Mixed messages, top-rate treatment: Donald Trump’s atypical hospital visit for COVID-19

President Donald Trump headed back to the White House after three days of treatment for COVID-19 at Walter Reed Medical Center. In tweeting the news, he told people not to be afraid of COVID-19.

"Don’t let it dominate your life," Trump said Oct. 5. "We have developed, under the Trump Administration, some really great drugs and knowledge."

Trump may well celebrate, but his experience might not hold a lesson for the average American. For starters, few people who contract the disease would have Trump’s medical attention. He was put under a doctor’s care immediately. He received an experimental drug to boost his immune response, another drug to slow the virus down, and a steroid to prevent inflammation that could damage his lungs.

The virus is still active in his body, and his doctor said that one of the main tasks is to monitor Trump until there is no evidence of the live virus that he could transmit to others.  

Trump’s latest take on his own illness pushed the limits of what medicine can promise. 

"That sort of ‘I beat this, you can, too’ message might raise hope in people, but there’s no guarantee if you get it that you will beat it," said physician Todd Rice, who oversees Vanderbilt University Medical Center’s intensive care unit for COVID-19 patients. "People still die from this. There’s no way around that."

When it comes to Trump’s health, the past few days have shown that the White House is selective in what it reveals, sometimes with confusing results.

Trump and his doctors have emphasized the positive from the moment he announced that he and first lady Melania Trump had contracted COVID-19. White House physician Sean Conley’s choices of what to reveal and what to hold back was part of a pattern that led to a mix of conflicting information.

On the day that Trump left Walter Reed, Conley refused to discuss whether the disease had damaged the president’s lungs. Asked if there were signs of pneumonia or any inflammation in his lungs, Conley demurred.

"We’ve done routine standard imaging," Conley said. "I’m just not at liberty to discuss. There are HIPAA (Health Insurance Portability and Accountability Act) rules and regulations that restrict me in sharing certain things."

But the day before, Conley was able to talk about a common test of lung capacity.

"Like every patient we perform lung spirometry on him and he’s maxing it out," Conley said. "We told him, see what you can do. (He was) over 2,500 milliliters each time." 

Rice said that is "completely inconsistent." But he also said the patient can set the rules.

"It is how HIPAA works sometimes," Rice said. "Essentially, the patient can say, ‘You can talk about x, y, z, but don’t talk about a, b, c.’ It is definitely weird. But as a physician, sometimes you are just stuck."

The day after Trump went to the Walter Reed Medical Center, Conley said, "this morning the president is doing very well." He said Trump had been given the first dose of Remdesivir, a drug — not yet approved by the Food and Drug Administration — that interferes with the spread of the virus in the body. 

When asked if Trump had received supplemental oxygen, Conley said he had not.

"Yesterday and today, he was not on oxygen," Conley said.

The next day, Conley said that he had.

"The president has experienced two episodes of transient drops in his oxygen saturation," Conley said.

Conley said Trump got oxygen Friday morning, when his oxygen level dropped to 94%, and on Saturday, when it dipped to 93%. (A healthy level is in the high 90s.) Both times, he said, Trump’s oxygen level recovered quickly and treatment stopped.

Asked why he didn’t say that the day before, Conley said he was trying to reflect the upbeat attitude of the team and the president.

"I didn’t want to give any information that might steer the course of illness in another direction and in doing so, it came off that we were trying to hide something, which wasn’t necessarily true," Conley said.

Conley also said that in response to Trump’s blood oxygen levels, he had been given dexamethasone, a steroid. Steroids have been found helpful in preventing COVID-19 from progressing.

Rice said dexamethasone is typically used when a patient’s oxygen levels fall to 90% or below. But according to Conley, Trump’s did not drop that low.

Soon after Conley’s exchange with reporters on Saturday, White House chief of staff Mark Meadows told reporters — at first, on background and only to be attributed to a "person familiar with the president’s health" —that the situation was more precarious. 

"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."

The reporters Meadows addressed directly did not disclose his identity, but other reporters could, and did. It raised the question of why Meadows found it necessary to send a different message than Conley.

There was a related snag later in the day.

When he was briefing reporters, Conley referred to Trump being "72 hours into diagnosis." But that would have pushed Trump’s first positive test result back to Wednesday, not late Thursday. Pressed by a reporter, Conley shifted and said there was a preliminary test Thursday that wasn’t confirmed until later.

The White House released a memo from Conley in which he explained that he should have referred to day three, not 72 hours. But the memo contained errors — referring to polyclonal rather than monoclonal antibodies, and misspelling the name of the drugmaker involved — casting doubt on whether Conley had written it. 

On Monday, Oct. 5, citing Trump’s good progress, his doctors said they were sending him back to the White House. Conley emphasized that a full complement of medical staff are on hand there.

"There’s nothing being done upstairs (at Walter Reed) that can’t be done at home," Conley said.

That’s not a situation many other COVID-19 patients would experience.