The President’s infection, day two.
Today’s reports confused me medically. Reports from the President’s physicians seemed to indicate that he is stable, in no respiratory distress, and requiring no supplemental oxygen to support his breathing. His personal physician also suggested the President no longer had a fever. There is certainly nothing disconcerting in any of these statements.
On the other hand, comments that are attributed to the President’s Chief of Staff and the other “unnamed” administrative personnel indicate that he has been short of breath and required oxygen, and in fact is in a potentially dire situation that requires close observation over the next 48 hours.
Assuming they are both accurate how do we reconcile these two sets of statements?
First, I believe that we need to take his physicians at their word. They have the most accurate information and best understanding of the President’s health at this moment, and I cannot imagine any reason why they would lie to the public. Therefore, we must assume that the President is currently stable without evidence of serious illness or deterioration. If we find out otherwise, it is an incredible breach of trust that I as a physician would find morally reprehensible.
One potential is that the President was significantly ill on Thursday and Friday morning, but responded to the experimental drugs that he’d been given on Friday. This potential scenario could be supported by the report that the President had a fever on Friday morning that had resolved by today. What goes against this is that the response times for the experimental drugs the President was given usually are much longer than 12 hours. Most patients will require several days of therapy before stabilizing and improving. Therefore, I don’t think this is the most likely situation.
A better possibility is that the statements suggesting more severe disease may have been generated through anxious observations of the President’s health by medically naive individuals. I am sure the atmosphere at the White House was highly charged after the President was diagnosed. I am also sure that the President himself was very anxious given the news that he had been infected with the coronavirus. Any acute treatments that occurred early on would have been almost reflexive to any symptoms the President might have had.
In this case, if the President had felt short of breath, he would have been given oxygen, potentially before an assessment of his physical status was conducted. There may have even been an attempt to assess the oxygen in his blood that gave poor but incorrectly low readings. I have seen trained medical people make this mistake using oximeters (oxygen testing devices) under intense situations. Given this potential, it might be easy to understand how a non-medical person would interpret the anxiety and actions of the physicians to indicate a worse situation than actually was occurring.
In addition, given the remarkable variability in the course of coronavirus infections, I could also understand why a physician would say something like “the President must be monitored closely because with this illness you can never tell what might happen. We will use any treatment available to help him.” These comments could then be interpreted by other individuals as suggesting a dire situation over the next few days despite the fact that the President is stable at the current time.
Let me make the modest suggestion that the President’s physicians should be the only people commenting on his physical status, and they should do this at some frequency, for example three times daily. This resolves the need for any other reports and makes everyone more comfortable with the situation. Having people without a medical background make statements based on secondary interpretation of physician’s information or medical tests is not helpful to anyone.
In acute situations like the illness of a President, statements are often made that are inaccurate or overblown. A good example was Alexander Haig’s hasty press conference after President Reagan was shot. It would be best to keep the noise to a minimum and the information accurate and direct.