Trump, who announced his diagnosis via a tweet early Friday, may be getting the best care in the world but he’s still an obese 74-year- old, and the excess weight is a big risk factor for a dangerous and mercurial disease. The White House has still not fully answered questions about the timing of his tests or symptoms last week — before and after he and Democratic opponent Joe Biden shared a debate stage without masks for 90 minutes Tuesday.
Former Baltimore Health Commissioner Leana Wen, a well-known public health expert, said Trump’s rapid progression from diagnosis to severe symptoms is highly unusual.
“The average time between symptom onset and having shortness of breath and other respiratory symptoms, it’s five to eight days,” Wen said. “For that to happen all within one day, either the President had an ordinarily high viral load, or there’s something about the time course that is off.”
The briefings have been fairly detailed about Trump’s treatment and some aspects of his symptoms. But questions linger about the severity of his disease, the timing of his diagnosis and when he began feeling ill.
Trump, who arrived at Walter Reed by helicopter Friday evening, has received two experimental drugs, plus one steroid used in patients who have moderate to severe disease and who have needed supplemental oxygen at time.
One of the drugs, a monoclonal antibody cocktail, hasn’t yet received FDA emergency use authorization or approval. The clinical trial data that has come out so far is promising, and drugmaker Regeneron has made the treatment available to a limited number of patients under a compassionate use program. The cocktail, which mimics the body’s natural antibodies, is thought to work best when administered early on in the disease.
The president is also getting the antiviral remdesivir. That’s usually given as an infusion, spread out over five days in the hospital, but Trump’s doctors said they are considering letting him return to the White House as early as Monday, and finish the treatment there.
“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,” said Brian Garibaldi, a doctor from Johns Hopkins University who is part of Trump’s medical team.
Are his lungs damaged?
The medical team confirmed that the president has needed oxygen twice, that his blood oxygen levels have dipped below 94 percent — but not precisely how much below that worrisome threshold, which the CDC says is a marker of moderate disease. And he’s run a fever at times.
They did not say much about what kind of lung imaging he had — although reporters asked repeatedly. They said the imaging they did perform showed “expected findings.” They didn’t elaborate — but “expected findings” could mean lung damage, according to several physicians interviewed who are not personally involved in his care.
“We know that this disease frequently affects the lungs and produces hypoxia — or low oxygen levels — and that there is also a kind of a typical picture that we see radiographically, whether that’s an X ray or a CT scan,” said Helen Boucher, chief of infectious diseases at at Tufts Medical Center. “So it would be very reasonable to surmise that someone with illness with Covid and an oxygen saturation below 94 percent would have the radiographic picture that goes with it.”
The president tweeted far less than usual on Sunday and hasn’t been calling into his favorite Fox TV shows. On Saturday evening, he released via Twitter a four minute video from his hospital room.
Notably, the president has not taken the anti-malaria drug hydroxychloroquine, despite championing it for months as a Covid-19 treatment and taking it for two weeks in May after a possible virus exposure. Multiple trials have shown it to have no clinical benefit for Covid-19.
There’s no way to know how long Trump will be sick, or how vigorously he will be able to campaign in the final month before the election. Covid-19 is notorious for its ability to attack multiple parts of the body, which can make the disease look very different from one patient to the next. It sometimes causes long-term health effects that can take months to recover from, and in some cases can leave lasting damage to vital organs. So far, his kidneys have been unaffected, the doctors said — and that’s good news given that some people who are seriously ill with the coronavirus have needed dialysis.
When was the president exposed?
It may be impossible to know. The National Institutes of Health says it can take up to two weeks for Covid-19 to be detected, with a median incubation period of four or five days.
Trump had a busy travel schedule last week, including the debate Tuesday, rallies and fundraisers. Several prominent Republicans who attended a White House reception — partly outdoors, partly inside — last weekend when Trump announced he was nominating Amy Coney Barrett to the Supreme Court have since tested positive.