1/ What did we learn about the President's health today?
- He had a fever and oxygen saturation level under 94% on Friday, which prompted his transfer to Walter Reed Hospital.
- His oxygen saturation dropped Saturday AM. He was started on dexamethasone.
2/
- The President's kidney & liver function have remained normal.
- His cardiac function is normal or improving? Was it ever abnormal? We know he's had an ultrasound. Was this an ultrasound of the heart (echocardiogram)?
3/
- He received Regeneron's monoclonal antibody cocktail on Thursday.
- He was started on remdesivir on Friday and dexamethasone on Saturday.
4/
- Having an oxygen saturation of less than 94% = SEVERE COVID.
- Remdesivir and dexamethasone are only recommended for patients with SEVERE COVID.
5/
- Some take it to be a good prognostic sign that the President walked to Marine One. This is meaningless.
- COVID patients can have very low oxygen levels & not feel short of breath—a phenomenon known as “silent hypoxemia” or “happy hypoxia.”
6/
- Yesterday Dr. Conley reported that POTUS had been sick for 72h. He then ?corrected himself & said that the President was on 3rd day of illness.
- Incubation period (time from exposure/infection with the SARS-CoV-2 virus to symptom onset) = average 4-5d (as long as 14d
7/
- POTUS most likely infected on 9/25 or 9/26, which coincided with indoor/outdoor events to announce the nomination of Judge Amy Coney Barrett to SCOTUS.
- These events appear to have been super spreaders, with many in attendance since testing positive for COVID.
8/
- But it remains possible POTUS may have been infected elsewhere.
- I was startled to hear that the WH’s “daily” COVID testing may not have been daily & didn’t extend to all staff.
- Former Trump WH Official Joe Grogan on WH working conditions:
9/
- Patients infected with SARS-CoV-2 may become infectious to others up to 3d prior to symptom onset. ncbi.nlm.nih.gov/pmc/articles/P…
- If POTUS developed symptoms on Wed/Thurs, he could have been infectious as early as Sunday & was almost certainly infectious at the debate on Tuesday.
10/
- It is notable that the President and his entourage flouted the “honor system” and failed to be tested in the hours leading up to the debate, putting Vice President Joe Biden, Chris Wallace, and others in attendance at risk.
thehill.com/homenews/media…
11/ Many questions remain:
- When did POTUS 1st test positive for COVID?
- When did he develop symptoms?
- Who did he expose?
12/ And more questions:
- Was POTUS given Regeneron monoclonal antibody cocktail in hopes that he wouldn’t become symptomatic?
and that the President’s diagnosis could be concealed?
- How sick is the President, really?

• • •

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More from @celinegounder

5 Oct
1/ Great speaking with @elemental's @smithdag today.
elemental.medium.com/everything-we-…
Some highlights:
- “If the fever came down on its own, that’s a very good sign prognostically. If the fever required medication to come down […] it wouldn’t necessarily mean he’s getting better..."
2/ Steroids like dexamethasone and medications like aspirin, Tylenol, and ibuprofen will reduce a fever.
3/ On Fri/Sat, Trump had an oxygen saturation below 94%. Dr. Conley said it didn't got down to the low 80s. So that would imply it dropped to the upper 80s.
Read 12 tweets
5 Oct
1/ POTUS says he's leaving Walter Reed and going back to the White House: washingtonpost.com/elections/2020…
Assuming he got sick Wed/Thurs, he's on day 5 or 6 of COVID. It's too early.
2/ On day 2 or 3 of COVID POTUS already had evidence of severe COVID with oxygen saturation under 94% on room air (& likely into upper 80s) & supplemental oxygen requirement.
3/ COVID patients often get worse at 7-10 days into illness (i.e. this Fri or Sat). I hope that doesn't happen. But he should be closely monitoring in a hospital NEAR AN INTENSIVE CARE UNIT until then.
Read 13 tweets
4 Oct
1/ It's concerning that President Trump got so sick so quickly. Here's my take for @CNN: cnn.com/2020/10/04/opi…
2/ Today we learned that POTUS had a fever & an oxygen saturation level below 94% on Friday morning, prompting his transfer to Walter Reed. Reading between the lines of what Dr. Conley did & did not say, it's possible that the POTUS' oxygen levels dropped into the upper 80s.
3/ He again had a drop in his oxygen saturation level to 93% Sat AM. It is unclear whether he again was given supplemental oxygen at that time. He is now on at least 3 medications for severe COVID, including Regeneron's monoclonal antibody cocktail, remdesivir & dexamethasone.
Read 62 tweets
3 Oct
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).
Read 8 tweets
3 Oct
1/ What was POTUS' lowest oxygen saturation in the past week? Why was he transferred to Walter Reed. WE STILL DON'T KNOW. Given there still hasn't been a transfer of power to VP Pence, President Trump owes the American people an explanation.
2/ It now appears that the president required supplemental oxygen prior to arrival at Walter Reed. (We're having to read between the lines based on Qs answered and not answered).
3/ POTUS was given remdesivir. *Assuming* evidence-/guideline-based use of remdesivir, this would 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).
Read 7 tweets
3 Oct
1/ Great thread here by my old friend @CharlesBHolmes.
Regeneron's press release (not a study!) didn't comment on side-effects. With other monoclonal antibodies, side-effects have included fever, chills, weakness, headache, nausea, vomiting, diarrhea, low blood pressure, & rash.
2/ More severe side-effects may include: life-threatening anaphylaxis, cytokine release syndrome (also caused by COVID), cardiac toxicity, clotting dysfunction, immune-related effects, infections, autoimmunity, and off-target effects.
3/ The Regeneron monoclonal antibody cocktail is so new we don't yet have data on its side-effects. And it hasn't been tested in older patients, like the president.
Read 6 tweets

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