UPDATES: Trump may be stuck at Walter Reed for up to 10 days. The White House is almost certainly downplaying how serious Trump's illness is.



Updates:
  • Trump has been sicker for longer than they said. In an update to the press this (10/3) morning, the White House physician Sean Conley slipped up to say Trump was 72 hours into diagnosis, which would put the time of diagnosis sometime around morning-to-midday on Wednesday, not late Thursday night, when the White House made it public.

  • Trump was on oxygen: The New York Times and Associated Press have confirmed that Trump was given supplemental oxygen on Friday before he was taken to Walter Reed. This explains why Conley kept avoiding the question of whether Trump was ever on oxygen during the aforementioned press conference.


Since Donald Trump announced on Twitter that he and Melania Trump had tested positive for the coronavirus, the White House has embarked on a crisis management project, but the crisis it's managing isn't the president's (and the first lady's) infection. The crisis for this White House appears to be the damage to Donald Trump's public persona as a strongman who can't possibly be really affected by a pesky, little, possibly deadly virus.

But despite the efforts to downplay and obscure just how sick Trump is from the coronavirus, quickly escalating developments paint a different story. An examination of the timeline and White House statement and news reports make it clear that Trump is not well. Within 24 hours of announcing the positive test result, Trump went from being set to quarantine "at home within the White House" to taking some very serious, high dose experimental therapy to being air lifted to Walter Reed hospital to being on another experimental therapy that works with being given oxygen, though the White House insists Trump doesn't need the oxygen.

But a fuller reading between the lines of the physician's notes alone tells a story of a serious condition, along with a hospital stay potentially extending up to 10 days.

As someone who's observed patients, clinical research, and the pharmaceutical industry for a long time, the first serious indication I had that Trump is in more serious trouble than he is letting on was this note from the White House physician noting that Trump had received an experimental cocktail from the drugmaker Regeneron. Two large red flags jump out from the note.

First, as I noted on Twitter, Trump was given the 8 gram dose of the cocktail, which is the more aggressive dose of the cocktail associated with slightly better overall outcomes than the more moderate, 2.4 gram dose. But much more critically, as Regeneron notes on its own release on the polyclonal antibody cocktail, the therapy is not majorly effective on patients who are already producing their own antibodies to the novel coronavirus, also known as seropositive patients. Seropositive patients do not really need it to get their viral loads under control. Regeneron's data shows that its therapy is most effective on seronegative patients, or patients whose immune systems are having a difficult time producing native antibodies to battle the virus.

This could very well mean that The Donald isn't producing enough antibodies on his own, and needs a highly experimental therapy to make up for his immune-deficiencies.

But at least the president was administered the antibody cocktail within the White House - a small indication of how capable and prepared the White House medical staff is to handle health care needs of its residents, and how serious a proposition it is for its primary occupant to have to be flown to the Walter Reed Medical Center in a previously unplanned trip, which Trump also had to do.

Sure, the White House is trying to spin Trump's travel to - and now stay at - Walter Reed as a measure taken out of "an abundance of caution", but an caution has never been this administration's strong suit when it comes to responding to COVID, whether in mounting (the lack of) a national response, or in the White House itself, where high level staff is still huddling without masks.

After Marine One made the trip to Walter Reed, Trump began a course of Remdisivir, yet another experimental therapy, according to a second note from the White House physician.

Remdisivir received emergency use authorization by the FDA for treatment of hospitalized COVID patients only, which may explain one of a potentially myriad of reasons Trump needed to be admitted to Walter Reed. Although since expanded, the original FDA EUA approval for Remdisivir was for patients with low blood oxygen levels, meaning, its most obvious benefit is for patients whose condition is so deteriorated that they may need supplemental oxygen. It's likely the reason the Physician's note stresses that Trump isn't currently on oxygen, assuming the White House physician is telling the truth.

The note also states that Trump has completed only the first course. Remdisivir is given - at the hospital - for one initital dose and up to 9 daily follow-up doses, meaning Trump may be stuck at Walter Reed for up to 10 days (but certainly may also be for a shorter period of time).

Now, there is significant merit to the argument that regardless of how serious Trump's condition may be, doctors are being overprotective by throwing every possible therapy at him given the office he holds. That may well be true. But as I already noted, at least some of the experimental therapies he's being given are actually not effective for 'healthy' patients.

Until there is a full press conference by Trump's treating physicians with license to speak at length and at liberty about Trump's condition - which will never happen - there is no choice but to read the tea leaves. And my reading of the tea leaves say Trump is not well.