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Unanswered questions remain over Trump’s health

Dr. Sean Conley, President Trump’s physician, said the president had “continued to improve” and could be discharged from Walter Reed medical center as soon as Monday. Dr. Craig Spencer, director of global health emergency medicine at New York-Presbyterian and Columbia University Medical Center joins Hari Sreenivasan to discuss the president’s diagnosis and some unanswered questions that remain.

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  • Hari Sreenivasan:

    For more on the president's diagnosis and treatment, I spoke with Dr. Craig Spencer, Director of Global Health in Emergency Medicine at New York-Presbyterian and Columbia University Medical Center.

    Dr. Spencer, it's been a couple of days now that the president has been in the hospital, there's been a couple of briefings and some information released by the White House. What are you still concerned about?

  • Craig Spencer:

    I'm concerned because I think there are still more questions than there are answers. Today's briefing, the Sunday briefing, certainly gave us more information than what we got yesterday. I think they did allude to the fact that they weren't completely forthcoming yesterday. And I think what they said was that they were trying to convey an upbeat attitude of the team, which is great. But I don't think that's necessarily what medical providers are supposed to do.

    We're supposed to report on what's actually happening. And I do believe that it's important for the American public to understand what's happening with the president's illness. This is both a health issue as well as a national security issue. We're in the middle of a pandemic that's taken over 200,000 lives in the United States. So I think we need more details.

  • Hari Sreenivasan:

    One of the things that the doctor mentioned that they saw in his lung scans what they would expect to, and that there was nothing that was of clinical concern. So what are the things that you'd expect when somebody is going through COVID?

  • Craig Spencer:

    I think it's most important to point out that they didn't say normal. So it means it's not normal. What I normally expect when I do an X-ray or a CT scan of someone which COVID-19 is what we call bilateral ground-glass opacity or infiltrates. Basically, this kind of looks like a haziness on both sides of the lung. It looks pretty characteristic for COVID-19. We've seen this a lot, especially since March and April here in New York City. Other things, though, are possible pneumonias, other things that we may see in chest X-rays or CT scans could also be considered normal in a COVID-19 chest X-ray.

  • Hari Sreenivasan:

    There was a new drug added to this, a steroid dexamethasone, and that has shown at least some trials to decrease the rate of mortality. Good idea?

  • Craig Spencer:

    It's really hard to say. I think we need more details. Yes, you're right, dexamethasone, which is a steroid meant to reduce inflammation, is one of the medications that's been shown to have the most profound impact on decreasing mortality. That being said, the impact was primarily in patients who were being mechanically ventilated, so on a ventilator or receiving supplemental oxygen.

    For patients who were not on oxygen, there was actually some hinting that it may make things worse as opposed to actually help. It's hard for me to speculate without knowing all the details but if you were my patient, a 74-year-old man not currently on oxygen, I think there'd be a lot more questions. I'd need a lot more information before I decide to start that.

  • Hari Sreenivasan:

    I want to ask about the experimental drug, because he's the President of the United States. Should he have access to anything that's showing any promise or should we be taking the most conservative approach possible because he's the President of the United States?

  • Craig Spencer:

    This is a huge ethical question. You could make the argument that right now we don't have really many magic bullets for this treatment and the President of the United States needs to receive the best cutting-edge care. There does seem to be a good indication that things like the Regeneron monoclonal antibodies are helpful and that the benefits outweigh the risks.

    Others are saying that this is treating the president as a guinea pig and it's not the right thing to do. I think this is a discussion that needs to happen among the medical team involving the patient and involving kind of everyone else that will be impacted by this to determine whether or not this is the right course of treatment. And I presume that's what's happened here. The same thing that would happen if I were taking care of a similar patient in my emergency department.

  • Hari Sreenivasan:

    I also wonder, you and I are talking about this drug. Everybody is talking about this drug. If it's still an experimental drug, what is the ripple effect on any sort of a clinical trial? If it doesn't work, do I want to sign up for a clinical trial with a drug that didn't famously work on the president? Or if it did work, right? I mean, isn't that kind of tainting the process a little bit?

  • Craig Spencer:

    Absolutely. This was a problem that we had with convalescent plasma, if you remember that announcement at the end of August. Convalescent plasma had been given to tens of thousands of patients already. But we still didn't have good data on whether or not it actually worked. That's because it was being given under a separate program outside of clinical trials, meaning that you could ask for it or could be offered and you didn't necessarily have to be offered to be part of a clinical trial. So they could say, hey, do you want to receive this medication that may potentially help, as opposed to, do you want to be in a clinical trial where you may receive a medication where this may help?

    The result is that without that good data, we don't know for convalescent plasma whether it actually works. And it could be the same here with the Regeneron. If it gets an emergency use authorization from the FDA, people could potentially be receiving it outside of clinical trials. And it may make it harder for us to understand whether or not it's actually clinically beneficial.

  • Hari Sreenivasan:

    What do we know about people that have mild symptoms early on but have kind of longer term systems that fly under the radar that don't give them the same physical fatigue as a flu would and so forth?

  • Craig Spencer:

    You know, it's only been eight or nine months, but we have thousands and thousands of patients already that are reporting long term symptoms. They are labeling it 'Long COVID' or 'COVID long-haulers.' Many of them, regardless of whether their initial symptoms were mild, moderate or severe are continuing to have symptoms of fatigue, difficulty breathing, many months later. We've seen many articles already come out and a lot of research looking at myocarditis, which is an inflammation of the heart muscle. This is very common with other viral illnesses.

    I think what we're seeing here is that the scale of COVID, of this pandemic, is so much, so much higher than really anything we've seen before. So even if a small fraction of one percent of patients were infected with COVID have long term symptoms, when you multiply that by tens of millions of cases, you're going to have a pretty huge number of people, many of which are going to continue to be experiencing symptoms or issues long after the pandemic is gone.

  • Hari Sreenivasan:

    And to those folks who watch this and say, let's say best case scenario, the president recovers and is back in the White House in a couple of days and decides to go back on the campaign trail and says, "You know what? I don't need to wear a mask because I've already had COVID." What's wrong with that?

  • Craig Spencer:

    One, I still think that the president, everyone else in this country right now needs to set a precedent and wear a mask. If this virus can infect the president, it can infect all of us. It's not done with the U.S. It's going to continue to roll around in this country.

    And really, one of the best things that we can do, in addition to distancing, washing our hands, you know, being in pretty well-ventilated areas is wearing a mask.

    Now, we do know that for many patients, there is likely some immunity in the months following an infection with COVID-19. You build up antibodies. We suspect that that makes it impossible for the overwhelming majority of people to be reinfected. However, we've seen over a dozen cases of very well-documented reinfection in people who have already had COVID.

    So that means that immunity is certainly not 100 percent for 100 percent of people. And it's going to be really hard to say whether that's going to be the case for the president. I would recommend to him and everyone else that's had this to take the same precautions, because you don't know if you're one of those people who will be potentially unlucky enough to have COVID twice.

  • Hari Sreenivasan:

    If people follow you and have seen you before it really it was in the wake of not just Ebola, but what happened this spring in New York City. We've heard doctors in Texas say it this past week. It was doctors in Wisconsin talking about how overwhelmed their facilities are. When you keep seeing this, what goes through your mind?

  • Craig Spencer:

    We got hit on the head here in New York City. It's happened in Florida and Arizona and Texas. It will continue to happen in every community in this country that does not take it seriously. Just as I said in March, it remains true in October: if this virus finds you, it will infect you, and for a significant percentage of the people that are infected, they will have a negative outcome. They may die from this. And many of them, unfortunately, even if they survive, can have long-term consequences.

  • Hari Sreenivasan:

    Dr. Craig Spencer, thanks so much.

  • Craig Spencer:

    Thank you.

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