COVID Transmissions for 10-5-2020

Trump has COVID-19

Oct 05, 2020

Good morning! It has been 323 days since the first documented human case of COVID-19.

Welcome back from the weekend. And what a weekend it’s been! The President of the United States has contracted what appears to be a serious case of COVID-19. I’d like to talk through some of the particulars of his case, to help folks understand what’s going on here.

As usual, bolded terms are linked to the running newsletter glossary.

Keep the newsletter growing by sharing it! I love talking about science and explaining important concepts in human health, but I rely on all of you to grow the audience for this:

Share COVID Transmissions

Now, let’s talk COVID.

Trump’s Infection

Most other news has ground to a halt with the announcement that President Trump has become infected with COVID-19.

Almost immediately, there were conspiracy theories that his infection was not genuine and in fact some kind of campaign stunt to show that the virus is not serious. It’s clear by now that this is not the case. The President is, genuinely, ill with COVID-19.

The military has seen fit to deploy E-6B Mercury mobile command post aircraft:

Tim Hogan @TimInHonolulu

RT There's an E-6B Mercury off the east coast near DC. I looked because I would expect them to pop up if he tests positive. It's a message to the small group of adversaries with SLBMs and ICBMs.

These are used to ensure continuity of military command in the event of a disruption in government. With the President potentially compromised, an opportunistic adversary might try to knock out the rest of our government. The deployment of these aircraft is meant to signal that the US is ready for such an adversary and there would be a swift and terrible retribution. I’d kind of hate to be the guy whose job it is to make good on that retribution.

Anyway, that’s meant to communicate that this is obviously a very serious situation. Let’s discuss the actual COVID-19 aspect, though.

The current narrative of events is that the President seems to have developed symptoms starting Thursday, and experienced a troubling drop in blood oxygen saturation on Friday. This drop necessitated the administering of supplemental oxygen on Friday at the White House, as well as the transferring of the President to the Walter Reed military hospital.

We’ve learned that at various times since his diagnosis, the President has had a “high” fever, as well as drops in his blood oxygen saturation. Other information has been less forthcoming—his doctors have said that only “expected” findings were observed on chest x-ray and CT scans, which has proven more confusing than helpful since the expected finding in COVID-19 would be pneumonia.

We do know, however, that the President has received three treatments, two wholly experimental, and a variety of supplements, to treat his disease. These are the treatments that have been described publicly:

The Regeneron polyclonal antibody cocktail
Remdesivir by IV
Dexamethasone

Let’s walk through what each of these are for. The Regeneron cocktail is for the control of virus load in the patient. It has not been demonstrated to be effective and safe in a Phase 3 clinical trial, but it has had some encouraging clinical results. It is not currently approved, even under an Emergency Use Authorization (EUA), so clearly this had to be administered to the President by a special arrangement somehow. They typical patient might not be able to get access.

Remdesivir is currently available under an EUA. It is indicated for patients who have severe cases or who have reasonable suspicion of risk for a severe case of COVID-19. The need to administer supplemental oxygen to the President puts him into that category, as do his advanced age and his apparent obesity. Remdesivir has been demonstrated to reduce the length of hospital stays in COVID-19 patients, which is a sign that it typically does pretty good things for overall outcomes. However, it’s not without adverse effects.

Dexamethasone is a steroid. It is given also to high-risk patients and patients with severe cases, and appears to reduce the risk of death by about 1/3 in such patients. Steroids can have adverse effects as well, potentially serious ones. They are not given lightly.

These facts suggest that the President’s case is being taken very seriously by his care team. At the same time, messaging around his case indicates optimism and a good prognosis. I think that the press has gone a little far with speculating about this. There is good reason to be optimistic about the President’s health; he is receiving world-class care at an excellent facility, and even in his age group there are still more patients who survive than do not.

Likewise, it is important that the United States project a sense of continuity of leadership and stability, as a major global power. To suggest that a disease has led to chaos in Washington or that it is unclear if the President can lead is potentially quite dangerous, both to Americans in the US as well as to our soldiers and allies abroad. There is good reason to put forward an optimistic picture of the situation.

That said, this is clearly not an extremely mild case. It is not clearly a severe case, either. I am sure we will learn more as the days pass, but I neither think this is something to panic about nor something to take lightly.

What am I doing to cope with the pandemic? This:

Sukkot

It’s currently the Jewish festival of Sukkot, the next in a series of holidays that often leaves Jews saying “enough already!” this time of year. I happen to quite like Sukkot, which is full of fun imagery and a building project of making a little shack. Living in the city, I don’t tend to build my own, but I did enjoy doing so when I lived in the suburbs and had the space for it.

Join the conversation, and what you say will impact what I talk about in the next issue.

Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.

Viral Transmissions

Discussion about this post