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U.S. President Donald Trump as he departs the White House in Washington, Oct. 2, 2020.

LEAH MILLIS/Reuters

Americans in the late 1960s learned, in an evocative phrase from the student and women’s rebellions, that the personal was political. This month, they are learning with stunning suddenness that the personal health of the President is deeply political.

Actually, Americans should have learned that lesson decades before Donald Trump was admitted to hospital for a coronavirus whose pervasiveness and destructive power he repeatedly underestimated and even dismissed. Three American presidents have died in office after suffering illnesses, and a fourth spent the final 17 months of his administration in disabled seclusion, his wife secretly running the country in his name.

And yet Mr. Trump being taken to hospital – and the frequency of the adjective “concerning” in reports issued from the Walter Reed National Military Medical Center – caught the country unaware and unprepared, sending the public and political professionals examining contingencies that have been unrehearsed and crises that now perhaps are unavoidable.

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On COVID-19, Donald Trump has been hoist with his own petard

Trump sent to hospital as precaution after he and Melania test positive for COVID-19

“This country has a history of a secrecy around presidential health,” said Patricia O’Toole, a Columbia University historian and author of a 2018 biography of Woodrow Wilson, who was incapacitated after a 1919 stroke and was seldom seen by the public beyond orchestrated car rides until he left office in 1921.

“The Wilson coverup began on Day One, run by his doctor, whose loyalty was to the President and not to the Constitution. This Trump case for sure raises all sorts of important questions about transparency and is no way to run a country.”

Mr. Trump, 74 years old and overweight, may not be in mortal danger, but there may be grave dangers ahead for a country that – in the middle of a pandemic, a bitter Supreme Court confirmation battle and a contentious presidential election – is entering entirely uncharted waters.

With a President in hospital being administered supplemental oxygen and experimental medical treatments in the month before the voters go to the polls, constitutional scholars and campaign strategists alike are examining precedents, the 25th Amendment and the unexamined footnotes of the legislative record. This is all in an urgent, politically charged effort to be prepared if the President is incapacitated or dies and if such eventualities occur before the election or, more troublesome yet, between Election Day and Inauguration Day.

The drafters of the 18th-century Constitution and the architects of the 20th-century amendment governing some of these situations could not think of everything. It is an especially vexing circumstance now – with Mr. Trump suffering from a disease that can turn ruthless with a cruel suddenness – that the unthinkable could be unavoidable.

Even Mr. Trump’s most strident critics hope for his recovery; the New York Times, perhaps the President’s most committed conventional torturer, was conspicuously full of columnist wishes over the weekend for Mr. Trump’s return to full health. If his recovery lags, or if his condition deteriorates, there are procedures for Vice-President Mike Pence to become acting president.

The way forward if the President succumbs to the disease before the election is the road not taken, either by earlier presidents or by the drafters of the 25th Amendment. The amendment was passed after the assassination of John F. Kennedy placed House Speaker John McCormack, 72 years old but fragile and frail, in line for the presidency if vice-president Lyndon Johnson also died.

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In the event Mr. Trump is not the GOP candidate, the party’s opponent to former vice-president Joe Biden would likely be selected by the Republican National Committee, with members of the Electoral College chosen in states won by the party instructed to follow the committee’s guidance in choosing the president.

But none of that is certain, none of it has been tried before, and none of it is remotely ready for implementation.

In the meantime, the unreliability of Mr. Trump’s statements on even quotidian matters and his assault on medical and scientific expertise have contributed to the sentiment that the public is not being told the full truth about his health. Moreover, reports from his medical team have been affected by the importunes of his political team – a notion reinforced by an unsettling briefing at the military medical centre.

In an era of mistrust fed by social media and amid a presidential campaign, there are more questions unanswered than answered about the President’s condition and his fitness for further campaigning.

Then again, such questions were seldom even posed – not in the nation’s fourth decade, when William Henry Harrison died a month after taking the inaugural oath of office; nor in 1923, when Warren G. Harding died; nor even in 1945, when Franklin Roosevelt expired from a massive cerebral hemorrhage.

John F. Kennedy was assassinated, but had he lived, his health – defined by Addison’s disease, chronic back pain and injections of illegal drugs ordered by a physician known in the White House as “Dr. Feelgood” – almost certainly would have become an issue in a second term.

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A 2017 study in the Journal of Neurosurgery painted the situation starkly: “He relied on a near-daily therapy regimen, at times using various combinations of exercise, massage, procaine injections, support orthotics, crutches, narcotics, and illicit intravenous injections of methamphetamines in an attempt to manage this pain.”

But presidential health scares can redound to the public’s benefit. It was Mr. Kennedy – projecting an image of vigour despite his health issues – who encouraged Americans to engage in more strenuous activity through the President’s Council on Physical Fitness. Dwight Eisenhower’s 1955 heart attack vastly increased Americans' awareness of the importance of heart health.

“When a national leader like Donald Trump – someone we see all the time on television and hear from all the time – gets the virus it changes the way people look at COVID, even people who haven’t taken the virus seriously,” said Jason Opal, a McGill historian who is writing a history of epidemic diseases in the United States with his father, Steven Opal, a clinical professor of medicine at Brown University. “The fact that Trump’s family and inner circle now have it might convince people that this is for real.”'

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