President Donald Trump’s doctor, delivering his second evasive press conference on the president’s health in two days, said Sunday that Trump has been treated with a steroid after his oxygen levels dropped twice since he was diagnosed with COVID-19.
That new information suggests that the president’s condition is more severe than previously disclosed, despite the rosy picture painted by his medical team — who still suggested that Trump could be discharged as soon as Monday.
“Both of those pieces of data tell us you cannot call this a mild disease,” Bob Wachter, chair of medicine at the University of California, San Francisco, told BuzzFeed News.
Dr. Sean Conley also had to address the contradictory statements that had come from him and White House officials on Saturday, at one point admitting he was trying to “reflect the upbeat attitude” that officials, including Trump, wanted to portray.
Conley insisted Sunday that the president “has continued to improve,” but that over the course of his illness, he had “experienced two episodes of transient drops in his oxygen saturation.”
Conley said the president’s medical team “debated the reasons for this and whether we would even intervene.” The team then initiated a treatment with dexamethasone.
Trump received his first dose of dexamethasone on Saturday, and his medical team said the plan is to continue with the treatment “for the time being.”
Dexamethasone is a corticosteroid that suppresses the immune system, helpful in the later stages of severe COVID-19 when that system can go into overdrive and attack the lungs, but potentially harmful in earlier stages when the immune response is needed. In June, a major UK trial found that a daily dose of dexamethasone for up to 10 days reduces deaths by one-third in patients on ventilators and by one fifth in patients only receiving supplemental oxygen.
The World Health Organization recommends the use of corticosteroids on patients “with severe and critical COVID-19” — and explicitly specifies that it should be avoided for cases that are not severe, as it has shown no benefits and “could even prove harmful” for those less ill patients. The US National Institutes of Health has a similar guideline.
Conley also confirmed reports that the president had been given two liters of supplemental oxygen on Friday morning after he had a high fever and his oxygen level had dipped below 94%. He would not specify what the president’s oxygen levels were.
Wachter said the decision to start the steroid treatment made sense in light of that new information.
“Obviously, he’s getting world-class care, but I think you have to say he falls in a group that still has a significant chance of having a bad outcome, going to the ICU, requiring that kind of care and maybe even dying,” he added.
Conley said he had been concerned Friday for the “rapid progression of the illness” and recommended supplemental oxygen for the president. He said Trump was “fairly adamant” he didn’t need it, claiming that he was not short of breath.
After giving him two liters of oxygen, his saturation levels were over 95%, Conley said.
Conley said that on Saturday, Trump’s oxygen saturation level dropped to 93%, but refused to confirm if the president had received a second round of supplemental oxygen.
Reporters also pressed Conley whether Trump’s oxygen levels had ever dipped below 90%, and he would only say that “We don't have any recordings here of that.” Asked further if Trump had ever registered an oxygen level below 90% at any point since his diagnosis, whether at Walter Reed or at the White House, Conley demurred.
“No, it was below 94%. It wasn’t down into the low 80s or anything, no,” Conley said.
In general, the lower the blood oxygen level, the clearer it is that the coronavirus is harming lung capacity.
“If you’re sitting around and doing well and feeling well, your number is going to be 97 to 98,” Wachter said. “If you have a little bit of inflammation in your lung, it might go down to 93. If you have more inflammation in your lung, it might go down to 87. You’re more worried about the person at 87 than the person at 93.”
Asked specifically if doctors had found signs of pneumonia in or damage to the president’s lungs, Conley would only say “we’re tracking all that” and that there have been “some expected findings, but nothing of any major clinical concern.” Conley also repeatedly avoided answering any questions about Trump’s lung scans.
In a video he tweeted hours after the medical briefing on Sunday, Trump — who stood and appeared a bit livelier than his previous recorded appearance — said, "I learned a lot about COVID. I learned it by really going to school...and I get it, and I understand it, and it's a very interesting thing, and I'm going to be letting you know about it." (The pandemic has been ongoing for months and more than 208,000 people died in the US alone.)
Trump then announced a "surprise visit" to his supporters standing outside Walter Reed.
Moments later, a masked president, infected with COVID-19, and with at least two other people enclosed in an SUV, drove by and waved to his supporters on the street.
"Every single person in the vehicle during that completely unnecessary Presidential 'drive-by' just now has to be quarantined for 14 days. They might get sick. They may die. For political theater. Commanded by Trump to put their lives at risk for theater. This is insanity," a doctor at Walter Reed tweeted not long after.
"It's been a very interesting journey," Trump said in the recorded video. "I learned a lot about COVID. I learned it by really going to school. This is the real school. I get it and I understand it and it's a very interesting thing."
Since he checked into Walter Reed Medical Center on Friday, Trump’s doctors and members of the White House staff have sent a breakneck stream of contradictory messages about the president’s health. In a prerecorded video tweeted out that night, the president said, “I think I’m doing very well, but we’re going to make sure that things work out.”
There is no known cure for COVID-19, and the FDA has not yet approved any drugs to treat it.
Prior to Sunday, Trump’s known treatments included an experimental antibody cocktail made by the company Regeneron, in combination with remdesivir, an antiviral drug made by Gilead Sciences, which is authorized for emergency use but still unproven. Trump is also taking zinc, vitamin D, famotidine, melatonin, and a daily aspirin.
Taking remdesivir and dexamethasone is “now standard therapy” for patients with moderate to severe COVID-19, Wachter said. “The new twist here is the antibodies,” he added. There is no data on how the three treatments might interact with each other, though there’s “no good reason to think they would interact positively or negatively.”
At the Saturday press conference, Conley insisted that the president was recovering well and had “a mild cough and some nasal congestion and fatigue, all of which are now improving.” But Conley was not fully forthcoming about the president’s treatment. What he did not say, but that media outlets would later report, was that Trump had been given supplemental oxygen on Friday at the White House after his oxygen level dropped.
Conley also said the president had been fever-free for more than 24 hours, but wouldn’t say what his fever had been prior to that. Trump is also being treated with aspirin, which suppresses fever.
Then an unnamed source gave a much more alarming prognosis to the White House press pool, saying that Trump’s “vitals over the last 24 hours were very concerning” and “we’re still not on a clear path to a full recovery.” That source turned out to be White House chief of staff Mark Meadows, according to media outlets.
“The chief and I work side by side, and I think his statement was misconstrued,” Conley told reporters at Sunday’s press conference, when asked who should be believed. “What he meant was that 24 hours ago, when he and I were checking on the president, that there was that momentary episode of a high fever and that temporary drop in the saturation, which prompted us to act expediently to move him up here. Fortunately, that was really a very transient limited episode.”
Conley also said, in reference to his evasive remarks about Trump’s oxygen supply yesterday, “So I was trying to reflect the upbeat attitude that the team, the president, his course of illness has had. I didn’t want to give any information that might steer the course of illness in another direction and in doing so, you know, it came off that we were trying to hide something, which wasn’t necessarily true.”
Trump himself said in the video posted to Twitter Saturday night that he had been given the option to go to Walter Reed on Friday and decided to go so he would be “out front” while he is treated for the virus, mentioning nothing about going due to poor health.
Meadows told Reuters later Saturday that Trump was doing “very well” and that “doctors are pleased with his vital signs.” And later that night, in a video filmed at and released from Walter Reed, Trump said, “I came here, wasn't feeling so well, I feel much better now.” He said he was “starting to feel good,” but would “be seeing what happens over the next couple of days.”
This story has been updated to include comments from Bob Wachter of UCSF.