https://www.newyorker.com-By Dhruv Khullar
The President will probably be fine in the White House. But, by attempting to spin his own illness, he puts the rest of us at risk.Photograph by Erin Scott / Reuters
The President’s discharge from Walter Reed National Military Medical Center is the latest development in an unprecedented medical and political saga. Over the weekend, as positive test results trickled in from across the Administration and the Republican establishment, two narratives about his illness coalesced. The first, informed by medical experience and common sense, held that Trump was in real danger; the second, shaped by politics, proposed that he was basically fine. On Monday afternoon, Trump tried to lend momentum to the second story. “I will be leaving the great Walter Reed Medical Center today at 6:30 P.M.,” he wrote, on Twitter. “Feeling really good!” He added some advice that seemed not just ludicrous but—in light of the fact that more than two hundred and ten thousand Americans have died of the coronavirus—deranged: “Don’t be afraid of Covid. Don’t let it dominate your life. We have developed, under the Trump Administration, some really great drugs & knowledge.”
Almost certainly, Trump’s team will now describe him as a man who’s well on his way to defeating the virus, or who has already defeated it—an executive ready to lead, with COVID-19 firmly behind him. His opponents, by contrast, are sure to cast the discharge as another example of careless behavior from a reality-TV star who is more concerned with optics than science. Many Americans, meanwhile, may be understandably confused. Discharge certainly sounds good. It’s reasonable to imagine that, if the President is leaving the hospital, he must be O.K.
In fact, as doctors know, hospital discharge doesn’t mean—and has never meant—full recovery. In general, a discharge signifies only that a patient is no longer ill enough to require hospitalization and the continuous monitoring and ready access to therapy that hospitalization offers. When deciding whether it’s safe to discharge a patient, physicians consider many variables. They ask where a patient is being discharged to, and what level of support he’ll have there. They ask about the chance that his medical condition could worsen abruptly before he’s able to get help. An elderly patient being sent home alone to recover from pneumonia is one thing; an athlete being discharged to a rehabilitation center after knee surgery is another. Trump’s case falls somewhere in between. He is an older man with a serious condition that we’re told is improving, he is in the middle of an illness that could get much worse in the next week, and he is also leaving the hospital for the world’s most secure and responsive home. There, Trump’s condition will be watched closely by physicians working in the White House Medical Unit, an on-site facility with substantial resources. If his condition does worsen at the White House, he will have no difficulty gaining readmission to Walter Reed.
From a purely medical perspective, then, caring for Trump at the White House instead of the hospital may not be a wildly irresponsible decision. Not all patients with fevers, abnormal blood tests, or even lung damage need to—or should—remain hospitalized until they fully recover. In general, doctors prefer not to keep patients in the hospital for any longer than absolutely necessary, because hospitalization disrupts sleep, risks new infections, and can lead to elevated stress and other problems. Doctors also sometimes compromise in the face of patient preferences. (A person who may benefit from further monitoring may ask to be discharged early to attend her grandson’s high-school graduation, for example.) The risks of hospitalization may be of less concern to the President, who enjoys V.I.P. treatment at Walter Reed—and he is, of course, worried not about a family event but about looking “weak” during an election. Without access to important details about his illness, it’s hard to judge the risks of discharge with confidence; I would probably recommend against it, if the President were under my care. Still, on medical grounds, it is not outlandish.
From here, a few scenarios are possible. In the worst case, Trump might have to return to the hospital after his condition abruptly deteriorates. If that were to happen, it would be an alarming sign, portending a dire outcome or at least a prolonged illness. It’s more likely that he’ll continue to improve. But that doesn’t necessarily mean that he’ll quickly return to normal. Many COVID-19 patients, especially those with severe illness, experience fatigue, shortness of breath, cardiovascular problems, and cognitive issues that persist for months after infection. Some report “COVID fog”—they have problems with thinking, and suffer from anxiety and depression. Even among patients with less severe disease—those who never need hospital-level care—a third continue to report symptoms weeks later. These problems don’t require hospitalization, but they can interfere with a person’s ability to engage in everyday activities, to say nothing of governing a country. A discharged President isn’t necessarily a healthy President.
The real recklessness of Trump’s discharge is not personal; it’s the rest of us that he’s putting in harm’s way. By spinning his own illness, and denying its seriousness—“I feel better than I did 20 years ago!” he tweeted—he encourages his followers to deny reality; while receiving the world’s best medical care, he tells other Americans to embrace risk. After his discharge, Trump arrived at the White House, where he posed, maskless, on a balcony overlooking the South Lawn. He is in the midst of an active coronavirus infection—and so, in the coming days, there’s a good chance that he will pass the virus on to others who work at the White House, which has now become a viral hot zone. He seems determined to be the Superspreader-in-Chief. Sean Conley, the White House physician, has assured Americans that Trump “is back.” In a way, Conley is right. The President is spreading the virus and misinformation, as usual.
Dhruv Khullar is a physician and writer in New York City.