October 9, 2020

White House physician says Trump could resume public activities Saturday. Is that risky?

Daily Briefing

    Sean Conley, the White House physician, in a memo Thursday said President Trump has remained "stable" and "devoid" of Covid-19 symptoms, suggesting he could safely return to public engagements as soon as Saturday.

    Update on Trump's health

    In the memo, Conley, a naval officer, said Trump has completed his Covid-19 treatment and has remained "stable" since returning to the White House on Monday. "Saturday will be day 10 since Thursday's diagnosis, and based on the trajectory of advanced diagnostics the team has been conducting, I fully anticipate the president's safe return to public engagements at that time," Conley wrote. White House officials have declined to disclose if Trump has tested negative for the coronavirus.

    In an interview with Fox Business on Thursday, Trump said he's feeling well. "I'm feeling good. Really good. I think perfect," he said. "I think I'm better to the point where I'd love to do a rally tonight," adding, "I don't think I'm contagious at all."

    In a separate interview with Fox News, Trump said was asked whether he had tested negative for the virus since his diagnosis. The president said he expected to be tested on Friday. "There's no reason to test all the time," he said.

    In the meantime, Trump suggested he'd like to get back out on the campaign trail and hold a rally in Florida on Saturday. Trump's re-election campaign also issued a statement calling for the second presidential debate to be held in person, after it was announced the debate would be held virtually in light of Trump's Covid-19 diagnosis.

    "There is, therefore, no medical reason why the Commission on Presidential Debates should shift the debate to a virtual setting, postpone it, or otherwise alter it in any way," the statement said.

    However, Frank Fahrenkopf, co-founder of the commission, said the debate will still not be held in person.

    Should Trump isolate for longer? CDC guidance offers limited clarity.

    CDC recommends those who test positive for the coronavirus stay isolated for at least 10 days after their positive test or at least 10 days after first onset of symptoms. Those with a moderate or severe case of Covid-19 could be infectious for 20 days or longer, according to CDC.

    CDC guidance suggests that severe cases include patients who were "admitted to a hospital and needed oxygen," as occurred in the president's case. But it offers no fixed timeline for how long such patients should remain in isolation, saying only that "your health care provider may recommend that you stay in isolation for longer than 10 days after your symptoms first appeared (possibly up to 20 days)."

    Some medical experts say there's risk involved in resuming public activities too early, although they say the lack of full transparency about Trump's condition and treatment make it difficult to weigh the dangers.Based on what has been publicly revealed, "No, I would not clear him to start public engagements on Saturday," Phyllis Tien, an infectious disease physician at the University of California, San Francisco, told the New York Times.

    Experts say there's no exact way to tell if a person with the new coronavirus is still contagious, however Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said two negative polymerase chain reaction (PCR) tests 24 hours apart is key.

    "So, if the president goes 10 days without symptoms, and they do the tests that we were talking about, then you could make the assumption, based on good science, that he is not infected," Fauci said.

    William Morice, who oversees laboratories at the Mayo Clinic, said if the White House did daily PCR tests on Trump, "you could watch [his viral load] go down. If his viral load is low, the chance he can spread the virus is low as well."

    Still, two negative tests aren't a guarantee Trump is no longer contagious—and it's unclear from Trump's response during his interview with Fox if he's received two consecutive tests.

    "At this point there's no diagnostic test that tells you whether a person [who's] infected remains infectious," Benjamin Pinsky, leader of virology labs at Stanford University, said. "There is absolutely a chain of unknowns" (Haberman, New York Times, 10/9; Wu, New York Times, 10/8; Miller et. al., Associated Press, 10/9; Choi, Politico, 10/8; Renault, Associated Press, 10/9).

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