Service agents have lived by a straightforward ethos: They will take the president where he wants to go, even if it means putting their bodies in front of a bullet.

But that guiding principle has been tested in recent days by President Trump’s desire to get back to work, play or campaigning, despite an active coronavirus infection that could pose a serious threat to those around him.

The problem came into focus on Sunday, when a masked Mr. Trump climbed into a hermetically sealed, armored Chevy Suburban with at least two Secret Service agents so the president could wave to supporters outside Walter Reed National Military Medical Center in Bethesda, Md., where he was hospitalized from Friday to Monday.

Medical experts said the move put agents at risk. Secret Service personnel have privately questioned whether additional precautions will be put in place to protect the detail from the man they have pledged to protect.

“It’s on everybody’s mind,” said W. Ralph Basham, a former director of the Secret Service and the commissioner of U.S. Customs and Border Protection in the George W. Bush administration. “The ones no longer there are happy they’re not there. These are tough decisions to have to make.”

Central to the job of Secret Service agents is a willingness to say yes to the president no matter what he asks. Now, that means subjecting an agent’s health to Mr. Trump’s whims.

Critics say the president is not repaying his protectors’ dedication with anything like care or consideration. While agents have volunteered to sacrifice themselves for those they protect, they do so knowing that there is a low chance they will need to step in between a gunman and the president.

If they’re on the protection detail, they’ll take a bullet for their protectee,” said Janet Napolitano, President Barack Obama’s first homeland security secretary. “There’s a difference between that and being unnecessarily exposed to risk,” she added, one that extends to their families.




Trump Removes Mask Despite Coronavirus Infection

After President Trump arrived at the White House from the hospital on Monday, he climbed stairs to a balcony and took off his mask.

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After President Trump arrived at the White House from the hospital on Monday, he climbed stairs to a balcony and took off his mask.CreditCredit…Anna Moneymaker for The New York Times

A day after exhorting Americans to overcome their fear of the pandemic, an ailing President Trump cast the crisis as a state-of-mind problem on Tuesday morning, saying the country is “learning to live” with the virus — and likening it, as he has done in the past, to the flu.

Public health experts had hoped that Mr. Trump, chastened by his own infection and alarmed by the cases that have erupted among his staff members, would act decisively to persuade his supporters that wearing masks and social distancing were essential public health safeguards.

Instead, the president has continued his yearlong pattern of playing down the deadly threat, tweeting on Monday from the military hospital where he had been receiving state-of-the-art treatment for Covid-19, the disease caused by the virus.

“Don’t be afraid of Covid,” he wrote, shortly before flying back to the White House late Monday. “Don’t let it dominate your life.”

The president was back at it again first thing on Tuesday, taking to Twitter to offer a mixed message that combined the boilerplate of a public service announcement with his little-to-fear-but-fear-itself spin on a pandemic that has killed more than 210,000 Americans.

“Flu season is coming up!” wrote Mr. Trump.

“Many people every year, sometimes over 100,000, and despite the Vaccine, die from the Flu,” he added, echoing, if not quite repeating, his earlier false claims that Covid-19 was comparable in lethality to the seasonal influenza, which experts say is much less deadly than coronavirus.

“Are we going to close down our Country? No, we have learned to live with it, just like we are learning to live with Covid, in most populations far less lethal!!!”

Upon Mr. Trump’s return on Monday evening from Walter Reed National Military Medical Center, he climbed the steps of the White House, turned to face the TV cameras that were carrying the news live and removed his mask.

He appeared to breathe with difficulty, but his respiration seemed less labored in a direct-to-camera video he taped shortly after.

The president’s comments and actions over the past few days have drawn outrage from scientists, ethicists and doctors, as well as from some people whose relatives and friends have died. They come about a month after the journalist Bob Woodward disclosed that Mr. Trump knew the virus was far more deadly than the flu soon after the pandemic emerged as a national threat this spring.

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical School in Tennessee, called the president’s message “dangerous” because it encouraged his followers to ignore basic recommendations to keep themselves safe.

“I am struggling for words — this is crazy,” said Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania. “It is just utterly irresponsible.”

Credit…Erin Schaff/The New York Times

President Trump is hardly the first president confronting a crush of last-minute pressures and obstacles in the closing weeks of a re-election campaign. Jimmy Carter was saddled with the hostages in Iran. Barack Obama had to recover from a weak first debate. George W. Bush had to overcome deep reservations about the war in Iraq.

But it seems fair to say that no president in the history of American politics has ever confronted the hurdles that Mr. Trump faces as he attempts to be at once a president seeking re-election and a coronavirus patient. Mr. Trump is charging into uncharted territory, against the advice of doctors who warned against leaving the hospital and about the random and often lethal nature of the disease.

There are all kinds of questions that will determine if Mr. Trump can make an easy, quick transition from the hospital room to the campaign trail. The most critical one is whether the disease is really in remission; Covid-19 has proved to linger and return in often debilitating ways.

Will Mr. Trump have the energy to stage the two-hour rallies on his feet that have characterized his campaign? Will voters, campaign aides, White House staff, Secret Service agents and reporters want to be close to him, particularly if he continues to flaunt not wearing a mask, as he did upon returning from Walter Reed National Military Medical Center?

Patients struggling with Covid-19 are supposed to stay isolated. But Mr. Trump seems ready to jump on airplanes, into presidential motorcades and crowded campaign settings.

Many of these questions may be resolved by the virus. It could disappear, or it could re-emerge and send Mr. Trump back to convalescence.

For now, there is one key test coming up: Mr. Trump is supposed to debate former Vice President Joseph R. Biden Jr. on Oct. 15. It is a critical debate for Mr. Trump. He hurt himself with many voters in the first debate, and he is trailing in polls. This will be one of the last chances to turn things around.

But this is a town hall debate, which if it is set up at all like past town hall debates — a big if, of course — means that Mr. Trump and Mr. Biden would be in a setting where voters, asking questions, are in fairly close proximity — not only to one another but to someone just out of the hospital, including a certain president. Mr. Trump may be game for that. The question is, will anyone else?

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