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Lenox Hill Hospital Expansion Battle Resumes After Pandemic Pause

UPPER EAST SIDE, NY — The battle over an ambitious expansion plan by Lenox Hill Hospital is showing signs of coming back to life after going dormant for several months while the hospital responded to the coronavirus pandemic.

In a community meeting last month, Lenox Hill officials revealed changes to the multibillion dollar expansion project, which notably scrapped a controversial, 490-foot-tall residential tower on Park Avenue that would have helped fund the expansion.

The hospital will present a revised plan Tuesday, during a meeting convened by Manhattan Borough President Gale Brewer between local leaders and hospital representatives.

Starting last year, neighbors rose up in fierce opposition to the project by owner Northwell Health, which was also slated to include a 516-foot hospital tower on Lexington Avenue.

Community Board 8 voted overwhelmingly last October to oppose the plan, and a preservation-oriented group called Committee to Protect Our Lenox Hill Neighborhood sprung up to fight the project, citing its “unacceptable” size and the environmental hazards brought on by a decade-long construction project.

This spring, the committee went on an abrupt hiatus, as the group acknowledged the poor optics of fighting a hospital’s expansion while its workers served on the front lines of a global pandemic.

“We want to explicitly thank Northwell Lenox Hill and all of the other New York City hospitals, especially the doctors, nurses and staff for the incredibly brave and selfless work they are doing to protect us all,” a message on the group’s website reads.

Now, the activity has resumed — on Sept. 15, Brewer’s task force between hospital and community leaders held its first meeting in months, where hospital leaders announced the removal of the apartment tower.

An initial rendering of Lenox Hill Hospital's planned expansion at Lexington Avenue and East 76th Street, presented to Community Board 8 in March 2019. (Northwell Health)
An initial rendering of Lenox Hill Hospital’s planned expansion at Lexington Avenue and East 76th Street, presented to Community Board 8 in March 2019. (Northwell Health)

“We will conclude meetings this month and we look forward to seeing Northwell’s proposal enter the public review process,” Brewer spokesperson Aries Dela Cruz said Monday.

Meanwhile, expansion opponents are pursuing a new angle of attack, rolling out statements from health care advocates questioning the project from an equity perspective.

Mark Hannay, director of the advocacy group Metro New York Health Care for All, suggested that Lenox Hill should focus its resources in the outer boroughs, which have been hard-hit by COVID-19, rather than expanding its presence on the hospital-rich Upper East Side.

“If the COVID-19 pandemic crisis has shown anything, it is that access to hospital care across our city is grossly unequal, and beds are much more needed in Lower Manhattan and the outer boroughs,” Hannay said in a statement. “Our public officials need to urge Northwell to rethink their entire plan for Lenox Hill and their larger role across our city.”

Anthony Feliciano, director of the Commission on the Public’s Health System, another community-based health advocacy group, suggested that the expansion was driven by financial concerns, rather than public health.

“This is about profit, not healthcare equity — and

Kansas ‘losing the battle’ on COVID-19

TOPEKA, Kan. (AP) — Kansas’ top public health official warned Friday that the state is “losing the battle” against the coronavirus as it reported another record increase in new cases.

The state Department of Health and Environment said Kansas reported 1,855 new confirmed and probable coronavirus cases since Wednesday, an increase of 2.9%, to bring the total for the pandemic to 65,807. The state also reported another 40 COVID-19-related deaths, increasing the pandemic total to 763. Twenty-six of those were reported Thursday in Shawnee County, where the local health department reviewed previous death certificates from the Topeka area.

“Other states are doing bad, and we’re doing worst than most,” Dr. Lee Norman, the head of the state health department, said during an interview. “We’re losing the battle right now.”

The state saw an average of 671 new cases a day for the seven days ending Friday, breaking the state’s previous record of 667 for the seven days ending Sept. 28. The state has seen that seven-day average hit or exceed 600 cases per day for five of the six reports it has issued in the past two weeks.

Norman predicted last week that the state’s reporting of new cases could increase to as many as 900 a day on average in the coming months. COVID-19-related deaths have for about a month hovered around 1.1% of reported cases, but with Friday’s report, the figure was 1.16%, the highest in almost two months.


The actual number of cases is thought to be much higher because people can be infected without feeling ill or they may have only minor symptoms, and because of a lack of testing, particularly early in the pandemic. Norman said earlier this week that between 4% and 4.5% of the state’s population probably has been infected since the pandemic reached Kansas in early March — between 116,000 and 131,000 cases.

Norman blamed the increases on residents’ refusal to consistently follow public health guidelines for mask-wearing, social distancing and avoiding large public gatherings. He said people need to do all of them in tandem to check the virus’ spread.

“One of the things that we just have to collectively as a state start working together with is what are the social and psychological underpinnings for the reasons why for we’re going the direction we’re going,” Norman said. “Our curve is going absolutely the wrong direction.”

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Doctors and nurses battle virus skeptics

MISSION, Kan. (AP) — Treating the sick and dying isn’t even the toughest part for nurse Amelia Montgomery as the coronavirus surges in her corner of red America.

It’s dealing with patients and relatives who don’t believe the virus is real, refuse to wear masks and demand treatments like hydroxychloroquine, which President Donald Trump has championed even though experts say it is not effective against the scourge that has killed over 210,000 in the U.S.

Montgomery finds herself, like so many other doctors and nurses, in a world where the politics of the crisis are complicating treatment efforts, with some people even resisting getting tested.


It’s unclear how Trump’s bout with the virus will affect the situation, but some doctors aren’t optimistic. After a few days of treatment at a military hospital, the president tweeted Monday, “Don’t be afraid of Covid. Don’t let it dominate your life. … I feel better than I did 20 years ago!”

After one tough shift on the coronavirus unit at Cox South Hospital in Springfield, Montgomery went onto Facebook to vent her frustrations about caring for patients who didn’t socially distance because they didn’t believe the virus was real. The hospital later shared her post on its website.

She complained that some people demand the anti-malaria drug hydroxychloroquine and think the only patients who get really sick have underlying health problems.

“The majority of people don’t understand and can’t picture what we are seeing. That has been frustrating for all of us,” Montgomery said in an interview, adding: “It wears.”

Combating virus skeptics is a battle across the country.

In Georgia, at Augusta University Medical Center, visitors have tried to get around the mask requirement by wearing face coverings made of fishnet and other material with visible holes, something the hospital has dubbed “malicious compliance.” People also have shown up with video cameras in an attempt to collect proof the virus is a hoax, said Dr. Phillip Coule, the health system’s chief medical officer, who contracted the virus in July and has seen two staff members die.

“Just imagine that while you are caring for your own staff that are dying from this disease, and while you are trying to keep yourself safe, and you are trying to keep your family safe, and you are trying to deal with a disease that such little is known about, and then to have somebody tell you that it is all a hoax after you have been dealing with that all day,” he said. “Imagine the emotional distress that that causes.”

He said most skeptics — including some who have argued with him on Facebook — are converted to believers when they get sick themselves. And he is starting to hear fewer people dismiss the virus entirely since the president was diagnosed.

“It is unfortunate that the president has contracted the disease, but it is difficult for groups who support the president to be out there saying it doesn’t exist,” he said.

But he also said he

Novak Djokovic enters French Open semi-finals but faces fitness battle

Video: Serena pulls out of French Open with Achilles injury (Reuters)

Serena pulls out of French Open with Achilles injury

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Novak Djokovic is still in the French Open – but only after a drawn-out struggle in four sets on Wednesday night against Pablo Carreño Busta, the Spaniard who cashed in at the US Open when the world No 1 was disqualified for striking a line official with a spare ball. It was not a joyous reunion.



Novak Djokovic is swinging a racket at a ball: Photograph: Clive Brunskill/Getty Images


© Provided by The Guardian
Photograph: Clive Brunskill/Getty Images

A month after their shared New York drama, Carreño Busta had notions of winning on his own merits after taking the first set of the second quarter-final on day 11, but Djokovic ignored nagging pain in his upper left arm and his neck as he cobbled together a 4-6, 6-2, 6-3, 6-4 win in 3hr 10min under the lights on Court Philippe Chatrier. He has two days to recover before playing Stefanos Tsitsipas on Friday, and he will need every waking hour of them.



Novak Djokovic is swinging a racket at a ball: Novak Djokovic plays a forehand during his French Open quarter-final victory against Pablo Carreño Busta of Spain.


© Photograph: Clive Brunskill/Getty Images
Novak Djokovic plays a forehand during his French Open quarter-final victory against Pablo Carreño Busta of Spain.

Related: Rafael Nadal weathers cold and Jannik Sinner to reach French Open semi-final

If the 2016 champion is to win the title again he has to beat injury, an in-form Tsitsipas and, probably, the 12-time champion, Rafael Nadal, who plays Diego Schwartzman in the other semi-final. It is the sort of mountain Djokovic loves climbing, but the question remains: is he fit and strong enough to reach the summit?

Djokovic was cleared to play in Rome, where he beat Schwartzman in the final, and in Paris after testing positive for coronavirus on his Balkans exhibition tour earlier in the summer – but he looked a physical mess in the first set. Sweating and anxious, he grimaced, tugged at his arm and bandaged neck and tried to bang life into his upper legs with his racket as his opponent waited for his chances.

The tournament physio massaged Djokovic’s arm during the break and the player told him: “It feels better now.” Yet he did not look remotely comfortable, even when he got his serve working and levelled at a set apiece. The trainer returned between the third and fourth games, and it seemed to lift Djokovic’s spirits. Just when he looked as if he was slipping into a confused state again, he bounced back to level at a set apiece.

Related: Petra Kvitova sets up French Open semi-final meeting with Sofia Kenin

He broke early in the third, overcame a blip when Carreño Busta broke back for 2-3, then hit hard again to go a set up. But he looked far from commanding. Carreño Busta dug his heels into the Roland Garros clay in the fourth, and Djokovic had to fight for every point. Carreño Busta chose a woeful option to hand him the break for 3-4, Djokovic saved break point to hold through deuce

Newlywed, mom ‘COVID long haulers’ battle debilitating symptoms months later

Doctors say they’re bracing for a “tsunami” of “COVID long haulers”

As the coronavirus pandemic continues across the U.S., experts are noticing another wave of the pandemic with what they’re calling “COVID long-haulers,” or people suffering debilitating symptoms months after having the coronavirus.

Doctors say they are seeing many people who have recovered from COVID but are finding themselves still not well.

Caitlin Barber, a 27-year-old newlywed, is one of these “COVID long haulers,” who led a healthy lifestyle with her husband and spent time training as a runner. She was also a dietician at a nursing home.

Caitlin Barber poses for a photo after a marathon.

Caitlin Barber poses for a photo after a marathon.

Caitlin Barber poses for a photo after a marathon.

“We were living the newlywed dream, you know and loving life,” Barber told “Good Morning America.”

In March, things changed instantly when she was diagnosed with COVID-19. Barber recovered from the disease, but getting rid of the virus wouldn’t be the end of it.

Seven months after getting COVID, Barber said that the side effects of the disease have lingered, affecting her ability to walk on her own and even do simple tasks like showering.

“We kind of call it the Corona Coaster because one day could be okay, and the next day I’m on the floor, having convulsions, thinking I’m having a heart attack,” said Barber.

Michaelene Carlton, a mom of two from Delaware, has also been struggling since recovering from COVID-19. Some of the symptoms she’s been experiencing are extreme headaches.

“A bad day is some days me not being able to get out of bed,” Carlton told “GMA.” “The headaches are so extreme that I’m taking migraine medicine and sleeping for 14 to 16 hours a day.”

Because of how bad their symptoms were getting, both women sought help online among a community of people experiencing the same thing after recovering from COVID-19. It was in the Facebook support group SurvivorCorps that each learned about Mount Sinai’s post-COVID clinic — the largest clinic in the country dedicated to treating long haulers.

“What we’re seeing at the center is a very wide distribution of both age, sex, ethnicity, preexisting conditions versus healthy patients,” said Dr. Zijian Chen, director of Mount Sinai’s post COVID clinic. “You’re not protected if you’re young and healthy, unfortunately.”

At Mount Sinai, they’re experiencing an influx of patients who are turning to them for help, and the waitlist is growing.

“I have patients not only across the country, but across the world that are seeking advice because they just haven’t been able to find the support in terms of the healthcare system,” said Mount Sinai’s Dr. Dayna McCarthy.

Chen also warned that the growing number of people experiencing COVID long hauler symptoms may have major consequences down the line.

“This other group of patients with symptoms are unrelenting that need to see many

‘You’re Gonna Beat It.’ How Donald Trump’s COVID-19 Battle Has Only Fueled Misinformation

President Trump Recuperates Amid Questions About His Health And Campaign
President Trump Recuperates Amid Questions About His Health And Campaign

U.S. President Donald Trump salutes Marine One helicopter pilots on the South Lawn of the White House in Washington, D.C., on Oct. 5, 2020. Credit – Ken Cedeno—Polaris/Bloomberg/Getty Images

Less than 24 hours after requiring supplemental oxygen and being hospitalized for COVID-19, President Donald Trump was already talking about the virus in the past tense.

“I learned a lot about COVID. I learned it by really going to school,” Trump said in a video filmed from his hospital suite on Saturday. “And I get it, and I understand it, and it’s a very interesting thing.”

It had been a rare and ominous sight to watch the President of the United States get airlifted to Walter Reed National Military Medical Center to be treated for a disease that has killed more than 210,000 Americans and sickened millions more. Laid low by the very virus that he has consistently downplayed, and with more than a dozen White House and Republican officials around him also infected, Trump struck a rare note of uncertainty, tweeting “Going well, I think!” Messages of shock and sympathy came in from around the world.

But if public health officials, and even some of Trump’s own aides, had hoped the experience would chasten him to change his message after months of questioning the severity of the disease, it quickly became clear that they were mistaken. “Don’t be afraid of Covid,” the President, who has received the very best medical care in the U.S., repeatedly told Americans a mere 72 hours later.

By the time he was staging his triumphant return from the hospital on Monday evening — still infected and heavily medicated — the sentiment that the president’s experience proved the virus had been exaggerated had exploded in the conservative media ecosystem. Slickly produced White House videos depicted Trump as a returning war hero, in an aggressive campaign to paper over any seeming vulnerabilities in a president who has always valued the appearance of strength above all else. The implication was that Trump was over the disease, which he isn’t, and that the nation needed to be as well, which it is not.

Trump’s message — not only urging Americans not to be afraid of the deadly illness, but promising they are “gonna beat it” if they get infected — was met with disbelief by many doctors and health experts who have spent the past nine months watching patients fight for their lives and die alone. “What the president is saying is untrue and irresponsible,” said Carlos del Rio, an infectious disease expert at Emory University in Atlanta, tells TIME. “He’s giving the impression: ’I’m strong, I made it, you’re the weak ones that didn’t make it.’ I think it shows a lack of compassion.”

On Tuesday morning, Trump continued to minimize the severity of the virus. “Flu season is coming up! Many people every year, sometimes over 100,000, and despite the Vaccine, die from the Flu.

Victims of disgraced Harley Street dentist call for ‘outrageous’ legal loophole to be closed as they launch battle for compensation

Victims of a disgraced Harley Street dentist who was kicked out of the profession for a catalogue of botched procedures have launched a legal bid for compensation.

Fraser Pearce, 51, was left with a pierced sinus from faulty dental work by Dr Shahram Sahba, while Helen Pitt, 55, had £10,000 of veneers fitted in a negligent attempt to fix a receding gum line.

Dr Sahba, who ran the Lister House Dental Clinic in London’s famous medical district, was struck off last year after his professional regulator found him guilty of more than 400 charges of misconduct, negligence, and dishonesty.


A first attempt by his patients to sue for damages was blocked, as the disgraced dentist had left England and his insurers had no obligation to pay out when their client was not co-operating.

Fraser Pearce 

Mr Pearce and Ms Pitt, represented by law firm Devonshires, are now using the Consumer Credit Act to bring fresh legal action, to get money back via the credit card transactions used to pay for the botched procedures.

William Collins, a specialist medical negligence lawyer from Devonshires, called situation “outrageous” and called for the government to close the legal loophole.

Mr Pearce, a business consultant from Sandwich, Kent, needed an operation to try to repair his sinus after work by Dr Sabha, and also discovered the dentist had applied a crown to a perfectly health tooth.

“I felt physically violated”, he said. “I was really angry as I felt like he had breached the relationship between a doctor and his patient.”

Helen Pitt (Submitted)

Ms Pitt, who was treated by Dr Sahba for six years, may need to have her veneers replaced every ten years. She said: “I was so angry as I would never have had them fitted if I’d known that was the case.”

She added: “Dentists are in a position to do serious damage to their patients, so how can it be that dentists are allowed to have insurance that is discretionary and does not protect patients?”

Dr Sahba, who ran his practice just off Harley Street between 2009 and 2015, did not return from Sweden for a General Dental Council disciplinary hearing last year, when he struck off the professional register.

As well as botched procedures, he was found to have charged patients for work they did not receive and also lied about his qualifications.

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Why Trump’s battle isn’t over

Good evening. I’m Soumya Karlamangla, and it’s Monday, Oct. 5. Here’s what’s happening with the coronavirus in California and beyond.

After a chaotic weekend of conflicting information about President Trump’s battle with COVID-19, the First Patient headed home from Walter Reed National Military Medical Center on Monday evening.

His departure came just three days after he was hospitalized for COVID-19. During that time, he received supplemental oxygen, remdesevir and dexamethasone, medicines typically reserved for the sickest of patients. That Trump was given these treatments so soon after his positive test result was announced raised questions about when the president actually fell sick, when he was first diagnosed, and how serious his symptoms were. Those questions remain unanswered.

Trump and some of his staff maintain that his symptoms are mild. On Sunday, he staged a motorcade drive-by to wave at his supporters lined up outside Walter Reed. On Monday, the president tweeted a message that downplayed the severity of the disease.

“Don’t be afraid of Covid. Don’t let it dominate your life,” he wrote on Twitter. “I feel better than I did 20 years ago!”

Meanwhile, the number of Trump associates testing positive continues to grow. White House press secretary Kayleigh McEnany and aide Nick Luna tested positive for the virus, as did Riverside Pastor Greg Laurie, who attended the Sept. 26 Rose Garden event where Trump announced his nomination of Judge Amy Coney Barrett to the Supreme Court.

Even more could fall sick in the week ahead, as it typically takes between five and seven days to test positive after exposure. Trump traveled to multiple states in the week before the announcement of his diagnosis. Now health officials in New Jersey are trying to contact 200 people who may have been exposed to the virus at a Trump campaign event.

As for Trump’s prognosis, experts say he remains contagious and should isolate himself in the White House for 10 days to avoid infecting others. His physician, Dr. Sean Conley, told reporters that the president has “met or exceeded all standard hospital discharge criteria,” even as he cautioned that Trump could face a relapse and is not “entirely out of the woods yet.”

“If we can get through [next] Monday … then we will all take that deep sigh of relief,” he said.

By the numbers

California cases and deaths as of 4:00 p.m. PDT Monday:

 <span class="copyright">(Los Angeles Times Graphics)</span>
(Los Angeles Times Graphics)

Track the latest numbers and how they break down in California with our graphics.

See the current status of California’s reopening, county by county, with our tracker.

A map of California showing what tiers counties have been assigned based on their local levels of coronavirus risk.
A map of California showing what tiers counties have been assigned based on their local levels of coronavirus risk.
The tiers to which California counties are assigned based on coronavirus risk level. These determine what can reopen.
The tiers to which California counties are assigned based on coronavirus risk level. These determine what can reopen.

Across California

Months of lying in a hospital bed stripped away not only 50 pounds from Dr. Jay Buenaflor, but sometimes the will to live. The Imperial

Precision medicine uses multiomic details to battle kidney disease

September 10, 2020

6 min read


Source/Disclosures



Disclosures:
Bansal, Eadon, Jones-Smith, Kiryluk, and Sharma report no relevant financial disclosures.

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The value of precision medicine has been shown with the identification of the genetic causes of tumors that differ among patients. Applied to nephrology, precision medicine can offer an earlier look at the potential risk for kidney disease.

“Precision medicine is a personalized approach to disease management of the patient … The goal is to have the right dose, delivered at the right time, for the right patient,” according to Shweta Bansal, MD, an associate professor of nephrology at the University of Texas-San Antonio School of Medicine. “It is not about one approach that fits all patients. It must be tailored.”

The treatment regimen is the last step in precision medicine, Bansal said. The work begins with the detection of the origins of disease through genomics.

“[NIH director] Francis Collins said it most straightforward. Precision medicine is the application of prevention and treatment strategies that take individual variability into account,” Michael Eadon, MD, assistant professor of medicine in the divisions of nephrology and clinical pharmacology at Indiana University School of Medicine, told Nephrology News & Issues. “There has always been an overarching connotation that genomic information, either from your genome or downstream applications like gene expression, would be integrated into evidence-based medicine.”

Kumar Sharma, MD, chief of nephrology and professor of medicine at the University of Texas-San Antonio, said research at the Center for Renal Precision Medicine will reveal the likelihood of chronic kidney disease early in high-risk individuals.

Source: Center for Renal Precision Medicine.

Genomic testing

Two examples of the application of genomics to detect the risk of end-stage kidney disease is research on the efficacy of the drug tolvaptan for patients with autosomal-dominant polycystic kidney disease (ADPKD) and the identification of risk variants in the apolipoprotein L1 (APOL1) gene that can lead to kidney disease.

In a study in Clinical Journal of the American Society of Nephrology, David J. Friedman, MD, and colleagues wrote that many types of severe kidney disease are higher in Black patients than in other patient groups. That disparity is attributed to genetic variants in the apoL1 (APOL1) gene found only in individuals with recent African ancestry, the authors wrote. “These variants greatly increase rates of hypertension-associated ESKD, [focal segmental glomerulosclerosis] FSGS, HIV-associated nephropathy, and other forms of nondiabetic kidney disease.”

Friedman and colleagues said the discovery of the APOL1 risk variants has led to discussions about incorporating genetic testing in the screening process for living kidney donors. Those with the APOL1 genomic makeup could pass

Trump reports feeling better, but here’s why the next few days are ‘the real test’ in his COVID-19 battle

President Donald Trump’s battle with COVID-19 will come to a critical turning point in the next few days as the disease tests his immune system.



Donald Trump wearing a suit and tie: President Donald Trump is pictured speaking during the first presidential debate in Cleveland, Ohio.


© Julio Cortez, AP
President Donald Trump is pictured speaking during the first presidential debate in Cleveland, Ohio.

On Saturday, Trump and his doctors acknowledged the importance of the coming days as the illness enters what White House physician Dr. Sean Conley called “phase 2.”

In a video statement released Saturday evening from Walter Reed National Military Medical Center, Trump echoed the concern: “I’m starting to feel good. You don’t know over the next period of a few days, I guess that’s the real test, so we’ll be seeing what happens over those next couple of days.”

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The course of COVID-19 can be highly variable, but the next three to five days are likely to be crucial, physicians who have treated hundreds of coronavirus patients told USA TODAY.

Several days after symptoms of COVID-19 appear, the body’s immune system must make an important switch to fight the virus with precision — or possibly face life-threatening consequences.

COVID-19 patients can “look pretty good for a few days, then they go south,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University.

That rapid deterioration can occur when the body’s immune system, unable to successfully target the virus, causes widespread collateral damage as it “brings in the troops,” Schaffner said.

A typical timeframe for patents’ decline is about five to 10 days after the person starts getting sick, said Dr. J. Randall Curtis, a professor of pulmonary and critical care at the University of Washington school of medicine in Seattle. 

Conley on Saturday said Trump is in his third day of fighting the virus.

During the early part of a patient’s COVID-19 illness, the body uses an “agnostic” immune response, said Dr. Greg Poland, director and founder of Mayo Clinic Vaccine Research Group. It doesn’t know what it’s fighting, but realizes something potentially dangerous is occurring. That’s called the innate immune system.

Key to a successful recovery is an immune response that targets the coronavirus itself. That’s called the adaptive immune system. 

To avoid serious illness, a patient’s innate and adaptive immune systems must stay in balance, and the virus itself must not cause serious complications along the way.

Age is a risk factor. Older patients tend to be less successful in activating the adaptive response, according to Melissa Nolan, an infectious disease expert and professor at the University of South Carolina.

Trump turned 74 in June, putting him at 90-times higher risk of death than someone in their 20s, according to data from the U.S. Centers for Disease Control and Prevention.

But the course of COVID-19 can be highly variable. The president’s VIP medical treatment and access to cutting-edge therapies make the trajectory of the illness even tougher to predict.

Patients tend to see short-term fluctuations in their symptoms