Doctors question wisdom of move
Should President Trump have left Walter Reed Medical Center while he has COVID-19?
Doctors have varying opinions on whether that’s a good idea given he has spent three days in the hospital, required oxygen and is on at least two medications that require IV drugs.
Trump tweeted Monday afternoon that he felt good, adding, “I feel better than I did 20 years ago!”
But leaving the hospital now could be problematic, according to several doctors who treat COVID-19 patients.
Although the White House has an excellent medical unit, it’s known that people with severe COVID-19 can deteriorate quickly – within a half an hour to an hour, said Bob Wachter, chair of medicine at the University of California, San Francisco.
“You want to be 50 feet from an ICU, not a helicopter ride away,” he said.
Sean Conley, the president’s doctor, acknowledged in a news conference Monday afternoon the next week will remain crucial to Trump’s recovery.
“Though he may not entirely be out of the woods yet, the team and I agree that all our evaluations, and most importantly, his clinical status, support the president’s safe return home, where he’ll be surrounded by worldclass medical care 24/7,” Conley said.
Conley added that the president had not had a fever in 72 hours, his oxygen levels were good, he’s was walking around and his breathing was normal.
“Today it got to the point, he’s holding court with those of us around him, the whole team, going over all specifics, the testing, what the future is,” Conley said. “We’ve been back and forth on what’s safe and what’s reasonable, and he has never once pushed us to do anything that was beyond safe and reasonable practice that we all first wanted.”
As the president will have access to high-quality care at his residence, it’s not unreasonable to send him home, said Dr. J. Randall Curtis, a professor of pulmonary and critical care medicine at the University of Washington School of Medicine in Seattle.
“If he really is getting better, the chance that he will need more intensive care or a ventilator is low. It’s not zero, but it’s low,” he said.
Curtis said he has had patients in their 70s and even 80s who have done well with mild COVID-19 and been able to return home. That’s reasonable “as long as they have someone to keep an eye on them,” he said.
Curtis emphasized that the president’s course of illness can’t be extrapolated to everyone else who gets the disease.
“This in no way diminishes the importance of masks and social distancing,” he said. “Over 200,000 people have died in the United States. It is irresponsible to not take the pandemic seriously simply because one person’s medical course was not that bad.” Others were less convinced. Wachter noted the president still has two to three days during which he is at highest risk for a sharp downturn in his condition.
“If the president is demanding to return to the White House, it’s a sign of poor decision-making,” he said.
Wachter said he wasn’t privy to the president’s full medical history and it’s impossible to know if the he is being affected by the illness, which can cause fuzzy thinking called “COVID fog.” He’s also taking a steroid, dexamethasone, which can cause mania.
But Wachter was adamant that no one who has been hospitalized with COVID-19 should be allowed to make a medical determination of their ability to leave.
“The same things that will make you altered in your thinking will also make you unable to make good judgments as to whether you’re altered,” he said.
If he had a patient wanting to leave the hospital three days into a stay for severe COVID-19, who was on multiple medicines and needing oxygen, his strong medical advice would be for them not to do it.
“If they insisted,” Wachter said, “I would have them sign a form saying they were leaving against medical advice, so they could not sue us later for malpractice.”