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Why the first week is important



The next five to ten days will be crucial for President Donald Trump after testing positive for Covid-19. Doctors warn that the disease can suddenly worsen after several days of relatively mild symptoms.

This is especially true for patients with two of the greatest risk factors for serious and even life-threatening complications of the disease: obesity and age. At 74 years of age and a body mass index of 30.5, which qualifies him as obese, Trump fulfills both criteria.

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“I̵

7;m worried,” said Dr. Vin Gupta, pulmonologist and associate assistant professor at UW Medicine in Seattle, on NBC’s “TODAY” Friday.

“I’ve taken care of several patients with this one-two punch,” said Gupta. “If they get sick, if they are symptomatic, they can quickly lead to intensive care.”

Research has also shown that men from Covid-19 tend to perform worse than women.

White House chief of staff Mark Meadows told reporters Friday that the president was experiencing “mild symptoms” but declined to elaborate. First Lady Melania Trump tweeted that she too has mild symptoms but “feels good overall”. A letter from the White House doctor confirming positive test results for both Trumps said they were “fine at this point”.

Only time will tell how the virus affects them. “The hallmark of this infection is its unpredictability,” said Dr. Michael Saag, Associate Dean of Global Health at the University of Alabama. “It is impossible to know what will clinically happen to someone once they are infected.”

Saag doesn’t just treat Covid-19 patients; In March he had a serious illness.

“The most common symptom is severe fatigue. Having experienced this infection myself, I can underline the word profoundly,” Saag said, adding that fatigue is generally the longest lasting symptom.

“I would predict that if he starts to have symptoms, he will experience some degree of fatigue from now through Election Day.”

It is not known when the president was infected. Knowing this would be key in determining how his doctors will monitor and possibly treat him.

“I try to get as much control as possible if my patient becomes infected with the virus,” said Dr. Pieter Cohen, a doctor with the Cambridge Health Alliance Respiratory Clinic near Boston. “If the president was exposed to the coronavirus less than five days ago, it is very early in the infection.”

Cohen and other doctors who have been looking after Covid-19 patients for months say the infection has two main parts: an initial phase with minimal to no symptoms, followed by a more severe phase.

“Then there are the later, more worrying sick days, usually days four to eight, but later as well,” said Cohen. “Then serious complications begin, which often begin with difficulty breathing.”

Dr. Josh Denson, a pulmonologist and intensive care doctor at Tulane Medical Center in New Orleans, said it was rare for a person to get very sick in the first few days after being infected.

“That could drag on,” said Denson. “If he recovers, it will take about a week. But I’ve left some patients seriously ill more than 2-3 weeks after the first infection.”

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The Centers for Disease Control and Prevention Policy states that the President should be isolated and in a “sick room or area and away from other people” for at least 10 days.

It’s likely that during this time Trump’s oxygen levels will be carefully monitored with a device called a pulse oximeter, Gupta said. Monitoring oxygen levels is vital as it can drop in people with Covid-19 even if they don’t feel sick.

“His doctors will check his oxygen levels. Is he short of breath? Does he have a fever? Does he have chills or a cough? Extreme vigilance is required here,” he added.

Saag also said that shortness of breath, especially when walking, could be an important predictor of a complication like pneumonia. Patients who are about to enter this second phase of the disease may develop a dry cough.

“I can tell because these patients are difficult to test. I’ll say take a breath and they’ll be about halfway through and just start coughing,” Saag said.

Other symptoms may include difficulty concentrating and chest pain.

Doctors can treat any symptoms the president may develop, but there is no known treatment that has been shown to prevent Covid-19 patients from progressing from the early stages of the disease to the second, potentially more dangerous, stage, Cohen said.

It is possible that Trump’s doctors could offer him remdesivir, convalescent plasma, or a similar type of treatment called a monoclonal antibody. However, all of these require intravenous infusions, and Remdesivir is given over a five-day period.

The Food and Drug Administration has issued emergency clearances for remdesivir and plasma, but studies of these treatments are ongoing. With the potential benefit comes a potential risk.

“Like many other things about this epidemic,” Saag said, “this is a huge experiment.”

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