A doctor at the Walter Reed medical center where Donald Trump is currently being treated for COVID-19 has described the president's de...
A doctor at the Walter Reed medical center where Donald Trump is currently being treated for COVID-19 has described the president's decision to go on a drive to wave at supporters as 'insanity', as other medical experts questioned the assessment that the president could be returning to the White House on Monday and said the scant details of his treatment suggested a serious condition.
Dr James Phillips, a Walter Reed attending doctor, condemned the president's Sunday afternoon drive, which violated Centers for Disease Control (CDC) guidelines.
He said it was dangerous and reckless, in comments which quickly went viral - gaining more than 100,000 'likes' and 40,000 retweets in the first hour.
With Trump's condition still shrouded in confusion, doctors have suggested that the president could return to the White House as early as today.
Trump today tried to project an image of business as usual by tweeting about the election, accusing Democrats of planning a 'massive tax increase' and touting the success of the stock market ahead of the November 3 poll.
But doctors said the president's treatment with dexamethasone - a steroid used for patients who require extra oxygen - is the clearest sign yet that Trump may have a severe case of Covid-19.
Trump was driven by his supporters where he waved at them from the SUV and he wore a face mask during the short trip
President Trump briefly left his hospital room at Walter Reed Medical Center to thank supporters lined up outside the hospital
Trump supporters waved American flags and Make America Great Again campaign signs outside of Walter Reed hospital
![One supporter waved a 'we [heart] Trump' sign](https://i.dailymail.co.uk/1s/2020/10/05/06/33979190-8804699-One_supporter_waved_a_we_heart_Trump_sign-a-297_1601874918606.jpg)
One supporter waved a 'we [heart] Trump' sign
The crowds have gathered outside the hospital to cheer and shout their support to Trump
While Trump is in hospital, empty chairs were put on display near the White House to represent the 200,000 people who have died of coronavirus in the United States, by far the highest tally in the world
Dr James Phillips, a Walter Reed doctor, was angered by Trump's Sunday drive-by to wave at his supporters
Phillips, chief of disaster medicine at George Washington University's Emergency Medicine division, and a COVID-19 consultant specializing on how to reopen safely, said that the design of the presidential vehicle, specifically modified to protect the passengers from attacks, made the drive even more dangerous.
'That Presidential SUV is not only bulletproof, but hermetically sealed against chemical attack,' he continued.
'The risk of COVID19 transmission inside is as high as it gets outside of medical procedures.
'The irresponsibility is astounding. My thoughts are with the Secret Service forced to play.
'Every single person in the vehicle during that completely unnecessary Presidential 'drive-by' just now has to be quarantined for 14 days,' Phillips pointed out.
'They might get sick. They may die. For political theater. Commanded by Trump to put their lives at risk for theater. This is insanity.'
The CDC website explicitly states that COVID patients should stay at home except to get medical care.
In their section advising healthcare workers, the CDC states: 'In general, transport and movement of a patient with suspected or confirmed SARS-CoV-2 infection outside of their room should be limited to medically essential purposes.'
Other doctors took issue with Trump's medical team's rosy picture of his health.
In particular, they were surprised at the suggestion that he could be discharged from Walter Reed on Monday and return to the White House.
Dr James Phillips, a Walter Reed doctor, reacted with anger to the president's jaunt on Sunday night
'People can be doing OK, but it can get rocky very quickly,' said Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security.
The experts told the Washington Post that Trump's medical team has withheld key information about his condition, and that he was on a 'kitchen sink' regimen of monoclonal antibodies, the anti-viral remdesivir, and steroids.
'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 three, even with the White House's medical capacity,' Robert Wachter, chairman of the University of California at San Francisco's department of medicine, told the paper.
President Donald Trump on Sunday made a last-minute, surprise visit to his supporters outside Walter Reed Medical Center, briefing leaving his hospital room to thank the cheering loyalists.
The president was in a suit, but no protective equipment beyond his face mask.
In the front passenger seat was a person wearing a gown, face mask and face shield.
It was unclear whether the driver was similarly protected.
The president went into the hospital Friday evening after testing positive for the coronavirus.
A second doctor, Jonathan Reiner, professor of medicine and surgery at George Washington University, echoed Dr Phillips' condemnation.
'By taking a joy ride outside Walter Reed the president is placing his Secret Service detail at grave risk,' he said.
'In the hospital when we go into close contact with a COVID patient we dress in full PPE: Gown, gloves, N95, eye protection, hat. This is the height of irresponsibility.'
And Dr Craig Spencer, an ER doctor who survived Ebola and is currently director of global health in emergency medicine at Columbia University, was shocked at the president's 'joyride'.
'Moments after stating 'I learned a lot about COVID', the President takes a joyride in an enclosed space with presumably #COVID19 negative people, all while on experimental medications,' he said.
NBC News' Peter Alexander said on Sunday night that he had asked why Melania Trump was not visiting her husband, and was told it was because she did not want anyone else to become infected.
'Reminder: A White House official, on Saturday, told me the First Lady would not be visiting Trump at Walter Reed because 'she has COVID and that would expose the agents who would drive her there,'' he tweeted.
Dr Jonathan Reiner, professor of medicine and surgery at George Washington University, was equally unimpressed
Dr Craig Spencer, an ER doctor in New York and director of global health in emergency medicine at Columbia, was shocked
The White House released a photo of Trump on Sunday night taking part in a phone call with his Chief of Staff, Vice President Mike Pence and the Joint Chiefs from his conference room at Walter Reed
The White House said the president made a short trip and then returned to the presidential suite inside the hospital.
'President Trump took a short, last-minute motorcade ride to wave to his supporters outside and has now returned to the Presidential Suite inside Walter Reed,' White House deputy press secretary Judd Deere said in a statement.
'Appropriate precautions were taken in the execution of this movement to protect the President and all those supporting it, including PPE. The movement was cleared by the medical team as safe to do.'
The White House press corps issued a statement, condemning the Trump administration for not keeping them informed of his whereabouts.
They had not been warned that the president was about to leave the hospital, breaking the usual protocol of keeping the pool reporters informed.
'It is outrageous for the president to have left the hospital — even briefly — amid a health crisis without a protective pool present to ensure that the American people know where their president is and how he is doing,' the White House Correspondents' Association said in a statement.
'Now more than ever, the American public deserves independent coverage of the president so they can be reliably informed about his health.'
A crowd Trump's supporters gathered outside the Bethesda, Maryland, hospital - and many were not wearing face masks.
People wore 'Make America Great Again' paraphernalia, waved campaign signs and hoisted Americans flags.
One woman waved a 'we [heart] u Mr. Trump sign' while another man waved a 'We [heart] Trump' sign.
The president posted a video to his Twitter account shortly before his visit outside, indicating he was about to make the trip.
He also said he's been visiting soldiers at the military hospital and has learned a lot about COVID, which has infected more than seven million Americans.
Trump supporters waving US flags and wearing Make America Great Again caps rally in Los Angeles on Sunday, one fo them holding an 'All Lives Matter' - a slogan seen as a provocative riposte to the Black Lives Matter movement
Donald Trump's supporters gathered outside the Walter Reed hospital on Sunday
Trump surprised them Sunday night with a brief visit, waving from the SUV as it drove past
Many of the supporters did not wear face masks
He started his short remarks by thanking the medical personnel taking care of him and added he has 'gotten to meet some of the soldiers.'
The president did not say what precautions were taken for his meetings.
'I also think we're going to pay a little surprise to some of the great patriots,' he said, hinting to his outside visit.
'They've got Trump flags and they love our country so I'm not telling anybody but you but I'm about to make a little surprise visit so perhaps I'll get there before you get to see me.'
He said he had learned a lot about the coronavirus since he was flown by helicopter to hospital on Friday.
'It's been a very interesting journey. I learned a lot about COVID. I learned by really going to school. This is the real school,' he said.
'In the meantime, we love the USA and we love what's happening. Thank you.'
The president's doctors said Sunday that he could be discharged from Walter Reed as early as Monday.
Trump's top physician said he was given a steroid and put on oxygen, as a treatment for COVID-19.
'Our plan for today is to have him to eat and drink, be up out of bed as much as possible, to be mobile,' Dr. Brian Garibaldi, one of the doctor's on Trump's team, said.
'And if he continues to look and feel as well as he does today, our hope is that we can plan for a discharge as early as tomorrow to the White House where he can continue his treatment course.'
He also revealed that Trump would continue taking doses of Remdesivir, a broad-spectrum antiviral medication, and dexamethasone, a steroid, whether he remains at Walter Reed or is transferred to the White House.
Pressed about the conflicting information he and the White House released the previous day, the president's top doctor, Navy Commander Sean Conley, acknowledged that he had tried to present a rosy description of of the president's condition.
'I was trying to reflect the upbeat attitude of the team, that the president, that his course of illness has had. Didn't want to give any information that might steer the course of illness in another direction,' Conley said.
'And in doing so, came off like we're trying to hide something, which wasn't necessarily true. The fact of the matter is that he's doing really well.'
Yet medical experts on Sunday evening took issue with Conley and his team's rosy update - in particular with the suggestion that Trump could be discharged on Monday.
'If he continues to look and feel as well as he does today, our hope is that we can plan for a discharge as early as tomorrow to the White House where he can continue his treatment course,' Garibaldi said
Physician to the President Dr. Sean Conley, a Navy Commander, was forced to explain during the briefing Sunday that there was some confusion over Trump's condition because Chief of Staff Mark Meadow's comments were 'misconstrued'
Meadows v. Conley: Meadows rubbed his forehead Sunday (left) as Conley spoke to reporters outside Walter Reed. 'The president's vitals over the last 24 hours were very concerning and the next 48 hours will be critical in terms of his care. We're still not on a clear path to a full recovery,' Meadows told reporters anonymously and it was later revealed he was the source of the remarks
Conley, a Navy Commander and physician to the president, revealed during the briefing on Sunday that Trump was treated with the steroid dexamethasone after a drop in oxygen levels on Saturday.
Dexamethasone is recommended only in patients who are extremely ill, according to many guidelines, but a number of hospitals routinely give the drug to any patient who requires supplemental oxygen, if only for a few hours.
It has not been shown to benefit those with milder forms of the disease.
A recent study found it tends to reduce deaths from the virus among those with severe cases, but nearly a quarter of infected patients getting it with supplemental oxygen — as Trump has — still died.
Steroids in high doses and over long periods of time also can lead to serious changes in mental status that include delirium, hallucinations and confusion.
'Over the course of his illness, the president has experienced two episodes of transient drops in his oxygen saturation. We debated the reasons for this and whether we'd even intervene,' he said.
'As a determination of the team, based predominantly on the timeline for the diagnosis, that we initiate dexamethasone.'
Doctors told the New York Times they were puzzled by the drug's use.
'The dexamethasone is the most mystifying of the drugs we're seeing him being given at this point,' said Dr Thomas McGinn, physician-in-chief at Northwell Health, the largest health care provider in New York State.
The drug is normally not used unless the patient's condition seems to be deteriorating, he added.
'Suddenly, they're throwing the kitchen sink at him,' Dr McGinn said.
'It raises the question: Is he sicker than we're hearing, or are they being overly aggressive because he is the president, in a way that could be potentially harmful?'
Dr Esther Choo, a professor of emergency medicine at Oregon Health & Science University in Portland, said of the doctors' statements on Sunday: 'This is no longer aspirationally positive. And it's much more than just an 'abundance of caution' kind of thing.'
Some thought that the president may be directing his own care, and demanding intense treatment despite risks he may not fully understand - something which is termed V.I.P. syndrome.
'You think you're helping,' said Dr Celine Gounder, a clinical assistant professor of medicine and infectious diseases at the N.Y.U. Grossman School of Medicine.
'But this is really a data-free zone, and you just don't know that.'
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, Sean Dooley, a pulmonary critical care doctor, 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.
William Schaffner, a professor of infectious diseases at Vanderbilt University's medical school, was asked by the Washington Post about the idea of sending Trump back to the White House on Monday.
'Absolutely not,' he said.
'I will bet dollars to doughnuts it's the president and his political aides who are talking about discharge, not his doctors.'
All pointed out that the president was being given an unusual combination of three strong treatments, with a handful of supplements and an over-the-counter drug sprinkled in. That made his quick release even more improbable, they said.
Several doctors expressed worry there is no data indicating how these treatments might react with each other, especially in an overweight 74-year-old man with a mild heart condition who is in the high risk group for severe coronavirus disease.
Lewis Kaplan, a critical care doctor at the University of Pennsylvania and the Veteran's Administration, said this type of untested combination therapy is typically only applied as a desperate measure — when a patient is seriously ill and probably in the intensive care unit.
On the other hand, he told the Post, giving this cocktail to a sitting head of state as a preventive measure as a way to reduce the risk of a more severe course could be construed as 'reasonable.'
'And we just don't know which one reflects reality,' Kaplan said.
Hydroxychloroquine - an anti-malaria drug which Trump promoted in his press conferences as warding off COVID-19, and then said he was taking - is not on the list of medications his doctors said Trump is taking at Walter Reed.
Another treatment missing from Trump's regimen arsenal is a blood thinner which is given as a standard practice these days to any hospitalized patient with COVID-19 to reduce the risk of clots.
In the spring, many doctors were surprised to find that microclots that appear in the lungs and heart appeared to be killing some patients.
Doctors speculated the president may have declined the treatment after what happened to his younger brother, Robert, who died in August due to brain bleeds. He had been taking blood thinners.
The doctors gave their second update in two days on Trump's condition as questions emerged over conflicting statements
Donald Trump's doctors revealed Sunday that they treated the president with a steroid and put him on oxygen Saturday as they were concerned over the rapid progression of the virus
Conley on Sunday detailed the timeline of Trump's treatment and the decision Friday to move him to Walter Reed National Military Medical Center just hours after the president announced that he and first lady Melania Trump tested positive for coronavirus.
'Thursday night into Friday morning when I left the bedside, the president was doing well with only mild symptoms and his oxygen was in the high 90's.
'Late Friday morning when I returned to the bedside, president had a high fever and his oxygen level was transiently dipping below 94 per cent,' Conley said.
'Given these two developments, I was concerned for possible rapid progression of the illness,' he continued. 'I recommended the president try some supplemental oxygen.'
Conley said Trump was 'very adamant that he didn't need it. Was not short of breath. He was tired, had the fever, and that was about it.'
He said after a minute of oxygen, Trump's levels were back up above 95 per cent – but said that he kept the president's on the measure for about an hour.
Conley explained that the president's oxygen level did not dip into the 80's and reiterated that he was up and about shortly after the 'transient' episode.
Meadows received backlash Saturday after it appeared his comments on Trump's condition contradicted others' assessments, including the president's.
'The president's vitals over the last 24 hours were very concerning and the next 48 hours will be critical in terms of his care. We're still not on a clear path to a full recovery,' Meadows told reporters anonymously and it was later revealed he was the source of the remarks.
Meadows' comments came just after a White House team of doctors said that Trump's condition was improving and that he was already talking about returning to the White House.
One doctor said Trump told them, 'I feel like I could walk out of here today.'
In an update on Saturday, Conley wrote: 'This evening he completed his second dose of Remdesivir without complication.
'He remains fever-free and off supplemental oxygen with a saturation level between 96% and 98% all day.
'He spent most of the afternoon conducting business, and has been up and moving about the medical suite without difficulty.
'While not yet out of the woods, the team remains cautiously optimistic.
'The plan for tomorrow is to continue observation in between doses of remdesivir, closely monitoring his clinical status while fully supporting his conduct of Presidential duties.'
Several hours later, Deputy White House Press Secretary Judd Deere posted a picture showing Trump working into the night from the hospital.
The new comments from the president's medical team on Sunday comes as Trump's campaign advisers Stephen Miller and Steve Cortes claimed Sunday the president is eager to get back to campaigning even after Conley said Saturday he is not yet 'out of the woods.'
Miller, the campaign's senior adviser, said he spoke to Trump recently and said the president told him 'he's going to defeat this virus… and our campaign is going to defeat this virus.'
'Once he gets out of the hospital, he's ready to get back to the campaign trail,' Miller told NBC's Chuck Todd during an interview on 'Meet the Press' Sunday morning. 'He sounded pretty energetic.'
'But he said something else that I thought that was important too,' Miller said, 'and that was to be careful, and that was to remind folks to wash their hands, use hand sanitizer, make sure that if you can't socially distance, distance to wear a mask. And I thought that was a pretty important message to send and a reminder to the rest of the country.'
Cortes, another senior campaign adviser, reiterated the president's fitness during an interview with Chris Wallace on 'Fox News Sunday.'
'He's doing well,' Cortes attested.
'We spoke to the president yesterday, we meaning senior campaign staff,' Cortes said. 'He was as upbeat and assertive as he's ever been.'
He added: 'This president is going to recover, we are highly confident of that.'
No comments