How do age, health, gender, and race affect outcomes?
The recent Covid infections among President Trump, his family, and his staff have the world wondering about the risks to those infected. How dangerous is it for the President? Melania Trump? Should we be worried? How do the risks compare between President Trump and Melania Trump or Hope Hicks?
In a recent series of blog posts, we used a logistic regression model to understand the relationships between age, race, and other factors in Covid outcomes. Using the model, we developed probabilities for outcomes based on these risk factors. We can leverage that work to understand the risks to the President, the First Lady, and Hope Hicks. Since they represent a cross-section of the population, it will also help us understand how Covid risks differ from person to person.
The analysis is based on outcomes in the CDC's case surveillance data. The case data only considers patients that tested positive for Covid and have known outcomes. Since we're only looking at positive tests, our findings will be higher than the experience in the general population. Don't make the mistake of comparing our analysis to mortality rates. We are only looking at probabilities for people that test positive with specific conditions. president Trump also has a number of advantages: he's surrounded by medical personnel, has full access to available treatments, and is constantly monitored. We can expect these advantages to give him and other staff members more favorable outcomes than the general population. We would expect this of any President, not just Trump.
What is the age risk?
In spite of his advantages, President Trump has a number of issues that place him at greater risk to an adverse Covid outcome. The most obvious risk factor is his age. Our analysis used the 40-49 year old age group as a baseline. Those younger than 40 are less likely to die from Covid, while those 50 and above are more likely to die of Covid than someone in their 40s. Based on our data and the model we developed, somebody in their 70s is 14 times more likely to die from Covid than somebody in their 40s. Using the odds as a baseline, patients in their 70s showed a 28% probability of dying from Covid.
What about Melania Trump and Hope Hicks?
Melania Trump is 50 years old without any known health conditions. We would expect her to be at significantly less risk than her husband. Looking solely at age, a 50-59 year old with a positive test has about a 6% probability of dying from Covid. Melania's risk based on age is about four times less than the President's.
Hope Hicks is a 31 year old without any known health conditions. Her risk is even smaller, with a probability of about 1%. Based on age, she's six times less likely than Melania and 28 times less likely than President Trump of dying from Covid. Age clearly has a significant impact on the likelihood of dying from Covid.
On the plus side, Trump's race gives him an advantage. The probability of a white person with a positive test dying is 9.6%. The probability of a black person dying, based solely on race, is about 14%. Being white reduces risk.
What about pre-existing conditions?
Another risk factor is pre-existing conditions. Given Trump's weight alone, he qualifies as someone with pre-existing conditions. Using our model, the estimated probability of someone with a positive test and medical conditions is 14.86%. Trump shows increased risk due to his age, gender, and medical conditions. Since Melania Trump and Hope Hicks don't have any known health conditions, their probabilities are considerably lower--only 1.12%. Because of their general health, Melania Trump and Hope Hicks are 14 times less likely to die from Covid than President Trump, based solely on pre-existing medical conditions.
What is the combined risk?
Many risk factors share characteristics. For example, older people are more likely to have pre-existing medical conditions. The risk of an older person dying from Covid due to age includes some portion of the risk due to medical conditions. In a sense, the risk from a pre-existing condition is buried in the risk due to age. Since the risk factors can overlap, we can't simply add up the probabilities. If we just added the two probabilities together, we would be double counting some portion of the risk factors. In order to consider combinations of risk, we need the model to create a formula for us that reflects these interactions. Once we have the formula, we can plug in the risk factors to get our probabilities. If we look at the combination of age and pre-existing conditions, a 70-79 year old with pre-existing medical conditions and a positive test has about a 31% risk of dying from Covid. Had we just added the two probabilities together, we would've come up with a 43% probability of dying, so there's definitely overlap between the two conditions. What about Melania Trump? As a 50 year old with no medical conditions, her risk is significantly lower. The probability of a 50 year old with no medical conditions and a positive test is just 1.2%. Hope Hicks fares even better, with a probability of just 0.4%.
What if we combine all of the risk factors (age, medical conditions, race, and gender)? Combining all of the available risk factors for President Trump, we end up with a probability of 31.5%. Combining all the factors for Melania (50 year old white female with no medical conditions) results in a 1% chance. Hope Hicks has even less risk with a 0.2% probability of dying from Covid, given that she has a positive test and is a 30 year old white female with no pre-existing conditions. While this is good news for Hope Hicks and Melania Trump, it's concerning for the President. His risk is over 30 times greater than Melania's and over 150 times greater than Hope Hicks'.
While these aren't numbers you want to see when you're a 70+ year old with Covid, the numbers do tell us that the majority of 70 year-olds eventually recover. In fact, the odds are about 2.5 to 1 that somebody in the same risk group as the President will recover. Covid is not a death sentence. The President is more likely to recover than not. Nonetheless, there is clearly significant risk to the President, and it's understandable that his medical team is taking every precaution.
What about hospitalization?
We can also look at the likelihood of hospitalization. Technically, the President is already in the hospital, but we don't know if he was hospitalized because of a medical emergency or simply for monitoring and emergency preparedness. Within the general population, a 70+ year old white male with medical conditions runs a 59% risk of being hospitalized. The President has better than even odds of going to the hospital, given his age, conditions, gender, and race. For Melania, the probability of hospitalization is about 9%. Hope Hicks' probability of hospitalization is only about 3%. The President is about 6 times more likely to end up in the hospital than Melania and about 20 times more likely than Hope Hicks.
On the one hand, we shouldn't be surprised that the President went into the hospital early. Given the risk factors, it's a sensible precaution. The high likelihood of ending up in the hospital emphasizes how serious Covid can be for people in their 70s. Anybody with similar age and risk factors should be monitored carefully, and family members and friends shouldn't hesitate to get them to the hospital if their condition deteriorates.
President Trump contracting Covid is not a reason to panic. He is more likely to survive Covid than not. During the Influenza epidemic of 1918, Woodrow Wilson, FDR, and even Walt Disney contracted the virus. They all survived. Nonetheless, we should be respectful of the risk he faces. He is likely to be sick for weeks. Given his risk factors, he needs to be monitored closely with treatments readily available. Moving him into Walter Reed and giving him Regeneron's antibody cocktail and Remdesivir are sensible precautions.
Melania Trump and Hope Hicks are at significantly less risk than President Trump. This doesn't mean that they are out of the woods or can't get seriously ill. However, the odds are 9:1 against Melania Trump even needing to go to the hospital. Over 30:1 odds against Hope Hicks going to the hospital, much less dying. However, if you're the one, the odds don't count for much. Melania Trump and Hope Hicks should also be respectful of a disease that has claimed hundreds of thousands of American lives and will likely claim many more.