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Some medical experts question Trump's exit from Walter Reed hospital

"There is some element of disconnect between how you look and feel and what's going on inside you with this disease," one expert said.
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Allowing President Donald Trump to leave Walter Reed National Military Medical Center and return home to the White House while he remains in a potentially dangerous period of the illness is risky, some medical experts said Monday.

Others suggested that the move seems reasonable, given that the White House is very well equipped for medical care, with constant physician attention and resources available.

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"Right now there's nothing that's being done that we can't safely do at home," Dr. Sean Conley, the president's physician, told reporters at a briefing.

Some medical experts disagreed with Conley's assessment.

"There is a lot of concern about safety," said Dr. Kavita Patel, a primary care physician in Washington who is managing director in the Center for Health Policy at the Brookings Institution, on MSNBC Monday.

Conley said: "While he may not be entirely out of the woods yet, the team and I agree that all our evaluations and, most importantly, his clinical status support the president's safe return home, where he will be surrounded by world-class medical care 24/7."

Trump is receiving several medications, including the antiviral remdesivir and the steroid dexamethasone. Both are given intravenously, which can be done at the White House. He also received a single infusion of an experimental antibody treatment Friday, the White House said.

Trump's oxygen levels dropped twice, prompting doctors to give him supplemental oxygen.

Experts say the first seven to 10 days of the illness are key.

"We know that patients with severe Covid have symptoms hit this little honeymoon period where their symptoms look better," said Dr. Ken Lyn-Kew, a pulmonologist in the critical care department at National Jewish Health, a hospital in Denver. "Coming out of that honeymoon period, they either continue to get better or they have a decompensation."

Given the timeline of Trump's illness and the medications he is on, "most of us would not anticipate him being discharged in that setting," Lyn-Kew said.

"When we look at the president, you know, how he looks on the outside is only one indicator of how well he's doing," he said. "There is some element of disconnect between how you look and feel and what's going on inside you with this disease."

One phenomenon Lyn-Kew noted is referred to as "happy hypoxic, where the patient does not feel as sick as their vital signs indicate." When patients are hypoxic, their oxygen levels are low. "So for the purposes of a short video or a picture, the president can look just fine but still be doing poorly, and we wouldn't know it."

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Other factors that are not obvious from the outside include levels of inflammation and blood clotting.

Dr. Hugh Cassiere, director of critical care services for Sandra Atlas Bass Heart Hospital at North Shore University Hospital, part of Northwell Health, on Long Island, New York, agreed.

"The real question that we do not know is what is going on with his inflammatory markers, because that's going to be key," Cassiere said.

"Inflammation predisposes patients to blood clots," Cassiere said. "He could form a blood clot and have a pulmonary embolus, which is catastrophic." A pulmonary embolus is a blocked artery in the lungs.

The president will most certainly have multiple medical personnel watching over him upon his return to the White House.

"My sense is that it's like stepping from an ICU onto a hospital floor," said Dr. Steve Shapiro, a pulmonologist and chief medical and scientific officer at the University of Pittsburgh Medical Center. "The doctors will be there and nurses will be there. They can give him IV therapy. I suspect they can do quite a bit."

Dr. William Hartman, who is leading several Covid-19 clinical trials at University of Wisconsin Health in Madison, said it is unusual for patients to go home before they have finished their IV medications. But "the White House is a different situation, obviously," Hartman said. "He can get that type of care there."

Trump is scheduled to receive his fifth and final dose of remdesivir Tuesday. He remained on steroid therapy Monday afternoon.

"In general, patients do pretty well at home," Hartman said, "as long as they quarantine and take the appropriate measures."

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