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I'll be sharing updates here from today's (Oct 4) POTUS #COVID19 medical briefing:
President 'has continued to improve', 'frequent ups and downs'
The President has experienced two drops of oxygen saturation.
He's on dexamethasone.
On Friday, high fever and oxygen level dipping. Concerned for rapid progression at that time.
Was on 2L, saturation back above 95%. Was on that for an hour. "Off and gone"
That's when they decided to bring him to Walter Reed. So he WAS on oxygen.
Regarding his clinical status:
"Continues to improve"
Vital signs stable. On room air (no oxygen). No shortness of breath. Walking around "without limitation or disability"
"Continues to improve"
Vital signs stable. On room air (no oxygen). No shortness of breath. Walking around "without limitation or disability"
Continued 'normal or improving findings' on lab work.
Now to Dr Garibaldi...
Now to Dr Garibaldi...
Completed second dose of Remdesivir. Tolerated well. No side effects. Liver and kidney function normal. That's good - sometimes there are side effects from this.
First dose of steroid dexamethasone given yesterday.
Maybe discharge from hospital as early as tomorrow.
The medical team is sharing @realDonaldTrump's praise for the excellent medical team at Walter Reed.
Had another oxygen saturation drop yesterday to 93%. Not really low.
"potential benefits of [dexamethasone]' outweighed risk...
Currently blood oxygen level is 98%.
What's on imaging? 'Some expected findings', but no more details.
What's on imaging? 'Some expected findings', but no more details.
Little cagey about oxygen saturations.
"Whose statement about the president's medical health should we believe"
Meadows was referring to fever and drop in oxygen saturation.
Being reassured it was just transient.
Meadows was referring to fever and drop in oxygen saturation.
Being reassured it was just transient.
"Why isn't president wearing mask in videos?"
He says because medical staff is wearing PPE.
That's not appropriate.
He says because medical staff is wearing PPE.
That's not appropriate.
'We perform lung spirometry on him'
'He's maxing it out'
'He's maxing it out'
Why didn't you tell us he was getting oxygen?
"I was trying to reflect the upbeat message..."
'came off that we were trying to hide something'
You were. Come on.
"I was trying to reflect the upbeat message..."
'came off that we were trying to hide something'
You were. Come on.
MY TAKEAWAYS:
They were misleading yesterday. We knew it. They admitted it.
Condition is apparently improving. Not on oxygen now. That's good.
Wouldn't share any imaging findings.
Some labs were 'improving' - don't know which were initially abnormal.
And steroids...
They were misleading yesterday. We knew it. They admitted it.
Condition is apparently improving. Not on oxygen now. That's good.
Wouldn't share any imaging findings.
Some labs were 'improving' - don't know which were initially abnormal.
And steroids...
Didn't answer how high the fever was.
STILL DON'T KNOW LAST TEST NEGATIVE RESULT!
Deferred questions - 'have to check with the nurses'. That's strange. They need to know.
STILL DON'T KNOW LAST TEST NEGATIVE RESULT!
Deferred questions - 'have to check with the nurses'. That's strange. They need to know.
And dexamethasone...
There's a lot to say here, but let me quote the actual article: https://www.nejm.org/doi/full/10.1056/NEJMoa2021436
There's a lot to say here, but let me quote the actual article: https://www.nejm.org/doi/full/10.1056/NEJMoa2021436
“The RECOVERY trial provides evidence that treatment with dexamethasone at a dose of 6 mg once daily for up to 10 days reduces 28-day mortality in patients with Covid-19 who are receiving respiratory support..."
"We found no benefit (and the possibility of harm) among patients who did not require oxygen.”
So dexamethasone was found to be beneficial ONLY in patients on a ventilator OR on oxygen.
NOT on patients who don't need oxygen.
There was even the possibility of harm in that patient population.
NOT on patients who don't need oxygen.
There was even the possibility of harm in that patient population.
They say 'expected findings' on CXR/CT:
I would expect bibasilar ground glass appearance. But could also be more consistent with pneumonia?
They didn't say 'normal', so not normal.
I would expect bibasilar ground glass appearance. But could also be more consistent with pneumonia?
They didn't say 'normal', so not normal.
The President is now on at least 3 medications:
Regeneron mAbs
Remdesivir
And now steroids (dexamethasone)
Regeneron mAbs
Remdesivir
And now steroids (dexamethasone)
And still no hydroxychloroquine FYI.
Personally, I don't think we are getting full transparency.
There are still some important missing data points here.
We don't know about last negative test. Fever course (is it no fever ON antipyretics?). Imaging results. Abnormal labs.
There are still some important missing data points here.
We don't know about last negative test. Fever course (is it no fever ON antipyretics?). Imaging results. Abnormal labs.
The timeline still doesn't add up.
Generally speaking, I wouldn't discharge a patient on 3 medications - including one that's only given by IV. Of course he's a different patient and they can undoubtedly do a lot of this in the White House.
Generally speaking, I wouldn't discharge a patient on 3 medications - including one that's only given by IV. Of course he's a different patient and they can undoubtedly do a lot of this in the White House.
Ok. I'm signing off. Still a bit confused. Need more details.
Wishing the president (and ALL the 30k #COVID19 patients currently hospitalized throughout the country without access to the same experimental meds and level of care) a swift recovery!
WEAR A F'ING MASK PEOPLE!
Wishing the president (and ALL the 30k #COVID19 patients currently hospitalized throughout the country without access to the same experimental meds and level of care) a swift recovery!
WEAR A F'ING MASK PEOPLE!
I want to add this great thread by infectious disease specialist @celinegounder with her thoughts on the POTUS health update. Most notably she WOULD start dexamethasone based on what we heard today. https://twitter.com/celinegounder/status/1312794752186748930
