By Robin Foster and E.J. Mundell
SUNDAY, Oct. 11, 2020 (HealthDay News)
Hours after President Donald Trump held a rally on the White House lawn for hundreds of supporters, his doctor said he is “no longer considered a transmission risk to others.”
In a memo released Saturday night, White House physician Dr. Sean Conley said he was sharing information about the status of Trump’s coronavirus infection with permission from Trump, The New York Times reported. But the amount of information he provided was limited. Trump was first diagnosed with COVID-19 on Oct. 2.
Health experts have repeatedly questioned the severity of Trump’s illness, and his health could still deteriorate in the next few days, they added.
“I don’t think he’s out of the woods for certain,” Dr. Krutika Kuppalli, an infectious disease physician based in South Carolina, told the Times. Trump’s recent course of steroids, which suppress certain parts of the immune system, could also make him vulnerable to other infections, Kuppalli added. “I would still be careful with someone like him.”
The start date of Trump’s symptoms has also remained unclear, the Times reported. According to the U.S. Centers for Disease Control and Prevention, most people stop being infectious 10 days after becoming sick. By Conley’s assessment, Trump would have needed to show signs of his illness on Wednesday, Sept. 30, for Saturday to qualify as 10 days from the onset of symptoms.
“This evening I am happy to report that, in addition to the president meeting CDC criteria for the safe discontinuation of isolation, this morning’s COVID P.C.R. sample demonstrates, by currently recognized standards, he is no longer considered a transmission risk to others,” Conley said in his memo. “Now at day 10 from symptoms onset, fever-free for well over 24 hours and all symptoms improved, the assortment of advanced diagnostic tests obtained reveal there is no longer evidence of actively replicating virus,” he wrote.
“In addition, sequential testing throughout his illness has demonstrated decreasing viral loads that correlate with increasing cycle threshold times, as well as decreasing and now undetectable subgenomic [COVID] mRNA,” Conley added.
But several experts were skeptical about the wording describing Trump’s test results, which did not explicitly categorize the president as “negative” for the coronavirus.
Conley’s memo suggested Trump’s viral load was dropping, but appeared to still be detectable. And the mRNA Conley mentioned is a part of the virus that can be spotted by lab work, Susan Butler-Wu, a clinical microbiologist at the University of Southern California, told the Times. But that procedure is “experimental at this point,” she added.
There is also no test that can definitively show if a person at the end of a coronavirus infection is still contagious, Melissa Miller, a clinical microbiologist at the University of North Carolina School of Medicine, told the newspaper.
It was unclear when Trump last had a fever or whether his symptoms were resolved or merely better than they were before, the Times reported. He was treated with an experimental antibody cocktail, the antiviral remdesivir and dexamethasone, a heavy steroid that appeared intended to reduce inflammation in his lungs. He has said he is off the medication now, the Times reported.
Upper Midwest hit hard by coronavirus
Meanwhile, the new coronavirus continued to strike the Upper Midwest with a vengeance, as Wisconsin and the Dakotas became COVID-19 hotspots and health officials scrambled for hospital beds.
After months where residents of those states downplayed the virus and rejected mask requirements, all three now lead all other states in new cases per capita, the Associated Press reported.
“It’s an emotional roller coaster,” said Melissa Resch, a nurse at Wisconsin’s Aspirus Wausau Hospital, which is working to add beds and reassign staff to keep up with a rising caseload of seriously ill COVID-19 patients.
“Just yesterday I had a patient say, ‘It’s OK, you guys took good care of me, but it’s OK to let me go,'” Resch told the AP. “I’ve cried with the respiratory unit, I’ve cried with managers. I cry at home. I’ve seen nurses crying openly in the hallway.”
What is unfolding in the Upper Midwest mirrors what has happened in other parts of the country since the pandemic began. In the spring, New York City hastily built field hospitals as emergency rooms were flooded with COVID-19 patients. Then, the coronavirus spread to states like Arizona, Texas, Florida and California over the summer. It then moved into the Midwest.
“What worries me is we haven’t learned our lessons,” Ali Mokdad, a professor of health metrics sciences at the University of Washington in Seattle, told the AP. He cited data showing mask usage at 39% in Wisconsin and 45% in the Dakotas, both below the U.S. average of 50%.
“People let down their guard. They said, ‘It’s not us. It’s big cities,'” Mokdad said. “But eventually, like any other virus, it’s going to spread. Nobody lives in a bubble in this country.”
In Wisconsin, health officials plan to open a field hospital at the state fairgrounds to prevent health care centers from being overwhelmed by virus cases, the AP reported.
Meanwhile, the Northeast is now seeing the first signs of what might become a second wave of coronavirus, the Times reported. The rise in case numbers has prompted state and local officials to reverse course, tightening restrictions on businesses, schools and outdoor spaces.
Michael Osterholm, an infectious diseases expert at the University of Minnesota, told the Times that no state should let down its guard. “The point is, once you let up on the brake, then eventually, slowly, it comes back,” he said.
Two companies seek emergency approval for antibody cocktails
Regeneron Pharmaceuticals Inc. said this week that it is seeking emergency approval from the U.S. Food and Drug Administration for an experimental antibody cocktail given to President Donald Trump shortly after he was diagnosed with COVID-19.
Hours before the company made the announcement, Trump proclaimed in a video released by the White House that the drug had an “unbelievable” effect on his recovery from coronavirus infection, the Washington Post reported.
“I think this was the key,” Trump said, after acknowledging that the antibody cocktail was one of several drugs he was prescribed by his medical team. While there is no hard evidence yet proving the drug’s effectiveness in humans, it has shown promise in treating mild cases of the new coronavirus, the Post reported.
In his video, Trump said, “I have emergency-use authorization all set, and we’ve got to get it signed now.” However, an FDA spokeswoman told the Times that the agency does not confirm or deny product applications.
Regeneron said in its statement that it could initially produce doses of the antibody cocktail for 50,000 patients, and then ramp production up to doses for 300,000 patients in the next few months if granted emergency authorization.
The antibody cocktail is now in late-stage testing. The company has granted fewer than 10 “compassionate use” requests allowing people not enrolled in its trials to use the drug, the AP reported.
The U.S. government first inked a contract with Regeneron back in July, and has promised to distribute initial doses of the treatment at no cost if it is approved, the Post reported.
Regeneron isn’t the only company developing an antibody cocktail to battle COVID-19 infection: Eli Lilly and Co. announced earlier on Wednesday that it was seeking emergency-use authorization from the FDA for a similar cocktail. Both treatments use lab-made antibodies to give patients’ immune systems a boost. In both cases, scaling up production to meet demand is expected to be a major challenge, the Post reported.
COVID continues to spread around the globe
By Sunday, the U.S. coronavirus case count passed 7.7 million while the death toll passed 214,000, according to a Times tally.
According to the same tally, the top five states in coronavirus cases as of Sunday were: California with over 854,000; Texas with more than 827,600; Florida with nearly 729,000; New York with over 477,800; and Illinois with more than 320,000.
Curbing the spread of the coronavirus in the rest of the world remains challenging.
By Sunday, India’s coronavirus case count passed 7 million, a Johns Hopkins tally showed.
More than 108,000 coronavirus patients have died in India, according to the Hopkins tally, but when measured as a proportion of the population, the country has had far fewer deaths than many others. Doctors say this reflects India’s younger and leaner population.
Still, the country’s public health system is severely strained, and some sick patients cannot find hospital beds, the Times said. Only the United States has more coronavirus cases.
Meanwhile, Brazil passed 5 million cases and had over 150,000 deaths as of Sunday, the Hopkins tally showed.
Cases are also spiking in Russia: The country’s coronavirus case count has neared 1.3 million. As of Sunday, the reported death toll in Russia was over 22,400, the Hopkins tally showed.
Worldwide, the number of reported infections passed 37.2 million on Sunday, with over 1 million deaths, according to the Hopkins tally.
Copyright © 2020 HealthDay. All rights reserved.
SOURCES: The New York Times; Washington Post; Associated Press; Oct. 7, 2020, statement, Regeneron Pharmaceuticals Inc.