Vancouver Sun

Trump could leave hos­pi­tal to­day

U.S. PRES­I­DENT COULD GO HOME AS SOON AS MON­DAY DE­SPITE WEEK­END OF CON­FUS­ING RE­PORTS

- TOM BLACK­WELL Health · Medicine · U.S. News · US Politics · Therapy · Medical Treatments · Politics · Donald Trump · United States of America · McMaster University · Walter Reed · Reed · Sean Conley · Mark Meadows · White House · Regeneron Pharmaceuticals, Inc. · United Kingdom

Don­ald Trump's doc­tors of­fered an­other up­beat as­sess­ment of his health Sun­day, say­ing the pres­i­dent may be head­ing home from hos­pi­tal Mon­day, three days af­ter he tested pos­i­tive for COVID-19 and sent shock waves through U.S. pol­i­tics.

But they also ad­mit­ted to ear­lier be­ing less than forth­com­ing about his con­di­tion, ne­glect­ing to men­tion that Trump's blood-oxy­gen lev­els had twice dropped be­low nor­mal and that he was briefly on sup­ple­men­tal oxy­gen.

Mean­while, news that he had been given a steroid treat­ment proven ef­fec­tive for the sick­est of pa­tients left some Cana­dian ex­perts scratch­ing their heads.

Ei­ther the pres­i­dent is in worse shape than de­scribed, or the steroid ther­apy was of­fered too early in the ill­ness, said the in­fec­tious-dis­ease spe­cial­ists.

In fact, the trial that found steroid dex­am­etha­sone was use­ful in treat­ing hos­pi­tal­ized pa­tients on oxy­gen sug­gested it was a dou­ble-edged sword, ac­tu­ally in­creas­ing the risk of death slightly in those with nor­mal blood-oxy­gen lev­els.

“If you look at the peo­ple in the clin­i­cal stud­ies ver­sus him, he would not prob­a­bly qual­ify for any of these treat­ments,” said Dr. Zain Chagla, a Mc­Mas­ter Univer­sity in­fec­tious dis­ease spe­cial­ist. “As much as more may be bet­ter, there may ac­tu­ally be some down­sides to giv­ing more ag­gres­sive ther­apy just for the sake of giv­ing more ag­gres­sive ther­apy.”

The news Sun­day added to a con­fus­ing few days of some­times-con­flict­ing in­for­ma­tion about the pres­i­dent and the sever­ity of his case.

Un­der­lin­ing the im­por­tance of Trump's prog­no­sis to the cam­paign — barely four weeks be­fore the U.S. elec­tion — a pha­lanx of doc­tors clad in iden­ti­cal white lab coats stood at at­ten­tion out­side Wal­ter Reed Med­i­cal Cen­ter to brief re­porters Sun­day on their pa­tient. Trump was dra­mat­i­cally air­lifted to the mil­i­tary hos­pi­tal on Fri­day.

There have been ups and downs, as ex­pected with any ill­ness and es­pe­cially with some­one be­ing mon­i­tored so closely, but he has been steadily im­prov­ing, said White House physi­cian Dr. Sean Con­ley.

“The fact of the mat­ter is that he's do­ing re­ally well,” said Con­ley.

He had made sim­i­lar com­ments in a news con­fer­ence on Satur­day, and seemed to dodge ques­tions about whether Trump had been on oxy­gen, only to have Mark Mead­ows, the White House chief of staff, tell re­porters in a sep­a­rate brief­ing that their boss's vi­tal signs had been con­cern­ing.

Con­ley was more trans­par­ent Sun­day, in­di­cat­ing that the pres­i­dent had twice had episodes of fall­ing blood- oxy­gen lev­els. Those lev­els are im­por­tant be­cause they in­di­cate how much oxy­gen the lungs are trans­fer­ring into the blood sup­ply, cru­cial for keep­ing the body's var­i­ous sys­tems func­tion­ing.

The first time oxy­gena­tion dropped, late Fri­day morn­ing at the White House, Trump briefly and re­luc­tantly re­ceived oxy­gen, his lev­els ris­ing again within a minute, said Con­ley.

There was an­other dip on Satur­day, but he couldn't say if the pres­i­dent had re­ceived oxy­gen then.

Trump has also re­ceived a bat­tery of largely ex­per­i­men­tal treat­ments. They in­clude a cock­tail of “mon­o­clonal an­ti­bod­ies” whose man­u­fac­turer, Re­gen­eron, says can help re­duce the vi­ral load, based on small study that has yet to be pub­lished or peer-re­viewed.

He is also be­ing treated with Remde­sivir, an­other new medicine that has shown some prom­ise.

And Con­ley said Trump had re­ceived a dose of dex­am­etha­sone.

The physi­cian ad­mit­ted he had not re­vealed the whole story ear­lier, edit­ing his com­ments for the pres­i­dent's sake.

“I didn't want to give any in­for­ma­tion that might steer the course of ill­ness in an­other di­rec­tion,” said the doc­tor. “In do­ing so, it came off that we were try­ing to hide some­thing, which wasn't nec­es­sar­ily true.”

The Remde­sivir, though ex­pen­sive and cur­rently in short sup­ply in Canada, makes sense as a treat­ment ear­lier in the ill­ness, as it com­bats the virus it­self, said Dr. Lynora Saxinger, an in­fec­tious dis­ease spe­cial­ist at the Univer­sity of Al­berta. The mon­o­clonal an­ti­bod­ies serve a sim­i­lar func­tion, though there is in­suf­fi­cient ev­i­dence yet to prove they ac­tu­ally work, she said.

Dex­am­etha­sone — used to fight an ex­ag­ger­ated im­mune re­sponse and in­flam­ma­tion later on — stood out to her, given that data from

Bri­tain's re­spected RE­COV­ERY trial in­di­cate it is ef­fec­tive for pa­tients who have been sick at least seven days and need oxy­gen.

“Maybe his lungs are worse than they're sug­gest­ing, or they're us­ing it a lit­tle out­side of what the ev­i­dence would sup­port,” said Saxinger. “They might have jumped the gun a lit­tle bit.”

Chagla said his read­ing of the pub­licly avail­able in­for­ma­tion sug­gests Trump does have a rel­a­tively mild case of COVID-19, one that in a reg­u­lar pa­tient would call just for sup­port­ive care and no drugs yet. But, the physi­cian ac­knowl­edged, Trump is no or­di­nary pa­tient.

“All of these treat­ments that he got, given his con­di­tion, were prob­a­bly above and be­yond what would nec­es­sar­ily be in­di­cated,” said Chagla. “( But) he's be­ing mon­i­tored so, so care­fully, with such pre­ci­sion, that any twinge of any­thing wrong pushes him into that cat­e­gory of more treat­ment.”

 ?? ALEX EDELMAN / AFP VIA GETTY IMAGES ?? U.S. Pres­i­dent Don­ald Trump waves from the back of a car in a mo­tor­cade out­side Wal­ter Reed Med­i­cal Cen­ter in Bethesda, Md., on Sun­day. The pres­i­dent, in­fec­tious with COVID-19, ac­knowl­edged sup­port­ers who have kept vigil out­side the hos­pi­tal be­fore quickly re­turn­ing to the fa­cil­ity.
ALEX EDELMAN / AFP VIA GETTY IMAGES U.S. Pres­i­dent Don­ald Trump waves from the back of a car in a mo­tor­cade out­side Wal­ter Reed Med­i­cal Cen­ter in Bethesda, Md., on Sun­day. The pres­i­dent, in­fec­tious with COVID-19, ac­knowl­edged sup­port­ers who have kept vigil out­side the hos­pi­tal be­fore quickly re­turn­ing to the fa­cil­ity.

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