When a phalanx of white-coated physicians spoke Sunday about the condition of President Donald Trump, some of what they said must have been unclear to the average listener.
It was not entirely clear to people with medical degrees, either.
Trump left the hospital Monday evening — presumably, a promising sign for his recovery, though patients with COVID-19 sometimes feel better before taking a turn for the worse.
But after a weekend of vague and sometimes evasive statements from the president’s medical team, doctors not involved with his care remain, in some respects, as puzzled as the rest of us.
“It’s really hard to say what’s going on,” said John Mellors, chair of infectious diseases for UPMC and the University of Pittsburgh.
Doctors avoid making formal diagnoses of people who are not their patients. But this is the president, whose health is a matter of public interest, and doctors watch news conferences like everyone else. And after months of treating patients in the pandemic, they have a good sense of how COVID-19 progresses for someone who is sick enough to go to the hospital. Except when details are scarce.
On Saturday, White House physician and Bucks County native Sean Conley dodged questions as to whether Trump had gotten supplemental oxygen (it turned out he had). On Sunday, asked whether Trump showed any signs of pneumonia, Conley said, “There’s some expected findings, but nothing of any major clinical concern.”
That remark stuck out for Eric Sachinwalla, medical director of infection prevention control at Einstein Medical Center Philadelphia
“I’m not quite sure what that means,” he said.
Nearly 40 years after President Ronald Reagan was shot, Mellors still recalls how much detail physicians disclosed about their famous patient: How much blood he lost, where the bullet was lodged in his lung, and how it was removed.
Long after, members of Reagan’s medical team would reveal that his condition had been worse than the way it was described to the public. Still, they were more transparent than than physicians who spoke this weekend outside Walter Reed National Military Medical Center, Mellors said.
“We had a swarm come out of Walter Reed where they were passing the hot potato around,” he said. “From what I heard, I didn’t get a clear understanding.”
Among the mysteries: If Trump was doing so well, why was he prescribed dexamethasone — a corticosteroid that is generally reserved for sicker patients? These steroids can rescue COVID-19 patients whose bodies are overrun with harmful inflammation. But like any medication, they carry some level of risk. If given for an extended period, they can suppress the immune system.
“It’s not like it’s a completely harmless intervention,” Sachinwalla said. “Just based on the information they’ve released, he doesn’t sound like the typical patient we would give dexamethasone to.”
Mellors said the use of the steroid suggests the president suffered from at least a low level of pneumonia, as indicated on an X-ray or CAT scan.
“They would not give dexamethasone unless there was an issue with oxygenation and what we called infiltrates or opacities” in the lungs, he said.
The president also was given monoclonal antibodies — potent immune-system proteins derived from the blood of patients who already have recovered from the disease.
It is plausible that treatment contributed to his recovery, but formal studies remain underway, said Gerard J. Criner, director of the lung center at Temple University Hospital, one site where the antibodies are being tested.
The president also could be feeling better due to one of his other treatments, or perhaps due to the combined effect of all of them, Criner said.
“It sounds as if the patient is in recovery,” he said. “I think there’s one thing that his case illustrates, and that is for COVID, there are no cures. There’s probably not going to be one therapy alone.”
Though communication from the president’s doctors has been vague at times, his discharge suggests that his vital signs are headed in a promising direction, Criner said. And if he is among those patients who suffer a relapse, a return to the hospital is just a helicopter ride away.