Evan Vucci / AP
Doctors and public health experts fear Saturday may be too early for President Trump to resume operations, both for his health and for the safety of those around him.
“Inconsiderate,” Dr Eric Topol of the Scripps Research Translational Institute said in an email after Trump’s doctor said the president could resume “public commitments” as early as Saturday.
Trump said he wants to hold events on Saturday, but the White House hasn’t released any information on what his program will entail. His doctors last updated the public on his condition on Thursday at the end, and it was unclear when the next update would be provided.
“We need the history of when he was infected … to prove that it is not contagious,” Topol wrote.
COVID-19 patients should remain in isolation for at least 10 days after their symptoms have begun to ensure they are still not contagious and are not spreading the virus to other people, according to guidelines from the Centers for Disease Control and Prevention.
“If his symptoms started on Wednesday, that would mean he was most contagious at the time of the debate,” Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital in Boston, said in an interview with NPR.
If so, Saturday would be in line with the CDC’s 10-day recommendation. But that scenario would also raise questions about the president’s presence at the debate. If his symptoms started later, Saturday would have been too early, Walensky and others said.
“He is close to other very important people. He shouldn’t put anyone in danger,” Dr. Michael Mina, an infectious disease specialist at Harvard T.H. Chan School of Public Health, he wrote in an email.
“We know that he cannot use a mask and continues to act irresponsibly in that way,” Mina wrote. “They should work as diligently as possible to ensure that the president poses no clear and present danger to anyone else.”
Additionally, the CDC recommends people with more severe cases of the disease stay in isolation even longer – up to 20 days. It is unclear how to characterize the president’s case as so little information has been released. His doctors gave conflicting information, sometimes suggesting it was a mild case. At the same time, he received treatment typically used in severe cases.
“I think it’s not likely that the president had a major attack, but again, greater transparency would make this decision easier to make,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. .
The steroid the president was prescribed could also potentially extend the time it can be contagious by suppressing his immune system’s response to the virus, several experts said.
“The turning point here is the steroids,” Dr. Ashish Jha, dean of the Brown School of Public Health, said in an interview. “There is now pretty good evidence that it can lengthen viral spread in COVID-19.”
Allowing the president to resume activities prematurely “is certainly consistent with the idea of doing less each time than is appropriate,” said Marc Lipsitch, professor of epidemiology at Harvard T.H. Chan School of Public Health.
It is unknown whether Trump’s medical team performed the type of sophisticated tests that can detect live viruses in his body, because information has been limited. That test would be the only way to know for sure that Trump is not contagious.
“If they find viral proteins or find culturable viruses, it is likely that they are still at risk of transmitting the virus,” Mina said. “If they don’t find viable viruses and proteins, it would be reasonable to assume it is no longer contagious.”
Regardless of the implications for the people around him, it was inadvisable for the president to resume activities for his own health, several doctors said.
“This is a 74-year-old gentleman who just had a disease in hospital – possibly viral pneumonia in hospital,” Walensky said. “Being around the campaign might, in fact, not be the best thing for him. People generally take a little longer to recover.”
Steroids tend to mask symptoms, making people feel better than they really are, he noted.
Several experts said the scant information released on the president provides little information on his current condition. A single measurement of her respiratory rate makes no sense, for example, they said. What would be more important is his blood oxygen level and respiratory rate after exercise, they said.
“I would be interested in oxygen saturation when walking because it provides information on respiratory reserve, “said Dr. Rajesh Gandhi, another infectious disease expert at Massachusetts General Hospital.