Some outside health experts, however, have said that Trump’s determination to participate in the Oct.15 debate is part of a pattern of unconsciousness that has defined his response to the pandemic, with the president and his aides not wearing masks or observing. contact reduction. At least 19 people on his staff or campaign, or who attended recent White House events, have tested positive for the virus in the past week.
On Tuesday, White House physician Sean P. Conley continued to deliver upbeat reports on Trump̵
Neither Conley nor other White House officials have said how they will determine when it might be safe for Trump to go out in public – for his health or for others close to him.
Several outside medical experts have suggested that the president’s actions indicate that he is not criticized by his own experience of contracting a virus that killed more than 210,000 Americans – or by the spread of infections among his staff and supporters.
Trump’s removal of the mask moments after his return to the White House on Monday night, and his subsequent claim that he would appear in the debate “is irresponsible and reckless, and frankly that borders on evil,” said Michael Mina, medical doctor. and assistant professor. of Epidemiology at the TH Harvard Chan School of Public Health.
“We should throw the kitchen sink at him, not just for treatment, but to make sure he is safe in society and doesn’t impose a risk on the citizens of this country,” Mina said.
Mina noted that the president’s medical team has many ways to determine the status of her infection. In addition to administering the “PCR” test, considered the most definitive way to assess if someone has the virus, he said doctors might ask him to cough on a petri dish to see if the virus grows, swab his nose to grow the sample. or administer antigen tests to see if he has the virus protein in his nose.
“The average American doesn’t have the tools to deal with all of this,” Mina said, “but the president is a very special person. We have the tools to do it.”
Patients with Covid-19 who were seriously ill may need to remain isolated for up to 20 days after the first symptoms, the guidelines say.
The CDC does not define a serious case, and Trump’s doctors hid some information that would have provided a clearer picture of his medical condition, such as how low his blood oxygen levels have dropped on two occasions or whether CT scans have showed signs of pneumonia or lung. damage.
If Trump develops symptoms at the end of last week, the 10-day window would end before the debate.
External doctors discussed whether the 10-day period for mild and moderate cases should apply to the president and whether it would be premature for him to go out in public next week.
Thomas M. File Jr., an infectious disease specialist from Akron, Ohio, and president of the Infectious Diseases Society of America, said Summa Health, the company he works for, generally follows CDC guidelines. In all but the most severe cases, he said, “we will allow someone to come to the public within 10 days of symptoms appearing.”
Georges C. Benjamin, executive director of the American Public Health Association, said most patients are no longer contagious after 10-14 days. But given the known times when Trump started feeling sick, “it will be very close. All you have to do is get it wrong within a day or two and it could easily become infected… It will be tight.”
Rajesh Gandhi, an infectious disease physician at Massachusetts General Hospital and Harvard Medical School, said the CDC guidelines make sense, but pointed out that covid-19 cases vary widely. About 80% of people have no symptoms or are mild to moderate. Another 15 percent are hospitalized for serious cases like the president’s, while the remaining 5 percent are seriously ill, Gandhi said.
“I would like to reiterate on average that we are more cautious around a week or so after symptoms appear,” Gandhi said.
Mina said the CDC guidelines are an average for an entire population, balancing the risk of transmission of the virus with the desire for people to return to work and other aspects of their normal interactions.
“The president is in the position that it should serve as the absolute gold standard,” he said, adding that Trump should get every possible method of testing, “since he is the president, since he goes to things that have so many people and have so many. transmission opportunities. “
Despite some seemingly labored breathing from the president, pundits saw little to worry about in Trump’s brief appearance in the White House.
“What I saw was that he took a couple of deep breaths standing there. He had just climbed two flights with a mask on his face, “said David Hager, a pulmonary and ICU specialist at Johns Hopkins.” I think he’s fine. “
Other doctors thought it might be premature for Trump to make plans for his own health simply because of the unpredictable course of the disease.
John Zerlo, head of the infectious disease division at Philadelphia-based Jefferson Health, said any of the president’s plans could change, depending on the progression of a disease that sometimes deceives doctors and patients.
People who look and feel good can suddenly crash and have to be put on fans, Zerlo said. “Self [the president’s doctors] they are not waiting ready to do it, they would be fools. This infection is quite capricious. “
Kevin Sheth, an intensive care neurologist at Yale Medicine, said the president should be monitored and tested for cognitive problems.
“You want to survive the respiratory piece,” he said, “but we know there are neurological complications.” These can include problems such as stroke and inflammation and long-term cognitive changes.
“For someone in a leadership position, this is what I would be worried about,” Sheth said. “Clearly the virus is affecting the brain in some patients.”
Many public health officials and some doctors said they were angered by the symbolism of the president’s tweets and actions since his diagnosis and the damage they think he has inflicted on the safety messages they have tried to convey to curb the worst public health crisis of the nation. in more than a century.
Hours before his discharge on Monday, Trump tweeted: “Don’t be afraid of Covid. Don’t let it rule your life.”
His tweet also said: “I feel better than 20 years ago!” Outside doctors noted that the treatment Trump received includes dexamethasone, a steroid used to treat inflammation that has been shown to increase the survival rate among the sickest covid-19 patients. Side effects of the drug can include insomnia, irritability, or a feeling of euphoria.
“He’s probably feeling a lot better,” said Keith Hamilton, an infectious disease specialist and associate professor of clinical medicine at the University of Pennsylvania’s Perelman School of Medicine. “Steroids make everyone feel better.”
Several doctors said they have seen patients taking the steroid become angry, confused or manic, but that such cases were rare and typically occurred when people were given high doses.
Al Sommer, former dean of the Johns Hopkins Bloomberg School of Public Health, who has used public health tools to wage global battles against diseases such as smallpox, said the president is thinking short-term about his recovery and re-election. “But the pandemic is far from being successful.”
Trump displays “an outrageous, irresponsible disregard for the advice of our best and most informed medical knowledge and public health practices,” Sommer said.
Peter Beilenson, director of the Sacramento County Department of Health Services, where coronavirus cases have fluctuated, called the president’s actions “totally irresponsible”, describing his efforts to counter people’s desire to abolish the measures. of public health as the dangers seem to diminish.
“This is a guy who got the best taxpayer-funded treatment in the world, acting like it’s not a big deal and we should face it,” Beilenson said. Over 210,000 The deaths, he noted, are countless patients known as long haulers – “people who have had extensive respiratory, cardiac, neurological problems for months, perhaps permanently. We do not know. “
Josh Sharfstein, deputy dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health, said that even if the president wins his battle against the virus, he is harming Americans’ well-being. “The confusion it causes is to the benefit of the virus,” Sharfstein said.