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What we know and what we don’t about Trump’s COVID illness

President Donald Trump’s release from Walter Reed National Military Medical Center and return to the White House make one thing blindingly clear: He is eager to get his battle with COVID-19 behind him, as a reelection campaign clouded by the pandemic draws to a close.

Little else about the president’s illness was certain, though. Trump’s doctors and aides were withholding key information on just how sick the president was, what risks lie ahead for Trump under progression of the illness and under treatment by a novel combination of powerful medications, and whether the White House’s aides, security guards, cooks, cleaners and servers from infection by the still-contagious president.

What we know, and what we don’t know:


WHAT WE KNOW

Trump made clear he is eager to put his three-night stay at Walter Reed behind him, and to play down a pandemic that has killed more than 209,000 Americans. “Feeling really good!” he tweeted. “Don’t be afraid of Covid.”

Disclosures over the weekend that the president’s blood oxygen levels had dropped below normal levels at least twice, and that he was receiving steroid treatment typically used in more serious cases, suggested the president was enduring more than a mild case of COVID-19.

Doctors say that Trump will continue to receive his treatments from the White House. Trump on Friday began a five-day course of remdesivir, a Gilead Sciences drug currently used for moderately and severely ill patients. He received a single dose Friday of an experimental drug from Regeneron Pharmaceuticals Inc. that supplies antibodies to help the immune system fight the virus.

Trump’s also received treatment with the steroid dexamethasone. It has only been proven to help in more serious cases. Among concerns with its use — steroids can tamp down the body’s own ability to fight off infection.

Trump’s doctor, Navy Cmdr. Sean Conley, said Monday that Trump “may not entirely be out of the woods yet” but he and the team “agree that all our evaluations and, most importantly, his clinical status support the president’s safe return home, where he’ll be surrounded by world-class medical care.”

Conley said the president could resume his normal schedule once “there is no evidence of live virus still present.”

The Centers for Disease Control and Prevention says those with mild to moderate symptoms — and it’s not clear if the president’s case falls within that range — should isolate for at least 10 days.

Back at the White House, the ranks grew Monday of infected people in the president’s circle. Press secretary Kayleigh McEnany announced she had tested positive for the virus Monday and was entering quarantine.

The White House says it is doing contact tracing for people who have been at White House events and with Trump and that “appropriate notifications and recommendations are being made.”

Stephanie Grisham, the spokeswoman for first lady Melania Trump, said “all precautions are being taken” to safeguard those serving the ailing Trumps in the White House’s residential quarters, in consultation with the White House’s medical unit.

Trump video tells supporters, ‘Don’t be afraid’

WASHINGTON (AP) — The Latest on President Donald Trump’s health after his COVID-19 diagnosis and hospitalization, and infections of close aides and others (all times local):

8:15 p.m.

President Donald Trump has tweeted a new video taped after he returned to the White House in which he tells the American public not to be afraid of COVID-19, which has killed more than 200,000 people in the U.S. and more than a million worldwide.

In message that is sure to infuriate medical doctors trying to keep the country safe, Trump says he has “learned so much” about the virus he contracted. And he says: “Don’t let it dominate. Don’t let it take over your lives.”

Trump was treated at Walter Reed National Military Medical Center by a team of some of the country’s best doctors and he received an experimental drug not readily available to the public.

Nonetheless, he told his followers who do not have access to the same level of care that they had little to fear.

“Don’t be afraid of it,” he said. “You’re going to beat it. We have the best medical equipment. We have the best medicines.”

Trump also again defended his decision to continue traveling and holding events before he got sick, saying he “knew there’s danger to it, but I had to it. I stood out front. I led.”

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7 p.m.

President Donald Trump says he feels “good” as he arrives back at the White House after three days at Walter Reed National Military Medical Center, where he was being treated for COVID-19.

Marine One landed at the White House just before 7 p.m. Monday just as the sun was setting.

He then walked upstairs to the South Portico balcony, took off his mask and stuffed it in his pocket, and flashed a double thumbs-up to the cameras. He saluted as he watched the helicopter lift back off. He walked into the White House without putting his mask back on.

Trump’s doctors said he would continue his recovery from the White House, where he will be cared for 24/7 by a team of doctors and nurses. His doctor says he’s still contagious.

Trump walked out the golden front doors of Walter Reed earlier Monday and offered a thumbs-up and fist bump before he stepped into an SUV that carried him to the helicopter. Lights had been set up to illuminate the scene for cameras.

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6:40 p.m.

President Donald Trump pumped his fist as he departed a military hospital after a three-day stay for the coronavirus.

A masked Trump walked out of Walter Reed National Military Medical Center on Monday evening toward a waiting SUV that carried him to Marine One for the short flight back to the White House. He said, “Thank you very much,” to the assembled reporters.

Even before he walked out the doors, he tweeted that he’d be back on the campaign trail soon.

The 74-year-old Trump was expected to continue his recovery at the White House,

What We Know And Don’t Know About His Status Amid Confusion Over Privacy

KEY POINTS

  • Doctors have refused to release information about Trump’s bloodwork after treatment for COVID-19
  • Trump will receive further treatment at the White House medical unit
  • Trump is 74 and overweight, two factors that place him in a high-risk category for developing complications

President Donald Trump may have won release from Walter Reed National Military Hospital Monday, but there are numerous unanswered questions about his condition.

Trump was airlifted to the hospital Friday after developing COVID-19 symptoms, including high fever and falling blood oxygen levels. He has been treated with an experimental antibody cocktail, the still-being-evaluated antiviral Remdesivir and the powerful anti-inflammatory steroid dexamethasone, which generally is given to the most seriously ill.

The president’s doctors have been relentlessly optimistic about his condition but have refused to answer several questions, including when Trump last tested negative for the virus and whether there is evidence of lung damage.

Trump was to be given a fourth infusion of Remdesivir before heading back to the White House, which has a fully equipped medical unit where he can receive further treatment. A fifth dose of the drug was to be administered Friday. He also was to continue taking dexamethasone.

White House physician Dr. Sean Conley acknowledged Trump’s full recovery is not assured. He said doctors were in uncharted territory because Trump had received the therapies so early in the course of the disease.

“If we can get through to Monday with him remaining the same or improving better yet, then we will all take that final deep sigh of relief,” Conley told reporters. However, though he said Trump is fever-free, dexamethasone can mask elevated temperatures.

The timeline for when Trump first tested positive for the infection was unclear. The White House has refused to say when he last tested negative. Asked Monday, Conley responded he didn’t want to go “backward,” adding that contact tracing was underway.

It also was unclear exactly how ill Trump was, with contradictory statements from the medical team, Trump aides and administration officials.

Asked whether there was evidence of pneumonia, Conley said doctors had seen “some expected findings,” but were not overly concerned.

“We’ve done routine standard imaging. I’m just not at liberty to discuss,” Conley said. He also declined to discuss Trump’s bloodwork or the quarantine precautions that will be in place at the White House once the president returns.

Conley said he made less-than-accurate statements about the president’s condition on Saturday because he wanted to keep Trump’s spirits up.

About a dozen people in Trump’s inner circle have tested positive for coronavirus, including his wife, Melania.

Trump is 74 and overweight, two factors that place him in a high-risk category for developing complications.

You can watch the full news conference below:

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What We Do & Don’t Know Right Now About Donald Trump’s Condition After COVID-19 Infection

Win McNamee/Getty Images Donald Trump at Tuesday’s debate

President Donald Trump announced early Friday morning that he and First Lady Melania Trump have tested positive for COVID-19.

Trump, 74, has long sought to downplay the novel coronavirus in the last seven months, contending at times that the highly contagious respiratory illness is a political “hoax” and just last week saying that it “affects virtually nobody.”

Including the president, the novel coronavirus has infected more than 7.3 million people in the U.S. and has killed at least 207,699, according to a New York Times tracker.

“Tonight, @FLOTUS and I tested positive for COVID-19,” Trump tweeted. “We will begin our quarantine and recovery process immediately. We will get through this TOGETHER!”

White House doctor Sean Conley went on to clarify over the weekend that Trump was first diagnosed Thursday evening.

Here’s everything we know so far. This story will be updated.

Joshua Roberts/Getty Images Donald Trump

What Symptoms Has Trump Shown?

Although White House doctor Sean Conley initially said on Friday that the first couple planned on remaining at home as they recovered from COVID-19, later that day Trump was admitted to the Walter Reed National Military Medical Center out of an “abundance of caution.”

“President Trump remains in good spirts, has mild symptoms, and has been working throughout the day,” White House Press Secretary Kayleigh McEnany said Friday afternoon.

Conley offered more details about the president’s symptoms the following day.

During a Saturday press conference, he said Trump had been fever-free for 24 hours and that his other symptoms, which included fatigue “are now resolving and improving.” Conley also noted that the president was not currently receiving oxygen, although he evaded specific questions about Trump’s fever or whether he had ever received supplemental oxygen.

However, a source familiar with the president’s health offered conflicting information. “The president’s vitals over the last 24 hours were very concerning and the next 48 hours will be critical in terms of his care,” the source said, according to a White House pool report. “We’re still not on a clear path to recovery.”

Trump was last seen by reporters on Friday as he departed the White House for Walter Reed hospital and was seen wearing a mask and giving reporters a thumbs-up sign.

What Led to Trump’s Positive Test?

MANDEL NGAN/AFP via Getty President Donald Trump

Trump’s positive result came after the news one of his top aides, Hope Hicks, had tested positive for the virus on Wednesday.

Hicks, a former 31-year-old public relations consultant, had reportedly been in the small group of confidants helping the president prepare for Tuesday’s debate. She also traveled with Trump on Air Force One to-and-from Minnesota on Wednesday evening for a campaign rally.

Several thousands showed up to the president’s outdoor rally, while pool reporters traveling with Trump noted “most” in the crowd did not wear masks. The president also met with local state lawmakers during private fundraising events in the state.

“It’s very, very hard when you

Presidential Physicians Don’t Always Tell the Public the Full Story

“He is suffering from the teeth,” Bryant said. “That is all.”

Bryant was the president of the New York Academy of Medicine and would later serve as the president of the American Medical Association. His credentials were unimpeachable.

And so the next day, the papers dutifully reported that Cleveland was suffering from nothing worse than a toothache, and the nation was reassured.

But Bryant had lied. Cleveland was in fact very ill.

In late June, Bryant had examined a lesion on the roof of Cleveland’s mouth and declared it a “bad-looking tenant.” The doctor recommended it be removed immediately. But Cleveland didn’t want the public to know he was ill, so the operation was performed on a yacht owned by one of the president’s friends.

In a 90-minute operation, a hastily assembled surgical team, sworn to secrecy, removed the tumor, along with five teeth and much of Cleveland’s upper-left palate and jawbone. The procedure took place entirely within the patient’s mouth, so that no external scars would betray the operation.

Cleveland eventually recovered, and the truth would not be known until long after he died, in 1908.

Cleveland insisted on keeping his condition secret, because he didn’t want to alarm the public. At the time, the nation was mired in an economic depression now known as the Panic of 1893. If the public knew he had cancer, Cleveland believed, the stock market would crash.

Cleveland, like all presidents, was also loath to appear weak in any way. (This is especially true of the incumbent, of course.) Presidents have an almost pathological need to appear vigorous, regardless of any infirmities. And if they can’t appear vigorous, then they try not to appear at all.

That was the case with Woodrow Wilson. On October 2, 1919, he suffered a massive stroke at the White House. The left side of his body was paralyzed. It was a pivotal time for the country: The Senate was debating whether the United States would join the League of Nations. According to the historian Robert Ferrell, “The president should have resigned immediately.” But rather than resign, Wilson went into hiding inside the White House, even concealing his ailment from his own Cabinet. His physician, Cary T. Grayson, announced that the president was merely suffering from “nervous exhaustion.” For the next four months, Wilson conducted virtually no official business. The United States never joined the League of Nations.

Donald Trump has been less transparent than most presidents about his health. His trip to Walter Reed National Military Medical Center last November remains shrouded in mystery. He is also prone to exaggeration. Harold Bornstein, the doctor who attended Trump before he became president, wrote in a 2015 letter that the then-candidate was in “astonishingly excellent” health and would be the “healthiest individual ever elected to the presidency.” Bornstein later insisted that Trump himself had dictated the letter.

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With people living longer, advisors make sure you don’t outlive money

sturti | E+ | Getty Images

Alfred Abraham has had colon cancer, prostate cancer, open heart surgery and his left eye removed.

Yet at 100, he’s still alive and well. Every day, he and his partner Brian eat fruit and salad and go for walks. He and his family were planning a big party to celebrate his becoming a centenarian this past April, but the pandemic wouldn’t allow for it. 

“At the present time, I’m doing very nicely despite what’s going on,” said Abraham, a former CPA and bank executive who lives in New York. 

One big part of why he’s doing so well is his financial advisor, he says.

More from Advisor Insight:
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“He’s doing a very good job for me,” Abraham said. “We talk at least once or twice a month to discuss my investments and financial plans.” 

There were more than 450,000 centenarians in the world in 2015, a  number that is expected to balloon to more than 3.6 million by 2050.

Although life expectancy has actually decreased slightly over the last few years, due to a rise in drug overdoses, suicide rates and liver disease, it’s becoming more likely that people make it into their 80s, 90s and beyond. A 65-year-old woman today has a 50% chance of living to 85, and a 25% chance of crossing into her 90s, according to the Schwab Center for Financial Research. 

One of the biggest concerns investors have is outliving their money – and it’s often their financial advisors who work with them to make sure this fear doesn’t become a reality.

As a result, financial advisors are increasingly accounting for the real possibility that their clients could be around for very long time. That includes finding ways to stretch out their savings and to protect their money from the risks and expenses associated with old age.

Amy Irvine

Source: Amy Irvine

“When we’re planning for clients, we’re planning to 95 or 100,” said Amy Irvine, a certified financial planner at Rooted Planning Group in Corning, New York.

“Many of our retirees are still in great shape,” she said. “They’re living longer, and requiring resources for longer.”

Stretching out clients’ savings 

Carolyn McClanahan, a CFP and director of financial planning at Life Planning Partners in Jacksonville, Florida, said too many advisors don’t think about how long their clients could live. 

“If you have a client who lives a very healthy life, and especially if they have longevity in their family, you should be planning to age 100,” McClanahan said. 

And sometimes the planning needs to go in the opposite direction, she said. 

“If you have clients who are absolutely not taking care of themselves, say they’re obese and have diabetes and smoke, you shouldn’t be using age 100 because you’re going to make that person not enjoy their money because they’re worried about running out,” she said.

Still,

Mosquitoes Don’t Help Spread Coronavirus

Mosquitoes and other biting insects can’t spread SARS-CoV-2, researchers reported, even if the blood suckers have had plenty of opportunity over the summer with everyone spending more time outside.

Unlike dengue, malaria, and Zika virus, the virus behind COVID-19 couldn’t replicate after being ingested by mosquitoes, Dana Mitzel, PhD, of the U.S. Department of Agriculture in Manhattan, Kansas, and colleagues reported on the preprint server bioRxiv without peer review.

“For arthropods to be transmission-competent vectors, the respective pathogen must be acquired from a host during blood feeding, then infect the midgut, escape the midgut barrier, disseminate to and infect the salivary glands, and finally be transmitted to a susceptible host during subsequent blood feeding,” they wrote.

The group fed SARS-CoV-2 spiked blood to a variety of common biting insects found in the U.S. that spread other RNA viruses — Culicoides sonorensis biting midges (important in spreading disease to farm animals), as well as Culex tarsalis and Culex quinquefasciatus mosquitoes (important in spreading disease to humans) — and then watched them for 10 days to mimic natural infection routes.

While most of the midges (85%) had detectable coronavirus RNA, only 17% of the Cx. tarsalis mosquitoes and 50% of the Cx. quinquefasciatus mosquitoes did at 10 days. But no structural changes were seen in any of their cells that would be expected with viral invasion, indicating they were not infected and would not be able to transmit replicating virus.

Testing cell lines derived from C. sonorensis midges, Aedes aegypti mosquitoes, Cx. quinquefasciatus mosquitoes, and Cx. tarsalis mosquitoes also showed no SARS-CoV-2 susceptibility.

The findings square with those of Italian researchers, who found no evidence of replication of the virus after it was fed to common or tiger mosquitoes, and another study affirming no infection or replication in Ae. aegypti or albopictus mosquitoes, which are also common in the U.S. The World Health Organization and CDC have also pointed to no evidence of mosquito-borne spread.

Disclosures

The researchers disclosed no relevant conflicts of interest.

Note that bioRxiv is a preprint server for posting manuscripts prior to undergoing formal peer review. As such, the data and conclusions should be regarded as preliminary until published in a peer-reviewed journal.

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AHA News: Despite Same Symptoms, Men and Women Don’t Always Get Same Mini-Stroke Diagnosis | Health News

(HealthDay)

WEDNESDAY, Sept. 30, 2020 (American Heart Association News) — A transient ischemic attack, often called a mini-stroke, usually doesn’t last long or cause permanent damage. But it still needs medical attention, because it may be warning of a future stroke that can have dire consequences.

Research has shown women are less likely than men to be diagnosed with TIAs, and a study published Wednesday in the American Heart Association journal Stroke aimed to explore why.

“Unlike a heart attack, the diagnosis of TIA doesn’t depend on a biomarker or a diagnostic test where you can definitely say this occurred,” said lead author Sophia Gocan, a stroke prevention nurse specialist at The Ottawa Hospital in Canada. “So, it really relies on a stroke specialist’s expertise to say if this was a concerning event. That’s important because the specialist’s decision determines whether that patient is going to go on to have different diagnostic tests or be prescribed therapies to prevent a stroke.”

The researchers examined the records of 1,770 patients referred to The Ottawa Hospital Stroke Prevention Clinic in 2015 to see if men and women reporting common symptoms were diagnosed differently.

Stroke is the fifth-leading cause of death in the United States, killing nearly 150,000 people each year, and is a major cause of disability for those who survive. It occurs when the blood supply to the brain is interrupted, either by an artery that is blocked or ruptures. In a TIA, the blockage is only temporary, so some people may not notice it or ignore the dangers.

But the symptoms are the same, including numbness, severe headache, confusion, slurred speech and dizziness.

While many of the symptoms led to the same diagnosis in both men and women, the Ottawa study found several gender-specific differences.

Women over age 60 who reported a sudden onset of symptoms or an event lasting more than one minute were more likely than men to be diagnosed with TIA or stroke. But men who reported pain or sensory loss, such as trouble seeing, were more likely to receive the diagnosis than women.

“We know this is really just scratching the surface,” Gocan said. “Maybe this is an indication that women need to use certain keywords when they’re talking about their diagnosis to be taken as seriously, or maybe women and men describe their symptoms differently. That could be an important thing to look at in the future.”

One factor in the disparity, Gocan said, could be migraine headaches are more common among women. That might make women less likely to suspect a headache is signaling a TIA or stroke – or doctors more likely to dismiss a woman’s headache as a migraine.

“We’ve (medically) treated men and women the same for so many years,” she said. “We need to make sure we’re not painting everyone with the same brush when they may need a different approach.”

Dr. Karen Furie, chair of neurology at the Alpert Medical School of Brown University in Providence, Rhode Island, said