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When a phalanx of white-coated doctors spoke about President Donald Trump’s condition, some of what they said must have been unclear to the average listener.
It was also not entirely clear to people with medical degrees.
Trump left the hospital on Tuesday, presumably a promising sign for his recovery, although Covid-19 patients sometimes feel better before getting worse.
Alex Brandon / AP
President Donald Trump stands on the balcony outside the Blue Room as he returns to the White House.
But after a weekend of vague and sometimes evasive statements from the president’s medical team, the doctors who are not involved in his care remain, in some respects, as perplexed as the rest of us.
“It’s really hard to say what’s going on,” said John Mellors, president of infectious diseases at UPMC and the University of Pittsburgh.
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Doctors avoid making formal diagnoses of people who are not their patients. But this is the president, whose health is a matter of public concern, and doctors watch press conferences like everyone else. And after months of treating patients in the pandemic, they have a good idea of how Covid-19 progresses for someone who is sick enough to go to the hospital. Except when details are scarce.
On Sunday, White House physician Sean Conley sidestepped questions about whether Trump had been given supplemental oxygen (as it turned out). On Monday, when asked if Trump was showing signs of pneumonia, Conley said: “There are some expected findings, but nothing of major clinical concern.”
That comment caught the attention of Eric Sachinwalla, medical director of infection prevention control at Einstein Medical Center in Philadelphia.
“I’m not really sure what that means,” he said.
Evan Vucci / AP
Dr. Sean Conley, a physician to President Donald Trump, center, speaks to reporters at Walter Reed National Military Medical Center.
Almost 40 years after President Ronald Reagan was shot, Mellors still remembers how many details doctors revealed about his famous patient: how much blood he lost, where the bullet lodged in his lung, and how it was removed.
Much later, members of Reagan’s medical team would reveal that his condition had been worse than what was described to the public. Still, they were more transparent than the doctors who spoke this weekend in front of Walter Reed National Military Medical Center, Mellors said.
“We had a swarm that came out of Walter Reed where they were passing the hot potato,” he said. “From what I heard, I did not understand clearly.”
Among the mysteries: If Trump was doing so well, why was he prescribed dexamethasone, a corticosteroid generally reserved for the sickest patients? These steroids can rescue Covid-19 patients whose bodies are invaded by harmful inflammation. But like any drug, they carry a certain level of risk. If taken over a long period of time, they can suppress the immune system.
Evan Vucci / AP
President Donald Trump, left, leaves Walter Reed National Military Medical Center to return to the White House after receiving treatments for Covid-19.
“It’s not like it’s a completely harmless intervention,” Sachinwalla said. “Based on the information they have released, he does not seem like the typical patient that we would give dexamethasone.”
Mellors said use of the steroid suggests that the president was suffering from at least a low level of pneumonia, as indicated by an X-ray or CT scan.
“They didn’t give dexamethasone unless there was a problem with oxygenation and what we call infiltrates or opacities” in the lungs, he said.
The president also received monoclonal antibodies, powerful immune system proteins derived from the blood of patients who have already recovered from the disease.
It’s plausible that the treatment contributed to his recovery, but formal studies are still ongoing, said Gerard J. Criner, director of the lung center at Temple University Hospital, a site where the antibodies are being tested.
The president might also feel better because of one of his other treatments, or perhaps because of the combined effect of all of them, Criner said.
“It appears that the patient is recovering,” he said. “I think there is one thing that illustrates his case, and that is that for Covid there are no cures. There will probably be no single therapy.
Although communication from the president’s doctors has been vague at times, his discharge suggests that his vital signs are heading in a promising direction, Criner said. And if you’re among those patients who relapse, the return to the hospital is just a helicopter ride away.
