Is it safe for President Trump to return to the campaign trail?
President Trump appears eager to get back out on the campaign trail a little over a week after he was taken to the hospital for COVID-19. He told Fox News' Sean Hannity Thursday night that he wanted to hold a rally in Florida Saturday, although he is currently expected to remain at the White House through the weekend before resuming travel next week.
According to the Centers for Disease Control and Prevention, people with COVID-19 remain contagious for 10 to 20 days after their onset of symptoms, depending on the severity of the case. The president's personal physician, Dr. Sean Conley wrote in a White House memo, released hours before Mr. Trump's own announcement, that Saturday will be 10 days since Mr. Trump's diagnosis, "and based on the trajectory of advanced diagnostics the team has been conducting, I fully anticipate the President's safe return to public engagements at that time."
The White House has said that the president began experiencing symptoms on Thursday, October 1, and tested positive that night. The next day, he was flown to Walter Reed Medical Center where he received a combination of treatments. He returned to the White House Monday evening.
The CDC says a person with COVID can safely end isolation if at least 10 days have passed since their first symptoms, plus their fever has been gone for at least 24 hours and other symptoms are improving. It adds they can end isolation sooner if they receive "two negative tests results in a row, from tests done at least 24 hours apart."
Mr. Trump told Hannity that he would be tested for the first time since his diagnosis on Friday. "What we're doing is probably the test will be tomorrow, the actual test, because there's no reason to test all the time," he said in the Thursday interview. He said in a separate interview on Fox News Thursday that he thinks he's "better," adding, "to a point where I'd love to do a rally tonight."
"They are going to be testing him to determine the trajectory and whether he gets to the point where he's not infected," Dr. Anthony Fauci, the nation's top infectious disease official, told CBS News in an interview Friday. "I can guarantee you that they will be testing him before they let him go out."
But physician and Rutgers medical professor Dr. Bob Lahita says that if Mr. Trump were his patient, he would still be in isolation on Saturday.
"He's talking about getting in front of thousands and thousands of people, and making a speech without a mask," Lahita said on CBSN Friday. "This is an extraordinary display of behavior that's very unusual."
President Trump's treatment plan
The medications used in the president's treatment plan are suggestive of a severe COVID-19 infection, but could also be attributed to his multiple risk factors and high profile as president of the United States. Mr. Trump was given supplemental oxygen; Remdesivir, an antiviral drug manufactured by Gilead; dexamethasone, a commonly used corticosteroid; and an experimental antibody cocktail developed by Regeneron.
Remdesivir and dexamethasone are typically used to treat severe COVID cases, according to Dr. Ethan Weiss, a cardiologist at the University of California, San Francisco, who went to New York to treat critically ill COVD-19 patients during the city's surge last spring.
Dr. Matthew Heinz, a hospital physician in Tucson, Arizona, who served in the Department of Health and Human Services under President Obama, said the decision to use Remdesivir so soon after Mr. Trump's diagnosis piqued his interest. According to Heinz, who has treated hundreds of COVID cases since the pandemic began, the antiviral is not typically administered unless a chest X-ray or a CT scan show signs of viral pneumonia. "Those must be present — at least in the real world," he said. Mr. Trump's doctors have not released information about any such findings.
The steroid dexamethasone is usually used later on in a COVID-19 illness to dampen the body's sometimes intense immune response to the virus, according to Dr. Donald Yealy, senior medical director and chair of emergency medicine for University of Pittsburgh Medical Center's hospital system, as well as one of the directors of its COVID-19 leadership team.
CBS News chief medical correspondent Dr. Jon LaPook explained on "CBS This Morning" Thursday that there are two phases to a COVID-19 infection. "In that first phase the virus is multiplying in somebody's body. In the second phase, that inflammatory phase, the body's immune system is over-exuberantly reacting to that virus attack," he said. "... It's that over-exuberant reaction that can cause so much damage. What you want to do is in the first week [is] try to somehow decrease the amount of virus, or decrease the effect of the virus." He said that Remdesivir, as well as the Regeneron antibody cocktail, are used to decrease the "viral damage."
President Trump has finished taking a five-day course of Remdesivir, but is still taking dexamethasone. Lahita explained that the drug works by suppressing the immune system. "It's like turning down the lights in a dining room," he said. "So that prevents the immune system from attacking the lung tissue."
"However, we don't know how much damage has been done to his lung because I don't have access to his CT scan of his lung, or his X-rays," Lahita noted. "And this is a problem because they have not exposed us to that, we have no evidence that there is lung involvement — but I would predict, based on what we see in thousands of other people, that there is lung involvement."
"There are some things to suggest that he had severe COVID, the problem is that we don't know, and we don't know when he first got sick," Weiss said. "We don't know when to start the clock."
Feeling "great!" but still recovering
Upon returning to the White House, the president removed his mask on a balcony in front of photographers. Days later, Conley reported that Mr. Trump said he feels "great!" Mr. Trump posted a video to Twitter late Wednesday calling the therapeutic drugs a "cure" for him, even though there is no cure for COVID-19.
"I feel great. I feel like, perfect," the president said in the video. "I think this was a blessing from God, that I caught it. This was a blessing in disguise. I caught it, I heard about this drug, I said let me take it, it was my suggestion. I said, let me take it. And it was incredible the way it worked, incredible."
While the president says he is no longer feeling the effects of COVID-19, that does not necessarily mean he is free of the virus. Side effects of steroids like dexamethasone can include mood swings, aggression, as well as a sense of euphoria.
"I'm sure he feels great," Heinz said. "I worry that that is a perception, and not what is really going on in his body."
LaPook said Thursday that it's too early to tell the difference between side effects from the treatment, and actual recovery.
"There are symptoms — that's how somebody feels — and signs — that's actual data," LaPook said. "So, he says he's feeling well, I'm sure the president's doctors are very happy about that, but remember that he's on steroids that can mask symptoms. It can mask fever, and it can make him euphoric, and increase his mood, cause insomnia."
"Right now they've got to watch... not only the symptoms, but the signs. So what do the blood tests show? What do the chest X-rays show? Things like that," LaPook said.
The president's physician said in his Thursday memo that the president has "remained stable and devoid of any indications to suggest progression of illness" since returning to the White House. "Overall he's responded extremely well to treatment, without evidence on examination of adverse therapeutic effects," Conley wrote.
The White House has not released the president's chest X-rays or CT scans, making it impossible for physicians outside his medical team to evaluate the full picture of the president's health. How long the president needs to isolate, however, depends on the severity of his infection.
"The problem with this case is the information is incomplete at best, and inaccurate at worst," Weiss said.
Yealy said that anyone with symptoms of COVID-19 — including fever, cough or shortness of breath — should "absolutely, unequivocally" avoid public events.
With just 26 days left until the election, however, the president is highly motivated to get back on the campaign trail. A CBS News poll conducted after the first presidential debate — but before news of Mr. Trump's diagnosis — showed Joe Biden leading in Pennsylvania, another battleground state where the president is looking to hold a rally early next week.
If the president returned to public events too soon it could endanger those who travel with and work near him if he were still contagious, and could also compromise his recovery.
"I'd keep him isolated in his room resting because he can relapse at any time," Lahita said. "We've seen patients go for five, six days, and then all of a sudden become short of breath again and their pulse oxygenation drops, and they're back in the hospital. So, this is a big issue."
Heinz noted that stress of any kind makes it more difficult for our bodies to heal, and pointed to British Prime Minister Boris Johnson's COVID diagnosis as a cautionary example. Johnson was put in intensive care 10 days after testing positive for coronavirus.
"Being the president, running a campaign, speaking at rallies — you are pushing your body to potentially a more prolonged course of infection," Heinz said, adding that he recommends that the president take time to rest.
Yealy said he is most concerned by the message Mr. Trump appears to be trying to send about his recovery: that COVID-19 is not serious. Upon his return to the White House, the president told Americans not to be afraid of the virus or let it "dominate your life." As he spoke, the virus had already taken the lives of more than 210,000 people nationwide.
"Just because someone acquired the infection and is improving does not mean that this is not real," Yealy said. "It doesn't mean that other people's experience of the virus is not valid."
