President Trump revealed that he and the first lady, Melania Trump, have both tested positive for coronavirus, but it may be many days before the country knows the true severity of their cases.

Early Friday, Melanie tweeted a message stating that she had mild symptoms but was “overall feeling good” and “looking forward to a speedy recovery.” White House Chief of Staff Mark Meadows said Trump also was also experiencing mild symptoms, saying that the president was “in good spirits” and “very energetic.”

Meadows added that he was very optimistic that Trump would have a quick recovery.

Trump, meanwhile, was reported to be “fatigued” and later was transported to Walter Reed National Military Medical Center as a precautionary move.

It’s common for COVID-19 cases to start with mild symptoms, according to health experts, and it’s possible to feel fine before drastically feeling worse. 

This is a phenomenon known as the “happy hypoxia” syndrome, according to Priya Sampathkumar, an infectious disease expert at Mayo Clinic in Rochester, Minnesota.

A COVID-19 patient with this syndrome might have very low oxygen levels, yet still feel pretty good.

“You feel fine and so you don’t even go to the hospital,” she explained.

Because of this, she said it’s important that the president is monitored carefully in the coming days, and that his oxygen levels are checked frequently.

How soon symptoms progress depends on a number of factors, including age and how much of the virus a person was exposed to, according to Sampathkumar.

Typically, most symptoms start to develop within the first week after getting infected, but some patients could take 14 days or more to show symptoms.

At first, Sampathkumar said the symptoms are typically mild for a few days, much like what has so far been described for the first lady and the president. However, in the second week of infection, things can quickly take a turn for the worse, sometimes even in a matter of hours.

“The second week is when people tend to get very sick,” Sampathkumar said.

Trump is 74 years old, placing him at higher risk for hospitalization and death from the virus. COVID-19 patients who are between 65 and 74 years old are five times more likely to be hospitalized from the virus and 90 times more likely to die from the virus than patients between the age of 18 and 29, according to the Centers for Disease Control and Prevention.

“The older you are, the worse the risk is for adverse outcomes,” said Mayo Clinic infectious disease expert Pritish Tosh.

Trump is also more at risk because he is obese. A memo released by the White House in April revealed that he is 6’3″ and weighs 244 pounds, making his BMI 30.5. A BMI over 30 is considered obese.

Lastly, men in Trump’s age range have a much higher rate of death than women, according to Laura Goetz, who is the Medical Director of the Translational Genomics Research Institute North Clinical Laboratory.

However, she said it’s difficult to estimate exactly what Trump’s odds of survival are.

“His underlying illnesses are questionable,” Goetz said. “We don’t really know until we know all the variables.”

Overall, Trump’s chances of survival are still high. One study showed that COVID-19 mortality in the 70-79 year age group varied by country and ranged from 4.8% to as high as 12.8%. 

The high end of the rate is from Italy where COVID-19 outbreaks in nursing homes and overwhelmed health care facilities may have driven a higher death toll.

Additionally, Goetz said that the fatality rate among older individuals has been dropping since the beginning of the pandemic.

Trump’s age and weight also place him at higher risk for suffering side effects from the virus, which can include heart damage, lung damage, damage to the gut, or even brain damage.

Sampathkumar said that COVID-19 has been known to cause stroke-like symptoms and in rare instances, muscular weakness or an inability to move.

However, she noted that Trump will likely receive the best care possible, including receiving therapeutics earlier on in the infection, which could prevent him from developing more severe symptoms. 

The president announced in a tweeted video Friday that he was heading to Walter Reed Hospital to receive care, and the New York Times reported that he had a low-grade fever. 

The fever would signal that Trump may be at a higher risk of developing further complications, according to James Dearing, the senior vice president and chief medical officer of Synergy Health.

However, Dearing said the biggest factor to look for to predict Trump’s chances of surviving are inflammatory markers, which are measurable signals of inflammation in the body.

“The higher the inflammatory markers at the time of admission, that predicts their mortality better than any co-morbidities that exist,” he said. “The risk factors play a part but I’ve had people with terrible risk factors and they’ve made it.”

So far, the White House released a statement Friday stating that Trump was treated with a single dose of an antibody cocktail made by Regeneron Pharmaceuticals, a New-York based pharmaceutical company.

These antibodies are synthetically made based on antibodies found in recovered COVID-19 patients. In theory, they work by blocking the spike on the outside of the virus that the virus uses to enter and infect cells. 

“It’ll basically just block any negative action the virus has,” Goetz said. “It won’t be able to reproduce, it won’t be able to cause damage, though that’s if it’s going to work.”

Sometimes, Geotz said, antibodies don’t do anything at all, and this treatment is still very experimental and unproven.

“It’s still very up in the air right now,” she said, explaining that the body can make its own antibodies to block injected antibodies from working.

Typically, these antibodies aren’t used as a precautionary measure, she added, stating that in a clinical setting, they tend to be given to patients who are worse off, since it is still experimental with no proven benefit.

However, since Trump is the president and has higher risk factors, she speculated that the risks of getting the experimental treatment are likely lower than the benefits of potentially staving off a severe infection.

Regeneron released data about this treatment from a study on 275 patients earlier this week in which COVID-19 patients without naturally occurring antibodies were given either a placebo or given a dose of the cocktail.

The results showed those who received a placebo took 13 days, on average, to recover, whereas those who received either a high or low dose of the antibody cocktail took an average of eight and six days, respectively. 

It’s unclear when Trump was last tested for the novel coronavirus before Thursday evening. Trump is tested fairly regularly. In a July press briefing Trump stated, “I do take probably, on average, a test every two days, three days.”

Because he’s tested often, it’s likely that he is currently in the first week of his infection.

He was probably most infectious the day before he started showing symptoms, which would have been on Wednesday or Thursday of this week. 

“For COVID-19, the amount of virus is highest the day before they feel sick,” Tosh said. 

It’s unclear whether Trump could have caused any sort of so-called super-spreading event. Tosh said the novel coronavirus seems to spread similarly to other related strains of coronavirus such as SARS, where many infections come from a single source.

However, researchers and health care experts don’t yet fully understand what makes someone a super spreader, he said.

So far, former Vice President Joe Biden, who debated Trump earlier this week, has tested negative for COVID-19. But it’s too soon to tell whether Trump infected others, according to Paul Keim, a microbiologist at Northern Arizona University who also serves as the co-director of the Translational Genomics Research Institute’s Pathogen and Microbiome Division.

“The other shoe has yet to drop,” Keim said. “This is very early. We’ve got to keep watching this very closely.”

Just because somebody tests negative today doesn’t mean that they won’t test positive in a few days from now or next week, once the virus has a chance to spread in their system.

“Even with quarantining, that doesn’t stop transmission because most of the spread has already occurred,” Dearing said, pointing out again that the virus is most transmissible before symptoms occur.

Unlikely to figure out how Trump got sick

It wouldn’t take too long to analyze Trump’s virus sample and figure out which strain of the virus he has.

It would only take about a day, according to Keim.

While this could give researchers information about what strain of the virus Trump has, “it probably will not tell us exactly where he got it from,” Keim said.

Even if researchers also matched Trump’s samples to top Trump aides who have gotten sick — such as Hope Hicks, who was announced to have tested positive just hours before Trump — Keim said it wouldn’t prove that Hicks, or anyone else gave it to him.

Keim also noted that it’s possible that Trump could’ve given it to Hicks and other top aides instead of the other way around.

It’s likely, Keim said, that we may never know how exactly Trump got infected with COVID-19.

“It’s easier to disprove transmission than to prove transmission,” he said.

Additionally, what strain of the virus the president is infected with will not make a difference on treatment protocols at this point. 

While testing is necessary, Tosh said that this incident highlights the importance of social distancing and wearing masks, because those in Trump’s inner circle are tested frequently and yet have still gotten sick.

“We’re not going to be able to test our way out of this,” Tosh said.  “If you are not distancing and not wearing masks, then you are still going to be at risk of coming down with COVID-19.”

Amanda Morris covers all things bioscience, which includes health care, technology, new research and the environment. Send her tips, story ideas, or dog memes at [email protected] and follow her on Twitter @amandamomorris for the latest bioscience updates.

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