Why Docs Aren’t So Certain Trump Is Feeling Higher From Covid-19

Why Doctors Aren’t So Sure Trump Is Feeling Better From Covid-19

The White House Doctor, Dr. Sean P. Conley, stood on the steps of Walter Reed National Military Medical Center Monday, with a phalanx of white-clad doctors behind him. He has ticked off President Trump's encouraging vital signs: no fever, just slightly elevated blood pressure and blood oxygen levels in the healthy range.

"He's back," said Dr. Conley later in the press conference.

But when reporters asked him about the results of Mr. Trump's chest x-rays and lung scans – crucial measures of how seriously the president got sick from Covid-19 – Dr. Conley responded, citing a federal law that restricts doctors' ability to share about patients.

With no critical data on his lung function, medical experts on Covid-19 and lung disease said they were struggling to get an accurate picture of how Mr. Trump is doing. They found that while most patients with the virus recover, it was premature to declare victory over an unpredictable, poorly understood virus that killed more than 210,000 people in the United States.

Less than a month after election day, Dr. Conley's patient, Mr. Trump, as strong and unimpressed by the coronavirus and appears to have directed his doctor not to reveal any health details that could affect his image of invulnerability.

Dr. Conley said Tuesday that Mr. Trump had no symptoms of the disease and was doing “very well”, although he himself warned on Monday that the president was not “out of the woods” and that “we will all reach this final with a deep sigh Relief ”if he still feels good next Monday.

Far from beating Covid-19, the outside doctors have said that Mr Trump is most likely still struggling with it and entering a crucial phase – seven to ten days after the onset of symptoms – in which he is quick to settle could turn for the worse. He is 74 years old, male, and moderately obese. These factors put him at risk for serious illnesses.

"I don't have to get into the president's business," said Dr. Talmadge E. King Jr., specialist in lung criticism and Dean of the UCSF School of Medicine. However, he said, "If their goal is for us to better understand what is going on, they have left off a lot of very useful information."

Several medical experts said that due to the incomplete information provided by Mr Trump's medical team, the President appeared to have at least at some point experienced a severe form of Covid-19 with lung impairment and blood oxygen levels below 94 percent, which is a cutoff for serious illness.

But here too, Dr. Conley did not fully express Mr. Trump's oxygen levels. He said the president's blood oxygen dropped to 93 percent on Saturday. However, he had avoided an earlier episode of oxygen starvation on Friday. When a reporter asked if Mr. Trump was ever under 90 percent, Dr. Conley that his oxygen levels never dropped to the "low 80s," which left the possibility open that he might have fallen into the high 80s, which experts said was worryingly low and a sign of very serious illness.

"We go crazy when it comes to 88 percent," said Dr. King.

Mr Trump received oxygen twice, said Dr. Conley, and Saturday started on a steroid, dexamethasone, which is only recommended for Covid-19 patients with severe or critical forms of the disease. Mr Trump also received an infusion of an experimental antibody cocktail and received five days of treatment with the antiviral drug remdesivir.

Dr. Conley said Monday that Mr. Trump did not need oxygen and had not complained of breathing difficulties. He said the medical team prescribed dexamethasone after Mr Trump needed oxygen and that doctors weighed the risks and benefits.

But Dr. Conley didn't provide a full list of the drugs Mr Trump is receiving, saying, "I'm not going to go into what he is and what is not."

Some experts said the decision to give Mr Trump dexamethasone could be a sign that he was battling more serious Covid-19 than his doctors revealed, or that his doctors had inappropriately prescribed him the drug.

“Does he have lung involvement? I suspect so because they gave him a lot of medication that they would only give to someone who did this, ”said Dr. Mangala Narasimhan, pulmonologist and director of intensive care at Northwell Health in New York.

World Health Organization and National Institutes of Health guidelines recommend that dexamethasone be given only to people who need mechanical ventilation or supplemental oxygen.

A large study of the drug in the UK found that Covid-19 patients who fell into these two groups could be at risk for those with milder symptoms and suppress an immune system that was effective in fighting the infection rather than calming down one that was dangerous gone into high gear.

Dr. Craig M. Coopersmith, director of the Emory Critical Care Center in Atlanta and a member of the National Institutes of Health panel that issued the dexamethasone guidelines, said his doctor's decisions were understandable given that Mr Trump was given at least some oxygen.

"It is both aggressive and sensible to start someone on steroids when they reach a threshold for serious illness – even with low oxygen levels," he said.

As his attending doctor, Dr. Narasimhan, she wanted to see the results of a lung scan and laboratory tests that show inflammation and immune responses. "We would be watching very closely these things that we don't have," she said.

On Saturday, Dr. Conley notes that Mr. Trump did well on a spirometry test, which measures lung capacity. "He's everything," said Dr. Conley. "He's fine."

Dr. However, Narasimhan and others said a spirometry test was virtually meaningless in Covid-19 patients. "It doesn't tell us anything and it's not anything we use in this disease," she said.

In the absence of crucial details from the President's medical team, some outside doctors tried a different approach – assessing the patient himself. On Monday, Mr. Trump was flown to the White House where he was in a highly choreographed event broadcast live on some cable channels exited the Marine One helicopter, crossed the lawn, and went up a flight of stairs to what looked like a lighted set. At the top he took off his mask, put it in his pocket and flashed two thumbs up.

For many, it was a political stunt. For Dr. King of UCSF, who was watching C-SPAN, returning to the White House was an opportunity to watch the President breath.

"As a pulmonologist, he did two things for me: he did a walk test and he did a stair-climbing test," said Dr. King, adding that, despite the availability of sophisticated technology, pulmonologists still rely on those old-fashioned tests "just to get a picture of how the patient is doing."

Dr. King said what he saw concerned him. Mr. Trump paused twice as he walked across the lawn – whether waving to cameras or catching his breath, he said it wasn't clear – and then seemed to gasp at the top of the stairs. He and others said Mr. Trump used his neck muscles to make it easier for him to breathe, a classic sign that someone's lungs are not getting enough oxygen.

"This suggests something is going on. I don't know what or to what extent," said Dr. King. “Any pulmonologist, I think that would give them a break. And you would say, what else do I not know about his condition that I would like to know? "

Dr. Ilan Schwartz, an infectious disease doctor and assistant professor at the University of Alberta, agreed. "As a doctor, I would refrain from commenting on anyone I haven't examined," he said. "But in this case the clinical symptoms are so obvious that they can be seen from a distance, even on a short clip of two or three seconds."

Chances are Mr Trump will recover from the virus, said Dr. Michelle Prickett, Associate Professor of Pulmonary and Intensive Care Medicine at Northwestern University's Feinberg School of Medicine.

"The vast majority of patients who do get better, and anyone who has treated this is hoping every patient falls into that category," she said. But for doctors like her, who have treated many Covid-19 patients, "we have all seen too many examples of worst-case scenarios."

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