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Céline Gounder, MD, ScM, FIDSA

5 Oct, 12 tweets, 4 min read

@Elemental

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.

4/ Despite multiple questions from the press, the results of the scans have not been provided, but Dooley did say the lung CT was consistent with COVID. This implies POTUS likely has ground-glass opacities in his lungs. If the findings are typical, why not release to the public?

5/ Dr. Dooley reported on Sat that Trump’s kidney, liver, and cardiovascular functioning were “normal or improving.” Later, another member of the president’s medical team stated that his liver and kidney functions have remained normal.

6/ If the president’s health was a deductive logic puzzle, one could imply that Trump had cardiovascular abnormalities over the weekend that were now improving.

7/ Heart function is a major concern with COVID. The virus can cause heart failure, heart attacks, blood clots, inflammation of the heart, and even directly infect heart cells themselves. Would love to see an echocardiogram.

8/ I would like to see POTUS' white blood cell and platelet count, as well as his levels of inflammatory markers and blood clot tests.

@celinegounder

9/ “I think his condition is more severe than they are communicating to us.” -@celinegounder elemental.medium.com/everything-we-…

@celinegounder

10/ “There’s no reason not to release more details... If the numbers are normal, this would put things to rest and reassure people, so they’re withholding that for a reason.” -@celinegounder elemental.medium.com/everything-we-…

@celinegounder

11/ “I suspect that the med list we got was not a complete med list and that it was only including medications that were directly related to his COVID treatment." -@celinegounder elemental.medium.com/everything-we-…

@celinegounder

12/ “They really should keep him in the hospital until about 10 days into his illness just to make sure he doesn’t get worse,” because that’s when patients usually decompensate. But, “What Trump decides to do is anybody’s guess.” -@celinegounder elemental.medium.com/everything-we-…

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA

@celinegounder

7 Oct

@CDCgov

1/ Late last month, Dr. Bill Foege—@CDCgov Director '77-83, central figure in smallpox eradication, former Task Force for Global Health & Carter Center leader, Senior Fellow at the @gatesfoundation, and a devout Christian—sent this plea to @CDCDirector Bob Redfield.

@CDCgov

2/ We are witnessing a "colossal failure of the public health response in this country." The result of "incompetence and illogic." The @CDCgov is the preeminent public health institution in the world. They should have been leading the response from the beginning.

3/ Basic tenets of public health:
- "Know the Truth." This White House is about obfuscation & confabulation.
- "a coherent FEDERAL plan," not a patchwork response: podcasts.apple.com/us/podcast/epi…
- We need cooperation & coalition, not division. The virus is winning by divide & conquer.

Read 8 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

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

Céline Gounder, MD, ScM, FIDSA

@celinegounder

4 Oct

@CNN

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

Céline Gounder, MD, ScM, FIDSA

@celinegounder

4 Oct

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.

Read 12 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

3 Oct

@meganranney

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

Céline Gounder, MD, ScM, FIDSA

@celinegounder

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).