COVID-19 pandemic

How Sick Is the President?: We don’t know, and that’s disturbing

Donald Trump – the President of the United States, the Commander-in-Chief, the leader of the free world – is hospitalized with a life-threatening medical condition. COVID-19 has killed well over 200,000 Americans, with a case-fatality rate over 3% for those exhibiting symptoms. For patients of similar age, weight and sex as the President, a 74-year-old obese male, the case-fatality rate is around 15%, and if symptoms need hospitalization, close to 30%.

COVID-19 hospitalization and death by age (Source: US CDC)

The White House has a long track record of being far less than candid about Trump’s health, notoriously giving conflicting and changing explanations for an unscheduled rush to the hospital in November 2019, which the press was embargoed from reporting at the time. A reporter for The New York Times later said that hospital visit was because of suspected “mini-strokes” and Vice President Mike Pence was alerted to be prepared to temporarily assume the duties of a President undergoing anesthesia and emergency surgery.

Numerous doctors for years have been publicly questioning Trump’s neurological fitness, including Ford Vox (“I’m a brain specialist. I think Trump should be tested for a degenerative brain disease”, STAT News, Dec 7, 2017) and James Hamblin (“Is Something Neurologically Wrong With Donald Trump?”, The Atlantic, Jan 3, 2018). Trump has repeatedly been photographed using both hands to drink water, and his awkward descent along a shallow inclined ramp attracted considerable attention. Speculation has ranged all the way to frontotemporal dementia and progressive supranuclear palsy, although with no real evidence for anything.

There is a long tradition of Presidents deceiving the public about their medical problems. Franklin Roosevelt knew but hid that he was dying of congestive heart failure in the spring of 1944, half a year before he would be reelected to a fourth term, and he did in fact die less than three months after inauguration day. Woodrow Wilson suffered a stroke in October 1919, after a series of mini-strokes the prior month, leaving him paralyzed and nearly blind until the end of his term in March 1921, during which his wife functioned as the de facto president, concealing the true state of affairs from the public and even from Congress. In 1893, Grover Cleveland had major surgery on a boat to escape the press, where doctors removed a cancerous tumor from his mouth, along with five teeth and much of his jawbone, under strict instructions not to modify his mustache out of concern that would give away the secret; although the press learned the truth, the doctors, cabinet members, and the White House all denied it, denouncing it as “fake” news, and their lies were believed until one of the doctors admitted the deception 24 years later in 1917.

Trump serves as President in an era of 24-hour news and social media, a completely different environment from that familiar to Roosevelt, Wilson and Cleveland. Official briefings from his medical team on Saturday and Sunday have been labeled as “obfuscation,” introducing confused and contradictory timelines that had to be “clarified” later, culminating in a surprise motorcade in which Trump was briefly driven around outside the hospital in an act of apparent political theater, denounced by the White House Correspondents Association in a statement: “It is outrageous for the president to have left the hospital — even briefly — amid a health crisis without a protective pool present to ensure that the American people know where their president is and how he is doing. Now more than ever, the American public deserves independent coverage of the president so they can be reliably informed about his health.”

The bizarre motorcade stunt was the last straw for the press corps, with CNN outright saying (“Trump’s photo op raises new questions about how seriously he takes the virus”, Oct 4, 2020), “The short trip, where Trump waved to his supporters through the window while wearing a mask in the back of his SUV, was an attempted show of strength that displayed the President’s questionable judgment, his willingness to endanger his staff and the fact that he still does not seem to comprehend the seriousness of a highly contagious and deadly disease.” CNN further reported, “An attending physician at Walter Reed harshly criticized Trump’s Sunday drive-by as a risk to the lives of Secret Service agents who accompanied him in his SUV. ‘Every single person in the vehicle during that completely unnecessary Presidential “drive-by” just now has to be quarantined for 14 days. They might get sick. They may die. For political theater. Commanded by Trump to put their lives at risk for theater. This is insanity,’ Dr. James Phillips tweeted.”

What is really going on is that the press has been giving the medical team time to come clean, but on Sunday night began losing patience and started reporting what has been blindingly obvious to those familiar with the progress of COVID-19 and its treatment.

The New York Times fired the first salvo in a formal statement from its Editorial Board (“The American People Need the Truth: The president is hospitalized. The public doesn’t need to know every detail, but they don’t deserve to be misled.”, Oct 4, 2020), followed by a news article (“Trump’s Treatment Suggests Severe Covid-19, Medical Experts Say: Many of the measures cited by his doctors are reserved for patients severely affected by the coronavirus.”, Oct 4, 2020) explaining that the drugs the President’s medical team said they administered, remdesivir and dexamethasone, are only appropriate for patients with significantly reduced lung function due to pneumonia or acute respiratory distress syndrome (ARDS). On this point, the medical team has been evasive if not misleading, according to POLITICO: “Sean Conley, the president’s physician, told reporters that X-rays and CT scans revealed only ‘some expected findings but nothing of any major clinical concern,’ declining to go into detail.” CT scans would be the usual way of looking for physical obstructions developing in the lungs from COVID-19 related ARDS.

Phases of Acute Respiratory Distress Syndrome (ARDS). (Source: Ichikado K, Muranaka H, Gushima Y, et al Fibroproliferative changes on high-resolution CT in the acute respiratory distress syndrome predict mortality and ventilator dependency: a prospective observational cohort study BMJ Open 2012;2:e000545. doi: 10.1136/bmjopen-2011-000545; license CC BY-NC 2.0)

Trump’s blood oxygen saturation has “dipped” below 95%, his medical team admitted, requiring supplemental oxygen to be administered on more than one occasion; this is a sign of severe COVID-19 complications, and is likely a consequence of compromised lung function. Normal is above 95%, and anything below will cause fatigue, lethargy, cognitive impairment; 80% saturation can cause organ failure. At this point, no one has any real treatment for ARDS, except to keep the patient alive long enough to hope the immune system can fight off the virus. Drugs such as remdesivir and dexamethasone may help, and they almost certainly will not hurt, but they are by no means “miracle drugs.”

Reading between the lines, Trump seems to be receiving very aggressive treatment, which is probably appropriate and justified, within the bounds of responsible medical consensus. He literally has access to the best medical care in the world and effectively unlimited resources. Nevertheless, COVID-19 is a dangerous and deadly proven killer, and it is so new that medical science is only beginning to learn how to treat it. Doctors today talk about feeling helpless, echoing the way doctors of the 1300s talked about feeling helpless against the plague. The president’s medical team is derelict in their duty if they are anything less than honest and straightforward with the people of the United States about the health of our President.

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