Boris Acting Healthy

Donald Trump’s victory march up the White House steps and dramatic mask removal will go down as his “Mission Accomplished” moment. The only thing missing was an aircraft carrier.   Telling us to worry less about a COVID-19 seems to be an astonishing act of denial, even for him. His announcement that he now understands the disease reflects an astonishing convergence of narcissism and steroid induced euphoria. To assess this, we need to remember Boris.

Medical Assessment

First, let’s figure out Trump’s medical condition. At this point, we only know two things: 1) he has required supplemental oxygen and 2) he has taken three drugs/treatments, monoclonal antibodies, Remdesivir, and Dexamethasone. His personal physician acknowledged this reluctantly. In light of his refusal to provide any further details, the term, spin doctor, takes on a whole new meaning.

Even these little bits of information provide important insights. A COVID-19 patient needing oxygen has some level of lung injury and would be hospitalized. Usually, a patient who is hospitalized has had symptoms for four days, not one, so his disease progressed rapidly. Second, the need for oxygen and the drugs he is receiving all indicate this is severe. First, he received a monoclonal antibody “cocktail” that is not FDA approved for general use. Giving an unapproved drug is an extreme step, suggesting a high level of concern. Second, both Remdesivir and Dexamethasone are drugs only in current use for severe cases. Dexamethasone, in particular, is an immunosuppressant used to control the explosive immune response that causes severe lung damage in later stages of disease. Given too early, it could make the disease worse. The NIH guidelines explicitly state that this drug should only be used for patients requiring oxygen or mechanical ventilation.  In other words, giving Dexamethasone to someone without severe disease would be malpractice.

Then, there is the triumphant-return-to-the-Whitehouse/photo-op. His discharge left the top doctors in America shocked. And, as for the precise, mission accomplished moment, experienced clinicians are not fooled. Canadian Infectious Disease physician and researcher, Ilan Schwartz, calls the video a “textbook example” of labored breathing. Talmadge King, Dean of UCSF School of Medicine, expressed a list of concerns about Trump’s breathing. He even wondered if his physicians had adequately evaluated it before discharge.

A History Lesson

Trump Acting Healthy

So, the President is severely ill. The fact that he has been able to Tweet and appear to be working, should not convince us otherwise. The story of British Prime Minister, Boris Johnson, is instructional in this regard.

Boris Johnson began to develop symptoms of COVID-19 on March 27. For the next nine days, he isolated himself at 10 Downing Street with a cough and a fever. He repeatedly tweeting out videos demonstrating his good health. These videos bear an uncanny resemblance to the Trump’s I-am-healthy video Tweets . Ten days later, he was in the ICU, a schedule typical for COVID-19.

If we look at the Prime Minister’s videos, he is, if anything, in better shape than Trump at this point in his illness. He was not on supplemental oxygen and does not display the same labored breathing as the President. They provide the most graphic indicator possible that Trump is not out of the woods.

Vomiting Epidemiologists

The image of Trump dramatically removing his mask just before he entered the White House made, in the memorable words of Harvard’s Eric Feigl-Ding, “epidemiologists just wanna vomit”. I can assure you that we all puked again when Trump later announced he had beaten the disease and people shouldn’t let it “run their lives”.

Oddly, this has become all about the President. We hear nothing about the health of the more than 34 people (and rising) that have been infected by this event. The horror of this President is his constant willingness to put the lives of others at risk. Superspreaders are not people, they are events. Three things define this risk. The number of people present, the precautions those people take in terms of masks and social distance, and the level of ventilation. Those events are open cans of gasoline waiting for a spark in the form of an infected carrier. Trump has been holding them routinely. It is a near certainty that, at some of those rallies and meetings, ignition occurred. But those events were not packed with Senators and other prominent figures, so we don’t know about them. And even with this event, we are only hearing about the health of Trump.

Trump wants desperately to put this disease behind us, to give it the same kind of dismissive nickname and spin he gives his human opponents. Over the past week, 5,000 Americans have died from a disease the President is telling us not to worry about. Those numbers are likely to rise over the coming months, especially if we follow the President’s deadly example. America is not out of the woods.

And neither is Donald Trump