WASHINGTON — President Donald Trump’s doctor was evasive on major details of the president’s illness, including the timeline of his treatments, in a short and highly anticipated press conference Saturday morning.
And just moments after the press conference ended, an unnamed source told reporters entirely contradicting information: that the president's health has been "very concerning," the opposite of the upbeat report Trump's doctor gave on TV.
Dr. Sean Conley told reporters that the president is not currently on oxygen, but would not say definitively that he has not needed supplemental oxygen since he began being treated for COVID-19. The New York Times later reported, and multiple outlets confirmed, that Trump was given supplemental oxygen on Friday at the White House after his oxygen level dropped.
Conley also said the president is “72 hours into the diagnosis,” and his team said Trump had received an experimental antibody cocktail "48 hours ago" — changing the timeline for Trump’s illness from late Thursday, when Trump announced his test, to Wednesday.
A little more than an hour after the press conference, Conley released a new memo to the media saying he misspoke and that Trump was first diagnosed Thursday night and received the antibody cocktail on Friday.
Throughout, Conley insisted Trump was recovering well. “Thursday he had a mild cough and some nasal congestion and fatigue, all of which are now improving,” he told reporters. The president’s physician would not answer questions about whether he had sustained any lung damage so far.
Minutes after Conley had finished speaking, the White House press pool sent a report with much more troubling views, sourced to someone "familiar with the president’s health."
“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," that person said. "We’re still not on a clear path to a full recovery.”
The White House pool report, which is sent to reporters covering the White House at many media organizations, did not specify the source. But after Conley's press conference, White House chief of staff Mark Meadows was captured on video gathering reporters present to speak privately, off the record.
This matters beyond the detailed rules of journalism: There's a White House official, who asked not to be named, speaking privately moments after the president's own physician held a widely viewed and unclear press conference.
Hours later, the Associated Press and the New York Times attributed the comment contradicting Conley’s rosy remarks to Meadows. Meadows then gave a statement on the record to Reuters saying Trump is doing “very well” and that “doctors are pleased with his vital signs.”
Later Saturday night, Trump tweeted a four-minute video address from Walter Reed, where he spoke about his condition in a clearly hoarse voice, and in a rare appearance without a tie.
"I came here, wasn't feeling so well. I feel much better now," Trump said. "We're working hard to get me all the way back, I have to be back because we still have to make America great again." He said he was "starting to feel good," but would "be seeing what happens over the next couple of days." He added that he had the "choice" to stay in the White House, but decided not to in order to be "out front" and "not locked up in a room upstairs." He is currently in Walter Reed hospital, and it's unclear when he will be leaving.
"We're going to beat this coronavirus, or whatever you want to call it, and we're going to beat it soundly," he said.
Trump's stance that he is improving substantially within 24 hours conflicts with what doctors have said about how COVID-19 courses through patients — it's often not a linear progression, there are some days where a person may feel fine followed by days where a person may feel seriously ill. And it's the week after an initial diagnosis that can be far more treacherous.
"The main thing to realize about this is that this is week one of his illness — week two is the worst," said Cedric Dark, an assistant professor of emergency medicine at Baylor College of Medicine. He added that the second week of COVID-19 infection is when the body's own inflammatory response to the virus can lead to severely injured lungs. "That's when oxygenation tends to dip significantly."
"Everyone's talking about what happened the last two, three days. I wouldn't worry about the last two, three days. I'd watch him like a hawk the next week," Dark said.
Conley had told reporters Trump had been fever-free for over 24 hours, but would not say what his fever had previously been.
“Thursday no oxygen, none at this moment, and yesterday with the team while we were all here he was not on oxygen,” Conley said when pressed, never ruling out the hours between the time the president announced his diagnosis and Conley’s treatment update, which came at 4 p.m. on Friday.
Conley was one of 10 people on the president’s medical team at the event, including several pulmonary doctors and an anesthesia specialist. Dr. Sean Dooley said Trump told doctors Saturday morning, “I feel like I could walk out of here today,” and that the president was not struggling to breathe.
"I’m old enough to remember the press briefings from Dennis O'Leary when President Reagan was shot. They were models of clarity and transparency. The country found them truly reassuring. And let’s just say this one did not meet that standard," said Bob Wachter, chair of the department of medicine at the University of California, San Francisco.
Conley's "job is to give clear credible accurate information. We got misdirection, we got confusion, we got evasiveness," Wachter added. "This was sort of a first pass to see whether we’re going to be able to believe what the White House puts out about Trump's condition, and I’ve come out of this thinking they’re going to put out propaganda rather than truth."
Dark noted that Trump's reported oxygen saturation, 96%, was below normal but not at a level that would currently require supplemental oxygen. But both Dark and Wachter said being given supplemental oxygen at some point is not unusual. "The decision to provide supplemental oxygen is sometimes like putting a blanket on somebody — it’s harmless and it’s cheap," Wachter said. He noted that the bigger concern would be knowing if Trump's oxygen saturation had dipped considerably at any point.
The president tweeted early Friday morning that he and the first lady tested positive for the coronavirus. That was the last the president was heard from for many hours: By mid-afternoon, the Trump campaign announced all events involving the president would be postponed or moved to virtual. Soon after, the White House released a memo from Sean P. Conley, the president’s physician, on his course of treatment, which included an 8-gram dose of an experimental antibody cocktail, zinc, vitamin D, famotidine, melatonin, and a daily aspirin.
Trump was helicoptered to Walter Reed Hospital early Friday evening per Conley’s recommendation, according to the White House press secretary Kayleigh McEnany. She said the president would be working from there for “the next few days.” Before walking to the helicopter without speaking to reporters, Trump recorded a brief video that was posted to Twitter.
Later Friday night, the White House issued another physician’s memo to say the president was taking the drug remdesivir but was not in need of supplemental oxygen. Just before midnight, Trump tweeted a short and uncertain update:
There is still no cure for COVID-19, and the FDA has not given its standard approval to any drugs to treat the illness.
Trump’s treatment course includes a very new and experimental antibody treatment made by the company Regeneron, in combination with a more established, but still unproven, antiviral drug, remdesivir, which he received when he was moved to Walter Reed Hospital.
Asked about the decision to put Trump on two experimental treatments so early in the course of his illness, Conley said, “We're maximizing all aspects of his care, attacking this virus, you know, multi-prong approach.”
The Regeneron experimental antibody treatment is a combination of two lab-made antibodies. Early data has shown that it could be effective in reducing the amount of virus present when given early on in an infection. But the biotech firm did not release full data — only releasing early data via a press release four days ago. Since the treatment does not have any FDA authorization, the president was given the treatment via a “compassionate use” exception for emergency cases.
Some scientists have criticized use of the experimental therapy on the president, saying that not enough data has been made public.
"I personally don't care what your viral load is — because I treat your clinical condition," said Dark, who noted that because only limited information was released via press release, clinicians could not know enough about the effects of using the drug. "There's nothing that's actually a legitimate clinical outcome — whether it prevents you from requiring oxygen, or needing to go to the ICU, or mortality reduction. We don't have that kind of information that I as a practicing clinician would want to say that this drug is better than doing nothing."
In contrast, the antiviral drug remdesivir is a more commonly used treatment that received emergency authorization in May, allowing for its use in hospitalized patients. However, remdesivir has also not made it through a full FDA approval process, which would require clinical trial data that conclusively show that it is safe and effective.
Early studies of remdesivir had mixed, but promising, results. One trial of 1,063 patients suggested that the drug provided a benefit for people with moderate infection. Compared to a placebo, use of the drug reduced hospital stays from 15 to 11 days, but did not have any measurable effect on the number of people who died. Another small trial halted use of the drug after it led to significant side effects. On Friday, the European Union’s medical regulator announced it is investigating a link to “acute” kidney damage in patients given the drug.
On Saturday morning, Conley said Trump’s kidney function was being closely monitored and so far was normal. He stated that they planned to keep Trump on a full five-day course of the antiviral drug.
Asked when the president might be discharged, Conley refused to provide an answer, saying that the medical team was still concerned about the latter phase of Trump's illness.
“Well, I don't want to put a hard date on that. He is doing so well,” Conley said. “But with the known course of the illness, day seven to ten, we get really concerned about the inflammatory phase, phase two.”
This story was updated with reporting from multiple outlets that the president was given supplemental oxygen on Friday.
A doctor on Conley's team originally had said the president received an experimental antibody cocktail "48 hours ago." An earlier version of this story misstated which doctor had made that statement.