The decision to hospitalize President Trump on Friday night for several days after he tested positive for COVID-19 appears to be a wise one, taken out of an abundance of caution. It shouldn’t lead anyone to conclude he is seriously ill at this time.
As a pulmonologist and intensive care physician who has treated COVID-19 patients at NYU Langone Health, where I practice, I know full well that the disease caused by the coronavirus can be quite serious — and fatal in some cases. But importantly, I also know that the vast majority of COVID-19 patients recover from the disease.
The statistics tell the story. The confirmed death toll in the U.S. from COVID-19 is 208,520 at this writing — certainly a tragic toll. But there have been more than 7.3 million confirmed cases of the disease in this country. The overwhelming majority of patients infected with the coronavirus have fully recovered.
It is my heartfelt prayer that President Trump and first lady Melania Trump, who has also tested positive, will be among those who recover from COVID-19. The odds are certainly in their favor.
The president is not and never has been my patient. I have never examined him and I don’t have access to his medical records. But based on news reports and statements from the White House, it appears to me that the main reason he has been hospitalized is because of the importance of his position as leader of our nation, rather than because of the seriousness of his condition.
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President Trump is now reported by the White House to be mildly symptomatic with fatigue. He walked independently and with a strong stride to the helicopter taking him to Walter Reed Military Medical Center in Maryland on Friday night, and was not receiving oxygen. He spoke on a brief video shortly before he headed for the hospital and did not appear short of breath.
This leads me to believe that if Donald Trump was still a businessman he would not be hospitalized right now. But the president of the United States requires the highest possible level of health care, with every precaution taken. He will be able to get whatever he needs at Walter Reed, so taking him there makes sense.
As president, Trump has access to the best medical minds in the nation in infectious diseases, pulmonary critical care medicine, and immunology. He will very likely be given the most sophisticated medical tests to diagnose the impact of COVID-19 on his body.
We can be absolutely certain that the president's blood oxygen levels are being readily assessed and frequently or possibly continually monitored, since many COVID-19 patients who fall seriously ill develop low oxygen levels even before symptoms are apparent. If there is a need, he can receive low-flow oxygen and his response can be carefully assessed.
Decisions that the president’s physicians are taking now are aimed at reducing the viral burden on his body as quickly as possible. This can include the use of experimental treatments that doctors believe will be helpful.
The Boston Globe reported Friday that President Trump’s physician has provided medical records that confirm the president is 6-foot-3 and weighed 244 pounds in May. This would give him a calculated body mass index of 30.4, which just crosses into the threshold of Class I obesity.
Obesity is a recognized risk factor that can sometimes lead to more severe coronavirus infections. In fact, some of the first definitive data on outcomes in hospitalized obese coronavirus patients actually came from NYU Langone Health, the hospital I am affiliated with.
In addition to being overweight, President Trump is 74. His age puts him at higher risk than people who have not yet reached senior citizen status.
But it’s important to remember that despite his obesity and age, the odds are extremely favorable for President Trump’s full and complete recovery for three reasons: His disease was detected very early due to the frequent testing he receives; he has access to extraordinary medical care and experimental treatments as announced, including receiving the drug Regeneron; and apart from COVID-19, he has been reported to be in good overall health.
The president is publicly documented to be on two medicines for high cholesterol and on aspirin. This is consistent with good preventive medicine at maintaining a healthy lipid profile, which is important in many older men and is nothing unusual.
It is clear to anyone observing President Trump in public that he has tremendous energy and stamina, and keeps a rigorous schedule. Fortunately, he has no known history of diabetes, high blood pressure, or chronic kidney disease — all risk factors for worsening the course of COVID-19.
The president does not take any drugs to suppress his immune system, does not have cancer, and does not have any lung disease or other serious illness that makes it very difficult for his body to fight off the coronavirus. These factors all point to a high likelihood of his recovery from COVID-19.
The president also benefits by the fact that 10 months into the coronavirus pandemic, doctors and medical researchers know a lot more about the coronavirus and COVID-19 than we did last winter. As a result, there are now better treatments, improved outcomes, and a lower fatality rate caused by the disease.
Doctors understand that no specific treatments have been found to be effective in the initial stage of COVID-19, when patients experience no symptoms or only mild symptoms like the ones the president is reported to be experiencing.
Strategies to reduce the viral burden include convalescent plasma, as documented in a study published in Journal of the American Medical Association in August. The plasma comes from patients who have recovered from COVID-19 and who have produced antibodies in their blood that can fight the coronavirus.
The study showed that in those patients with severe cases of COVID-19 receiving convalescent plasma, 91.3% experienced clinical improvement — compared to 68.2% of patients not receiving convalescent plasma.
The study also showed that convalescent plasma is the fastest way to clear the body of coronavirus infection. The coronavirus was undetectable within 72 hours in patients participating in the study who were treated with convalescent plasma.
However, convalescent plasma requires invasive monitoring and the insertion of intravenous lines, and may also cause patients to experience allergic reactions.
This is why Regeneron — containing genetically engineered antibodies — is so exciting. Now a trial drug, the fact that it is being used to treat President Trump shows his physicians are thinking of the most imaginative strategies possible to restore him to good health.
We are likely to see that Regeneron will become approved by the Food and Drug Administration as a coronavirus treatment for more people who are infected if clinical trials show promise for the experimental drug.
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Targeting the coronavirus with an antibody that neutralizes the virus — as Regeneron does —and renders it incapable of entering human cells will immediately lower the viral burden. This will protect the body from the intense immune response to the virus that has made so many people severely ill.
Doctors are clearly aiming to clear the president’s body of coronavirus as quickly as possible and reduce the chances of his body responding with an intense immune storm that could have more widespread impact.
When the president ultimately recovers — and all indications at this time point to his full recovery — his body will develop its own innate immunity to the coronavirus. This should give him sufficient protection from a repeat infection until vaccines likely become available in the coming months.
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One thing is clear: President Trump’s own health will now benefit from the farsighted programs he launched to battle the coronavirus. These include Operation Warp Speed, the most rapid vaccine development program in history; the use of the Defense Production Act to require companies to manufacture items needed to protect Americans from COVID-19; and massive funding for the development of drugs and a coronavirus vaccine.
Regardless of political party, I know that the American people join me in praying for and wishing our president and first lady a full recovery and their doctors every success. I have unwavering confidence and faith in the abilities of doctors to treat both President and Melania Trump in the short term, and to develop effective vaccines and ever-more effective treatments for COVID-19 to protect us all in the months ahead.
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