Why Doctors Aren’t So Sure Trump Is Feeling Better From Covid-19

Standing on the steps of Walter Reed National Military Medical Center on Monday, with a phalanx of white-coated doctors behind him, the White House physician, Dr. Sean P. Conley, ticked off President Trump’s encouraging vital signs: no fever, only slightly elevated blood pressure and a blood oxygen level in the healthy range.

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

But when reporters asked him for results of Mr. Trump’s chest X-rays and lung scans — crucial measures of how severely the president has been sickened by Covid-19 — Dr. Conley refused to answer, citing a federal law that restricts what doctors can share about patients.

Without critical data about his lung function, medical experts in Covid-19 and lung disease said they were struggling to piece together an accurate picture of how Mr. Trump is faring. They noted that while most patients with the virus do recover, it was premature to declare victory over an unpredictable, poorly understood virus that has killed more than 210,000 people in the United States.

Less than a month from Election Day, Dr. Conley’s patient, Mr. Trump, is presenting himself as strong and unfazed by the coronavirus, and seems to have instructed his doctor to steer clear of disclosing health details that might puncture his image of invulnerability.

Dr. Conley said on Tuesday that Mr. Trump was experiencing no symptoms of the disease and doing “extremely well,” though he himself cautioned on Monday that the president was not “out of the woods” and that “we will all take that final deep sigh of relief” if he still feels well next Monday.

Far from having vanquished Covid-19, the outside doctors said, Mr. Trump is most likely still struggling with it and entering a pivotal phase — seven to 10 days after the onset of symptoms — in which he could rapidly take a turn for the worse. He’s 74, male and moderately obese, factors that put him at risk for severe disease.

“I don’t need to get in the president’s business,” said Dr. Talmadge E. King Jr., a specialist in pulmonary critical care and the dean of the UCSF School of Medicine. However, he said, “if their goal is for us to understand more completely what is going on, they have left a lot of very useful information off the table.”

Several medical experts said that based on the incomplete information Mr. Trump’s medical team had provided, the president appeared to have at least at some point experienced a severe form of Covid-19, with impairment of the lungs and a blood oxygen level below 94 percent, which is a cutoff for severe disease.

But again, Dr. Conley has not been fully forthcoming about Mr. Trump’s oxygen levels. He said that the president’s blood oxygen had dipped to 93 percent on Saturday. He was evasive about an earlier episode of low oxygen on Friday, though. When a reporter asked if Mr. Trump was ever below 90 percent, Dr. Conley said that his oxygen level had never dropped to the “low 80s,” leaving open the possibility that it had fallen into the high 80s, which experts said would be troublingly low and a sign of very serious illness.

“We go crazy when it gets to 88 percent,” Dr. King said.

Mr. Trump was twice given oxygen, Dr. Conley has said, and on Saturday was started on a steroid, dexamethasone, which is recommended only for Covid-19 patients who have severe or critical forms of the disease. Mr. Trump also received an infusion of an experimental antibody cocktail and is getting a five-day course of the antiviral drug remdesivir.

A large study of the drug in the United Kingdom found that it benefited Covid-19 patients who fell into those two groups and might be risky for patients with milder symptoms, tamping down an immune system that was effectively fighting the infection rather than quieting one that had gone dangerously into overdrive.

Dr. Craig M. Coopersmith, the director of the Emory Critical Care Center in Atlanta and a member of the National Institutes of Health panel that issued the dexamethasone guidelines, said that because Mr. Trump received at least some oxygen, his doctor’s decisions were understandable.

“Starting somebody on steroids when they hit a threshold of being in severe disease — even with low levels of oxygen — is both aggressive and reasonable,” he said.

As his treating physician, Dr. Narasimhan said she would have wanted to see the results of a lung scan, as well as lab tests showing inflammation and immune response. “We would watch those things very carefully, which we don’t have,” she said.

On Saturday, Dr. Conley noted that Mr. Trump had fared well on a spirometry test, which measures lung capacity. “He’s maxing it out,” Dr. Conley said. “He’s doing great.”

However, Dr. Narasimhan and others said a spirometry test was virtually meaningless with Covid-19 patients. “It doesn’t tell us anything and it’s not something we use in this disease,” she said.

Lacking crucial details from the president’s medical team, some outside doctors tried another tack — evaluating the patient themselves. On Monday, in a highly choreographed event that was covered live on some cable channels, Mr. Trump was flown to the White House, where he left the Marine One helicopter, crossed the lawn and walked up a set of stairs, to what looked like an illuminated stage set. At the top, he removed his mask, placed it in his pocket and flashed two thumbs up.

The odds are that Mr. Trump will recover from the virus, said Dr. Michelle Prickett, an associate professor in pulmonary and critical care medicine at the Northwestern University Feinberg School of Medicine.

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