Trump's doctor sows confusion with reversals on president's vitals
WASHINGTON (BLOOMBERG) – Mr Donald Trump’s physician admitted to giving a misleading statement about the president receiving oxygen, the latest in a series of contradictory and confusing accounts about Mr Trump’s coronavirus infection.
White House physician Sean Conley told reporters on Sunday (Oct 4) that Mr Trump had received supplemental oxygen on Friday, after saying the previous day that the president hadn’t been treated with oxygen on Friday.
He said he gave the misleading information initially to “reflect the upbeat attitude” of Mr Trump and his doctors.
Sunday’s briefing also included a series of inconsistent or misleading responses that appeared intended to serve Mr Trump’s desire to reassure Americans, but instead left the country with an incomplete snapshot of his health.
Even as their statements left doubt about the president’s condition, the doctors on Sunday insisted that Mr Trump is doing well and could be discharged as soon as Monday.
They also announced he was on a new drug, while remaining evasive about whether he received supplemental oxygen on Saturday and declining to detail any damage to his lungs.
Later Sunday evening, Mr Trump unexpectedly left the hospital to greet supporters, waving to them from his motorcade in a bid to demonstrate strength. Video images showed the mask-wearing president waving from behind the closed window of a black sport-utility vehicle.
In a video released on Twitter around the same time, Mr Trump said he’s “learnt a lot” about the coronavirus while undergoing treatment. “This is the real school,” he said. “And I get it. And I understand it.”
His outing, he said, was meant to “pay a little surprise” to his supporters.
“The president is not out of the woods,” said William Schaffner, an infectious disease doctor at Vanderbilt University.
Mr Trump’s doctor was “very evasive” in discussing what lung scans had showed, he said.
The disease’s effects on patients’ lungs is often worse than is indicated by their outward symptoms. “It is kind of a stealth infection,” Dr Schaffner said.
The White House has withheld information about Trump’s illness from the beginning.
On Friday, Chief of Staff Mark Meadows and Press Secretary Kayleigh McEnany said throughout the day that Trump had only mild symptoms. The White House and Mr Trump’s medical staff have since acknowledged that he had what Dr Conley called a “high fever,” that his oxygen levels were dipping below 94 per cent, and that he was given oxygen for about an hour, before eventually being hospitalised.
Dr Conley issued two written statements on Friday through Ms McEnany. The first said that Mr Trump had been given an experimental antibody treatment from Regeneron Pharmaceuticals Inc. but made no mention of his fever or oxygen levels, saying only that he was “fatigued but in good spirits.”
A second written statement, sent out just before midnight, said Trump “is not requiring any supplemental oxygen,” though he had received some earlier that day. It also didn’t mention Trump’s earlier fever.
On Saturday, Dr Conley gave his first press briefing, and avoided several direct questions. At one point, pressed on whether Trump was receiving oxygen, he said that “yesterday and today, he was not on oxygen,” referring to Friday and Saturday. He has since said that was incorrect.
“I was trying to reflect the upbeat attitude that the team, the president, that his course of illness had had,” Dr Conley said Sunday.
“I didn’t want to give any information that might steer the course of illness in another direction, and in doing so it came off that we were trying to hide something, which wasn’t necessarily true.”
He added: “The fact of the matter is he’s doing really well.”
Asked Sunday about Dr Conley’s remarks, White House spokeswoman Alyssa Farah said, “It’s kind of a snapshot in time. Saturday the president was doing extremely well. Friday was a little bit more concerning, but he continues to trend upward. So Dr Conley was giving an update from that morning.”
But Dr Conley made several other misstatements. Dr Conley said they were now 72 hours into Mr Trump’s diagnosis, though it had only been 35. He later issued a written statement clarifying that he’d meant to say it was the third day.
Dr Conley also mischaracterised the type of Regeneron antibody that Mr Trump had received. Regeneron later had to issue its own statement to clear up the confusion. The drug is not yet approved by the FDA, even on an emergency-use basis, but Mr Trump received it under a compassionate-use clause.
Broadly, White House officials have repeatedly described Mr Trump’s health as improving even while doctors were administering a rising number of drugs. He received Regeneron’s therapeutic on Friday, and later that night began a treatment course of Gilead Sciences Inc.’s remdesivir. Remdesivir is given intravenously.
Mr Trump’s doctors said on Saturday that Mr Trump “likely” would stay at Walter Reed National Military Medical Centre for all five days of that treatment if he needed the full dose. On Sunday, they changed course and said he could get the final doses at the White House, emphasising that Mr Trump was improving.
“Since we spoke last, the president has continued to improve,” Conley said. “As with any illness, there are frequent ups and downs over the course.” He then announced that Mr Trump had been given dexamethasone, his third therapeutic treatment in as many days.
Dexamethasone is used to calm an overly active inflammatory response to the infection, one that typically doesn’t start until the virus has been present for some time. Mr Trump receiving it at this stage is a sign that doctors may think the illness is progressing quicker than expected, or that he’d actually contracted it earlier.
The decision to give Mr Trump dexamethasone suggests that his physicians were worried that he might be about to suddenly deteriorate, said two doctors not involved in his care. Covid-19 is a two-phase infection, and the most life-threatening symptoms often come not from the virus itself, but when the immune system spirals out of control in the second stage of the disease.
“The reason they gave him the dexamethasone is they were concerned he was moving into the second phase of the infection which is due to a more immunological response, Vanderbilt’s Dr Schaffner said. “The dexamethasone tamps down on the immunological response.”
Dr Conley acknowledged the risk of the third drug. “We debated if we’d even start it, the dexamethasone,” Dr Conley said on Sunday. “And we decided that, in this case, the potential benefits early on in the course probably outweighed any risks at this time.”
Doctors on Sunday continued to also be evasive about Mr Trump’s oxygen levels. They disclosed that Trump’s oxygen had dropped for a second time, down to 93 per cent, on Saturday. Conley would not say categorically if Trump had received oxygen that day, instead saying he’d have to check with nurses. “If he did, it was very limited,” he said of a potential second round of oxygen treatment on Saturday.
“It was concerning that there were two episodes” where the president’s blood-oxygen levels dropped, said David Nace, clinical chief of geriatrics at the University of Pittsburgh and chief medical officer at UPMC Senior Communities. The dexamethasone treatment is another worrisome sign, he said.
What likely happened was that “the oxygen dropping like that scared them enough that they thought they should take the extra precautionary step of starting the steroid,” Nace said.
Dr Conley was also asked if Mr Trump’s oxygen had ever dropped below 90 per cent. He responded by saying “we don’t have any recordings here of that,” referring to Walter Reed hospital. Asked if they had readings below 90 per cent at the White House, he said “it was below 94 per cent, it wasn’t down to the low 80s or anything,” a response that signals Trump’s oxygen levels could indeed have dropped below 90 per cent on Friday. Dr Conley said Sunday that Trump’s current level was 98 per cent.
Dr Conley was also evasive about the results of X-rays and CT scans of Trump’s lungs. “There’s some expected findings but nothing of major clinical concern,” Conley said, appearing to acknowledge that Trump has suffered lung damage to some extent. Asked about Trump’s lung function, Conley said Trump is “maxing” out lung capacity tests. “He’s doing great.”
As of the conclusion of Sunday’s briefing, the doctors said Trump was improving but that they would continue treatment of both remdesivir and dexamethasone. Trump has received two of a planned five doses of remdesivir, one dose of Regeneron’s treatment and one dose of dexamethasone, which another of Trump’s doctors, Brian Garibaldi, said they plan to continue “for the time being.”
“If he continues to look and feel as well as he does today, our hope is that we can plan for a discharge as early as tomorrow to the White House, where he can continue his treatment course,” Dr Garibaldi said.
That statement also was contradicted by the White House, with National Security Adviser Robert O’Brien telling CBS shortly before that days 7 through 10 of the infection are the most crucial. O’Brien himself has already recovered from the virus.
“We need to keep him in the hospital,” said Vanderbilt’s Schaffner. “He needs to be monitored 24-7.”
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