Updated Oct. 5, 6:43 p.m. 

Oct. 5, 2020 – President Donald Trump walked out of Walter Reed Military Medical Center shortly after 6:30 p.m., where he had been receiving treatment for a COVID-19 infection since Friday.

Trump entered an SUV that took him to Marine One for a short flight back to the White House, where he will stay for the rest of his quarantine and treatment.

In a tweet earlier Monday, the president announced he would leave the hospital and said he is “feeling really good!”

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

But Trump's doctor said he "may not entirely be out of the woods yet." Cmdr. Sean Conley, DO, the president’s doctor,  told reporters Monday afternoon that Trump “has continued to improve. He’s met or exceeded all standard hospital discharge criteria.”

Conley, however, refused to say when Trump last tested negative for coronavirus. Conley stressed that while they do not yet know if Trump remains contagious, plans are being made for him to work and live at the White House, although would not say if that meant remaining in the first family’s residence or returning to the Oval Office.

Still, Conley said concerns remain about the president worsening. Typically, if a patient begins to deteriorate from COVID, it happens after the fourth day of illness.

“You’re absolutely right,” Conley said about the ongoing threat to the president’s health. “That’s why we all remain cautiously optimistic and on guard. We’re in a bit of unchartered territory when it comes to a patient that received the therapies he has so early in the course.”“We’re looking to this weekend,” Conley said. “If we can get through to Monday with him remaining the same or improving – even better yet – then we can all take that final deep sigh of relief.”

In addition to the anti-malarial drug remdesivir, Trump has also been given the steroid dexamethasone as well as an experimental antibody therapy. And Conley revealed for the first time that Trump has twice been given supplemental oxygen because of low blood oxygen levels. He previously said the president was only given oxygen on Friday. 

Trump will receive on more dose of anti-malarial drug remdesivir before leaving the hospital and will be given the fifth and final dose on Tuesday at the White House.

Among other updates on the president’s conditions, doctors said it has been 72 hours since his last fever, he is not taking fever-reducing drugs, his blood pressure and oxygen levels are all normal.

However, other doctors pointed out online that the steroid dexamethasone is, in fact, a fever-reducing drug.

“Dr. Conley just said that POTUS has not been on fever-reducing medications for 72 hours. That is wrong,” tweeted Celine Gounder, MD, a clinical assistant professor of medicine and infectious diseases at New York University and a Bellevue Hospital Center doctor.

It is not unusual, Conley said, for patients to continue to receive anti-COVID medications or treatments after they leave the hospital.

“We try and get patients home and out of the hospital as quickly as is safe and reasonable,” he said. “Every day a patient stays in a hospital unnecessarily is a risk to themselves. And right now there’s nothing being done upstairs (at Walter Reed) that we can’t safely conduct at home.”

“Our plan for today is to have him eat and to drink to be up and out of bed as much as possible,” Brian Garbaldi, MD, said Sunday. “[I]f he continues to look and feel as well as he does today our hope is to plan for a discharge as early as tomorrow to the White House to continue his treatment course.”

But Conley also said Trump, who was first diagnosed with coronavirus late Thursday, twice had low blood oxygen levels, once Friday and again Saturday. 

Trump himself released a video at about 5 p,.m. Sunday via Twitter. While he did not address his condition, he said, "we're getting great reports from the doctors" and said he planned to go outside and greet supporters who have gathered outside the hospital. 

"So, it's been a very interesting journey," Trump said. "I learned a lot about COVID. I learned by really going to school. And I get it. And I understand it. And it's a very interesting thing."

Earlier, Conley said that in addition to continued injections of anti-malarial drug remdesivir, doctors also started giving the president the steroid dexamethasone, which studies have shown may help reduce risk of death in hospitalized COVID patients.

Conley said Trump does not have a fever and is up and walking around the presidential suite at Walter Reed.

But Friday, he said, Trump had a “high” fever and oxygen levels below 94%. Although Trump insisted he didn’t need it, Conley said they gave him supplemental oxygen “for an hour, maybe, and then it was off and gone.”

Eric Topol, MD, editor in chief of Medscape, WebMD’s sister site for medical professionals, says giving Trump dexamethasone at this point only makes sense if he was still on supplemental oxygen.

“Now dexamethasone has been added to the kitchen sink of drug interventions,” Topol said on Twitter. “For his ‘brief’ need for oxygen? (compared with no oxygen). Patients in the pivotal trial showed no benefit, and potential harm, if oxygen was not received.”

Topol also questioned Conley’s respond to a question about the status of Trump’s lung function. Asked about the president’s lung X-rays and scans, Conley said, “we’re tracking all of that. There are some findings but nothing of a major concern.”

He refused to respond to questions about what those findings were.

“Of course the truth on all these medical matters inevitably come out,” Topol tweeted.

Vin Gupta, MD, told CNBC that said the doctors’ actions suggest Trump may have pneumonia.

“The treatment the doctors report they administered suggest the president has COVID pneumonia of at least mild severity,” said Gupta, who is a member of the faculty at the University of Washington’s Institute for Health Metrics and Evaluation.

The president, who is at higher risk for severe illness because of his age and obesity, also received a dose of an experimental antibody therapy on Friday “as a precautionary measure,” Conley said Friday.

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.

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.

While the president’s doctors said he could return to the White House on Monday, Cohen said that is around the time when patients often experience worsening symptoms.

“Starting this weekend, (Saturday) 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 said Saturday.

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.

Speaking on CNN, Sanjay Gupta, MD, said he was surprised doctors suggested Trump return to the White House considering he is still taking so many different kinds of drugs.

Staff writer Brenda Goodman contributed.

Show Sources

JAMA, “Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19.”

CNN: Reliable Sources, Oct. 4, 2020

Cmdr. Sean Conley, DO, doctor to the president

Brian Garibaldi, MD, Johns Hopkins University


CNBC.com, "Trump put on steroid recommended for severe Covid-19 cases, even as doctors share upbeat outlook."

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