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.
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.
4/
- Vaccine nationalism/hoarding could backfire.
- If anyone understands herd immunity, it's Bill Foege. It's how the world eradicated smallpox.
- We have NEVER been able to achieve herd immunity with any infectious disease through natural infection, ONLY THROUGH VACCINATION.
5/ What happened to Dr. Deborah Birx?
6/ @CDCDirector Bob Redfield should have resigned while taking a very clear and public stand for all to see. There are times to try to change the system and mitigate harm from within. This is not that time.
7/ "IT IS A SLAUGHTER AND NOT JUST A POLITICAL DISPUTE." -Dr. Bill Foege
Public health officials must serve the public above all and everyone else, including the President.
8/ "REVISIT YOUR RELIGIOUS BELIEVES AND ASK YOURSELF WHAT IS RIGHT." -Dr. Bill Foege

This is exactly what every single one of us must do right now.

• • •

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Keep Current with Céline Gounder, MD, ScM, FIDSA

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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
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
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

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