Thursday, 29 Oct 2020

Experts say details of Trump's Covid-19 treatment and dipping oxygen levels show his condition might be more serious

WASHINGTON (NYTIMES) – US President Donald Trump’s medical team delivered an update on Sunday (Oct 4) of his condition, as the president’s personal physician acknowledged delivering an overly rosy description of his illness a day earlier.

The details of the briefing signalled to some health experts that the president’s condition might be more serious than a mild case of Covid-19.

“I didn’t want to give any information that might steer the course of illness in another direction, and in doing so, you know, it came off that we were trying to hide something, which wasn’t necessarily true,” Dr Sean Conley, the White House physician, said in a briefing with reporters on Sunday.

Later in the day, presumably to allay concerns, Mr Trump posted an upbeat if rambling video praising his doctors at the Walter Reed National Military Medical Centre.

“It’s been a very interesting journey,” he said. “I learned a lot about Covid.” He added: “I get it, and I understand it.”

Wearing a dark jacket and no necktie, Mr Trump stood in the video and spoke energetically and with no apparent trouble breathing as he praised the “enthusiasm” of his supporters outside the hospital, then promised to pay them a surprise visit.

A short time later, Mr Trump’s black SUV, escorted by Secret Service vehicles, appeared on the street outside the hospital. Mr Trump could be seen in the back, wearing a suit and a mask and waving.

On Friday, the doctors said that Mr Trump had a “high fever” and that there had been two incidents when his oxygen levels dropped – one Friday and one Saturday. They said that Mr Trump received oxygen at the White House on Friday; they were not clear about whether it was administered again on Saturday.

Medical experts said that despite the relatively upbeat tone of the news conference on Sunday, the details of his treatment and the fact that his oxygen levels have been dropping showed that the illness has progressed beyond a mild case of Covid-19.

Mr Trump’s oxygen levels dropped to 93 per cent at one point, his doctors said; that is below the 95 per cent level that is considered the lower limit of the normal range. Many medical experts consider patients to have severe Covid-19 if their oxygen levels drop below 94 per cent.

“This is no longer aspirationally positive,” said Dr Esther Choo, a professor of emergency medicine at Oregon Health & Science University. “And it’s much more than just an ‘abundance of caution’ kind of thing.”

Dr Conley said that the president had been given the steroid dexamethasone on Saturday, in addition to remdesivir, an antiviral drug. Dexamethasone has been shown to help patients who are severely ill with Covid-19, but it is typically not used in mild or moderate cases of the disease.

“He got the therapies that anybody going into any good hospital in the United States would receive today,” said Dr Carlos del Rio, a professor of medicine at Emory University in Atlanta.

He said even if Mr Trump is discharged from the hospital, “He’s not going to your house or my house; he’s going to the White House.” The White House is equipped with a medical suite.

The World Health Organisation issued guidelines on Sept 2 recommending that dexamethasone only be given to patients with “severe and critical Covid-19.”

The National Institutes of Health has issued similar guidance, specifying that the drug is recommended only for people who require a mechanical ventilator to help them breathe, or who need supplemental oxygen.

A large study of dexamethasone in Britain found that the drug helped those who had been sick for more than a week, reducing deaths by one-third among patients on mechanical ventilators and by one-fifth among patients receiving supplemental oxygen by other means.

On Friday, Mr Trump was given an infusion of an experimental antibody cocktail that is being tested by the drugmaker Regeneron. Mr Trump is also receiving a five-day course of remdesivir, another experimental drug that is used in hospitalised patients and has been granted emergency authorisation by the Food and Drug Administration.

Regeneron’s antibody cocktail is being tested early in the course of the infection, because it fights the virus itself and could prevent it from spreading throughout the body.

Remdesivir is also an antiviral drug but has been commonly used along with dexamethasone, which reduces the body’s immune response and is given later in the illness, when some people’s immune systems go into overdrive and attack their vital organs.

Even though he has had low-oxygen episodes and is receiving dexamethasone, the doctors said that Trump was doing better and might be discharged from the hospital and return to the White House as early as Monday.

The briefing came a day after a messy and contradictory presentation Friday about whether Mr Trump had serious medical issues.

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