Politico

What we know — and still don't know — about Trump's fight with coronavirus


President Donald Trump’s medical team’s latest briefing about the status of his fight against the coronavirus gave the nation a mixed picture of his condition, leaving unanswered questions about the course and gravity of his disease one month before the presidential election.

The physicians acknowledged on Sunday that he’s sick enough to have needed oxygen and steroid treatments — but they also said they might let him go home to the White House on Monday.

Arrayed in white coats and masks in front of Walter Reed National Military Medical Center, the health team also ignored some key questions from reporters, like what kind of imaging tests have been done on Trump’s lungs, and what they found.

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’s treatment

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 Sunday evening he briefly left the hospital in a motorcade to wave to supporters gathered outside before returning to Walter Reed — a move that drew immediate criticism as endangering the Secret Service agents who accompanied him.

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.

Did the White House have effective safety measures?

The White House hasn’t said how it screens staff and visitors, and Trump’s campaign has hosted large rallies with packed crowds of largely unmasked people. The rallies have mostly been held outdoors, where the risk of virus spread is lower, but his campaign held an indoor rally in Nevada about three weeks ago in defiance of state restrictions, and another in Duluth, Minn., on Wednesday.

The administration has in the past relied on a rapid test from Abbott Laboratories that can produce results in as soon as 15 minutes. But the test has been shown to have high error rates, and the White House confirmed the president’s infection with additional lab-based testing. The White House declined to comment on testing procedures.

Even the best tests don’t catch every case, though. Public health experts say there’s no substitute for wearing face coverings and observing social distancing — precautions Trump has frequently flouted.

“I think it’s really important to keep reminding everybody, about the things that we can all do to protect ourselves and our families,” Boucher said. “That is washing our hands, wearing a mask and watching our distance avoiding crowds. This whole thing is a wake-up call on the importance of those measures.”

What other drugs might he take?

The Trump administration has also aggressively promoted the use of antibody-rich blood plasma from coronavirus survivors. It’s been used in the past to treat diseases ranging from Ebola to diphtheria, with mixed results. There’s no clear evidence it helps those ill with Covid-19, and an expert panel advising the government says it should not be considered standard of care. The FDA issued an emergency use authorization for the treatment in late August over the objections of top federal scientists, and Trump had pushed them to do so. But there’s been no sign that he’s received the plasma, with several drugs available to him.

Could there be long-term effects?

A growing population of patients have not fully recovered from the coronavirus months after falling ill. Many of these “long haulers” had mild or moderate symptoms that sometimes didn’t require hospitalization.

Common symptoms that linger over time include fatigue, a cough, shortness of breath, headaches, joint pain and in some cases, damage to the heart, lungs or brain. The difficulty of predicting outcomes has led scientists to study patients who had related viruses like SARS. The Mayo Clinic notes many who recovered went on to develop chronic fatigue syndrome, which worsens with physical or mental activity but doesn’t improve with rest.

But even patients who don’t develop the “long-hauler” syndrome can take several weeks to feel like themselves again. That will be something to watch as the election approaches.

Adriel Bettlehim and Sarah Owermohle contributed.

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