Reaction from some medical experts was swift - and sharply critical - after President Trump tweeted Monday that he would leave Walter Reed in a matter of hours despite his COVID-19 diagnosis.
“I will be leaving the great Walter Reed Medical Center today at 6:30 P.M.," Trump tweeted at 2:37 p.m. "Feeling really good! Don’t be afraid of Covid. Don’t let it dominate your life. We have developed, under the Trump Administration, some really great drugs & knowledge. I feel better than I did 20 years ago!”
That didn’t sit well with Dr. Dara Kass, an associate clinical professor of emergency medicine at Columbia University.
“I don’t care that he is leaving the hospital at risk to himself,” Kass tweeted. “I am embarrassed that his doctors have been so clearly marginalized from making decisions. I am enraged that he is minimizing the pandemic that has killed over 200K and infected millions more.”
Dr. Peter B. Bach, a pulmonary and ICU physician based in New York, referenced the reported steroid treatments Trump had received in the hospital, suggesting the president may have a false sense of his current health.
“I don’t know POTUS condition, but in light of him tweeting that he feels the best he has in 20 years, it is worth noting that when we give high dose corticosteroids like dexamethasone, we warn patients to not be misled about [where] they are in recovery,” tweeted Bach, who’s also a health outcomes researcher at Memorial Sloan Kettering Cancer Center.
Closer to home, Dr. Jeremy S. Faust, an emergency medicine physician at Brigham and Women’s, tweeted a macabre riff on Trump’s exhortation to not let the virus “dominate your life.”
“Correction: Do not let Covid dominate your *death*,” Faust tweeted. “STAY AWAY. WEAR A MASK.”
The CDC’s own guidelines say COVID-19 patients “can be discharged from the healthcare facility whenever clinically indicated. Meeting criteria for discontinuation of Transmission-Based Precautions is not a prerequisite for discharge from a healthcare facility. Isolation should be maintained at home if the patient returns home before the time period recommended for discontinuation of hospital Transmission-Based Precautions.”
Trump was initially hospitalized Friday.
According to the CDC, patients with mild to moderate illness who aren’t severely immunocompromised can stop taking precautions against transmitting the disease after at least 10 days have passed since symptoms first appeared; at least 24 hours have passed since the last fever without the use of fever-reducing medications; and symptoms have improved. For patients who come down with a severe or critical illness, or who are severely immunocompromised, precautions should be taken for 10 to 20 days after the onset of symptoms, the CDC guidelines say.
Dr. Céline Gounder, an infectious disease specialist who teaches at New York University, tweeted Monday that Trump should remain in the hospital.
“COVID patients often get worse at 7-10 days into illness (i.e. this Fri or Sat),” she wrote. “I hope that doesn’t happen. But he should be closely monitoring in a hospital NEAR AN INTENSIVE CARE UNIT until then.”
Gounder also noted the president’s risk factors for a severe health outcome.
She wrote that he’s “elderly, male, obese, and heart disease. It is NOT SAFE for him to be so far away (even if a Marine One helicopter ride) from Walter Reed Hospital. If this were my patient, I would counsel against returning home.”
At the same time, Gounder wrote, Trump’s well within his right to leave the hospital Monday if he so chooses.
“Unless POTUS is declared cognitively impaired and unable to make decisions for himself, he has the right to leave the hospital AGAINST MEDICAL ADVICE. That is his right,” Gounder tweeted. “Are there reasons to be concerned about his capacity for decision making? Acute illness, hypoxemia (lower oxygen saturation levels) and steroids can impair cognitive function.”
Gounder noted that Trump has been treated at Walter Reed with the steroid dexamethasone, which she said could have made his fever go away.
“Patients also feel really good on steroids,” she tweeted. “Aches and pains go away. They feel energetic. They can develop insomnia, mania, agitation and grandiosity.”
Trump, she added, should isolate for at least several more days.
“His health aside, he should remain in isolation until day 10 of illness,” Gounder tweeted. “He could isolate in the White House, but that puts him too far from an ICU for his safety.”