President Trump appears likely to make a full recovery, based on the information provided so far, but COVID-19 has proved unpredictable and the president could still face serious illness, according to local physicians who have reviewed accounts of Trump’s condition.
Trump was discharged from Walter Reed National Military Medical Center Monday evening, a few hours after his doctors said he had improved significantly, hadn’t had a fever in 72 hours, and had maintained a high blood-oxygen level. Based on the timing of his positive test, he was probably still infectious as he removed his mask before entering the White House.
“I expect they would only be discharging him if they were certain he was doing OK,” said Dr. Nicholas A. Smyrnios, medical director of the medical intensive care units at UMass Memorial Medical Center.
But some patients who seem to be recovering will suddenly deteriorate a week or 10 days after infection, Smyrnios said. “There is a wide range for this disease, even for someone who is doing pretty well. It’s still early.”
In addition to getting better or getting sicker, doctors noted, there’s a third possibility: Some COVID-19 patients have lingering symptoms, including fatigue and brain fog.
Dr. Nicholas S. Hill, chief of the Pulmonary Critical Care and Sleep Division at Tufts Medical Center, said Trump might be well enough to resume campaigning in a week or so.
Still, Hill also cautioned, “I don’t think anyone can say definitively he’s out of the woods. The most likely possibility is that he will continue to improve and stay improved. But there is a chance that he could take a turn for the worse.”
Dr. Mitchell Levy, medical director of the medical intensive care unit at Rhode Island Hospital in Providence, said he was troubled by the sense that he doesn’t know the truth about the president’s condition.
“Yes, it sounds good, and at the same time we know that people who are going to do worse can often take up to 10 to 14 days before they deteriorate. I don’t think anybody, including his physician, would be able to guarantee that he isn’t going to get sicker.”
Dr. David Hamer, an infectious diseases physician at Boston Medical Center and a professor of global health and medicine at Boston University School of Medicine, expressed surprise that “they’re letting him go that quickly. They must have a lot of comfort with his vital signs, or they’re forced to do this for political reasons.”
Trump’s doctors have been less than transparent, declining to say when he had his last negative test or what scans of his lungs revealed. And aspects of his treatment remain puzzling. Although the president is believed to be in the early stages of COVID-19, doctors have been providing treatments usually reserved for very sick people far advanced in their illness.
In particular, dexamethasone, a steroid, is typically given to people taking supplemental oxygen or on a ventilator, Smyrnios said. In studies, patients who didn’t need oxygen did not derive any benefit from the drug. And there’s concern that, if given too early the course of illness, dexamethasone could make matters worse by suppressing the body’s ability to fight off the virus.
The president is also taking remdesivir, an antiviral shown to reduce the duration of illness in hospitalized COVID-19 patients.
Additionally, before he was hospitalized, the president took a single dose of an experimental drug, a mixture of two cloned antibodies, whose effectiveness is unknown.
Trump’s doctor, Sean Conley, said the president hadn’t taken any fever-reducing medications like ibuprofen or Tylenol in the past 72 hours. But dexamethasone also has that effect, and could explain the absence of fever, Hill said.
Steroids also affect the mind, BU’s Hamer noted. Trump’s tweet asserting he feels better than he has in 20 years “may be basically a steroid effect, a feeling of grandiosity, a feeling of being super powerful, which is the last thing he needs.”
Similarly, Hamer said, the decision to drive around waving to supporters on Sunday, which put Secret Service members in the car at risk of infection, raises the question whether he’s “having some sort of neuropsychological behavior effect” from the steroid.
“He’s basically endangering anyone that he’s close to,” Hamer said. Someone in Trump’s condition normally is isolated in the hospital room and approached only by people wearing gowns, double gloves, N95 masks, and eye protection, he said.
Dr. Peter B. Bach, a pulmonary and ICU physician based in New York, said in a tweet that steroids might be giving the president 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.
Dr. Joshua Barocas, an infectious disease physician at Boston Medical Center, raised concerns on Twitter about Trump’s failure to promise that he would isolate himself at the White House. “My thoughts are with the service staff in the residence and the >400 employees of the @WhiteHouse who will be undoubtedly exposed to #COVID19 given it is unlikely he will isolate and wear a mask; and that they will not have #PPE when changing his bed sheets/delivering his food,” Barocas tweeted.
My thoughts are with the service staff in the residence and the >400 employees of the @WhiteHouse who will be undoubtedly exposed to #COVID19 given it is unlikely he will isolate and wear a mask; and that they will not have #PPE when changing his bed sheets/delivering his food. https://t.co/ZMSb9jgTEa— Josh Barocas, MD (@jabarocas) October 5, 2020
Boston psychiatrist Nicole Christain-Brathwaite joined those who were disturbed by Trump’s advice not to fear COVID.
“Instead of saying Covid ‘isn’t that bad’ or not to be afraid, why not say how fortunate you were to have access to exceptional tx [treatment] that many Americans do not? Or express your sympathy for those who lost their lives or have lasting medical problems? Show some concern for others!,” she wrote.