President Trump’s doctor said Trump is not currently on oxygen, but would not say whether he ever received oxygen since his COVID-19 diagnosis.
President Trump is receiving oxygen and has begun on a course of steroids. Doctors say patients for whom that’s the case often spend several days in the hospital in the best-case scenario.
At a news conference Sunday morning, one of the physicians treating the president said he had begun a course of the steroid dexamethasone on Saturday following a drop in his oxygen levels. The president will continue to receive that “for the time being,” said Dr. Sean Dooley.
The president’s physician, Navy Commander Sean Conley, said if he continued to look and feel well “our hope is that we can plan for a discharge as early as (Monday) to the White House, where he can continue his treatment course.”
That would not be the typical plan for most COVID-19 patients who require oxygen and have been placed on steroids, said doctors who care for patients with the illness caused by the coronavirus.
“I will say that I’ve never started someone with COVID-19 on steroids and then thought I’d be discharging the patient home the next day,” said Dr. Russell Buhr, a professor of pulmonary and critical care medicine at the University of California, Los Angeles.
Oxygen is typically given to patients when the level of oxygen saturation in their blood is below 92%, he said.
“Generally once a patient is on oxygen, they stay in the hospital for four or five days, if everything goes well,” said Dr. J. Randall Curtis, a professor of pulmonary and critical care medicine at the University of Washington School of Medicine in Seattle.
“If a patient is off oxygen and then goes back on oxygen, that would suggest they’ve gotten a little bit worse. If they’ve started on dexamethasone, that suggests to me he’s gotten a little bit worse,” Curtis said. “If he’s requiring oxygen, then he has COVID pneumonia.”
While that might sound dire, it simply means there is an infection in the lung causing inflammation in the alveoli, the tiny air sacs in the lungs that transfer oxygen from the lungs to the bloodstream.
COVID pneumonia can range from mild to dangerously severe. It’s not possible to know the president’s condition from the description given by his doctors.
In Curtis’ experience treating more than a hundred COVID-19 patients in Seattle, people who require oxygen and get dexamethasone “would generally have some abnormality on their chest x-ray. Typically it’s what we call the ‘ground-glass’ pattern that’s seen with COVID pneumonia,” he said.
The ground glass pattern refers to a hazy white area in a lung x-ray or CT scan showing infection or inflammation. Typical lung tissue shows up as grey.
A COVID-19 patient with mild pneumonia and on oxygen could recover within two to five days and return home, Curtis said. But it could also go the other way.
“The concern is that in that window of time, it’s still possible that the pneumonia would continue to get worse,” he said. “Unfortunately, we don’t have any great ways of stopping that. Dexamethasone helps a little bit. Remdesivir helps a little but only a little.”
However treatment with dexamethasone generally indicates more severe disease, they said. Current recommendations for dexamethasone are that it be given to patients who require supplemental oxygen or who are on mechanical ventilation, Buhr said. It is not typically given prophylactically as an early defense against such an inflammatory response.
“The reason we don’t is that steroids are not totally benign. They increase your risk of other infections and they increase your risks of delirium,” he said.
Dexamethasone is a steroid given to tamp down an overactive immune response in the body that can cause its own troubles. This comes when the virus provokes an immune response that sends cells into the lungs to clean up the damage, which causes inflammation.
“That inflammation in and of itself can make it more difficult for oxygen to pass from the lung into the bloodstream,” and tends to occur later in the course of the disease, said Buhr, who added the inflammatory reaction can break down the lung tissue itself, “like a forest fire generating its own fuel.”
While he didn’t want to play armchair physician to the president, Buhr did say the treatments being reported by the president’s doctors and the rosy picture given in Sunday’s news conference “don’t line up.”
Contact Elizabeth Weise at email@example.com
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