Trump says he was beaten by Covid-19. The doctor is not so sure.

Standing on the steps of the Walter Reed National Military Medical Center on Monday, with a flock of white-coated doctors behind him, White House doctor Sean P. Conley checks the vital sign of President Trump’s encouragement. Did: No fever, only a slight healthy range of high blood pressure and blood oxygen levels.

“He’s back,” Dr. Conley said later in the press conference.

But when a reporter asked for the results of Mr. Trump’s chest x-ray and lung scan-an important measure of how badly the president got sick with Covid-19-Dr. Conley quotes federal law limiting what doctors can do. Share about patients who refuse to answer.

Due to the lack of important data on his lung function, Covid-19 and lung disease medical professionals said he was having a hard time figuring out exactly how Mr. Trump was progressing. They said most patients with the virus recovered, but it was too early to declare victory over the unpredictable and poorly understood virus that killed more than 210,000 people in the United States.

Less than a month after the election, Dr. Conley’s patient, Trump, has shown that he is resistant to the coronavirus and is not upset, which could pierce his image of defenselessness. He seems to have instructed his doctor not to disclose certain health details.

Dr. Conley said On Tuesday, Mr. Trump had no symptoms of the illness and he himself warned that he was “very successful.” Monday The president wasn’t “out of the woods,” and if he still feels good next Monday, “we all sigh that last deep relief.”

Far from defeating Covid-19, Trump said he’s still struggling and is likely to be in a crucial stage, which can quickly worsen 7-10 days after the onset of symptoms. Stated. .. He is 74 years old, is a man of moderate obesity, and is at risk of severe illness.

“I don’t have to get a presidential job,” said Dr. Talmadge E. King, Jr., a lung life-saving expert and dean of the UCSF School of Medicine. But he said, “If their goal is to have a more complete understanding of what’s going on, they’re removing a lot of very useful information from the table.”

Based on incomplete information provided by Mr. Trump’s medical team, some medical experts said the president, at least at some point, was severely ill with lung damage and blood oxygen levels of less than 94%. Said he seemed to have experienced, this is a cutoff for severe illness.

But, again, Dr. Conley hasn’t fully announced Mr. Trump’s oxygen levels. He said the president’s blood oxygen dropped to 93 percent on Saturday. But he was avoiding an early episode of hypoxia on Friday. When a reporter asked if Mr. Trump had ever fallen below 90 percent Dr. Conley said His oxygen levels never dropped in the “late 80’s”, leaving the possibility of falling in the late 80’s. Experts said this was annoyingly low and a sign of a very serious illness.

“When we reach 88 percent, we’re crazy,” said Dr. King.

Mr. Trump was oxygenated twice, Dr. Conley said, and was started on Saturday with the steroid dexamethasone, which is only for Covid-19 patients who have a severe or significant form of the disease. Recommended. Mr. Trump also received an antibody cocktail infusion and took a five-day course with the antiviral drug remdesivir.

Dr. Conley said on Monday that Mr. Trump did not need oxygen and did not complain of dyspnea. He said the medical team prescribed dexamethasone after Mr. Trump needed oxygen and doctors weighed the risks and benefits.

However, Dr. Conley did not provide a complete list of the medicines Trump was receiving and said, “I will not go into the details of what he is and what he is not doing.”

Some experts said that the decision to administer dexamethasone to Mr. Trump was suffering from Covid-19, which was more serious than he revealed to him, or his doctor improperly gave him the drug. He said it could be a sign of prescribing.

“Is he involved in the lungs? Dr. Mangalanarashinhan, a pulmonologist at Northwell Health in New York and head of critical care services, said:

Guidelines from World Health Organization And that National Institute of Health Dexamethasone is recommended only for those who require mechanical ventilation or oxygenation.

Large-scale research on drugs In the UK, it benefits Covid-19 patients in these two groups, May be dangerous to the patient Instead of calming the immune system, which is mild and dangerously overdriven, it weakens the immune system, which is effectively fighting the infection.

Dr. Craig M. Cooper Smith, director of the Emory Critical Care Center in Atlanta and a member of the National Institutes of Health panel that published the Dexamethasone Guidelines, said his doctor’s decision because Mr. Trump received at least some oxygen. Said I could understand.

“It’s aggressive and rational to start someone with steroids when you reach the threshold of having a serious illness, even with low levels of oxygen,” he said.

As a treating physician, Dr. Narasimhan said he wanted to see the results of lung scans and the results of clinical tests showing inflammation and an immune response. “We were watching very carefully what we didn’t have,” she said.

On Saturday, Dr. Conley said Trump had a successful lung capacity measurement test to measure vital capacity. “He’s making the most of it,” said Dr. Conley. “He’s fine.”

However, Dr. Narasimhan and colleagues said that spirometry tests are virtually meaningless in patients with Covid-19. “It doesn’t tell us anything, and it’s not what we use for this disease,” she said.

Due to the lack of important details from the president’s medical team, some outside doctors tried another approach — assessing the patient himself. On Monday, at a highly choreographed event covered live on several cable channels, Mr. Trump was sent to the White House, where he left the Marine One helicopter, crossed the lawn, climbed the stairs, and then. It became like. Illuminated stage set. At the top, he removed the mask, put it in his pocket, and raised two thumbs.

For many, it was a political stunt. For Dr. King of the University of California, San Francisco I was watching with C-SPANReturning to the White House was an opportunity to observe the president’s breathing.

“As a pulmonologist, he did two things for me. He did a gait test and a stair climbing test,” said Dr. King, with advanced technology available. Even lung doctors still rely on these old ones. -Old-fashioned test “to get a complete picture of patient behavior”.

Dr. King said what he saw was related to him. While walking across the lawn, Mr. Trump paused twice, waving at the camera or holding his breath. After that, I seemed to be out of breath at the top of the stairs. He and others said Mr. Trump used his neck muscles to help his breathing. This is a classic sign that someone’s lungs aren’t getting enough oxygen.

“This suggests something is happening. I don’t know what and how much,” said Dr. King. “Any pulmonologist would pause when he sees it. And, well, what else do you know about his condition I want to know?”

Dr. Iran Schwartz, an infectious disease doctor and assistant professor at the University of Alberta, agreed. “As a doctor, I refrain from commenting on people I haven’t seen,” he said. “But in this case, the clinical signs are so obvious that even a short clip of 2 or 3 seconds can be seen from a distance.”

Dr. Michel Prickett, an associate professor of lung and emergency medicine at Northwestern University’s Fineberg School of Medicine, said Trump is likely to recover from the virus.

“The majority of patients who have this will get better, and everyone who treats it wants all patients to fall into that category,” she said. But for a doctor like her who has treated many Covid-19 patients, “there are too many examples of the worst scenarios.”

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