Opinion | Trump says he feels great. My experience — as a doctor and patient — says that might not last. - The Washington Post

"Michael S. Saag is associate dean for global health and director of the Center for AIDS Research at the University of Alabama at Birmingham.



As I watched President Trump standing on the Truman Balcony after returning from the hospital Monday night, I saw a reflection of myself in March, when I was infected with covid-19: short-winded after walking up a flight of steps. Trying to hide the shortness of breath and stifle a cough. Telling myself it was mostly over; that I had been through the worst and was on the mend.



“Feeling really good,” Trump tweeted Monday afternoon, and I hope that remains the case for him. But based on my experience — as a physician treating covid-19 patients and as a patient myself — I have some sober advice for the president and the country: That feeling of good health might not last.



This is a menacing virus, with sometimes misleading ups and terrifying downs. Symptoms come and go, only to return again, and again: fever, aches, chills, exhaustion. ”Don’t let it dominate your lives,” Trump said of covid-19. Unfortunately, Mr. President, the virus doesn’t give us much of a choice in the matter, especially when we are fighting through the infection itself.



The natural course of covid-19 in an infected person is summed up in one word: unpredictable. The usual course of infection, which I experienced, starts off slow, builds up over the first five to seven days, peaks around day 10 to day 12, and then fades away by day 14 or so. By the official account, Trump on Tuesday was at day six, which is why most physicians with experience treating this infection claim he’s not yet out of the woods.



Will Trump’s infection simply disappear, as his recent tweets imply? To his advantage, he’s been treated with a regimen that no one else in the world has received, two antiviral agents (remdesivir and Regeneron’s dual monoclonal antibody cocktail) along with a potent anti-inflammatory steroid, dexamethasone. By now, many hospitalized patients have received a combination of remdesivir and dexamethasone and the results are positive overall: reduced mortality and fewer days in the hospital.



The briefings on President Trump's health are a deliberate exercise in obfuscation, says physician and Post contributing columnist Leana S. Wen. (Video: Joy Sharon Yi/Photo: Micheal Reynolds/Bloomberg, Alex Edelman/Getty/The Washington Post)

The notion of using two antiviral agents simultaneously is employed with other viral infections, such as HIV and hepatitis C. I suppose the president is thinking this novel approach will stop the virus in its tracks, freeing him from the usual ravages of infection experienced by most everyone else who has suffered through symptoms of this horrific disease. It’s hard to know with a test panel composed of a single person.



More likely, the president will have a shortened course of symptoms but, like most covid-19 patients, will experience moments of seemingly good health, followed by stretches where his energy vanishes and he needs to lie down. This is what covid-19 infection does. It’s like a dog with a toy, shaking it vigorously for a few moments, resting for a while, and then shaking vigorously again. The beast — in this case, it’s a beast — doesn’t let go until it’s good and ready.



Based on my experiences as both an infected person and a provider to dozens of patients fighting the infection, I would expect the president to struggle this week with waxing and waning symptoms of covid-19: paroxysms of coughing, shortness of breath after mild exertion, headaches, moments of “fuzzy thinking,” intermittent fever and profound episodes of fatigue. The fatigue is particularly vexing and is the one symptom that likely will linger for weeks after he has recovered from the others. I wouldn’t be surprised if it persisted up to Election Day.



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Owing to the lack of transparency into the president’s condition, I can only speculate what his day-to-day symptoms are or how he truly is feeling moment to moment. Yet, having fought through this nightmare, I can imagine what it is like for him. The fear of the unknown, the terrifying nights when I wasn’t sure I would make it to the next morning without having to be hospitalized — that is something I never want to experience again.



The president urged Americans not to “be afraid” of covid-19. Perhaps that is good advice, but for sure, we all need to respect this virus: how it is transmitted, what it does to those people it infects and how it leaves countless family members bereaved after it has taken a loved one to the grave. As we learn more about the virus, it is incumbent on scientists and clinicians to do what we can to improve therapies and create vaccines. And it is incumbent on all of us to use what we know to reduce its spread: avoid crowds, keep physical distance and, for goodness’ sake, wear a mask.



Even — or perhaps especially — on the Truman Balcony."



Opinion | Trump says he feels great. My experience — as a doctor and patient — says that might not last. - The Washington Post