On Friday, the world learned that President Donald Trump tested positive for COVID-19. Given my experience as both a COVID patient and an Emergency Medicine physician, I can offer some thoughts on what may lie ahead for the President.
I am a healthy, 47-year-old male who actively exercises and has no medical problems, but on March 22, I was admitted to the ICU at Einstein Medical Center in Philadelphia with COVID-19. I was one of the first COVID-19 cases in the hospital. I had bilateral ground-glass opacities in my lungs on chest X-ray and was diagnosed with COVID pneumonia. Thankfully, I recovered and left the hospital three days later. Relatively little was known about the virus when I was admitted. Since that time, more than 7 million Americans have been infected and more than 200,000 have died. Read on, and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus.
President Is at Increased Risk
First, it must be acknowledged that President Trump is at increased risk for a complicated clinical course of COVID-19. According to the CDC, his advanced age creates significant risk. As a 74-year-old, he has eight times the risk of hospitalization and 90 times the risk of death compared to a person 18-29 years old. According to a prior Lancet article, his age alone puts him at around an 8% risk of mortality. In addition, simply by virtue of being male, he appears to have an increased risk of death from COVID-19. Further, other studies have shown an increased risk of death is also associated with obesity.
As an obese, 74-year-old male with COVID-19, Trump is generally at increased overall risk for a complicated course, hospitalization, and death. Currently, the president is reporting symptoms such as fatigue, fever, and congestion. Often, patients will start with symptoms that may progress dramatically as the disease course evolves. It is not uncommon for patients to begin having muscle aches, fatigue, and chills that soon progress to more concerning symptoms such as dyspnea (shortness of breath) and chest pain.
Symptoms Got Worse After 5 Days
When I discharge COVID patients from the ER, I often caution them to return for worsening symptoms such as shortness of breath. In addition, I have advised patients to obtain a pulse oximeter. This device fits on your finger and can determine your blood oxygenation. I advise that they intermittently check the levels and return immediately for any level below 95%. Particularly on days 5 to 10 of symptoms, patients can become hypoxic, have worsening symptoms and progress to viral pneumonia. This is exactly what happened to me.
It is really difficult to say at the beginning of the course how things will ultimately evolve. In addition, COVID-19 makes patients more susceptible to thrombosis (blood clots) and has been associated with pulmonary emboli, stroke, and myocardial infarction (heart attacks).
What's Next for the President
As President Trump appears to have been symptomatic since October 1, his doctors will have to watch him closely over the next week. Notably, a typical patient infected with COVID-19 has an average incubation period (time infected prior to symptoms) of 5 days. Thus, the President may have been infectious several days prior to having symptoms.
On October 2, the President was admitted to Walter Reed National Military Medical Center. This was reportedly done out of an abundance of caution. However, it is not clear what his clinical status truly is.
He was also reportedly started on the anti-viral drug Remdesivir when he arrived at the hospital. This medication is typically reserved for hospitalized COVID-19 positive patients with hypoxia (decreased oxygenation) who require supplemental oxygen. This drug has been shown to significantly shorten the duration of illness in these hospitalized patients.
However, the White House press release noting the treatment specifically states that the President was not requiring supplemental oxygen. It may be that the President is getting the medication even though he is not hypoxic. Further, if he does become oxygen-dependent or is intubated, Decadron treatment would be beneficial as well. Both of these medications have been shown to be clinically beneficial for treating hypoxic patients with COVID. In the interim, he will benefit from close monitoring at the hospital and intermittent pulse oximetry checks (checking his oxygen saturation of his blood). As for yourself: To get through this pandemic at your healthiest, don't miss these 35 Places You're Most Likely to Catch COVID.
Darren P. Mareiniss, MD, FACEP is a doctor who also practices critical care. He has published multiple articles on pandemic response and helped write the Maryland ventilator allocation guidelines. Dr. Mareiniss is currently practicing Emergency Medicine at Einstein Medical Center.