I am an Emergency Medicine doctor who has treated many COVID-19 patients and have been infected myself. Recently, the President was infected with COVID-19 and was hospitalized on October 2, 2020. Reportedly, he first experienced symptoms on October 1. Since returning to the White House, it is unclear if he has been tested again. However, he reports that his symptoms are improving and that his doctors think he is doing clinically well. As a result, President Trump is reportedly planning to resume in-person rallies as early as this weekend.
However, given his disease and timeline, this may be premature. Read on, and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had Coronavirus.
His Condition Would Fit the Definition of Severe Disease
The CDC guidelines state that symptomatic patients with mild to moderate disease should not be around others until 10 days after onset of symptoms. Further, these patients need to be without fever for 24 hours without the use of any antipyretic medication (medications like Tylenol or ibuprofen that decrease fever). In addition, the symptoms of COVID-19 (e.g., coughing, muscle aches, fatigue, shortness of breath, diarrhea, sore throat) need to be improving, excluding loss of the sense of smell and taste, which may persist for weeks or months. By CDC guidelines, once all of these are requirements are met, patients recovering from COVID-19 can be around others if they wear a mask. For patients with severe illness, the CDC requires all of the above and up to 20 days of isolation to prevent the spread of infection.
The CDC defines severe disease as individuals having respiratory frequency over 30 breaths per minute, oxygen saturation lower than 94% on room air at sea level (or, for patients with chronic hypoxemia, a greater than 3% decrease from baseline), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) less than 300 mmHg, or lung infiltrates of greater than 50%.
As the President’s oxygen saturation was reportedly below 94% during his hospitalization, he would fit the definition of severe disease and, as a result, may have prolonged viral shedding. In addition, he was treated with Dexamethasone, a drug typically reserved for covid patients with severe disease. Again, this seems to imply that he had severe disease and would require up to 20 days of isolation. Of note, CDC data shows that some patients have low levels of virus for up to 3 months after being infected.
In light of his likely severe disease, it would be prudent for the President to isolate up to 20 days. Although it is not absolutely required by CDC guidelines, the President should probably be tested – with a PCR test – for the presence of coronavirus after meeting all the above requirements. (PCR, or polymerase chain reaction, is the most sensitive way to test for coronavirus.) If he is negative, he could potentially be around others while wearing a mask. In order to be even more cautious, it might be advisable to require a second negative PCR test 24 hours later. This would increase the sensitivity of the testing and ensure that the President is not shedding virus.
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The President is at Risk for Becoming Sicker
Beyond the risk to others, the President is still at risk for becoming sicker and having a clinical decline. Patients with COVID-19 often will have a worsening of the disease on day 5-10 of symptoms. If the President was first symptomatic on October 1, 2020, as reported, he is presently within the timeframe in which symptoms may worsen. If the President is without fever and has significant symptomatic improvement and negative testing, he may be able to leave isolation earlier than 20 days, but it is unclear at this point and will be up to his doctors. In short, the President may still present an infectious risk and should continue to isolate in order to prevent the spread of the virus and avoid a potential clinical decline.
As for yourself, wear a face mask, wash your hands, avoid crowds, don’t congregate with people indoors, get your flu shot—and to get through this pandemic at your healthiest, don’t miss these 35 Places You’re Most Likely to Catch COVID.