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Mr Trump, who faces off against Democrat challenger Joe Biden on November 3, has struck a bullish tone since he left Walter Reed Medical Center on Monday, and raised eyebrows with a barrage of all-capitals tweets, at one point firing off 18 messages in the space of an hour. The previous day he had left the hospital while still a patient, ordering his security detail to drive him along the road outside so he could wave to supporters, and upon his discharge, he also removed his face mask despite still being infectious.

This week Mr Trump claimed he has been “cured” of coronavirus and today referred to himself as a “perfect physical specimen”.

The 74-year-old is currently being treated with a cocktail of drugs including the steroid dexamethasone, which has numerous side effects including, rarely, grandiose delusions, psychosis and even hallucinations.

In addition he has received Regeneron and Remdesivir, the side-effects of which are still not fully understood.

Speaking today, Ms Pelosi, who as Speaker of the House of Representatives is second to the Presidency after Vice-President Mike Pence, was today asked by reporters if it was time to “invoke the 25th Amendment”.

She replied: “I’ll talk to you about that tomorrow. I’m not going to talk about it today.”

Ms Pelosi also voiced concern about the time-frame of Mr Trump’s illness, given at least 27 people working closely with him have now been infected, prompting speculation that the President himself is a “super spreader” of the disease.

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She asked: “Mr President: when was the last time you had a negative test before you tested positive?

“Why is the White House not telling the country that important fact about how this spread and made a hotspot of the White House?”

Ms Pelosi previously referenced Mr Trump’s mental state in the light of his decision to pull the plug on budget negotiations and determination to press ahead with the confirmation of Supreme Court judge Amy Coney Barrett.

She told Bloomberg: “I’ve quoted others to say that there are those who say that when you’re on steroids and/or if you’ve had Covid-19 or both – that there may be some impairment of judgment.

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“But, again, that’s for the doctors and scientists to determine, but it was very strange, really surprising and I’m rarely surprised, when the President took to the tweet and saying that he wants the Senate to have full focus on this confirmation of the justice and turned attention away, so we’re stopping negotiations.”

The 25th amendment is a rarely used clause in the US constitution which provides a mechanism for the handover of power in the event that a President is unable to discharge his duties.

It has been invoked to allow an acting President on three occasions – in 1985, when Ronald Reagan underwent a colonoscopy, when George HW Bush took temporary charge, and in 2002 and 2007, when George W Bush likewise underwent a colonoscopy, with Dick Cheney replacing him on each occasion.

The 25th amendment was not invoked in 1981 after the assassination attempt on Mr Reagan left him requiring surgery to remove a bullet from his lung.

Mr Trump also did not transfer any powers to Vice President Mike Pence, despite his illness.

Massachusetts-based psychiatrist John Martin-Joy, writing on the Psychology Today website yesterday, said: “As a first procedural step, the 25th amendment lets a president declare himself incapacitated

“That move is not impossible, but is unlikely to happen when there is a psychiatric impairment.

“Instead, the vice president or a cabinet official would have to become concerned enough to initiate the process.

“What would need to happen? For the vice president to assume the powers of the presidency, he or she and a majority of the Cabinet would have to inform the House and Senate that they agree on the president’s incapacity.

“Once that happens, the vice president is temporarily in charge.

“If the president then says in writing that ‘no disability exists’, the vice president and cabinet have four days to tell the House and Senate otherwise.”

Google searches for “25th amendment” have spiked sharply since September 20, and the phrase is also trending on Twitter.

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