WINDHAM, MAINE – To Ed Couture, a 67-year-old contractor in rural Maine, President Donald Trump becoming sick with covid-19 shows that the White House did not take the health threat posed by the novel coronavirus seriously.

But that does not change Couture’s support for the president. A former union member who once voted with Democrats, Couture cast a ballot for Trump in 2016, and he did the same thing Monday, the first day of in-person absentee voting for the general election in Maine.

“I just like him because he speaks like a regular person,” Couture said of the president, whose illness after contracting the coronavirus has upended the 2020 campaign. “He’s just like us.”

With four weeks until the election, voters are facing circumstances that are virtually unprecedented. The president is sick with an illness that has killed more than 209,000 Americans. The virus has spread to much of his inner circle, crippling parts of the White House at a pivotal moment. And with the coronavirus still threatening much of the country, many voters are casting ballots by mail – or early in person – for the first time to protect their health.

Voters in a half-dozen states turned up at polling places or election offices Monday for the start of early voting. And Trump’s health loomed large for many of them – a reminder that many Americans will be casting their ballots long before the campaign ends on Nov. 3.

In Omaha, Nebraska, at the Douglas County Election Commission office, a 72-year-old oral surgeon and former longtime Republican expressed disappointment with Trump’s handling of the pandemic, including his rhetoric blaming China as “a kind of boogeyman.”

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“It should not be politicized,” said Harold Tu. “It should be based on science and medicine. It’s so important that people see information as credible.”

Blaming Trump, Tu called the handling of the pandemic “an example of a failure of leadership, and a failure to address the public health crisis of our time.” He said he had switched his party affiliation to Democrat earlier this year.

Voters who leaned toward Democrats tied Trump’s illness to his opposition to the Affordable Care Act, arguing that repealing the law would hurt patients.

In Davenport, Iowa, Sally Ellis, 76, said that the president is “pretending to be well because it makes him look powerful and strong. He’s being self-centered and not caring about the people around him.”

Noting that she has never missed an opportunity to vote, Ellis said the pandemic, the environment and the Affordable Care Act were motivating her to cast a ballot against Trump.

“There are so many people covered by that insurance that will die if they’re not covered,” Ellis said of the 2010 health-care law, as dozens stood outside the Scott County auditor’s office waiting to vote.

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About 20 voters were waiting when the office opened at 8 a.m. The line swelled to more than 50 as the morning went on. Auditor Roxanna Moritz, wearing a mask, asked voters to stand at least six feet apart.

James Hickles, 62, of Davenport, who also voted in person, said he doesn’t think the president is being truthful about the severity of his covid-19 diagnosis.

“I think he may have a mild case of it, and his team is [exaggerating] the intensity of it,” Hickles said through his mask, which had the word “vote” on it.

Hickles, a federal contract specialist, said he believes that Trump is taking the country in the wrong direction. “He’s not doing anything to correct the problems out there, and add to that covid and the distrust and madness associated with it,” he said. “I need a 46th president.”

Not everyone who stood in line wore a mask. Ronald Baumbach, who works for the Illinois National Guard, said he is supporting Republicans this year because of how well he believes the economy is running.

Baumbach, 51, said he knows a few co-workers who were diagnosed with covid-19. As for the president’s diagnosis, he said: “It happens. It’s something that’s going around.” He added that he wished the president a full recovery.

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Yvonne Johnson, 82, of Davenport also wished the president well as he fights the illness but added that she was glad he contracted the coronavirus.

“He always said it’s a hoax,” said Johnson, a retired foundry inspector. “Now he knows it’s not a hoax.”

In Portland, Maine, recently naturalized citizen Jeanne Mendomo, who was born in Cameroon, chose to take her absentee ballot home to fill out with help from her daughter, who helps her translate between English and French.

Mendomo, 74, said she had not decided whom she was voting for in most races yet, but she thought Trump’s covid-19 diagnosis was a divine message telling him to take the virus more seriously.

“God is speaking to President Trump,” she said, adding: “Everyone is the same, Black or White, rich or poor. God is telling Trump that anyone can get this.”

Back in Windham, Maine, Maxine Campbell, 82, dropped her ballot in a box outside the clerk’s office shortly before 1 p.m. She said the high stakes of the election had motivated her to get out early.

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“This is probably the most important election of my lifetime,” she said. “I couldn’t wait to come and vote. We need a change.”

Campbell, a retired nurse, is not supporting the president and said she keeps her head down in the rural town of 17,000, which backed Trump in 2016. She said her reaction to his covid-19 diagnosis was skepticism – about how serious his case was or whether he had it at all.

“I’m not sure if I believe him or not,” she said. “I feel like he’s controlling everything behind the scenes.”

Ron Dyer, a 77-year-old Vietnam veteran also in Windham, said he voted against Trump because he thought the president was too close to Russian President Vladimir Putin.

“The country’s going to turn communist if Trump gets reelected,” he said, and then raised two fingers pressed closely together. “He and Putin are like this.”

Dyer said he thought the president “got [covid-19] because he deserved it – not wearing a mask, and all that.”

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Wolfe reported from Maine, Genoways reported from Nebraska, and Wellner reported from Iowa.