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What Trump’s Symptoms, Treatment Mean for COVID Course

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This story was last updated Oct. 4 at 10:45 a.m.

Oct. 2, 2020 -- President Donald Trump is breathing normally, doesn’t have a fever now, and is “doing very well” as he recovers from the coronavirus, his personal physician, Sean Conley, DO, said Saturday morning during a press briefing at Walter Reed Medical Center.

“At this time, the team and I are extremely happy with the progress the President has made,” Conley said.

Trump was taken to Walter Reed Medical Center on Friday afternoon after testing positive for COVID-19, according to a statement from the White House. He is at higher risk for severe illness because of his age and obesity,

First lady Melania Trump, who also tested positive, is doing well and does not need to be at the medical center, Conely said.

After Conley’s briefing, however, Mark Meadows, the White House chief of staff, told White House pool reporters that the next two days will be “critical” for the president’s recovery, according to The Associated Press.

“The president’s vitals over the last 24 hours were very concerning and the next 48 hours will be critical in terms of his care,” Meadows said. “We’re still not on a clear path to a full recovery.”

In addition, Trump received supplemental oxygen at the White House on Friday, sources told The New York Times and the Associated Press, and he was sent to Walter Reed to be monitored with better equipment. Conley said the president did not receive oxygen therapy at Walter Reed.

The president started taking a course of the anti-viral drug remdesivir Friday, a drug under study as a COVID-19 treatment. Earlier, the president received a dose of an experimental antibody therapy on Friday “as a precautionary measure,” Conley said. Late Saturday, Conley said Trump was "not yet out of the woods." On Sunday, Conley said, Trump would be monitored "in between doses of remdesivir."

Regeneron, the company that makes the “antibody cocktail,” released early results of the therapy this week, saying the drugs tamped down symptoms and reduced viral load in COVID patients who were not in a hospital and who had not mounted their own immune response to the virus. The first study included just 275 patients. Another study is underway to confirm the findings.

Trump got the highest dose of the therapy given to patients in the initial study, 8 grams. Conley says he had no side effects from his IV infusion. Trump also has been taking zinc, vitamin D, heartburn drug famotidine, melatonin and aspirin, according to memo from White House press secretary Kayleigh McEnany.

The president will work from the presidential offices at Walter Reed, according to a statement from the White House. In a video Friday evening, he said he thinks he's doing "very well." 

Medical experts say the next few days will be critical in determining the course of Trump’s illness.

Pieter Cohen, MD, has spent the past few months closely following patients through their first symptoms of COVID. He works in the COVID-19 respiratory clinic that was set up by the Cambridge Health Alliance in Cambridge, MA.

In studying the history of the infection, he’s found that symptoms are almost always mild during the first few days and may look just like those of a run-of-the-mill cold or bout of flu. Those nondescript symptoms include a stuffy nose, coughing, a low-grade fever, muscle aches, fatigue, headaches, and gastrointestinal complaints like diarrhea and belly pain.

“All that’s really common and really indistinguishable from having any viral illness, or really even eating something that was a little bad the night before or being under a lot of stress,” Cohen says, noting that a loss of smell at this point is one symptom that is a little unusual.

What happens to most people who get COVID is that these symptoms, while no picnic, may hang around for a week or two, and then people gradually start to feel better.

Cohen says that around the fourth day after the first symptoms appear, and continuing through day 10, things can take a turn for the worse. He says this period is when mild infections may become severe for about 15% to 20% of people who are infected.

What starts to happen is that people become breathless. They may start to pant, especially when they’re trying to walk around and do things.

“Sometimes people just get dizzy or lightheaded, or like their legs are giving out on them. It’s described in different ways,” Cohen says

In a study of over 1,000 patients who came through his clinic, Cohen says he found that this breathlessness -- which happens several days after the first symptoms -- is like a fingerprint that helps distinguish COVID from other respiratory infections.

“Starting this weekend, tomorrow, especially on Sunday, and going into early next week are going to be the real key days to watch to make sure that things aren't worsening” for the president, Cohen says.

He says he watches patients who develop this telltale breathlessness very closely over the next 72 hours. If it gets worse with activity, he says, that’s often a signal that their illness is going to be more serious.

Cohen and other experts cautioned that members of the general public shouldn’t infer too much from the outcome of the president’s case.

Trump is getting exceptional medical care that wouldn’t be available to most Americans.

The Regeneron antibody therapy, for example, which works by mimicking the body’s own immune response to the virus, isn’t yet available to the general public.

“This is just one person with COVID. We see that COVID is dramatically different, even with the same risk factors,” Cohen says.

“Let’s say the president has a mild case. That should not reassure anyone that if they get it, they're going to have a mild case, because it's so unpredictable and we have seen plenty of people in their 40s who have needed to be hospitalized because of severe disease with no more risk factors than the president has,” Cohen says.

Trump is also likely to benefit from months of knowledge doctors have learned about COVID-19 and how to best treat it.

“I expect that he will be fine,” says Colleen Kraft, MD, associate chief medical officer at Emory University Hospital in Atlanta.

Kraft says that back in March, when she saw her first patient, “I couldn’t even imagine that we would have this many drugs, this much understanding -- you know, sort of gotten to a place where we feel really comfortable treating this disease,” she says. “It doesn’t mean it goes well for everybody, but it certainly, you know, we have a framework that’s very robust in which to treat him.”

Carolyn Crist and Ralph Eillis contributed to this report.

WebMD Health News Reviewed by Neha Pathak, MD on October 02, 2020

Sources

Pieter Cohen, MD, associate professor of medicine, Harvard Medical School, Cambridge, MA.

Colleen Kraft, MD, associate chief medical officer, Emory University Hospital, Atlanta.

News release, Regeneron, Sept. 29, 2020.

Mayo Clinic Proceedings, June 1, 2020.

@realDonaldTrump, Oct. 2, 2020.

News briefing, Dr. Sean Conley, Oct. 3, 2020.

New York Times, “’We’re still not on a clear path to a full recovery,’ the president’s chief of staff said.”

Associated Press, “Official: Next 48 hours ‘critical’ for Trump in virus fight.”

CNN, “White House sows confusion about Trump’s condition as source tells reporters next 48 hours will be critical.”

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