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President Trump’s doctor said Trump is not currently on oxygen, but would not say whether he ever received oxygen since his COVID-19 diagnosis.

USA TODAY

Doctors appeared before reporters outside Walter Reed National Military Medical Center on Sunday morning to update the public on the status of President Donald Trump’s health after testing positive for COVID-19.  

White House physician Sean Conley said the president is improving and, later in the day, Trump showed his progress by waving to supporters from the back seat of an SUV as it drove by a demonstration. 

But even as Trump and his doctors say he may be discharged as early as Monday, some health experts are troubled by details of his condition and treatment. 

Here are five takeaways from Sunday’s news conference. 

Donald Trump, on dexamethasone, may be discharged ‘as early as tomorrow’

Dr. Brian Garibaldi: We did initiate dexamethasone therapy and he received his first dose of that yesterday … If he continues to look and feel as well as he does today, our hope is that we can plan for a discharge as early as (Monday) to the White House where he can continue his treatment course.

Dexamethasone has only been shown to benefit extremely ill COVID-19 patients. Russell Buhr, a professor of pulmonary and critical care medicine at the University of California-Los Angeles, said patients are recommended the steroid if they require supplemental oxygen or require mechanical ventilation. It is not given as a pre-emptive prophylactic, he said.

Dexamethasone also is not typically advised for patients with mild symptoms, as steroids can sometimes “hinder your body’s ability to fight the virus,” Yale Medicine’s Dr. Onyema Ogbuagu told USA TODAY in June.

A further issue: Researchers found that dexamethasone can interfere with the benefits of remesdivir, another medication Trump is currently taking. “Clinicians need to be cautious regarding this interaction,” they wrote in an study published in August in the journal SN Comprehensive Clinical Medicine.

What complications could remdesivir lead to?

Dr. Brian Garibaldi: The president yesterday evening completed a second dose of remdesivir. He’s tolerated that infusion while we’ve been monitoring for any potential side effects and he has had none that we can tell.

Remdesivir is taken intravenously over the course of five days. It is generally given to patients who need oxygen but do not require ventilation. In August, the FDA approved the drug for widespread use — to some concern from experts.

Side effects of remdesivir, per University of Minnesota’s Center for Infectious Disease Research and Policy, include nausea, possible liver damage and worsening respiratory failure. 

What do ‘transient drops’ in Donald Trump’s oxygen saturation refer to?

Dr. Sean Conley: There was that momentary episode of the high fever and that temporary drop in the saturation, which prompted us to act expediently to move him up here. Fortunately, that was really a very transient limited episode…Yesterday there was another episode where he dropped down about 93%. He (didn’t) ever feel short of breath, we watched it and it returned back up.

“Transient drops” in oxygen saturation — or the levels of oxygen in a patient’s blood — is known as hypoxemia. Supplemental oxygen is typically given to patients whose oxygen saturation levels are reduced to around 92%, said Buhr.

It is possible Trump may be experiencing silent hypoxemia, which takes place when a patient does not experience shortness of breath, even as blood oxygen levels are significantly low.

Patients who go back on oxygen after previously being taken off it, explained University of Washington pulmonology professor Dr. J Randall Curtis, may have “gotten a little bit worse.”

COVID-19 pneumonia: What X-ray images could be telling us

Question to Dr. Conley: And what do the X-rays and CT scan show? Are there signs of pneumonia? Are there signs of lung involvement were any damage to the lungs? 

Dr. Sean Conley: Yeah, so we’re tracking all of that. There’s some expected findings, but nothing of any major clinical concern. 

Curtis says COVID-19 pneumonia can typically be seen as an abnormality in a chest X-ray. The abnormality shows up as a “ground-glass pattern,” referring to a hazy white area in a lung X-ray or CT scan showing infection or inflammation. Typical lung tissue shows up as grey.

In Curtis’ experience treating more than 100 COVID-19 patients in Seattle, people who require oxygen and get dexamethasone would typically have shown evidence of lung damage.

Pneumonia is an infection in the lung causing inflammation in the alveoli, the tiny air sacs in the lungs that transfer oxygen from the lungs to the bloodstream. It can range from mild to dangerously severe. 

Why is it important for Donald Trump to be ‘out of bed as much as possible’?

Dr. Brian Garibaldi: Our plan for today is to have him to eat and drink, be up out of bed as much as possible to be mobile.

Doctors recommend COVID-19 patients walk during their recovery. Walking promotes blood flow of oxygen throughout the body while maintaining normal breathing functions, according to OakBend Medical Center, near Houston. It also can help stop the development of blood clots that could lead to a stroke.

However, experts say patients shouldn’t overexert themselves. Noah Greenspan, a cardiopulmonary physical therapist and founder of the Pulmonary Wellness Foundation in New York City recommends recovering patients incrementally increase exercise starting from two minutes of walking a day.

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