Mystery surrounding Senator Mitch McConnell’s health is deepening as the US Congress prepares to return from recess next week.

McConnell, 84, has not been seen in public since he was admitted to hospital in the Washington area on 14 June. Nearly a month later, the Kentucky Republican’s office has released only sparse updates, saying he is “continuing to improve” and remains engaged with Senate business, while refusing to disclose the nature of his illness or explain why he remains hospitalised.

Emergency dispatch audio obtained by media outlets indicates that first responders were sent to his home following reports of an unconscious person and that CPR was under way. On Friday, CNN released video footage that showed a person on a stretcher being wheeled towards an ambulance, though their face was not visible.

The senator’s office has neither confirmed nor denied the reports, leaving a vacuum that has been filled with fevered speculation, based on circumstantial evidence, about McConnell’s condition.

“I think he’s dead,” opined Malcolm Nance, a career counter-terrorism intelligence officer, in an interview with Amy McGrath, who lost to McConnell in the 2020 election, on the Truth in the Barrel podcast. “It’s very clear. I heard that 911 tape and I was an EMT when I was in the military at one point and you know we used to do CPR a lot. One of the things that teach you about CPR is the probability of coming back from CPR is very, very, very small.”

McGrath, a former marine fighter pilot, replied: “Well, it’s an interesting take. We’ll see what happens there as well.”

The Senate returns on Monday for a four-week legislative session dominated by defence spending, national security and government funding bills. McConnell’s continued absence threatens to complicate Republican efforts to advance those measures with only a narrow 53-47 majority.

McConnell chairs the Senate rules committee and a defence appropriations panel, which is crucial in shaping Pentagon funding and where Republicans hold only a one-seat advantage.

Without him, partisan disputes over annual appropriations could become even harder to resolve ahead of the 1 October deadline for new federal spending. Congressional leaders are already signalling that another temporary spending measure may be needed to avert a government shutdown.

The lack of information has also prompted unusual public intervention from Kentucky’s Democratic governor, Andy Beshear, who published an open letter urging McConnell to provide reassurance to his constituents.

“Kentuckians have grown increasingly concerned about the current state of your health and well-being, and ability to hold office,” Beshear wrote, adding that persistent uncertainty was unfair both to the senator and to the people he represents.

McConnell’s office has said only that he appreciates the “outpouring of support” and continues working closely with staff on Senate and Kentucky matters while recovering in hospital.

Senior Republican colleagues have attempted to dampen speculation. Senate majority leader John Thune and the Republican whip, John Barrasso, both said this week that they had spoken with McConnell, describing him as alert and engaged in discussions about current events.

Asked aboard Air Force One how the senator was faring, Donald Trump replied simply: “I have no idea how he’s doing.”

McConnell was the longest-serving party leader in Senate history. Even before his latest illness, his health had become an increasing concern. He suffered a concussion after a fall in 2023, twice froze while speaking to reporters later that year, sprained his wrist in another fall and spent more than a week in hospital earlier this year with flu-like symptoms.

His latest absence has drawn comparisons with that of Congressman ​Thomas Kean, a New Jersey Republican ​who was out for nearly four months before ​disclosing that he had been treated for depression. Some have also detected parallels with Democratic efforts to conceal the declines of Joe Biden and Dianne Feinstein, a California senator who died in office at the age of 90 amid growing concerns over her mental acuity.

Reed Galen, president of JoinTheUnion.us, a pro-democracy coalition, said of McConnell: “I assume he’s still alive because if he was not alive that would be news that would be too hard to keep. But while he is incapacitated – and I go back to Feinstein, there are staff who are basically making decisions on behalf of the people of Kentucky.

“These are all people with pretty significant political equities of their own. We saw this, frankly, with President Biden’s people. It’s the next example of a gerontocracy in Washington DC that thinks more of itself than it does of its people.”

Should McConnell remain in office but be unable to return before January, there is little constitutional remedy. Senate rules do not permit proxy voting, meaning Republicans simply lose one vote whenever he is absent.

His resignation or death would create an even more complicated situation. Kentucky law was changed by the Republican-controlled legislature in 2024 to eliminate the governor’s power to appoint a temporary replacement.

Instead, any vacancy would trigger a special election, although the timing remains legally untested and could become the subject of court challenges. Depending on when a vacancy occurred, the seat could potentially remain empty until the new Congress is sworn in next January.

John Zogby, an author and pollster, offered another analogy: “This in some ways reminds me of Generalissimo Franco in the 1970s, who was reported to be unawake but still alive, and no one believed it after about six weeks, because they hadn’t figured out a transition yet in Spain.”