October 29, 2020

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Trump receiving powerful drug, indicating more serious symptoms, as doctors remain upbeat

A Reuters/Ipsos poll published on Sunday found that Biden had opened a 10-point lead over Trump nationally, slightly wider than it has been for the past two months.

US President Donald Trump released a video update on his health on Saturday.

US President Donald Trump released a video update on his health on Saturday.Credit:Twitter

Some 65 per cent of Americans said Trump likely would not have been infected had he taken the virus more seriously – a view that half of registered Republicans polled supported. Some 55 per cent said they did not believe Trump had been telling the truth about the virus.

At Sunday’s briefing, the White House physician, Dr Sean Conley, provided several significant new pieces of information about the 74-year-old President, saying that he had experienced a “high fever” Friday morning and had received supplemental oxygen for about an hour before being transported to the military hospital in suburban Bethesda, Maryland, later that day.

He disclosed that Trump’s oxygen level had fallen again on Saturday to the point that supplemental oxygen was again required, and that scans of his lungs showed some indications of damage, although he insisted they were not of “major clinical concern”.

Significantly, Conley said the President had been given dexamethasone, a steroid. Doctors prescribe that drug for COVID-19 patients to combat lung damage caused by inflammation, which is one of the major ways the disease can kill patients. Experts had said previously that a decision to put Trump on the drug would be a major development.

Conley had not answered a question on Saturday about whether Trump had been given any steroid and had also evaded repeated questions about supplemental oxygen. On Sunday, he acknowledged that he had omitted some information at the earlier briefing, saying he was “trying to reflect the upbeat attitude” of Trump and his aides.

“It came off that we were trying to hide something,” he said, adding that had not been their intent. He continued to withhold some information, however, declining to say how low Trump’s oxygen level had dropped, for example. On Friday it fell “below 94 per cent” but hadn’t hit “the low 80s,” he said.

The disclosure that Trump is receiving dexamethasone is a clear signal that his illness is a serious one, said Ashish Jha, dean of the Brown University School of Public Health. In an interview Saturday, Jha said he would watch for use of dexamethasone, which would be a “very clear signal that he has a more severe disease.”

In mild cases, he said, “we actually think it does more harm than good.”

On Sunday, Jha repeated that assessment, noting that it was unclear whether Trump could suffer long-term damage to his lungs. Some patients have breathing trouble even after their initial recovery, he noted.

Although doctors have only released incomplete information, Jha said it appears Trump has a moderate case of COVID-19.

“I don’t think he’s out of the woods yet. He could get worse,” Jha said. “And I think he needs very close monitoring.”

Like other steroids, dexamethasone can have significant side effects that could have an impact on Trump’s ability to work. Those can include irritability, mood swings and trouble sleeping, according to medical experts. The National Institutes of Health recommends its use for COVID-19 patients who need supplemental oxygen, but cautions against it in mild cases.

Despite the disclosure of more serious symptoms, the medical team said Trump was doing well on Sunday.

“Since we last spoke, the President has continued to improve,” Conley said, adding that the course of any illness has “ups and downs.”

Aged 74 and clinically obese, the President is at higher risk of serious complications from a virus that has infected more than 7 million people nationwide and killed more than 209,000 people in the US.

First lady Melania Trump has remained at the White House to recover from her own bout with the virus.

Another of the medical team, Dr Brian Garibaldi of Johns Hopkins University, said Trump was “up and around” and feeling well.

“Our hope is that we could plan for a discharge as early as tomorrow,” he said.

At the same time, however, the doctors said that Trump was only midway through a five-day course of remdesivir, an anti-viral drug that medical experts have said would be more difficult to provide outside a hospital setting.

Jha said on Sunday he was puzzled by the comment that Trump could be discharged quickly.

“This whole thing strikes me as very unusual. You would not have a normal person getting discharged at this moment,” he said. “Obviously they can do a lot for him out of the White House. But I find this strange, and not consistent with how this is typically managed.”

Earlier on Sunday, Trump’s national security advisor, Robert O’Brien, appearing on CBS’ Face the Nation, portrayed Trump as “firmly in control” of the government. He refused to discuss details of contingency plans if the President were incapacitated, but said “we’re prepared” for any scenario.

“Look, we have a great Vice-President,” he said. “We have a government that is steady, and is steady at the tiller.”

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O’Brien, who recovered from a bout of COVID-19 over the summer, said he would expect the President to remain hospitalised “for at least another period of time,” adding that “day seven and eight are the critical days”.

The sometimes contradictory accounts by doctors and White House officials indicate how Trump, who often tries to mold facts to fit his preferred narrative, has extended that approach to his own medical care.

Asked why he wasn’t upfront on Saturday about Trump receiving oxygen, Conley admitted that the omission was part of a public relations front.

“I was trying to reflect the upbeat attitude that the team, the President, that his course of illness had had,” Conley said. “I didn’t want to give any information that might steer the course of illness in another direction.”

The comment was an unusual one since viruses aren’t swayed by press conferences. But the President has a reputation for watching his staff and allies on television shows, and his critical gaze appears to have fallen on his doctors as well.

Trump even attempted to inject some of his own medical advice into his care. On Saturday, Conley said the President had asked about whether he should take hydroxychloroquine, an anti-malarial drug that has been touted among his allies and in conservative media despite no proof that it’s effective against the coronavirus.

“We discussed it. He asked about it,” Conley said. “He’s not on it now.”

House Speaker Nancy Pelosi, appearing on CBS, emphasised that “our prayers are with the President and the first lady,” who has also tested positive for coronavirus, but suggested that senior Democrats were being left in the dark about the President’s condition.

“We’re getting our information the way everyone else is, in the media,” she said.

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Without directly addressing the contradictory statements about Trump’s condition, Pelosi alluded to the President’s tendency to berate or undercut aides when their words, even if factual, displease him.

“We have to trust that what they’re telling us about the President’s condition is real,” the speaker said. The public, she said, should not be left with the impression that when Trump’s doctors give a briefing, “it has to be approved by the President. That’s not very scientific.”

The White House has also undertaken a less-than-robust effort to trace other people who might have been in contact with Trump and exposed to the virus. A number of people who were around the President over the previous week have said publicly that no one from the White House had reached out and urged they be tested.

O’Brien, in his CBS interview, shed little light on that, saying “there’s contact tracing going on” and then changing the subject.

Pressed as to who was doing it, he said the White House medical unit and “others in the White House” were working on it.

The White House has been working to trace a flurry of new infections of close Trump aides and allies. Attention is focused in particular on the September 26 White House event introducing Trump’s Supreme Court nominee.

That day, Trump gathered more than 150 people in the Rose Garden, where they mingled, hugged and shook hands – overwhelmingly without masks. There were also several indoor receptions, where Trump’s Supreme Court pick, Amy Coney Barrett, her family, senators and others spent time in the close quarters of the White House.

Among those who attended and have now tested positive are former New Jersey governor Chris Christie, former White House counsellor Kellyanne Conway, the president of the University of Notre Dame and at least two Republican lawmakers – Utah Senator Mike Lee and North Carolina Senator. Thom Tillis.

The President’s campaign manager, Bill Stepien, and the head of the Republican National Committee, Ronna McDaniel, have also tested positive, though they were not at the Barrett event.

Los Angeles Times with Reuters, AP

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