Trump's medical team briefing reveals things are worse than we knew

President Donald Trump’s doctors at Walter Reed National Military Medical Center revealed Sunday that the president’s condition is more serious than the White House has so far acknowledged.

“I didn’t want to give any information that might steer the course of illness in another direction,” Sean Conley, the president’s physician, told reporters during a hospital briefing. “In doing so, it came off that we were trying to hide something, which wasn’t necessarily true.”

Conley and others on Trump’s medical team remained upbeat, but said the president had trouble breathing Saturday morning and had started a drug used only for severe or critical cases of Covid-19.

Here’s what we learned from the latest briefing.

Trump given steroid, a worrying sign

As a determination of the team based predominantly on the timeline from the initial diagnosis that we initiate dexamethasone. — White House physician Dr. Sean Conley

Dexamethasone — a safe, inexpensive steroid that has been around for decades — is generally reserved for patients with severe or critical Covid-19 cases.

The National Institutes of Health and World Health Organization both recommend the drug for patients on supplemental oxygen or ventilators, based on a large clinical trial that found it reduced the risk of death. But both guidelines warn the drug could harm people who don’t require oxygen therapy or a ventilator, and should not be used for such patients. Trump's doctors said Sunday that he has received oxygen therapy twice for limited periods. They also said he’s run a fever.

The decision to give Trump dexamethasone shows “he’s actually having effects on his lungs from the virus,” said Abraar Karan, an internal medicine doctor at Brigham and Women’s Hospital in Boston.

Trump continues antiviral treatment that can shorten length of illness

The president yesterday evening completed his second dose of remdesivir. He's tolerated that infusion well. – Dr. Brian Garibaldi

Remdesivir is an antiviral drug made by Gilead Sciences originally developed to fight Ebola. Trump’s doctors said Friday that he had begun the standard five-day course of infusions of the drug.

Remdesivir has been shown to speed recovery, but it’s not clear whether it actually reduces the risk of death. The Food and Drug Administration has authorized emergency use in hospitalized patients.

Trump's oxygen levels have dipped to concerning levels

Late Friday morning, when I returned to the bedside, the president had a high fever and his oxygen saturation was transiently dipping below 94 percent. Given these two developments, I was concerned for possible rapid progression of the illness. I recommended the president we try supplemental oxygen, see how he would respond. He was fairly adamant that he didn't need it. He was not short of breath. He was tired, had the fever and that was about it. And after about a minute, on only two liters, his saturation levels were back over 95 percent. He stayed on that for about an hour, maybe, and was off and gone. — Dr. Conley

Another oddity of Covid-19: some patients’ oxygen levels fall, but they don’t have trouble breathing. That’s why doctors watch blood oxygen levels.

The president’s physicians gave him oxygen after his level dropped below 94 percent — a key threshold for Covid-19 patients. Dipping below that level signals that a patient’s case is moderate or severe, with the exact diagnosis depending on other vital signs, according to the Centers for Disease Control and Prevention.

“Once you drop below 94 percent, by definition you have severe Covid,” said Carlos del Rio, an infectious-disease expert at Emory University.

What do Trump's lung scans actually show?

What did the X-rays and CT scans show? Are there signs of pneumonia? Are there signs of lung involvement? Or any damage to the lungs? – Reporter

We're tracking all of that. There's some expected findings but nothing of any major clinical concern. — Dr. Conley

Trump’s doctors repeatedly ignored questions about what CT scans or other advanced imaging he had, and what they showed about his lungs. His doctors said only they had seen “expected findings.”

Their admission that the president’s oxygen saturation had dropped below 94 percent at times, that he has twice required oxygen, and that he has started on dexamethasone point to at least a moderate case of Covid-19.

Many patients with moderate disease develop pneumonia signaled by “ground glass opacities,” lung damage that appears as hazy white patches on CT scans. These develop when the virus injures tiny air sacs, filling them with pus or other fluid and making it harder to breathe. Trump’s doctors have not revealed whether he has this type of damage; if he did, it would be a reason for heightened concern.

How long has the president been sick?

Yesterday you told us that the president was in great shape, had been in good shape and fever free for the previous 24 hours. Minutes after your news conference White House chief of staff Mark Meadows told reporters that the president's vitals were very concerning over the past 24 hours. Simple question for the American people, whose statements about the president's health should be believed? — Reporter

White House officials and Trump’s medical team have issued seemingly contradictory assessments of the president’s condition and the timing of his diagnosis since Trump announced his diagnoses on Twitter early Friday. That has made it harder to know how sick Trump is or how far along he is in the course of the disease.

“What jumped out is the continued lack of information on several critical aspects,” said Leana Wen, a former health commissioner for Baltimore and ER physician. “What is the president’s respiratory status? There is no chance that the president wouldn't have had multiple chest imaging studies done at this point. It would be standard of care to do at least daily.”

When could Trump leave the hospital?

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. — Dr. Garibaldi

The possible discharge from Walter Reed National Military Medical Center so soon raised eyebrows. Patients’ condition often worsens about seven to 10 days in.

“The beginning of that second week is a phase we pay particular attention to,” said Helen Boucher, chief of infectious disease at Tufts Medical Center.

Remdesivir must be administered in a hospital setting. Of course, the White House has far more medical capacity than your average home, and can airlift the president to a hospital by helicopter. But it’s still possible his medical team will reconsider and advise the president to remain at Walter Reed.

But several doctors not involved with his care said it may be fine to discharge Trump, given the White House’s medical resources. “Once they see him turning for the better, and he’s getting better, I think they're right to go back to the White House," said Emory’s del Rio.

CORRECTION: Correction: A previous version of this article misstated Leana Wen's former title. She was health commissioner of the city of Baltimore.