Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Medicine / Infectious Disease / Epidemiology / @KFF @CBSNews @NYUGrossman @BellevueHosp doc / https://t.co/ePJoqg37pn / https://t.co/FWR3TI2WIX

Oct 3, 2020, 8 tweets

1/ Why do doctors like me & @meganranney ask how high the POTUS' fever has been, if his O2 levels have been low, whether he's required supplemental oxygen? It's the difference between moderate & severe COVID. This tells us a lot about prognosis & what treatments are indicated.

2/ If the president required supplemental oxygen, he has SEVERE COVID and should hand power over to VP Pence until he is clinically improved.

3/ POTUS was given remdesivir. *Assuming* evidence-/guideline-based use of remdesivir, this would also indicate that the president has SEVERE COVID (i.e. oxygen saturation less than or equal to 94% on room air, requiring supplemental oxygen/ventilator/ECMO).

4/ But we know the president doesn't abide by evidence and guidelines, so it's hard to know for sure if that's what his receiving remdesivir means.

5/ Dr. Sean Conley, the president's personal doctor, ended the press conference when asked whether the president had received dexamethasone. Dexamethasone is indicated in severe/critical COVID, but not mild/moderate COVID.

6/ Assuming a non-denial = tacit affirmation, the president has received dexamethasone. This would mean he has (at the very least) SEVERE COVID. He should transfer power to VP Pence until he's clinically improved.

7/ There are reasons NOT to give dexamethasone if COVID is not severe enough: psychiatric side-effects (e.g. agitation, confusion), suppression of adrenal glands, risk of bacterial/fungal infection. I don't think the decision to give dexamethasone would be cavalier.

8/ The questions Dr. Conley is avoiding / refusing to answer (highest temperature, lowest oxygen saturation, requirements for supplemental oxygen, need for dexamethasone) would tell us something about the president's prognosis. THE LACK OF TRANSPARENCY IS, ITSELF, A DIAGNOSIS.

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