at about 11 30 eastern time today saturday october 3rd president trump's personal physician dr sean
conley as well as the rest of his medical team at walter reed medical center they gave a press
conference now there's a delicate balance between maintaining patient confidentiality
versus what the public is entitled to know when it comes to being the president of the united
states of america and the line between these two is blurry and what should be kept private and what
should be disclosed to the public is somewhat up for a debate as the president fdr once said when
it comes to the president's health you have to be transparent with the public as they can take it on
the chin so we need to know how sick our president is in this press conference dr conley walks out to
the podium with the rest of the medical team which included three pulmonary critical care doctors two
infectious disease doctors and anesthesiologists in addition to a pharmacist and nurses and here
are my five biggest takeaways from president trump's covid 19 diagnosis and his hospitalization
for one we did get some important information but dr sean conley seemed to be evasive when asked
questions by reporters it's pretty obvious to me that he's cherry-picking medical details
he seemed evasive like when president when asked if president trump was on supplemental oxygen he
said he's not on oxygen right now he also said that his oxygen saturation at that time or as of
this morning was 96 percent while off of oxygen he also described his vital signs today as heart rate
in the 60s and 70s with systolic blood pressure 110 to 120 which he says that's where it's always
been it hasn't budged he said and there was also a report that came from the white house
that was released right after dr conley's press conference which said the president's vitals over
the past 24 hours were very concerning in the next 48 hours will be critical in terms of his care
we're still not on a clear path to a full recovery that's what a white house official was anonymous
told a pool reporter and that's how that got relayed to the media so which are we to
believe here are we to believe the pool reporter's report that came from the white house or are we to
believe in this about the same time within an hour of each other or are we to believe
dr conley and the medical team so dr conley who is saying all is well and vital signs are just fine
which by the way those numbers that he gave if those are in fact the real numbers
those are stable vital signs but if we believe this statement that was put out by the white house
that totally contradicts dr conley's update so this needs to be clarified by dr conley what we do
know is that he was able to walk to and from the helicopter yesterday without supplemental oxygen
that's because we actually could see that and i could see that he's not in respiratory distress
when he was doing that that in itself tells me as a lung doctor that his oxygen status is stable
especially when you see that he was not showing signs of respiratory distress with him having a 96
oxygen saturation while breathing room air today in conjunction with him having a cough
that tells me he likely has some degree of viral pneumonia and it's probably mild so from a medical
standpoint when it comes to the oxygenation that is reassuring right now i'm breathing room air
which is 21 oxygen and i'm not in respiratory distress i'm not breathing fast i'm not using
any accessory muscles of breathing now what's the complete opposite end of that spectrum
the complete opposite end would be someone who's on a mechanical ventilator with a breathing tube
getting 100 oxygen that's the most you can get so we have room air not in respiratory stress versus
someone who has a breathing tube getting 100 oxygen and everything else is in between
so trump is definitely closer to this end of the spectrum than here so overall he's requiring very
minimal if any supplemental oxygen as of right now with that said it would be still nice to know
how much lung inflammation you see on his chest x-ray or lung ultrasound or on a cat scan of the
lungs the other thing is when someone has covid 19 another concern is that someone might have blood
clots in the lungs and that would require a cta of the lungs meaning a ct angiogram of the lungs
so did he have this done we don't know dr conley provided little information and did
not answer all the questions that were asked he even walked away and didn't answer a question
when a reporter asked if he was getting steroids he also refused to say how high his fever was
or when the last time trump tested negative also what blood work did they do they said that
his kidney function was normal and his liver function was normal so that tells me that his
cmp his complete metabolic panel at least when it comes to the liver and the kidneys
were fine they also said his cardiac workup was fine so presumably that means he had a negative
troponin level in his blood work and he also had a normal ekg and i imagine they also did
an echocardiogram which is an ultrasound of the heart presumably they did that and presumably it
was normal if they are to be believed that his cardiac workup was normal but getting back to
the blood work something else i'd want to know is how high was his d dimer how high was his ferritin
his cbc the complete blood count did that show low lymphocytes which would be an indicator of
worse prognosis with covid did he have low albumin levels which also would indicate a worse prognosis
we know that dr conley is only saying things that trump will allow him to say so credibility
is zero in my eyes this is all the more reason we need to have objective findings presented to the
public and proof of vital signs otherwise america in the world won't know what is going on with our
president okay the second thing this might seem trivial but it's not dr conley described president
trump as slightly overweight but it's more like slightly obese there's a difference trump's
height is six foot three his weight 243 pounds and when you use a bmi calculator his body mass index
comes out to 30.4 which is classified as obese so overweight bmi would be anywhere from 25 to 29.9
and then obesity is a bmi of 30 or higher this is important because we know that obese patients have
a worse prognosis with covid 19. it's also important because it's more evidence that he's
making things look rosier than they really are and when that happens you lose credibility another
thing that dr conley said is that day seven to ten of covid 19 illness is when the inflammatory phase
occurs and therefore they're going to monitor him closely at that time whether that's in the
hospital or back in the white house that remains to to be determined based on how he's doing there
are lots of covid cases and this is something i see in my experience as a pulmonary and critical
care doctor is that lots of times covid 19 starts out slow and seemingly innocuous and then things
can quickly go south now at this 7 to 10 day mark if the cytokine storm is going to develop meaning
lots of inflammation in the lungs and systemic inflammation it's going to be around typically
it's around this point at this point there is no doctor in the world who knows how this is going
to play out with trump trump can get better he could get worse it could happen slowly it could
happen quickly i've had patients who are months out recovering from covid 19. i had a patient
who had symptoms with covid they got better and were discharged from the hospital they later came
back to the hospital and ended up dying there's no way of predicting this illness it's just
unpredictable the other thing is that president trump received an experimental therapy called
regn cov2 so this is made by a biotech company called regeneron it's essentially two different
monoclonal antibodies that are combined into a cocktail and regeneron scientists selected two
antibodies that best neutralized a version of the novel coronavirus sars cov2 in the laboratory they
then cloned these antibodies and put them into a cocktail therapy regeneron announced results
from the first 275 non-hospitalized patients in a late stage trial that showed that treatment
was safe and seemed to reduce viral levels and improve symptoms of patients with covid 19.
the greatest improvements were seen in those who hadn't already mounted a detectable immune
response to this new coronal virus the patients in the trial were on average age 44 years old
and almost half of the patients in the trial were obese about two-thirds of them had one or
more underlying risk factors for severe covid so there will be more data to come from this trial
and from a trial involving hospitalized patients and one that is testing the antibody cocktail
as prevention for people who have contact with someone in their household who has covid 19. as of
right now there are no published studies of this therapy of this cocktail therapy dr conley also
declined to say when trump had his last negative covid 19 test which has important implications
for contact tracing the incubation time for this virus on average is anywhere from four to seven
days it can be up to 14 days technically it can actually be longer than that but the vast majority
of people will develop symptoms from the time that they first contracted the virus within 14 days but
on average it's around four to seven days that means most likely he first contracted the virus
about four to seven days before he first had symptoms so he had symptoms on thursday so that
was two days ago so subtract four to seven days also you look at the contact tracing for him and
the rose garden event where there's lots of people and it's probably somewhere around then
if not that exact event where he contracted the virus but a more precise answer would come by
knowing his last no negative test and then when he tested positive and this is absolutely something
that needs to be disclosed you have to remember that when someone contracts the virus let's say
right now there's someone right in front of me who has the virus i don't have the virus and it gets
transmitted to me right away that virus is going to start to replicate once it's inside my body
but then it's going to take time for me to test positive if i were giving a test it's not going to
test positive right now it's not going to test positive in a couple hours it's most likely a
day or two but we don't know exactly when that is for sure it depends on different factors and
it's going to be variable for different people but this is why people who have been exposed to
someone with covid 19 this is why they have to be quarantined for 14 days so everyone who was
exposed to trump since he first contracted the virus needs to be in quarantine which by the way
isolation is almost the same as quarantine except that isolation is when someone is known to have
covid 19. a question that often comes up is what defines exposure and that is somewhat of
a gray area it's loosely defined as being within six feet of someone with covid 19 who is not
wearing a mask for more than 15 minutes what i'm most curious about right now is the diagnostic
testing what did his chest x-ray show did he have a cat scan was it a regular cat scan or was it a
cta cat scan of the lungs looking for pulmonary embolism meaning blood clot when dr conley
mentioned ultrasound i wouldn't be surprised if he did ultrasound of the lungs because you
can get similar information as you would a chest x-ray and a cat scan of the lungs when it comes
to looking for the degree of inflammation within the lungs so that's something i'm curious about
in addition to some of the blood work that they didn't talk about such as his albumin levels and
his lymphocyte counts these have very important implications in terms of prognosis for covid 19.
and then again someone who has covid 19 to the point of requiring hospitalization
that oxygen status can change very quickly can change within minutes to hours and there can
be a progressive decline and that's something that they're watching very closely and if that declines
over a short amount of time things can go south real quick to the point of sometimes
requiring intubation with a ventilator so this is something that they're going to continue to
watch closely and this is something that i'm going to continue to monitor very closely
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