Everything We Know (and Don’t) About Trump’s Health Right Now
By: Dana G Smith
Tags: Coronavirus, Trump Administration, Trump

Everything We Know (and Don’t) About Trump’s Health Right Now

Here’s what the president’s doctors said — and didn’t say

President Trump drives past supporters in a motorcade outside of Walter Reed Medical Center. Credit: ALEX EDELMAN / Getty Images

Updated 3:50 pm 10/5/20: There were no significant changes regarding Trump’s health made public at the Monday news conference. Dr. Conley provided no additional information on the president’s medications, scans, or date of disease onset. He said Trump’s tweets are an indication of his mental status.

Donald Trump is not doing well. Or he’s doing great! Depends on whom you ask. The President’s medical team has been cagey and at times deliberately misleading about his condition, but we do have some information about the progression of his illness over the weekend.

Despite the rosy picture painted by the White House physicians, Trump — who is in several high-risk categories based on his age, weight, sex, and medical history — is currently being treated as if his case of Covid-19 is severe. In a briefing given Sunday, however, it sounded as if his condition is improving.

What are his vitals?

Fever

On Sunday, White House physician Sean Conley, DO, stated the president had a high fever on Friday, but he would not say how high it had been. Pulmonologist Sean Dooley, MD, followed up to say that Trump had been fever-free since then. Neither physician provided information about whether Trump had been given medication to lower his temperature, although the president does take a daily aspirin, which can act as a fever reducer at high doses.

Celine Gounder, MD, an infectious disease expert at NYU Langone, says the question of whether Trump has taken another fever-reducing medication, such as Advil (ibuprofen) or Tylenol (acetaminophen), is important. “If the fever came down on its own, that’s a very good sign prognostically. If the fever required medication to come down […] it wouldn’t necessarily mean he’s getting better, it would just mean he’s gotten rid of the fever,” she says.

Blood oxygen

The president’s medical team also admitted that on Friday and Saturday, Trump had an oxygen saturation under 94%, which is considered to be a sign of severe Covid-19. They did not say how low his oxygen levels had gotten, leading Gounder to speculate that it could have dipped into the upper 80s. After obfuscating about the question on Saturday, Conley confirmed that Trump had received supplemental oxygen both times. According to Conley, Trump’s oxygen levels on Sunday were back up to 98%.

Scans

The doctors said that Trump had a lung X-ray, a lung CT, and an ultrasound, although they didn’t say of which organ. Despite multiple questions from the press, the results of the scans have not been provided, but Dooley did say the lung CT was consistent with Covid-19. Gounder says this implies the president could have ground-glass opacities in his lungs — an abnormal pattern that can be seen when the lungs are sick — but this has not been confirmed.

Other vital signs

Dooley reported on Sunday that Trump’s kidney, liver, and cardiovascular functioning were “normal or improving.” Later, another member of the president’s medical team, Brian Garibaldi, MD, stated that his liver and kidney functions were normal. If the president’s health was a deductive logic puzzle, one could imply that Trump had cardiovascular abnormalities over the weekend that were now improving.

Heart function is a major concern with Covid-19 and is one of the primary causes of death from the disease. The virus can cause heart failure, heart attacks, blood clots, inflammation of the heart, and even directly infect heart cells themselves. Trump has a common, moderate form of heart disease, which puts him at high risk for cardiovascular complications from the coronavirus.

Gounder said that in addition to the information provided, she would like details about the president’s white blood cell and platelet count, as well as his levels of inflammatory markers and blood clot tests. “I think his condition is more severe than they are communicating to us,” she says. “There’s no reason not to release more details like blood tests unless they’re wanting to withhold that kind of information. If the numbers are normal, this would put things to rest and reassure people, so they’re withholding that for a reason.”

“They really should keep him in the hospital until about 10 days into his illness just to make sure he doesn’t get worse. Usually that’s when patients decompensate, and they can decompensate very quickly.”

What medications has he received?

Monoclonal antibodies

Trump received one dose of a monoclonal antibody cocktail on Friday. This experimental drug, developed by the pharmaceutical company Regeneron, has shown promise in an early clinical trial, but it is not approved by the FDA for Covid-19 or any other diseases. It consists of two types of antibodies — specialized proteins made by the immune system — that prevent the virus from infecting more cells in the body. However, these monoclonal antibodies were made in a lab rather than being taken from the plasma of a recovered patient.

Monoclonal antibodies work best at the beginning of an infection before the virus has had much chance to spread throughout the body.

Remdesivir

Friday evening, Trump’s doctors announced that he had been started on a five-day course of remdesivir. This antiviral drug also works to stop the virus from spreading, and it is one of the few therapies that has been approved by the FDA to treat Covid-19. It’s an intravenous drug that is typically given to moderate to severe patients, however, Gounder says that it can also be effective in the earlier stages of the disease.

Dexamethasone

Most alarming, Conley said that because of Trump’s drop in oxygen levels, he had been started on the steroid dexamethasone on Saturday. Dexamethasone, which is only given in severe cases because it suppresses the immune system, signifies that the president has progressed in his illness. It suggests that his doctors are no longer only trying to stop the virus from replicating, but also attempting to prevent or stop a hyper-inflammatory immune response.

Several physicians took to Twitter to express their concern about the president receiving the steroid. Most pressing is the fact that dexamethasone can cause confusion, delirium, and hyperactivity.

Gounder says she would like to know what other medications Trump is taking in addition to these three drugs, particularly whether he’s been given a blood thinner or a cardiovascular medication. “I suspect that the med list we got was not a complete med list and that it was only including medications that were directly related to his Covid treatment,” she says.

When will he be discharged?

Trump’s doctors said he could be released as early as today. This prognosis looks overly optimistic for several reasons. For one, the president is on day three of a five-day course of remdesivir, which needs to be given intravenously. He’s also on a hefty cocktail of medications, all of which can have serious side effects, including liver and kidney toxicity, for which he should be monitored closely.

Also, if the timeline the White House has provided is accurate (which is up for debate), Trump is on day five of the disease. Many people who have severe cases of Covid-19 have initial symptoms, a brief recovery, and then appear to relapse around days 7 to 10 of the infection.

“They really should keep him in the hospital until about 10 days into his illness just to make sure he doesn’t get worse,” Gounder says, because that’s when patients usually decompensate. But, she adds, “What Trump decides to do is anybody’s guess.”

Update 2:40 pm : Trump announced on Twitter that he would be leaving Walter Reed Medical Center this evening.