San Francisco Chronicle - (Sunday)
Health experts slam Trump over reaction to illness
More than a week into President Trump’s coronavirus illness, a grim resignation seemed to settle over much of the public health domain that for months has railed against his administration’s failing pandemic response.
The president, who came face to face with the virus that has killed more than 213,000 Americans under his watch, was unfazed. In fact, he seemed exhilarated by the experience, calling it a “blessing” that gave him a new understanding of COVID19.
Nothing had changed, said the doctors and scientists in social media posts and television interviews. Provided with the best health care in the U. S. and seemingly on the path to recovery, they said, the president remained committed to a
dangerous agenda that threatens the public health of the nation.
“I hoped this would be a teachable moment,” Dr. Robert Wachter, chairman of the department of medicine at UCSF, wrote at the end of a long string of Twitter posts Thursday afternoon. “The hope that illness would lead to humility and compassion for millions of sickened and 210,000 dead Americans was to ask too much. Now I simply wish him good health.”
Later in an interview, Wachter added: “I never considered, although I should have, the possibility that he would do well and then frame it as almost doubling down, that it’s not that bad, don’t be scared of it, if you’re tough enough you can get through it. Imagine being the family member of someone who died and hearing that?”
Public health worries
Trump’s experience with COVID19 could have transformed the nation’s pandemic response, but instead the fallout could be a public health nightmare on an entirely new order of magnitude, say doctors and scientists who have long criticized the president.
Over the past nine days, since he announced he was infected, Trump has used his unparalleled platform to tout an unproven cure, advise Americans they have little to fear from this virus, and flout public health guidance. On Saturday, he made a maskless speech from the White House balcony to a crowd of cheering supporters on the lawn below. He claims to have made a remarkable recovery, though outside doctors say they have little sense of how serious his illness was or remains, or whether he is recovered.
Trump is uniquely powerful in his position to influence public behavior by example, and his continued refusal to wear masks and stay socially distant from others — crucial for controlling the pandemic — is likely to entrench his supporters who don’t see the virus as a deadly threat, public health experts fear.
Meanwhile the pandemic is swelling in the Midwest as the United States lurches toward what may be its third surge. Between 40,000 and 50,000 new cases are being reported each day. With the flu season on the horizon, and the long winter months soon forcing people indoors, now is a critical moment in the nation’s pandemic, public health experts say.
“This was a real opportunity for the president to do the right thing, but of course it’s not happening,” said Dr. Yvonne Maldonado, an infectious disease expert at Stanford. “I’m worried about those pockets where people are at risk because of their inability to embrace public health guidelines.
“It’s not about the people who are going to vote for him because he survived. It’s not politics,” she said. “It’s about making sure that people are careful.”
Mystery illness
Much about the president’s illness is unclear. He announced on Twitter late Oct. 1 that he and first lady Melania Trump had tested positive, but his medical and press teams have refused to say when he last tested negative or if he had another positive test before that date. Since then, at least 32 others with White House connections have tested positive, including senators, presidential aides and advisers, journalists and White House staff members.
Trump was airlifted to the hospital on Oct. 2, and given three experimental therapies, including an antibody cocktail that is still in early clinical trials. His doctors said he was given supplemental oxygen more than once, and one of the treatments he received, the potent steroid dexamethasone, is recommended only for people who are severely ill.
The president returned to the White House after just three nights in the hospital, and even as he dramatically removed his face covering after ascending the steps to the Truman balcony, many doctors not involved in his care noted that his breathing seemed labored.
“This guy was sick, he was really sick. He was getting supplemental oxygen, he got steroids. That classifies it as severe disease,” said Dr. George Rutherford, an infectious disease expert at UCSF. “And he very easily could have tipped over. He could have progressed rapidly.” But Trump recorded subsequent videos where he seemed fine — even exuberant, as he hailed the “cure” he has since labeled the antibody therapy he received. Doctors say the steroid he was given is well known to cause euphoria and similarly manic symptoms. But they also acknowledge that the president seems to have responded well to treatment.
He’s not out of the woods yet, Rutherford said. Trump is still a highrisk patient because of his age, sex and weight. Many patients who suffer the most serious illness crash a week or more into their disease course, often after seeming to improve.
Back to work
Trump, though, received therapies that weren’t available even a few months ago. His doctor, who has cleared him to resume public activities, released a statement Saturday night that Trump “is no longer considered a transmission risk to others,” though the statement did not say whether Trump had tested negative for the virus.
The president rejected the suggestion of a virtual debate with Democratic nominee Joe Biden next Thursday out of safety concerns; the inperson debate later was canceled. He is scheduled to attend a campaign rally in Florida on Monday.
Dr. Peter ChinHong, a UCSF infectious disease expert who has treated COVID19 patients, said if he were Trump’s physician, he’d tell him to wait another week to 10 days to make sure he was no longer shedding virus and therefore safe to be around others. That’s especially true for a president on the campaign trail — though of course for that very reason Trump would want out of isolation as soon as possible, ChinHong acknowledged.
Like many of his peers, ChinHong said he is concerned about the message the president was sending to the nation by resuming social activities so soon after being infected. He risks exposing dozens or even hundreds of others if he’s still infectious, ChinHong said.
“The kinds of activities he’s going to do is not like a normal patient — shaking people’s hands, close proximity to photographers,” ChinHong said. “And we know he’s somebody who is not a mask aficionado.”
Trump’s persistent reluctance to don a face covering, before he got sick and even more strikingly after, is especially infuriating, said Dr. Steven Goodman, a Stanford epidemiologist.
The president pulled off his face covering as soon as he got home from the hospital, potentially putting anyone in proximity at the White House at risk of infection. He also insisted on being driven around the grounds of Walter Reed National Military Medical Center in an impromptu parade while he was still hospitalized. Though he wore a mask for that outing, it was still unwise given the close quarters, and he may have exposed anyone in the car with him to the virus.
But Goodman said that masking aside, every criticism he’s had of the administration’s pandemic response is now reflected in the president’s own words and behaviors since he fell ill.
“The complete, willful nonchalance about the hazard he is imposing on his fellow human beings that we’ve seen in his approach to the epidemic is now being demonstrated in his personal behavior,” Goodman said. “It’s extremely dangerous and unfortunate.”
Taking out the politics
Dr. Ethan Weiss, a UCSF cardiologist, said he appreciates the frustration of his colleagues. He, too, had hoped Trump might take his own illness as an opportunity to acknowledge the deadly threat of the pandemic and promote public health measures.
But he didn’t. And Weiss said it no longer feels helpful to get angry about it.
“Being outraged is not productive. It’s not healthy for us to all be constantly so angry, as much as maybe it’s warranted,” Weiss said. “The less attention we pay to him when it comes to anything related to COVID and public health, the better off we’ll all be.”
He held up Dr. Anthony Fauci, the nation’s top infectious disease expert and a member of the White House pandemic task force, as an example of fighting back with science and evidence, accurate information and clear public health messaging.
Fauci, in fact, said exactly the same in a virtual chat Thursday with UC Berkeley students and faculty. Asked about the role of politics in a pandemic, he said he’s managed to work with six presidents across the political spectrum by sticking to the facts.
He wasn’t asked about Trump.