Over the weekend, as news about President Trump’s case of Covid-19 grabbed global attention, STAT outlined some of the key unknowns about the president and his health.
Consider this a sequel.
Below, we sort through some of our biggest remaining questions about Trump and his infection, some of which could be answered in the coming days.
The president started feeling sick Thursday and tested positive for Covid-19 that night, his doctors have said. He was hospitalized at Walter Reed National Military Medical Center on Friday following a dip in his oxygen levels. He’s received the antiviral remdesivir, the steroid dexamethasone, and an experimental cocktail of monoclonal antibodies that is still in clinical trials. He returned to the White House Monday evening, and his doctor said Wednesday that Trump has been symptom-free for 24 hours.
What is Trump’s condition?
Trump’s medical team did not hold a briefing Tuesday as they did the three days prior, but in a memo, Sean Conley, the president’s physician, wrote that the president had no symptoms and that his oxygen saturation levels were a healthy 95% to 97%. “Overall he continues to do extremely well,” Conley wrote. On Wednesday, in a new memo, Conley wrote that Trump has not had a fever for four days and has not received any supplemental oxygen since Saturday, when he experienced what was at least the second drop in his oxygen levels.
That generally jibes with how the medical team has described the president every day since Saturday.
It’s possible that Trump really is feeling well and bounced back from the fever and fatigue he felt last Thursday, perhaps boosted by some of the treatments he’s been on. But the rosy descriptions of the president’s demeanor and energy by his medical team have confused outside experts given that all the therapies he’s received make it sound like this is a very sick patient, at least on paper. Conley has said, however, that the medical team has thrown everything they can at Trump because he is the president.
Meanwhile, the medical team still hasn’t answered some questions outside experts have said would be helpful to know more about Trump’s condition, including how high his fever reached last week, how low his oxygen levels got, and what his lung imaging has shown over time. The images could show whether Trump has had pneumonia or inflammation in his lungs.
When was Trump’s last negative test?
Trump tested positive for SARS-CoV-2 — the virus that causes Covid-19 — Thursday night, his doctors have said. But both the medical team and White House officials have been cagey about when he last tested negative. “I don’t want to go backwards,” Conley said when asked about it on Monday.
This has led to speculation that Trump perhaps wasn’t regularly tested, meaning the White House might have missed a chance to detect his illness earlier and to isolate an infectious Trump. On Thursday, for example, Trump went to New Jersey for events before testing positive.
Neither Trump nor Democratic presidential nominee Joe Biden was tested at the site of last Tuesday’s presidential debate, Chris Wallace of Fox News, who moderated the debate, has said.
If Trump recovers, what explains that?
It’s important to remember that the most probable outcome for Trump, despite being in higher-risk categories as a 74-year-old overweight man, is to recover from his infection. That’s what happens with the majority of people who get Covid-19, even those who have factors that make it more likely they’ll have a severe case or die.
But Trump also received an aggressive course of treatments during what appears to be the early part of his illness, a combination of therapies that few if any other Covid-19 patients have been given at this point in the infection. With just one patient, it’s impossible to disentangle what role, if any, each of the treatments had in his recovery overall or its pace.
When did he contract the virus?
The best guesses of when Trump contracted SARS-2 is likely over the weekend before he tested positive or late in the last full week of September. The president started feeling sick on Thursday, Oct. 1, his medical team has said, and most people who do show symptoms generally do so about five days after being infected. Other people who interacted with Trump those days have also since been diagnosed with Covid-19, including a number of people who were at the announcement of Amy Coney Barrett’s nomination to the Supreme Court on Sept. 26 at the White House.
But trying to pinpoint when and where Trump caught the coronavirus is likely impossible, given that he was around so many different people at so many different moments in those few days.
If Trump started feeling symptoms Thursday, how was he so sick by Friday that his oxygen levels dropped and he needed supplemental oxygen?
Once people start showing symptoms of Covid-19, it typically takes another five to seven days before those who develop more serious cases get sicker. How Trump went from fatigue and fever Thursday to a drop in his oxygen levels Friday, then, is a bit of a head-scratcher.
There are a few possibilities. Perhaps Trump was infected earlier than people think, and he was further along in the course of his illness by the end of last week than realized. Some people have wondered if he had a reaction to the infused monoclonal antibody therapy.
Nahid Bhadelia, the medical director of Boston Medical Center’s Special Pathogens Unit and an infectious disease physician, pointed out to STAT that the five-to-seven day span between symptoms and respiratory problems was the average. Perhaps Trump’s disease just moved more quickly than that.
“This would be a faster course than average,” Bhadelia said. But she added, “everybody’s course is different.”
What are the next few days like for the president?
Trump’s condition, based on what his medical team has said, appears to have improved. But any clinician who has treated Covid-19 will tell you that people can appear to be recovering only then to get much sicker — sometimes very rapidly. When that happens, it typically occurs about a week or more after people start feeling ill.
That means that Trump will need to be closely monitored for several more days at least, something his doctors have acknowledged at several points. In announcing that the president was being discharged Monday, Conley cautioned that “he might not be entirely out of the woods yet.”
Will he stick to guidelines about isolating?
Trump could still be infectious, so under recommendations from the Centers for Disease Control and Prevention, he should be isolated for 10 days after he became sick. (In certain cases, people who had severe illness should isolate for up to 20 days, the CDC has suggested.)
The concern is now that he’s back at the White House, Trump won’t stay away from other people. On Monday, he was filmed taking off his mask as he stepped back into the White House. If he doesn’t isolate, he could put additional administration officials and all the other people who work to keep the White House running at risk.
The White House on Tuesday released updated measures for people who work in the White House residence, but Trump has not been a model for keeping up with precautions. He has a history of mocking federal health guidelines aimed at reducing the spread of the coronavirus and has acted in ways that have alarmed experts since he was diagnosed with Covid-19, including by leaving Walter Reed to wave to supporters from the inside of a car that had at least two other people in it.
Will this change how Americans view the pandemic?
Any hope that Trump would take Covid-19 more seriously after being sick himself is not being realized. Even before he was released from Walter Reed, he told the public via tweet they should not be “afraid” of the disease, even as it’s killed more than 200,000 of their fellow Americans, despite all the efforts to slow the spread of the virus. On Tuesday, he again misleadingly compared Covid-19 to the flu, though there is a higher mortality rate overall for Covid-19 and scientists and clinicians are still uncovering new complications that some survivors of Covid-19 might have to live with. There are also vaccines and approved therapeutics for the flu, which, as of now, do not exist for Covid-19.
Trump’s comments this week could only cement the views of Americans who dismiss the threat of the pandemic and refuse to take the steps that can protect themselves and their communities.
About the Author Reprints
The man was shot full of expensive drugs – paid for by average Americans while he paid a ridiculous low amount of taxes in the past how many years? His Covid debut all but erased that little detail off the media trail. It is sad that the one real Magic Bullet to end the whole gong show is still missing.
This man is a joke, he will do anything for attention and fame. When he is judged for the last time may the heavens have pity on his polluted soul. Please Vote Nov,3rd!
In response to Reniam, “We know a large percentage of deaths were from other, more serious conditions and Covid was allowed to be listed in part 1 of the death certificate.”
Patients that have co-morbid conditions, such as COPD, asthma, CVD, HPT, etc., which are pharmacologically managed with medication (i.e., their disease[s] are under control) and also contract COVID-19 and subsequently die with within 2-8 weeks of becoming infected – coding their cause of death as COVID-19 is the appropriate cause of death.
Your speculation that it should be otherwise is utter nonsense. When you write the words, “We know,” you DON’T know. You also wrote “more serious conditions’ in your letter. COVID-19 currently has no approved treatments to cure an infected patient. Most care is the treatment of symptoms + supportive care. You are suggesting that a person with disease(s) that can and are being treated are MORE serious conditions that a COVID-19 infection which has no approved treatment and has killed 210,000 people within 8 months is LESS serious?
Question 9 – Why can people at the White House catch COVID-19 but can’t catch a raccoon that attacks Joe Johns the reporter?
@dipthroat “it is 25% among INFECTED people in that age group. And, officially, your beloved potus was infected, right?”
You do know those numbers are the IFR, and that the “I” stands for “infection”… right?
So, mathematically:
IFR = Deaths/Infected
It’s pretty simple stuff.
…”your beloved potus…”
I’m no fan of the president. I’m a scientist and politically agnostic. I don’t subscribe to some arbitrary, floating 1-dimentional left/right line.
Mark- Take a breath. The CDC is not being censored. It’s overdue for the CDC and FDA to be challenged about their methodology and conclusions just like every other institution. You might have the same inquisitive mind regarding the Mandarins that run our healthcare institutions as you have about the President’s health.
Pitsanu Boonsakul
“…it’s killed more than 200,000 of their fellow Americans, despite all the efforts to slow the spread of the virus. ”
200,000 Americans haven’t died from Covid. It’s hard to know what to say to people that still believe this, with all the data we have. We know a large percentage of deaths were from other, more serious conditions and Covid was allowed to be listed in part 1 of the death certificate. All one has to do is read the updated IPC code to see this has exaggerated the aggregate death count. If we did this with influenza, allowed it to be coded in this way, it’s death toll would be higher too. It would be nice if the press pointed out the methodology to count death isn’t uniform across the world and we’re very aggressive with it.
We know with our population and death rate, we expected 2.9 million Americans to die this year. By the end of September, we had a total of 2.09 million deaths. By the end of the year, we’re going to end up right where predicted. In other words, Covid hasn’t moved the needle in expected deaths.
“Trump’s comments this week could only cement the views of Americans who dismiss the threat of the pandemic and refuse to take the steps that can protect themselves and their communities.”
Ridiculous. It’s less likely Trump recovered quickly because of experimental drugs. It’s more likely he recovered quickly because Covid just isn’t that big a threat. For most of us it’s a cold or mild flu. This is a category 2 pandemic at worse. The guidelines outlined in 2005 and 2017 would have children in school, businesses open and recommended masks “if sick”. The response to Covid is completely disproportionate to the threat.
Andrew Joseph – why don’t you write an article on how Sweden correctly predicted this as a low level pandemic and, after 4 months, are back to normal with far, far fewer deaths than predicted?
You are making up your own facts. Just go spread the virus like you want to do and stop begging for support from people who know better.
It’s because of people like you that the USA is the most infected nation on the planet. You should feel some shame, no?
No, I feel no shame in realizing the heavy-handed response to Covid has been disproportionate to the threat. As more data has become available from Covid, the more the results tell us this is true. That’s how the Scientific Method works. We know from decades of research economic depressions are devastating. We know children not in school is bad. We know countries with heavy debt loads may have to make cuts to Medicare and Social Security in the future. We know these things affect the poor and disadvantaged the most. I’m more ashamed of folks like you that can’t interpret data and believe the way to fix a leaking roof is to burn down the house.
Let’s do some math:
US Death rate: 8.88/1K US Population:
331.44M US expected deaths = (331.44M/1K) * 8.88 = 2.94M
US deaths at end of September (from CDC): 2.09M
Simple linear analysis: September (9) / Total months (12) = 8/12 = 0.75
Expected deaths = 2.9 * 0.75= 2.175M
Difference between actual and expected deaths: 2.09M – 2.175M = -85,000
Covid has not changed the number of expected deaths in the United States. By years end, we will be at the expected 2.94M. It’s theorized we’ll end up higher next year as the lagging effect of the shutdown comes to fruition. It should be intuitively obvious to even the most casual of observer that if the total number of deaths hasn’t increased, then the listed deaths were of those whose death was unpreventable.
Search for: “Massachusetts Department of Public Health COVID-19 Dashboard – Tuesday, August 11, 2020”
This is the last day they broke down data “by age”. They didn’t like people to notice the vast majority of deaths were the very elderly with underlying conditions. Pay attention to slides 16 and 18. It clearly shows what I was referring to.
Search for: “Goals of Community Measures”
This is a simple presentation on mitigation strategies by category of pandemic. Covid is category 2 and it’s only “consider” children out of school for less than 4 weeks. Even within that, there is a spectrum within the cat 2, cat 3 column. So, a category 2 pandemic would be less likely to be “considered”.
Search for: “Community mitigation guidelines to prevent pandemic influenza — United States, 2017” This was what our pandemic response was supposed to be: “…include voluntary home quarantine of exposed household members and use of face masks in community settings when ill”
There is no recommendation for universal mask wearing because it was well established before that lay people wearing masks was false security at best, and at worse raises the incidence of the wearing to get and upper respiratory infection.
These were the recommendations, from scientists, when cooler heads prevailed. We are not following them; we’re still treating this like a category 5 pandemic. Sweden showed the way. That’s the direction we’re headed.
fun fact
data source CDC; period: Feb1-Oct03
-official COVID19 deaths: 197k
-Excess deaths: 240k-277k*
as compared to same period for years 2015-18 (adjusted for demographic increase)
*353k-387k if you consider 197k coronavirus deaths were indeed recorded Sep18, rather than Oct03. And indeed, likely still an under count.
That is, way more than 200k. Or, just an extra 50k-100k never-trumper that decided all to die in the last 10 months just to make potus look bad.
And Sweden has 5-10 times more deaths (adjusted for population) than neighboring Scandinavian countries, and the Swedish economy went into recession anyway. And the US is not Sweden. Swedes are educated, civilized and socialists. While Americans are ignorant, gross and selfish like … you
@drug czar
“While Americans are ignorant, gross and selfish like … you”
There’s nothing like an ad hominem to really hammer your point home. This stings. Here I am with my engineering and science degrees from “The Evening Institute for Younger Men” thinking I was enlightened and unselfishly wondering about the larger picture. But, all that matters is Coivd deaths.
The problem with the excessive death “fun fact”, which I’ve pointed out, is that it’s not showing up in the total aggregate death count. One would expect excessive deaths to change the total number of deaths we would have seen at this point. Certainly Spanish flu would have.
If Covid has caused the death of up to an additional 300k folks as you claim, how do you explain it not showing up in the aggregate death count?
“Sweden has 5-10 times more deaths”
Do you think all countries use the same methodologies for testing and to count deaths? Could that have something to do with it? If I would have said in April, Sweden’s total deaths would be under 6,000; I’d have been laughed at as a fool. Yet that’s where it’s at. Do you know Norway wasn’t as aggressive in counting nursing home deaths and that >80% of people in Denmark, Norway, Sweden and Finland reported they wear masks “not at all”
Why just cherry pick data for “neighboring Scandinavian countries”? Belgium, with it’s heavy lockdowns has more deaths. So does Michigan. Similar populations.
The right Senate is either he really DC idnt have it at all or the drugs that arent available to us stopped the virus. I saw him having trouble breathing after he walked up the steps at the WH. I personally think this is just a political ploy to say Trump is so strong.. But it’s really a slap in the face to all that have died because of this.
One thing is pretty clear. Both the timeline and therapeutic interventions don’t make any sense whatsoever. From when the positivity occurred, to the “acute” phase of infection, to his miraculous, unrealistic speedy recovery, and test negativity which are kind of physiological impossibilities. As well as, the claimed use of dexamethasone in a situation where not only it would be useless, but indeed jeopardizing his health by compromising a functional immune response. And BTW, in his age group the risk of death among infected is a whopping 25%, and pretty sure his obesity and unhealthy lifestyle don’t place him in the remaining 75%.
He just pulled off the ultimate scam. And the antibody injection (the only intervention I am sure took place) will make it pretty hard to unmask him and it will possibly protect him from actual future infection, as long as he will get one every 2-4 weeks.
I guess, we will have to wait for the next tell all book to know what actually happened.
“in his age group the risk of death among infected is a whopping 25%, and pretty sure his obesity and unhealthy lifestyle don’t place him in the remaining 75%.”
It’s amazing how much disinformation is out there. You’re using outdated numbers when the only folks getting tests were the very ill. Turns out, if you only test very sick people in a hospital, the fatality/tested ratio is high. We now have a much higher denominator.
Infection Fatality Ratios directly from the CDC’s “Current Best Estimate”
0-19 years: 0.00003
20-49 years: 0.0002
50-69 years: 0.005
70+ years: 0.054
If you’re under 50, there’s a statistically 0% chance of you dying from Covid. From 50 to 70, there is a list of many things you’re going to die from before Covid. There is data showing the heavy majority of deaths in the 70+ category are actually 80+, with severe underlying conditions. Many of the death being unpreventable and imminent. But even here, Covid isn’t the number one cause of death.
The more we find out about Covid, the less deadly is becomes.
It’s important to remember the CDC is reporting through a censer who manipulated data to suit their campaign ends.
It’s important to remember the CDC is being censored by a liar.
@Renian dear simple mind, it is 25% among INFECTED people in that age group. And, officially, your beloved potus was infected, right?
Ignorance and delusion really is bliss
CORRIGENDUM
@Reniam dear simple mind, I beg your pardon! It is 25% among SYMPTOMATIC INFECTED people in that age group. And, officially, your beloved potus was a symptomatic infected, right?
Ignorance and delusion really is bliss
Anything that makes Covid look deadly: “we’re listening to scientists”. Anything that shows Covid is turned out to not be as deadly as expected: “the CDC is being censored”.
Nevermind the rest of the world is showing the same results. Apparently critical thinking is lost on most.
Something smells bad here. Safety steps ignored. The white-house has become a hot spot for positive covid 19 tests, in an extremely short time, If trump did not test positive until Friday. There have also been no reports of anyone being very sick. Is it possible that this is a hoax for some political move to try to gain votes, as is being whispered? Why would any sane person do any of this?
Why would any sane person perpetuate the ridiculous notion that this is a political hoax?
@Martha we are talking about a guy that doctored a weather map with a sharpie, just to cover up his blunder and falsely claimed he was taking HCQ (that curiously doesn’t appear among the therapeutics used this time) to uphold his narrative.
There are a number of reasons why he likely faked it.
– To try to gain votes out of pity/sympathy.
– For what has been all over his and the conservative media of him looking like a hero that faced the virus head on and defeated it (even if anything, it is thanks to taxpayers, that is not him, paid premium medical treatments).
– to my current favorite hypothesis, that he used the alleged infection as a cover up for some other medical procedure.
So, any sane person, based on the illogical series of events of the past few days, should be at least skeptical.
“There have also been no reports of anyone being very sick.”
Apparently, folks have not been paying attention to the data coming from increased testing.
In the early days of Covid, the only people being tested were in the hospital because they were sick enough to need medical attention. This led people to believe that if you contracted Covid, you would be very sick and hospitalized.
With increased testing, this obviously is not true. We know the vast majority of folks with Covid either display no symptoms, or so mild as to be able to self care. Many that take the test don’t even know they have it. It’s more likely the reason no one is “very sick” is because Covid turned out to be rather mild, versus some whacky conspiracy involving hundreds of people.