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Was the president released too soon?
Dr. Wachter can't speak directly to President Trump's case because he doesn't have all of the information, but to release patients like him this soon would be "very, very fast. In general, we'd say to a patient, it's great you're feeling well but let's give it a few more days." Dr. Wachter did say since Trump is the president he's going back to a house where they have advanced monitoring and advanced medical facilities. "It's safer than it would be for the average patient."
Is the president in the clear?
"If what we've heard is all true, it sounds like he's doing well. The problem is COVID acts in a way that would make, I think, most physicians wonder about this." Dr. Wachter said. "You can be doing fine, feeling fine, and then get very sick very quickly." Dr. Wachter said the president is definitely not out of the woods and there's a real chance he would deteriorate in the White House.
What's this Dexamethasone drug he took?
The steroid is given to serious COVID-19 patients to reduce inflammation in the lungs. The problem is "Dexamethasone can make you feel really good," Dr. Wachter said, "I've heard that many, many times in my career. You may feel fine, but it's not doing anything to change the course of the illness, it could be a little bit of a fake-out." The steroid can cause confusion, manic behavior and euphoria.
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Should he be taking all these drugs?
Dr. Wachter said two of them, Dexamethasone and Remdesivir, are standard therapies they'd give to any patient with a serious case of COVID-19.
"The complexities are the messages (we're getting) that it's not that bad, yet they're giving him medications only proven to work, the benefits exceed the risks, in patients with severe COVID-19. The one that he got that no other patient would get is experimental," Dr. Wachter said referring to the Regeneron antibody cocktail. "Preliminary studies look promising, it may work and (this may) be a manifestation of that medicine working, but that would not be available to the average patient."
What information would you like to hear from the White House physician Dr. Sean Conley?
"I'd want much more detailed information on his oxygen levels over time, not just the good ones, but the bad ones. The CAT scan is a very important piece of information, Conley said it 'shows what was expected.' I have no idea what that means," Dr. Wachter said. "If it was normal he should have said it was normal. If it was abnormal he should have told us what that was. Those are two critical pieces of information."
Dr. Wachter said given the importance of the president's mental status, he worries about the side effects from a steroid like Dexamethasone.
Should we be afraid of COVID-19?
President Trump tweeted out "Don't be afraid of Covid". Dr. Wachter replied strongly on Twitter.
"Don't be afraid of Covid." Are you kidding me? After 210,000 deaths in the U.S. & 1 million deaths worldwide? This either shows a breathtakingly callous, inhumane & counterproductive attitude, or he has altered mental status – in which case the 25th Amendment should be invoked. pic.twitter.com/KjmQRdQkU1— Bob Wachter (@Bob_Wachter) October 5, 2020
Dr. Wachter added: "Don't be afraid of COVID, an illness that has killed more than 1 million people in 10 months including 210,000 people in the United States. I think we should all be afraid of COVID, not to the point where we live in total fear but it is a serious, serious illness. It is rational to be afraid of COVID. If you're not afraid of COVID you won't take the steps you need to take in order to protect yourself as apparently the president and others around him did not. To me, it came off as insensitive and counter-productive."
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How dangerous was that motorcade ride he took?
Dr. Wachter said if the secret service wore N-95 masks and the ride is short, the chances of the secret service getting COVID-19 are very low. But Dr. Wachter adds that in general, they limit close contact with a COVID-19 patient unless it's absolutely essential.
"You make the judgment if that was essential or not," Dr. Wachter said.
Dr. Wachter says they'll monitor President Trump the way they would in the hospital. They'll constantly check his vital signs and oxygen levels. He will get an IV or a dose of IV medicine.
"It's not monitoring that's worrisome," Dr. Wachter said. "The issue is if he were to get very short of breath very quickly, which is not likely, but certainly could happen then they would have to escalate care."
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