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What happens if Trump's COVID gets worse? Line of succession and transfer of power explained

WASHINGTON – Since President Donald Trump disclosed early Friday that he and First Lady Melania Trump had tested positive for the coronavirus, White House officials have sought to assure the country that the president remains well enough to discharge his duties even as he was readied for transfer to Walter Reed National Military Medical Center.

If Trump's condition worsens, leaving the 74-year-old commander-in-chief incapacitated, the Constitution provides for a line of authority to steer the government in his absence.

Under the 25th Amendment, the president could notify House Speaker Nancy Pelosi, D-Calif., and the Senate majority's senior member, Sen. Charles Grassley, R-Iowa, that he is unable to function, transferring power to Vice President Mike Pence until the president indicates that he is able to return.

The provision has only been invoked three times since the amendment's ratification in 1967, creating a legal mechanism for designating a head of state when the president is disabled.

It was used briefly when Ronald Reagan underwent surgery in 1985 and similarly when George W. Bush was under anesthesia in 2002 and 2007.

President Ronald Reagan and first lady Nancy Reagan wave as they walk with their dog Rex on the South Lawn of the White House on Sunday, June 15, 1986 in Washington after returning by helicopter from Camp David, Maryland. The Reagans spent the weekend at the presidential retreat and returned to the executive mansion on Father's Day. The man in the background is unidentified.

The amendment both set up the process for the president to voluntarily relinquish duties and created a method – which has never been used – for powers to be taken away when others believe the president is “unable to discharge the powers and duties of his office."

If Trump believes he can still do his job but Pence and a majority of the Cabinet disagree, a transfer of power to Pence would require the backing of two-thirds of both the House and the Senate. Lawmakers could also designate through legislation an alternative group – other than the Cabinet – that the vice president could work with to declare Trump unable to serve.

In an extreme circumstance, if the president were to die from the virus, Pence is first in line to succeed him.

Pelosi, 80, is second. The speaker tested negative for the virus Friday.

Grassley, 87, is third in line. Grassley said he won't be tested for COVID-19.

Secretary of State Mike Pompeo, 56, is fourth and also tested negative.

Vice President Mike Pence speaks during a press briefing with the coronavirus task force, at the White House, Tuesday, March 17, 2020.
Vice President Mike Pence speaks during a press briefing with the coronavirus task force, at the White House, Tuesday, March 17, 2020.

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Barbara Perry, co-chair of the Presidential Oral History Program at the University of Virginia’s Miller Center, said it’s too early to talk about the president’s demise, but it’s not too soon to think about the possibility of invoking the 25th Amendment if the symptoms of COVID-19 worsen and affect Trump’s thinking.

“Aside from his ability to do the job of the presidency, this coming as it does in the midst of a hard-fought presidential campaign in which he’s trailing in all the polls, just 32 days out of the election, makes it equally historic,” Perry said.

Beyond the concern for the continuity of government, analysts said Trump's illness raised national security worries.

Former Defense Secretary Leon Panetta said adversaries should be expected to exploit U.S. vulnerabilities.

The White House and national security agencies must move quickly to ensure the chain of command is secure and the military is prepared to respond without delay to provocation or attack, he said. The COVID-19 pandemic, the recession and Trump's questioning of the election's integrity could embolden adversaries to test the United States.

"We have the president and first lady ill and the country is in a vulnerable situation. We have to be very prepared to deal with the possibility that an adversary will seek to take advantage," Panetta said.

This is not the first time that a president or a presidential candidate suffered from an illness during a campaign.

President Theodore Roosevelt, Perry noted, was shot in the chest while on the campaign trail in 1912. Theodore went on to deliver his speech, during which he said, “I don’t know whether you fully understand that I have just been shot; but it takes more than that to kill the Bull Moose.”

Roosevelt’s cousin, President Franklin D. Roosevelt, who suffered from polio, was plagued with issues and questions about his health throughout his presidency. By 1944, when he was running for a fourth term, Roosevelt had already been diagnosed with congestive heart failure, although it wasn’t public at the time.

The 25th Amendment was first used for a temporary disability when Reagan underwent surgery at Bethesda Naval Medical Center to remove a cancerous polyp in his large intestine in 1985. After the anesthesia wore off, his chief of staff and counsel asked if he felt well enough to resume his authority. He said he did and congressional leaders were notified, even though Reagan had said he didn't think his situation was the kind the authors intended when creating the amendment.

Nevertheless, it was used twice again to temporarily transfer authority to the vice president when Bush underwent routine colonoscopies.

During Vice President Dick Cheney's two hours as acting president in 2007, he wrote a letter to his grandchildren as a souvenir for them.

Contributing: John Fritze, Brianne Pfannenstiel,

This article originally appeared on USA TODAY: If Trump's condition worsens: Line of succession explained