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US President Donald Trump made statements upon leaving hospital after being admitted with COVID-19 a few days ago.
Dr Nilu Ahmed, a behavioural psychologist at the University of Bristol, said:
“President Trump’s tweets telling people to not be afraid of Covid or let it dominate their lives could be misunderstood as advice to not take Covid seriously. The President holds a key position of authority and millions of people follow his words closely.
“The fact that the President as an older, overweight, male (key risk factors) appears to have made a swift improvement in a matter of days, and claims to be feeling better than he did decades ago, could be interpreted as Covid not being as dangerous as Health Professionals are warning. However, with the number of cases in America surpassing seven million and the number of deaths over 200,000; the USA represents a fifth of global cases. This evidence shows that many people who contract Covid do not quickly feel better, and it poses a significant risk to health and life, particularly for those with limited access to healthcare.”
Dr Julian Tang, Honorary Associate Professor in Respiratory Sciences, University of Leicester, said:
“President Trump is indeed in the high risk group for poor outcomes from COVID-19 – he is 74 years old (age-related risk), overweight (obesity risk), and he reportedly has a degree of atherosclerosis and coronary artery disease which is not unusual for his age (cardiac comorbidity risk).
“It is difficult to be specific about an exact fatality rate, but in individuals with these risk factors, it is perhaps as high as a 10-20% 1-year COVID-19-related fatality rate with this combination of risk factors, according to one study: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930854-0
“If he was PCR positive on Friday with more symptoms developing on Saturday last week, he is likely still infectious and shedding airborne virus each time he breathes, and we expect most acute COVID-19 cases to be shedding live virus for up to 10 days post-symptom onset – as per this WHO guidance: https://www.who.int/news-room/commentaries/detail/criteria-for-releasing-covid-19-patients-from-isolation
“Due to the production of neutralising SARS-CoV-2 antibodies around this time – over 10-15 days post-symptom onset: https://www.nature.com/articles/s41586-020-2196-x; https://www.nature.com/articles/s41591-020-0965-6
“However, his early treatment with the antiviral remdesivir, which acts to stop viral replication; plus the use of the antibody cocktail from Regeneron, which will help his immune system to remove the existing virus – may have reduced this shedding period significantly. Yet, the later addition of dexamethasone may act to oppose this – as it is an immunosuppressant drug (a steroid) which can inhibit host immune removal of the virus – even with the antibody cocktail.
“We now think that natural infection and recovery from COVID-19 will result in some antibody-related immunity for several months (as noted above) – with perhaps an even longer T-cell mediated immunity: https://www.sciencemag.org/news/2020/05/t-cells-found-covid-19-patients-bode-well-long-term-immunity
“But President Trump has not yet ‘recovered’ from his infection as yet, so his antibodies have not yet had time to form – which usually takes 10-15 days after onset of symptoms:
https://www.nature.com/articles/s41591-020-0897-1
“So, although he has apparently recovered to some extent from his acute COVID-19 phase, he is still in the process of clearing his virus – and this does not really say anything yet about any risks he may have of longer COVID-19 complications, which might include prolonged breathlessness and fatigue: https://www.bmj.com/content/370/bmj.m3001; https://www.bmj.com/content/369/bmj.m2490?ijkey=b6a976f622cd3b81b11bd635b4e78f8a0fd9489a&keytype2=tf_ipsecsha
“Most people with acute COVID-19 who needed hospitalisation and treatment would certainly not be back home or back at work by now – especially when they are still symptomatic and contagious. So clearly, this would not have been a normal medical decision.
“But admittedly, President Trump is not your everyday patient, so this decision (and any condemnation of it) really lies with his immediate medical team, who know more about both his clinical condition and any competing political demands.”
Dr David Strain, Senior Clinical Lecturer, University of Exeter, said:
“The President has been lucky enough to have been diagnosed very early, before the majority of individuals would even be aware that they had the disease, and then receive a concoction of experimental and proven drugs, that would not be readily available to most (nor would we necessarily advise in our practice). As a result, it is likely his viral load has been substantially reduced to allow him to respond quicker than most.
“Ordinarily COVID-19, in a gentleman of the President’s age and body mass index would have around ~20% of requiring hospitalisation for symptoms, and approximately an 8% mortality. The fact that he is part of the 92% does not lessen the impact for the rest of us.
“His return to the White House is a little surprising. Most patients that we treated with COVID-19 appeared to improve over the first week, but then a not insubstantial group would have a second dip between day 7 and day 10. We saw this with our own Prime Minister. This is the phase that ultimately causes admission to intensive care units and after a protracted admission death for a significant proportion. Presuming the dexamethasone was given appropriately for “severe COVID”, remembering that it increased death in mild COVID, and he is still in a time frame that would put him at risk of the second dip, I would have been reluctant to discharge him from my ward.
“His statement that “I feel better than ever” is likely to be a side effect of the high dose dexamethasone. High dose corticosteroids are well established to generate euphoria and insomnia. Paradoxically, however, they may also be associated with psychiatric reactions including profound mood swings, irritability and behavioural disturbance. For as long as he is still on these medications (and for the period shortly afterwards as he “comes down”) I would assume that his presidential decisions would be under additional scrutiny and his physicians are carefully observing not only his physical health but also his mental wellbeing.
“Most studies suggest people are still shedding active virus for up to 8 days after the first symptoms appear (hence the increase of the quarantine period to 10 days). Remdesivir does shorten this period, although it is not clear by exacly how much, remembering Mr Trump was diagnosed before he had any symptoms, he is almost certainly still contagious at the moment, although we may anticipate this to be falling more rapidly due to the Remdesivir than in the majority of patients.
Dr Andrew Preston, Reader in Microbial Pathogenesis, University of Bath, said:
“We can’t extrapolate from Trump’s situation to the average person!
“The average person does not have:
– A 24-7 army of personal medics covering every medical discipline.
– Medical provision in his home (the White House) equivalent to most small medical facilities.
– Immediate access to a cocktail of experimental drugs, most of which are difficult to access for most.
– A wall of screening of every person who might come into contact with them (regardless of whether they then use PPE in high risk situations).
“So, its pretty pointless of trying to compare Trumps situation with what has been gleaned from treatment of COVID of the general public.”
https://twitter.com/realDonaldTrump/status/1313186529058136070?s=20
https://twitter.com/realDonaldTrump/status/1313267615083761665?s=20
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
None received.