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Near real-time analysis of the press conference, starting with things that stand out, and worth revisiting:
âtransient dropsâ âbelow 94%â â2Lâ âabout an hourâ
âdexamethasone startedâ
moving about with only âmild symptomsâ â what are those?
/1
âtransient dropsâ âbelow 94%â â2Lâ âabout an hourââdexamethasone startedâmoving about with only âmild symptomsâ â what are those?/1
"vital signs are stableâ â thatâs not helpful, and not consistent with the two âtransientâ drops in oxygen saturation/2
âcontinued monitoring of cardiac, liver, and kidney functionâ â I understand the liver and kidney function based on the known adverse effect profile of Remdesivir, but the cardiac function seems to lack context.see: FDA EUA for Remdesivir: https://www.fda.gov/media/137566/download /3
âheâs had noneâ in reference to side effects from Remdesivir: Not in line with Conleyâs comments from yesterday, which made it sound like the primary reason for the hospitalization was the Remdesivir monitoring.
Taken together, it now sounds like oxygenation was the reason/4
Regarding dexamethasone: âhe received his first dose of that yesterdayâThis is a big one b/c:
Raises the level of concern significantly
Explains why Trump had energy to record video yesterday
Explains why yesterdayâs presser abruptly terminated(Iâll circle back)
Possible discharge "tomorrowâPerhaps @JReinerMD can speak to the facilities at the WH, but to me this sounds like they feel they have the staff and equipment they need to handle eventualities at the WH.
I donât necessarily see this as a reassuring sign.
/6
âexpected findingsâ on chest imagingâ - doesnât answer the question about the type of imaging
- also means that he has pneumonia, the question now is: has a CT scan been obtained, and did that show ground glass opacities?
/7
âheâs doing really wellâ -- Dr. Sean Dunlap (?) begs to differ based on his body language. He seemed to be nodding in agreement about the discharge planning piece of it, and then seemed taken aback by the comment.Not sure what to think there.
/8
Circling back to dexamethasone:
Itâs concerning because the best available evidence for its use comes from the RECOVERY Trial, which showed a benefit for patients needing help with their breathing and/or oxygen levels, but not for those without these issues⌠/9
Itâs concerning because the best available evidence for its use comes from the RECOVERY Trial, which showed a benefit for patients needing help with their breathing and/or oxygen levels, but not for those without these issues⌠/9
The use of dexamethasone for milder cases â such as that depicted by Dr. Conley (but not the other physicians) -- is not without its risks, and may actually worsen outcomes.
Taken together: heâs sicker than Conley is admitting, or theyâre toeing the line of overly aggressive/10
Taken together: heâs sicker than Conley is admitting, or theyâre toeing the line of overly aggressive/10
Continuing the dexamethasone observations:
Explains why Trump had the energy to record a video yesterday.
This temporary âboostâ in energy is a well-knownphenomenon with dexamethasone in particular (but also seen in other steroids of the same class).
/11
Explains why Trump had the energy to record a video yesterday.This temporary âboostâ in energy is a well-knownphenomenon with dexamethasone in particular (but also seen in other steroids of the same class).
/11
Final thoughts:
Yesterdayâs presser ended abruptly when asked re: dexamethasone
Why was Conley so evasive yesterday, but so willing to offer that information today?
Given the inconsistencies noted already, this remains the biggest open question in my mind.
/end
Yesterdayâs presser ended abruptly when asked re: dexamethasoneWhy was Conley so evasive yesterday, but so willing to offer that information today?
Given the inconsistencies noted already, this remains the biggest open question in my mind.
/end
