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Politics Trump is being discharged from Walter Reed medical center

23:00  05 october  2020
23:00  05 october  2020 Source:   vox.com

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President Trump said Monday that he’s being discharged from Walter Reed National Military Medical Center, where he was being treated for Covid-19, in a tweet that showed his determination to continue downplaying a disease that has killed more than 200,000 Americans and more than a million people worldwide.

a person wearing a hat: President Trump drives past supporters in a motorcade outside of Walter Reed medical center in Bethesda, Maryland, on October 4. © Alex Edelman/AFP via Getty Images President Trump drives past supporters in a motorcade outside of Walter Reed medical center in Bethesda, Maryland, on October 4.

“Don’t be afraid of Covid,” he tweeted. “Don’t let it dominate your life.”

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Trump’s physician Sean Conley confirmed the news of the discharge in a briefing Monday. “Over the past 24 hours, the president has continued to improve,” Conley said. “He’s met or exceeded all standard hospital discharge criteria.”

Trump — a lifelong germaphobe — had been eager to get out of Walter Reed. According to CNN’s Jim Acosta, he was concerned that being hospitalized “makes him look weak.” Separately, sources told the New York Times that a Sunday evening drive — in which he put Secret Service staff at risk of infection — was a compromise after he’d asked to be discharged yesterday and doctors refused.

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The rush to get out of the hospital makes sense politically: A Covid-19 infection, during which a patient is supposed to remained isolated, is extremely inconvenient for Trump’s presidential campaign, less than a month before the election.

But does it make sense medically? Let’s be clear: It’s tricky to know the severity, or stage, of Trump’s Covid-19 case. Even for a White House with a terrible track record of truth-telling, the flip-flopping of the last few days has been staggering. And that’s led doctors to question whether Trump’s case was more serious than the White House is letting on and when Trump was actually diagnosed.

“This White House is not necessarily adopting an approach of full transparency,” Theodore Iwashyna, a professor of internal medicine at the University of Michigan, summed up, “so it’s hard to know what to watch out for.”

There are at least two ways to interpret Trump’s early discharge

There are at least a couple of ways to interpret what the discharge means for Trump’s health, only a day after his doctors reported Trump was put on dexamethasone, a steroid for people who are critically ill with Covid-19.

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Iwashyna and other clinicians who work with coronavirus patients said Trump’s discharge could mean the president doesn’t need intensive care unit (ICU)-level attention, such as access to a ventilator or intubation, right now.

“It isn’t unreasonable to be treating patients at home like this for Covid because you’re actually reducing risk of infection without necessarily compromising patient care,” said intensive care physician Lakshman Swamy, who works with the Cambridge Health Alliance.

Or, it’s possible Trump is still sicker than Team Trump is letting on. Unlike other patients, the commander in chief isn’t going back to a normal home. The White House medical unit has a full team of health professionals at the ready who can do most of what’s possible in a hospital. “You can’t run an ICU at home but at the White House you can make supplemental oxygen easily available, IV medications available as needed,” Jen Manne-Goehler, an infectious disease doctor at Brigham and Women’s and Massachusetts General hospitals, told Vox. “It certainly indicates they don’t think he’s at the precipice.”

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“It’s not like I have to be worried Trump’s going to be left alone — he’s going to fall down and no one is going to be there and not help him up,” Iwashyna added. “He’s the most monitored man in the world.”

What we can learn from Trump’s case

It’ll take at least a week to know whether the president truly avoided life-threatening complications from the disease. Covid-19 patients can seem stable, and then rapidly deteriorate without warning. It’s not until 10 days after symptoms appear that doctors can be sure that someone has truly turned a corner.

Even then, there’s the risk of what’s become known as “long Covid,” which features chronic symptoms such as cognitive impairment and depression. There’s no correlation between the severity of a person’s Covid-19 case and whether they become a “long hauler.”

Whatever happens, Swamy warned about extrapolating anything from Trump. “Those of us that took care of a burden of patients with the virus during the surge ... [saw] it’s very hard to learn based on a few patients” what treatment approaches work.

“It scares me people will say ‘it’s not a big deal, and 99 percent of people do fine,’” after seeing the Trump case, Manne-Goehler said.

Iwashyna was slightly more colorful. “I live in a college town. Every now and then — people get drunk and wander down the street naked and drunk. And they don’t always get hit by a car. It would be a mistake from my perspective to say that means getting drunk and wandering naked down the street is safe.”

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In other words, just because Trump — with attentive care and monitoring — was able to get through Covid-19, like many people with the disease, doesn’t mean it’s not serious. “I’m still going to be wearing a mask when I go out,” Iwashyna added, “regardless of what happens to the president.”

What Team Trump has been saying about the president’s health

Let’s quickly recap what we know because it’s been a confusing few days. On Friday, after announcing Trump’s positive Covid-19 test result — and that the president had only mild symptoms — White House press secretary Kayleigh McEnany disclosed Trump was leaving the White House for Walter Reed medical center “out of an abundance of caution.

By Saturday’s press conference, Conley wouldn’t release basic details of Trump’s case, bungled the timeline of the president’s diagnosis, and later released a letter to correct it. That same day, the White House chief of staff, Mark Meadows contradicted Conley, saying Trump’s vitals were “very concerning,” in what was supposed to be an off-the-record statement that got recorded on video.

On Sunday, Conley said Meadows’ statement was “misconstrued” and that Trump’s oxygen levels had twice dropped to worrisome levels since Friday requiring supplemental oxygen to bring them back up. Conley said he’d withheld these details because he wanted to “reflect the upbeat attitude that the team, the president” has had about the course of Trump’s illness.

Finally, Conley shared that Trump on Saturday started yet another drug to fight Covid-19: dexamethasone. The steroid has been shown in clinical trials to improve outcomes — but is only recommended for patients with severe or critical Covid-19. It’s also the third Covid-19 drug to be administered to the president, following an experimental monoclonal antibody treatment given Friday and an ongoing, five-day course of the antiviral remdesivir.

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There are big holes in the narrative about Trump’s illness

Since the information the White House has released has been incomplete and at times contradictory, it’s been difficult to get a clear sense of the timeline of Trump’s illness. For example, his doctors did not provide details about the results of the president’s chest x-rays or CT scans, so it’s not clear if they’d found signs of pneumonia, or other manifestations of Covid-19 lung involvement. They also haven’t provided detailed information about Trump’s oxygen saturation levels.

And these are exactly the things that will be critical to monitor in the coming days. “The first is is making sure he doesn’t develop a worsening of Covid,” said Iwashyna, meaning he’s not developing pneumonia and his oxygen saturation levels aren’t declining.

Then, there’s the secondary complications that could arise, such as a reduction in heart function.

The president also got a cocktail of drugs, some with known and some with unknown side effects. Steroids like dexamethasone are known to increase the risk of bacterial infections and blood clots, said Iwashyna. “He was also given a drug that is not approved and has not had adequately safety tested right now at a dose that is not even the dose they’re recommending to push forward in trials, so the possibility of complications from the antibodies will be around for at least days, maybe weeks or months.”

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