Why the next few days could be so crucial

With COVID- 19, body’s immune system must make a key pivot.

President Donald Trump’s battle with COVID- 19 will come to a critical turning point in the next few days as the disease tests his immune system.

Saturday, White House physician Sean Conley said the illness is entering “phase 2.”

In a video statement released Saturday evening from Walter Reed National Military Medical Center, Trump said, “I’m starting to feel good. You don’t know over the next period of a few days, I guess that’s the real test, so we’ll be seeing what happens over those next couple of days.”

Several days after symptoms of COVID- 19 appear, the body’s immune system must make an important switch to fight the virus with precision – or possibly face life- threatening consequences.

COVID- 19 patients can “look pretty good for a few days, then they go south,” said William Schaffner, an infectious disease specialist at Vanderbilt University.

Rapid deterioration can occur when the body’s immune system, unable to target the virus, causes widespread collateral damage as it “brings in the troops,” Schaffner said.

A typical timeframe for patients’ decline is five to 10 days after the person starts getting sick, said J. Randall Curtis, a professor of pulmonary and critical care at the University of Washington school of medicine in Seattle.

Conley said Saturday that Trump was in his third day of fighting the virus.

During the early part of a patient’s COVID- 19 illness, the body uses an “agnostic” immune response, said Greg Poland, director and founder of the Mayo Clinic Vaccine Research Group. It doesn’t know what it’s fighting but realizes something is occurring. That’s called the innate immune system.

Key to a successful recovery is an adaptive immune system response that targets the coronavirus.

To avoid serious illness, a patient’s innate and adaptive immune systems must stay in balance, and the virus must not cause complications along the way.

Age is a risk factor. Older patients tend to be less successful in activating the adaptive response, said Melissa Nolan, an infectious disease expert and professor at the University of South Carolina.

Trump turned 74 in June, putting him at 90 times higher risk of death than someone in their 20s, according to the U. S. Centers for Disease Control and Prevention.

The course of COVID- 19 can be highly variable. The president’s VIP medical treatment and access to cutting- edge therapies make the trajectory of the illness tougher to predict.

Patients tend to see fluctuations in their symptoms throughout their illness, so doctors often evaluate a COVID- 19 patient over the course of days, said David Eisenman, a professor at UCLA Fielding School of Public Health. As of Saturday evening, the information from the White House was not enough for him to evaluate Trump’s progress.

Curtis said that the president’s fever improving is good but doesn’t necessarily indicate he’s out of trouble.

“We’re just going to wait and see,” he said.