Understanding Trump's COVID-19 Diagnosis, Treatment: What We Know

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President Donald Trump was discharged Monday from the military hospital where he has been treated for COVID-19 since Friday afternoon. It comes a day after he briefly ventured out while contagious to salute cheering supporters by motorcade in a move that was criticized by experts who say Trump endangered the lives of Secret Service agents riding along in the vehicle. Dr. James P. Phillips, an attending physician at Walter Reed, tweeted that everybody in the vehicle with Trump should be quarantined for 14 days.

Although the president's team initially said he only had "mild symptoms" and was taken to the hospital out of an abundance of caution, members of his administration and medical team provided conflicting reports over the weekend, leaving many confused about the severity of his illness.

Trump "may not entirely be out of the woods yet," but is well enough to return to the White House, his physician, Dr. Sean Conley, said during a press conference Monday.

As the leader of a nation that's seen over 7 million coronavirus cases and more than 210,000 deaths, Trump is now facing the very threat he largely downplayed for the past six months.

President Donald Trump briefly left Walter Reed Medical Center in his motorcade to salute at supporters outside the hospital. Trump was admitted to Walter Reed for COVID treatment on Friday. Doctors have said the president is doing “well” and could return to the White House as early as Monday.

Here's what we know so far:

The President's Condition and How Doctor's Are Treating Him

Trump tweeted Monday that he was "feeling really good" and would be leaving Walter Reed National Military Medical Center later in the day.

On Sunday, Dr. Sean Conley, the president's physician, said Trump was given a steroid called dexamethasone after his blood oxygen level had dropped suddenly twice in recent days, but he “has continued to improve” since then. Trump was evaluated again on Monday and was given the green light to depart for the White House.

Dexamethasone has been shown to be beneficial in those with severe COVID-19 and the National Institutes of Health COVID-19 treatment guidelines recommend against using the drug in patients who do not require oxygen. Among the concerns with earlier use is that steroids tamp down certain immune cells, hindering the body’s own ability to fight off infection.

The disclosures about Trump's oxygen levels and steroid treatment suggested the president is enduring more than a mild case of COVID-19.

Conley said Trump had a "high fever" and a blood oxygen level below 94% on Friday and during "another episode" on Saturday. Conley was evasive when asked whether Trump’s blood oxygen level had dropped below 90%: "We don’t have any recordings here on that." The level currently stands at 98%, Trump’s medical team said.

Blood oxygen saturation is a key health marker for COVID-19 patients. A normal reading is between 95 and 100. A drop below 90 is concerning.

Signs of pneumonia or other lung damage could be detected in scans before a patient feels short of breath, but the president’s doctors declined to say what those scans have revealed. Conley said, "There’s some expected findings, but nothing of any major clinical concern."

Trump's team said Sunday that Trump received oxygen at the White House on Friday. They were not clear on whether he received any Saturday.

The additional details emerged after White House chief of staff Mark Meadows on Saturday said some of Trump’s vital signs were "very concerning" Friday. That disclosure contradicted a rosy assessment Trump's doctors had initially provided.

Doctors treating President Donald Trump for the coronavirus at Walter Reed Medical Center gave updates on the president’s treatment on Saturday morning. “At this time, the team and I are extremely happy with the progress the president has made,” said the president’s physician, Dr. Sean Conley.

Trump’s treatment with the steroid dexamethasone is in addition to the single dose he was given Friday of an experimental drug from Regeneron Pharmaceuticals Inc. that supplies antibodies to help the immune system fight the virus. Trump on Friday also began a five-day course of remdesivir, a Gilead Sciences drug currently used for moderately and severely ill patients. The drugs work in different ways — the antibodies help the immune system rid the body of virus, and remdesivir curbs the virus’ ability to multiply.

Trump's team said Sunday that Trump is "up and around" and doing well — apparently so well that the president took an impromptu ride in a motorcade Sunday afternoon to wave to supporters outside the hospital.

However, his decision to leave the hospital sparked backlash from several medical experts.

"This is insanity," Dr. James P. Phillips, an attending physician at Walter Reed who is a critic of Trump and his handling of the pandemic. "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," the doctor added. "Commanded by Trump to put their lives at risk for theater."

White House Chief of Staff Mark Meadows spoke with reporters about the condition of President Donald Trump, who tested positive for COVID-19.‹›

Conley hasn't specified where Trump is in the "disease course" of COVID-19. Days seven to 10 typically are a time of higher concern, he said.

As far as the drive-by greeting to supporters, CDC guidelines say that, in general, moving a patient with COVID-19 outside his room should be limited to "medically essential purposes." The outing suggests to the common observer Trump's condition is not perilous, but medical authorities note that talk of Trump leaving the hospital for home after only a few days doesn't square with information about his treatments.

COVID-19 symptoms can appear as early as two days and as long as 14 days after an exposure, according to the Centers for Disease Control and Prevention. Most people who are infected develop symptoms after about five days, although approximately 20% to 40% who are infected don’t develop any symptoms.

The most common symptoms of the coronavirus are fever, a dry cough, shortness of breath and fatigue. Other symptoms can include headache, muscle pain, shortness of breath, nausea or vomiting, diarrhea and loss of taste and smell.

Up to half of patients who are hospitalized don’t have a fever when admitted but nearly all develop one. How people fare varies widely — some seem to be recovering and then suddenly worsen.

As for the first lady, she tweeted Friday that she was experiencing "mild symptoms but overall feeling good." She remains in quarantine at the White House as she recovers from her own bout with the virus.

How Did Trump Get the Virus?

It's still not clear exactly how the president and first lady got the coronavirus.

However, attention is focusing on a White House event Sept. 26 introducing Trump’s Supreme Court nominee. Trump gathered more than 150 people in the Rose Garden, where they mingled, hugged and shook hands — overwhelmingly without masks. Photos also show several indoor receptions, where Trump’s nominee, Judge Amy Coney Barrett, her family, senators and others gathered in the close quarters in the White House.

Among those who attended who have now tested positive: former New Jersey Gov. Chris Christie, White House counselor Kellyanne Conway, the president of the University of Notre Dame, a White House journalist, and Republican lawmakers Utah Sen. Mike Lee and North Carolina Sen. Thom Tillis.

Conway was also involved in the Trump campaign's preparations for Tuesday's presidential debate.

White House Outbreak: Tracking Who's Tested Positive in Trump's Orbit

Below is a running list of who in President Donald Trump’s orbit has tested positive for COVID-19 so far and those who have not. A negative test does not indicate that an individual is in the clear. These results could be a false negative, which are common in people who've been infected with the virus during the first few days after exposure.

Source: NBC News

There's no way to know for sure if the Rose Garden event was where Trump — who typically shuns a mask and has kept holding big public gatherings during the pandemic — was exposed. The president had a full week of official and campaign events before his hospitalization Friday.

A third Republican senator, Ron Johnson of Wisconsin, announced his positive test Saturday, and he had not attended Barrett’s nomination kickoff.

The administration says a White House medical team is tracing contacts.

The first couple were tested Thursday after a top White House aide, Hope Hicks, tested positive for the coronavirus. Hicks began to feel symptomatic while flying back from a campaign event with the president and several other Trump administration officials Wednesday night. She quarantined herself on the plane, but she had spent much of the past week with the president.

An RNC official confirmed Friday that Chairwoman Ronna McDaniel learned she had tested positive Wednesday afternoon and has been at her home in Michigan since last Saturday after a family member's positive test. McDaniel was last with Trump a week ago, according to The New York Times.

Medical experts say President Trump's age and weight increase his risk of severe complications as he battles COVID-19.

What Is the White House COVID-19 Protocol?

Senior staff have been tested for COVID-19 daily since two people who work at the White House complex tested positive in early May, prompting the White House to step up precautions.

The measures include deep and frequent cleaning of the West Wing and requiring staff who serve Trump and are close to him throughout the day — such as White House residence staff, his military valets and members of his Secret Service detail — to wear face coverings, the official said. Everyone who comes into contact with the president also receives a quick-result test.

Yet since the early days of the pandemic, experts have questioned the health and safety protocols at the White House and asked why more wasn’t being done to protect the commander in chief. Trump continued to shake hands with visitors long after public health officials were warning against it and he initially resisted being tested. He has been reluctant to practice his own administration’s social distancing guidelines for fear of looking weak, including refusing under almost all circumstances to wear a mask in public.

What Is the Risk to Trump's Health?

At 74 years old, Trump is at higher risk of developing severe complications from COVID-19.

People ages 65 to 74 are seven times more likely to be hospitalized for COVID-19 than those who are 18 to 29 years old, according to the U.S. Centers for Disease Control and Prevention. The risks rise exponentially at older ages. And about 80% of deaths in the U.S. from COVID-19 have occurred in those 65 or older, the CDC reports.

In 2018, Trump was diagnosed with a form of heart disease common among men in his age group, according to results of his annual physical at Walter Reed, NBC News reports. The president's physical last year revealed he had a body mass index of 30.4, which would categorize him as obese — thought just barely, according to to the National Institutes of Health. Both conditions put him at greater risk for severe complications from COVID-19.

Trump also takes a statin drug to lower his cholesterol, and that also raises his risk for COVID-19 complications, doctors said.

President Donald Trump posted a brief video on social media on Friday evening before his departure to Walter Reed Medical Center, saying that he and first lady Melania Trump are “doing very well.”

What Happens If Trump Gets Sick and Can't Perform His Duties as President?

While there is currently no evidence that Trump is seriously ill, the positive test raises questions about what would happen if he were to become incapacitated due to illness. The Constitution’s 25th Amendment spells out the procedures under which a president can declare themselves “unable to discharge the powers and duties” of the presidency. If he were to make that call, Trump would transmit a written note to the Senate president pro tempore, Republican Sen. Chuck Grassley of Iowa, and House Speaker Nancy Pelosi, D-Calif., who took a test Friday and tested negative. Pence would serve as acting president until Trump transmitted “a written declaration to the contrary.”

The vice president and a majority of either the Cabinet or another body established by law can also declare the president unable to discharge the powers and duties of his office, in which case Pence would “immediately assume the powers and duties of the office as Acting President” until Trump could provide a written declaration to the contrary.

President Donald Trump, who announced he has tested positive for the coronavirus, boarded Marine One and flew to Walter Reed Medical Center.

Will This Affect Trump's Work and His Campaign?

The Trump campaign announced Friday that all events involving the president and his family will either be turned into virtual events or postponed until further notice.

Bill Stepien, who heads Trump’s reelection campaign and tested positive for the virus himself Saturday, said Vice President Mike Pence, who has tested negative for COVID-19, plans to continue to his campaign schedule.

The spotlight on Pence will be especially bright on Wednesday when he will participate in the vice presidential debate with California Sen. Kamala Harris. Pence will almost certainly be pressed to explain shifting accounts of the president's health over the weekend and justify Trump's decision to hold large in-person campaign rallies during a pandemic — events that often flouted public health guidelines by congregating thousands of mostly mask-less supporters.

"Normally, the vice presidential debate is inconsequential. That is not the case in 2020," said Alex Conant, a Republican strategist who worked on Florida Sen. Marco Rubio’s 2016 presidential bid. "The public has so many questions about how we got here and it’s an opportunity for Pence to answer some of those."

With the election less than a month away, Republican strategists acknowledge the timing is bad the president. The virus has now grounded Trump in a quarantine, denying him the large public rallies that fuel his campaign.

However, Trump's physician wrote in his memorandum on Friday, "Rest assured I expect the President to continue carrying out his duties without disruption while recovering."

Does Biden Have COVID-19?

Democratic presidential nominee Joe Biden and his wife Dr. Jill Biden tested negative for the coronavirus again on Sunday, the campaign said. They have both been tested daily since Trump, whom they had seen Tuesday at the first presidential debate, tested positive.

"I hope this serves as a reminder: wear a mask, keep social distance, and wash your hands," Biden tweeted Friday after announcing their negative diagnosis.

Biden was on the debate stage with Trump for more than 90 minutes earlier in the week. While the two candidates maintained their social distance throughout the debate, many in Trump's campaign were not wearing masks.

Plans for the second debate are in question following Trump’s diagnosis. Biden said Monday he's willing to go forward with an in-person debate later this month “if scientists say it’s safe.” 

Democratic presidential nominee Joe Biden and his wife Dr. Jill Biden have tested negative for the coronavirus. Biden was in close proximity to President Donald Trump at the presidential debate in Cleveland on Tuesday.

In August, the Biden campaign announced that he and running mate Harris would be tested "on a regular basis to help further protect those around them" and it would announce if either candidate tested positive. The campaign also regularly tests staff.

Biden, who spent much of the summer off the campaign trail and at his home in Delaware, has since resumed a more active campaign schedule, but with small, socially distanced crowds because of the virus. Biden also regularly wears a mask in public, something Trump mocked him for at Tuesday night’s debate.

Has Pence Been Tested?

Vice President Mike Pence and his wife, Karen, have tested negative again for the coronavirus days after the president and first lady were diagnosed with COVID-19, a spokesman confirmed Sunday.

The second couple also tested negative on Friday, spokesman Devin O’Malley said, adding that Pence "remains in good health and wishes the Trumps well in their recovery."

Despite the president’s hospitalization, Pence is expected to resume regular campaigning this week with no changes to protocols meant to keep him from getting infected.

Pence is set to debate Democratic vice presidential nominee Kamala Harris on Wednesday night in Salt Lake City. The latest development has already informed changes to the vice presidential debate. Pence and Harris will stand 12 feet apart, rather than the 7 feet originally planned.

Has Anyone Else Tested Positive?

The White House medical unit began contact tracing efforts Friday to determine if anyone else who had close contact with the president or the first lady has tested positive.

On Monday, White House press secretary Kayleigh McEnany joined a growing list of people in Trump's orbit who tested positive for COVID-19. McEnany said in a statement that she tested positive Monday morning after several negative tests and is experiencing no symptoms at this time.

Over the weekend, former New Jersey Gov. Chris Christie tested positive and was hospitalized with mild symptoms. Earlier in the week, Christie and former New York City Mayor Rudy Giuliani joined Trump at the White House for prep prior to Tuesday's debate. Giuliani tested negative Friday.

On Saturday, Sen. Ron Johnson of Wisconsin announced he too had been infected. Several other Republicans announced they were awaiting test results or quarantining at home just to be safe.

One of the president’s personal assistants, Nick Luna, tested positive after having traveled with Trump several times recently, a White House official said Saturday night. The official wasn’t authorized to discuss the matter by name and requested anonymity.

Earlier Friday, Utah Sen. Mike Lee revealed that he has tested positive for the coronavirus after experiencing “symptoms consistent with longtime allergies.” Lee said in his statement that he had tested negative for the virus when he visited the White House on Saturday for Trump’s announcement that he had nominated Judge Amy Comey Barrett to the Supreme Court, an event which featured little social distancing and few masks.

Late Friday, Sen. Thom Tillis, R-N.C., announced he tested positive and would be isolated for 10 days. He was also at the White House on Saturday for the Supreme Court nomination announcement.

Former governor of New Jersey and close Trump ally Chris Christie announced on Saturday that he has tested positive for the coronavirus.

Another attendee at Saturday's White House event, University of Notre Dame President Rev. John I. Jenkins, tested positive for the coronavirus. Jenkins was seen not wearing a mask at the event, and in a letter to students and faculty, apologized for "failing to lead as I should have."

The White House also learned of Hicks' positive coronavirus test — and exposure to the virus by the president and others — before Trump arrived in New Jersey for an indoor fundraiser at his Bedminster golf club, White House Chief of Staff Mark Meadows said, but allowed the event to go forward anyway. The state of New Jersey has started contact tracing on Friday for people who attended the fundraiser.

Republican U.S. Reps. Tom Emmer, Jim Hagedorn and Pete Stauber, flew with the president to and from his rally in Duluth, Minnesota, on Wednesday night. All three said Friday afternoon that their test results came back negative. South Dakota Gov. Kristi Noem also crossed paths with Trump on Wednesday when she attended a Minneapolis-area fundraiser. Spokesman Ian Fury told the Argus Leader that Noem tested negative on Tuesday and was “not a close contact” of Trump or anyone else who tested positive.

Other officials who were in close contact with the president last week include: Trump's children and their spouses, many of whom are in the Trump administration; White House press secretary Kayleigh McEnany; Department of Health and Human Services Secretary Alex Azar; Department of Education Secretary Betsy DeVos; Office of Trade and Manufacturing Policy Director Peter Navarro; White House Chief of Staff Mark Meadows; White House Deputy Chief of Staff for Communications Dan Scavino, as well as several state representatives and other administration staff members.

White House official Carolina Hurley tweeted Friday morning that the president's daughter Ivanka Trump, and his son-in-law, Jared Kushner, both tested negative for COVID-19.

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