Trump has been launched from Walter Reed's medical middle

President Trump was discharged from Walter Reed National Military Medical Center Monday night after downplaying Covid-19, a disease that in a tweet killed more than 200,000 Americans and more than a million people worldwide.

"Don't be afraid of Covid," he tweeted. "Don't let it dominate your life."

I'm leaving the large Walter Reed Medical Center today at 6:30 p.m. I feel really good! Do not be afraid of Covid. Don't let it dominate your life. We have developed some really great drugs and knowledge under the Trump administration. I feel better than 20 years ago!

– Donald J. Trump (@realDonaldTrump) October 5, 2020

Trump's doctor Sean Conley explained the reasons for the discharge in an afternoon meeting. "In the past 24 hours the president has continued to improve," said Conley. "He met or exceeded all of the standard hospital discharge criteria" and continues to be monitored at home.

Trump – a lifelong germ cell – had been anxious to leave Walter Reed. According to CNN's Jim Acosta, he was concerned that hospitalization would "make him look weak". Separately, sources told the New York Times that a Sunday night drive exposing Secret Service staff to the risk of infection was a compromise after he asked for discharge yesterday and doctors refused to do so.

The rush to get out of the hospital may make political sense: a Covid-19 infection with a patient in isolation is extremely impractical for Trump's presidential campaign less than a month before the election.

"The most watched man in the world"

But does it make medical sense? Although there are many unknowns about the severity or stage of Trump's Covid-19 case, clinicians who work with coronavirus patients have said that Trump's discharge is not entirely unreasonable. This could just indicate that the president does not currently need intensive care (ICU) attention, e.g. B. access to a ventilator.

"It doesn't mean he wasn't sick, and it doesn't mean he is 100 percent out of the woods," said Jennifer Manne-Goehler, an infectious disease doctor at Brigham and Women and Massachusetts General Hospitals. "It means he's stable enough to be followed at home and (doctors) are comfortable that he doesn't need intensive care."

"It is not inappropriate to treat patients this way at home for Covid because you are actually reducing the risk of infection without necessarily compromising patient care," said intensive care doctor Lakshman Swamy, who works with the Cambridge Health Alliance.

In addition, unlike other patients, the commander in chief does not return to a normal home. He essentially lives in a hospital. The White House medical division has a full team of health professionals who can do most of what is possible for patients. "You can't have an intensive care unit at home, but in the White House you can easily provide additional oxygen and IV medication as needed," Manne-Goehler told Vox. "It sure shows that they don't believe he's on the brink."

Theodore Iwashyna, a professor of internal medicine at the University of Michigan, said he was not afraid that Trump would be left alone. "He's the most watched man in the world."

What we can learn from Trump's case

Trump is likely still contagious and it will take at least a week to know if the president really avoided life-threatening complications from the disease. Covid-19 patients can appear stable and then deteriorate quickly without warning. It is only 10 days after symptoms appear that doctors say they can be fairly certain that someone has really turned a corner.

When you sit and watch so many people of all ages die from it, it's scary. We shouldn't underestimate that.

Even then, there is a risk of what is known as "long covid", which causes chronic symptoms such as cognitive impairment and depression. There is no correlation between the severity of a person's Covid-19 case and whether they will become a "long distance driver".

Whatever happens, Swamy cautioned against extrapolating anything to the general population after Trump recovered from Covid-19. "For those of us who dealt with patient exposure to the virus during the surge … (saw) it is very difficult to learn from a few patients" which treatment approaches work.

Other doctors said they fear that some people who are not yet infected with the virus may get the wrong idea about the risks from the president. "It scares me that people will say," It's not a big deal and 99 percent of people are doing well, "after Manne-Goehler released Trump from the hospital." If you sit and watch like so many People of all ages die from it, that's scary. We shouldn't underestimate that. "

Iwashyna offered a colorful analogy to explain how he would feel about the importance of Trump's apparent recovery: “I live in a university town. Every now and then people get drunk and walk down the street naked and drunk. And they don't always get hit by a car. From my point of view, it would be a mistake to say that it is safe to get drunk and wander the street naked. "

In other words, even if Trump – with the unusually vigilant care and surveillance he has received – has been able to recover from Covid-19, the disease is still severe. "I will still wear a mask when I go out," added Iwashyna, "regardless of what happens to the president."

What Team Trump Said About The President's Health

In the coming days we will learn more about Trump's Covid-19 case. The image remains opaque for the time being. Even to a White House with a terrible track record of finding truth, the mixed messages of the past few days mattered. And that led doctors to wonder if Trump's case was more serious than the White House and when Trump was actually diagnosed.

On Friday, White House press secretary Kayleigh McEnany announced that Trump was leaving the White House for Walter Reed Medical Center "out of caution" after announcing Trump's positive Covid-19 test result – and that the President only had mild symptoms.

Speaking at the press conference on Saturday, Conley said Trump was in good shape but would not post basic details of Trump's case, botched the president's diagnosis schedule, and later posted a letter to correct it. On the same day, White House chief of staff Mark Meadows contradicted Conley, saying Trump's livelihood was "very worrying," which was supposed to be a confidential statement that was taped on video.

On Sunday, Conley said Meadows' statement was "misinterpreted" and that Trump's oxygen levels had dropped to worrying levels twice since Friday, requiring extra oxygen to get them going again. Conley said he withheld these details because he wanted to reflect "the optimistic attitude of the team, the president" about the course of Trump's illness.

In addition to the confusion, Conley said that Trump launched another drug to fight Covid-19 on Saturday: dexamethasone. The steroid has been shown to improve outcomes in clinical studies, but is only recommended for patients with severe or critical Covid-19. It is also the third Covid-19 drug to be given to the president after an experimental monoclonal antibody treatment on Friday and an ongoing five-day treatment with the antiviral remdesivir.

By Monday, Conley said Trump had continued to improve. "It has been more than 72 hours since his last fever. The oxygen levels, including ambulatory satiety and difficulty breathing, are normal." Trump will continue to take dexamethasone and receive a fourth dose of remdesivir before leaving the medical center, he added.

There are huge gaps in the narrative of Trump's illness

But when Conley pressed for details about Trump's health, he again disguised them. For example, Trump's doctors have not released the results of the president's x-ray or CT scans, so it's not clear whether they found signs of pneumonia or other manifestations of Covid-19 lung involvement.

"We took routine standard pictures," Conley said on Monday. "I'm just not free to argue." They also failed to provide detailed information on Trump's oxygen saturation.

And it is precisely these things that will be of vital importance in the days to come. "The first is to make sure he doesn't develop worsening Covid," Iwashyna said, which means checking that Trump isn't developing pneumonia and that his oxygen saturation isn't decreasing.

Then there are the secondary complications that can arise, such as: B. a reduction in heart function. Steroids like dexamethasone are known to increase the risk of bacterial infections and blood clots.

The president was also given a cocktail of drugs, some with known and some with unknown side effects.

"He was also given a drug that is not approved and whose safety has not yet been adequately tested, at a dose that is not even the dose they recommend to advance studies," said Iwashyna. "The possibility of complications from the antibodies will therefore exist for at least days, maybe weeks or months."

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