EXPERTS SAY TALK OF QUICK RELEASE FROM WALTER REED IS ILL-ADVISED

The assertion by President Donald Trump’s doctors that he could be discharged from the hospital as early as today astonished outside infectious-disease experts, who said he remains in a dangerous period of vulnerability when some COVID-19 patients decline precipitously and require urgent intervention.

During a midday briefing Sunday on the president’s medical condition and treatment, White House physician Dr. Sean P. Conley and his team twice referred to planning to release Trump as early as the next day “if he continues to look and feel as well as he does today.”

The talk of the president’s release from Walter Reed National Military Medical Center came as Conley and two other physicians treating Trump gave an upbeat but incomplete characterization of his condition.

Outside doctors said they were mystified by what they said was an inconsistent portrayal of the president’s illness as relatively mild despite the aggressive mix of treatments he is getting.

The president’s medical team was at times cryptic: Asked whether CT scans showed any signs of pneumonia or lung damage, Conley replied, “Yeah, so we’re tracking all of that. There’s some expected findings, but nothing of any major clinical concern.” He declined to elaborate.

At another point, Dr. Sean Dooley, a pulmonary critical care physician, said the president’s “cardiac, liver and kidney function demonstrates continued normal findings, or improving findings.” He did not disclose which of those had been subpar.

Dr. Robert Wachter, chairman of the University of California San Francisco’s department of medicine, said any patient of his with Trump’s symptoms and treatment who wanted to be discharged from the hospital three days after their admission would need to sign out against doctors’ orders because it would be so ill-advised.

“For someone sick enough to have required remdesivir and dexamethasone, I can’t think of a situation in which a patient would be OK to leave on Day 3, even with the White House’s medical capacity,” Wachter said.

“Absolutely not,” Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University’s medical school, said of the idea of sending Trump back to the White House today.

Medical consensus has emerged that COVID-19 patients are especially vulnerable for a period of a week to 10 days after their first symptoms. Some patients who seem relatively healthy suddenly deteriorate, either because of the virus or an excessive immune response that can cause damage to several organs, including the heart.

A multitude of cardiac complications have also been associated with COVID-19, the disease caused by the novel coronavirus; the most prominent involves a hardening of the walls of the heart that makes it difficult to pump blood and can lead to heart failure.

“People can be doing OK, but it can get a rocky very quickly,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security and an infectious-disease specialist at the University of Pittsburgh.

Underscoring the concerns is the fact that Trump may be the first patient to receive an unusual combination of three strong treatments, with a handful of supplements and an over-thecounter drug sprinkled in.

“He’s gotten kitchen-sink therapy,” said Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital.

She noted that when dexamethasone was tested in clinical trials this year, none of the patients were also given the experimental antibody cocktail Trump is receiving.

Several doctors expressed worry that there is no data indicating how these treatments might react with one another, especially in an overweight 74-year-old man with a mild heart condition who is in the high-risk group for severe coronavirus disease.

The list of treatments the president is receiving includes a five-day regimen of the antiviral remdesivir; monoclonal antibodies, an experimental treatment still in clinical trials; and dexamethasone, a steroid found to help patients with advanced respiratory distress.

Trump is also taking two unproven supplements (vitamin D and zinc) and an over-the-counter drug (famotidine, the active ingredient in heartburn medication Pepcid.) The president has personally touted the benefits of zinc — in combination with hydroxychloroquine — for the coronavirus, and his administration funded trials of famotidine despite allegations of conf licts of interest.

“All of these are data-free zones. We just don’t know,” Walensky said. She noted the mix of treatments — especially the use of a steroid usually reserved for coronavirus patients whose immune systems are overfunctioning — is inconsistent with the characterization by Trump’s physicians that he is getting better.