(Bloomberg) -- Bernie Sanders has so far muscled past questions about his age by keeping a grueling campaign schedule, bouncing between ice cream socials, private meetings, rallies or town halls in a single day -- with aides decades his junior struggling to keep up.
But the 78-year-old’s heart attack last week hinders a candidacy already faltering as Elizabeth Warren, his rival for the progressive mantle, edges into a statistical tie for frontrunner status in the Democratic presidential race.
The Vermont senator’s campaign is now facing an acute dilemma without precedent in modern American politics. No candidate has experienced and disclosed a potentially life-threatening health incident while running for a major party’s White House nomination.
Charles Franklin, director of the Marquette Law School Poll in Milwaukee, said he couldn’t think of a presidential primary candidate with “anything as serious as Sanders’s heart attack.”
Sanders in an interview Wednesday evening walked back comments to reporters a day earlier, when he said he would scale back his campaign activities after the heart attack.
“We’re going to get back into the groove of a very vigorous campaign, I love doing rallies and I love doing town meetings,” he told NBC Nightly News with Lester Holt, with his wife, Jane, by his side. But that won’t happen right away, he added, saying that, “I want to start off slower and build up and build up and build up.”
The senator also reached out to supporters Thursday morning in a web video distributed by his campaign, telling backers that “I am feeling really good and getting stronger every day.” He vowed to return to the campaign trail and reiterated that he’ll be at next week’s Democratic presidential debate in Ohio.
The health predicament adds to the importance of the debate, the only appearance Sanders has committed to since his campaign disclosed last week that he had been hospitalized for a heart attack and had two stents inserted. It will likely be the first chance for voters to examine whether he is vigorous or showing signs of weakness after his health ordeal.
Sanders already has been losing ground, falling into third place in recent national polls of Democratic voters behind Warren and Joe Biden, after consistently holding second place much of the year. A Real Clear Politics average of polls between Sept. 23 and Oct. 7 showed Warren with 26.6% support, Biden with 26.4% and Sanders with just 14.6%.
At the moment, the 2020 presidential campaign is led by older candidates, with Biden, Warren and Sanders -- as well as the likely Republican nominee, incumbent President Donald Trump -- all in their 70s.
Their prominence shows that voters have been discounting age as a concern, but that could change as Sanders’s health brings increased scrutiny that hampers his campaign, said Julian Zelizer, a history professor at Princeton University.
The heart attack “makes him campaign less in an incredibly competitive campaign,” Zelizer said. “If you’re running neck-and-neck with two people and there are a few others on your tail, you really can’t take time off very easily. And his campaign is built on rallies and on his presence as much as media appearances. So it’s really going to be tough and it will fuel concerns about his age and whether it’s a problem.”
Sanders, who draws on backing from progressive voters reaching back to his unsuccessful 2016 primary bid against Hillary Clinton, may not see any immediate drop in support, said Jennifer Lawless, a professor of politics at the University of Virginia. The stronger risk is that it will be more difficult for him to gather new supporters, she said.
“I don’t know that he loses support from this,” Lawless said. “I think it would be difficult to encourage more people to begin supporting him.”
Sanders’s campaign didn’t respond to a request for an interview, but it has planned a flurry of activity for supporters in the weeks ahead, signaling that it doesn’t intend to let up in the race for the nomination. The campaign on Wednesday said in a statement that its grassroots field program has scheduled 1,500 October events since his heart attack, including phone banks and door-to-door canvassing in key primary states.
And Sanders has plenty of money to power his way well into next year’s primaries. He raised $25.3 million in the third quarter, surpassing all the other Democratic contenders.
Still, the campaign’s handling of the heart attack showed a lack of transparency about his health that could rattle voters. When his campaign first disclosed that Sanders had been hospitalized on Oct. 2, it was described as a fleeting episode of chest pain. It wasn’t until three days later that the campaign acknowledged that he had suffered a heart attack, a far more serious health event that doctors say likely would have been diagnosed within hours after he experienced it.
In the NBC interview, Sanders said he was told quickly that he had suffered a heart attack, but dismissed criticism of the way the situation was managed.
“That’s nonsense,” he said. “I don’t know what people think campaigns are, you know we’re dealing with all kinds of doctors and we wanted to have a sense of what the hell was going on really.”
Zelizer and others say Sanders is in uncharted territory. The only other time a would-be president disclosed a life-threatening health issue was 27 years ago, when Democratic Senator Paul Tsongas of Massachusetts said that the non-Hodgkins lymphoma he earlier said he’d fought and survived had actually recurred five years before. But he had already suspended his campaign for the 1992 election.
President Dwight Eisenhower suffered a heart attack in 1955, but he had not yet announced that he would run for re-election the following year. And Bill Bradley, a former senator, was hospitalized with a heart rhythm problem in 1999, when he was running for the Democratic nomination.
The Tsongas episode sparked the current-day pressure on candidates to be open with voters about their health setbacks, Lawless said.
“It set a precedent for how we expect candidates to quell voter concerns about health crises, but I don’t know of anybody at this point in a primary who had to deal with that,” she said.
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