Just three days after President Donald Trump was taken by helicopter to the Walter Reed National Military Medical Center for treatment for COVID-19, he has been discharged back to the White House. “He’s met or exceeded all standard hospital discharge criteria,” Trump’s personal physician Sean Conley told a press briefing shortly after 3 p.m. ET.
But doctors on the front lines of treating patients with COVID-19 told BuzzFeed News that it is still too early to assume that he is on a certain road to recovery. Months of clinical experience have shown that the disease sometimes flares up dangerously in the second week of symptoms, even in patients who had seemed to be doing well.
“Clinicians should be aware of the potential for some patients to rapidly deteriorate one week after illness onset,” the CDC warns in its clinical guidance for managing patients with COVID-19, last updated Sept. 10.
“It can go in a lot of different directions,” Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco, told BuzzFeed News, shortly before the doctors announced that he would return to the White House later in the day.
“For the next few days, I’d want him 50 feet away from an ICU, not a helicopter ride,” Wachter said.
Trump has been given treatments that are normally reserved for seriously ill patients.
Over the weekend, Conley confirmed that Trump was given oxygen on two occasions when his blood oxygen levels dropped. But on Monday, hours before the president was discharged from the hospital, Conely seemed to downplay the significance of those episodes. “He wasn't short of breath. He wasn't looking ill. It was more of us trying to anticipate needs and see how he would respond, and in both cases, he came right off,” Conley told reporters. “He didn't need it for very long at all.”
On Sunday, Conley confirmed that Trump has been given a steroid, dexamethasone, that is normally only recommended for patients with severe cases of COVID-19 who are having serious trouble breathing. The drug damps down the body’s immune system, which can jump into overdrive and damage the lungs and other organs.
In a large UK trial, dexamethasone was shown to reduce the risk of death in patients requiring supplemental oxygen by about one-fifth. But even after being given dexamethasone, patients who required oxygen still had a mortality rate of about 20%. “These are not miracle drugs,” Wachter said.
Trump has also been treated with remdesivir, an experimental antiviral drug made by Gilead Sciences authorized for emergency use in May, and a cocktail of two monoclonal antibodies against the coronavirus, developed by the biotech company Regeneron. Both have yet to be proved effective.
To require oxygen and to be put on remdesivir and dexamethasone so quickly after becoming infected suggests that Trump’s illness was fairly severe, though it is unlikely that a typical COVID-19 patient with the same symptoms would have been given such intensive treatment.
Trump’s doctors have withheld some crucial information.
We do know that Trump was given a lung scan, which Conley said delivered “expected findings.” But the president's doctors have refused to answer multiple questions about what his lung scans show, citing medical privacy.
A lung scan would reveal whether the coronavirus has caused significant damage to the president’s lungs, such as pneumonia or inflammation. But it could also show evidence of previous, known lung conditions. Notably, Conley did not say that Trump’s scan was normal.
“We’re left trying to figure out what he really meant,” Wachter said.
Today, Conley also said: “He has not been on any fever-reducing medications for over 72 hours,” Dexamethasone has been shown to reduce fevers, however.
The other big uncertainty is when Trump got infected, as Conley has refused to answer questions about when Trump last tested negative before the positive results he received on Thursday.
That timeline is important, because the second week of COVID-19 can be the most dangerous.
Doctors warned that patients in the second week of the disease can suddenly get much more seriously ill.
“Week two is the worst because of the fact that you have the inflammatory response to the virus,” Cedric Dark, an assistant professor of emergency medicine at Baylor College of Medicine, told BuzzFeed News.
In the most severe cases, patients may experience a “cytokine storm,” an aggressive inflammatory immune response that causes severe lung damage. If unchecked, it can lead to multiple organ failure and death.
So knowing when exactly the president was infected and started experiencing symptoms can help assess his risks of a serious relapse.
“If we’re on week two of symptoms, then I’d feel more comfortable that he’s not going to get worse,” Dark said. “If on the other hand the president has been honest about his symptoms, then I’d be more concerned that he needs to be on alert until at least this weekend.”
The White House has its own advanced medical facility — so for Trump to return home isn’t like a regular patient being discharged from the hospital. “The level of monitoring he can have at the White House is just as good as you can get on a regular hospital floor in America,” Dark said.
Still, given the White House does not have an ICU, Wachter said that he would want to keep Trump under close observation at Walter Reed for a few days more, because of how rapidly patients can deteriorate, releasing him from the hospital only after three to four days of steady improvement without requiring oxygen.
Deterioration remains a possibility, Wachter warned. “There has got to be a least a 30% chance that he will get worse.”
Even patients who recover from the initial illness can experience longer-term problems including lung damage, neurological symptoms, and an increased risk of blood clots. Thousands of people have reported struggling with COVID-19 months after they first experienced symptoms.