Oct 6, 2020
Trump’s Doctor Has Job of Containing Patient Eager to Campaign
(Bloomberg) -- Donald Trump’s physician, Sean Conley, faces the daunting task of trying to keep the most powerful Covid-19 patient in the world from worsening his illness or infecting others, even as the president itches to return to the campaign trail to rescue his struggling bid for re-election.
Whether Conley and his White House Medical Unit can succeed remains an open question. In a West Wing where politics has taken priority over recommended public health measures, Conley’s office was unable to protect the White House staff, visitors or the president himself from the virus.
Now, the doctor must help determine when Trump can be released from isolation at home in the White House to return to the campaign trail, where he has fallen well behind former Vice President Joe Biden in both public opinion polls and fundraising. Moving too soon could risk the president’s health, but the longer he waits, the more pressure he’ll likely face from Trump himself.
Conley has given public assurances that his White House unit is outfitted to provide the president all the care he needs to recover from the illness. The White House doesn’t disclose its precise capabilities, but the unit has at least two locations in the complex, equipped to treat ailments from headaches to full-blown medical emergencies.
With more White House staff testing positive for coronavirus each day, Conley’s unit will have a tough time keeping the rest of the West Wing safe. And the White House appears to have eschewed rigorous contact tracing around its own outbreak, a practice at the heart of the Centers for Disease Control and Prevention efforts to contain the virus’s spread.
Still, Conley’s biggest challenge may be containing Trump, who has given every indication of a patient giving orders to his doctor -- not the other way around. On Tuesday, Trump showed defiance against the virus, again comparing it to the less lethal and less contagious common influenza.
An advocate of experimental medications, Trump has taken two powerful drugs normally administered to patients with more severe cases of Covid-19, as well as an “antibody cocktail” promoted by cable television hosts but not yet authorized by the Food and Drug Administration.
While hospitalized, Trump on Sunday had his motorcade drive him past supporters outside Walter Reed National Military Medical Center, a decision independent doctors called unconscionable. On Monday, Trump announced his own discharge from the hospital before Conley briefed reporters on his condition.
Trump appears eager to return to the rhythms of life in the White House, with aides wondering how long they’ll be able to persuade him to stay in the residence and off the campaign trail.
Whether the public believes Trump is making the right choice relies in part on Conley’s credibility, as he continues to relay information about the president’s health to the public. Conley acknowledged on Sunday that he had made misleading statements the day before about whether Trump was ever administered supplemental oxygen.
On Tuesday, Conley issued a brief memorandum saying that the president “reports no symptoms” of the disease. Trump’s vital signs are stable and his blood oxygen saturation is 95% to 97%, Conley said -- within normal levels, according to the Mayo Clinic.
Bill Lang, who served as deputy physician to the president under Bill Clinton and George W. Bush, said the president has the right to withhold health information for privacy reasons. But that can backfire.
“Be as complete as possible, be accurate in everything you say and bad news doesn’t get better with age. Those are kind of the three general guidelines we used,” Lang said.
A White House official said Conley’s statements have never been influenced by politics and he has never been pressured to say anything other than the truth.
White House spokesman Judd Deere called Conley a “qualified, talented physician with a wealth of experience well-suited to serve President Trump.”
Not Contact Tracing
The presidential physician said he did not initially share some details of Trump’s condition because “I was trying to reflect the upbeat attitude of the team, the president.”
Trump’s doctors on Monday released vital signs for the president that they had previously declined to provide, such as his temperature and respiratory rate, as Conley declared the president “met or exceeded” criteria to be released from the hospital.
But he cited federal patient privacy law in refusing to comment on Trump’s lung scans and also declined to say when the president last had a negative coronavirus test, which could help determine when he contracted the virus.
Conley’s office has also come under criticism for its contact-tracing effort around the White House outbreak. Some guests at recent White House events attended by infected people have said in interviews they have not heard from contact tracers.
An epidemiologist from the CDC was added to the White House Medical Unit in March to help with contact tracing, according to a White House official. And the White House says it is following CDC guidelines, which recommend tracing of those who were less than six feet away from an infected person for 15 minutes or longer in the 48 hours before they fell ill.
Conley, a 40-year old osteopathic doctor in the Navy, became physician to the president in 2018 after his predecessor, Ronny Jackson, was nominated by Trump to lead the Department of Veterans Affairs. Jackson, who that year delivered a report on Trump’s health that critics considered incomplete and inappropriately positive, withdrew from consideration for the cabinet job amid a probe of his workplace behavior. He’s now favored to win a Texas congressional seat in November.
Conley has also offered glowing assessments of Trump’s health, writing in a 2019 memo that he expected the president to remain in “very good” health “for the duration of his presidency, and beyond.”
Chain of Command
The doctor also raised concerns in May when he prescribed Trump hydroxycholoroquine as a preventive measure against Covid-19 infection, even though the FDA at the time cautioned against its use outside a hospital setting.
While fighting Covid-19, Trump was also prescribed Remdesivir, a Gilead Sciences Inc. antiviral authorized for hospitalized coronavirus patients. Dexamethasone, a steroid Trump received, is recommended by the National Institutes for Health only for hospitalized patients who also need assistance breathing. It can cause side effects like mood swings and aggression.
Conley, an emergency physician and commander in the Navy, joined the White House Medical Unit in late 2016 after serving in a trauma unit in Afghanistan. He is a 2006 graduate of the Philadelphia College of Osteopathic Medicine and completed his residency in 2013 at the Naval medical center in Portsmouth, Virginia.
Conley’s position in the military chain of command make it harder for him to push back against the president, according to a person familiar with the dynamics. But that does not mean Trump is strong-arming him at every turn.
“If Dr. Conley, as the quarterback of the medical team, strongly voiced his objection” to leaving the hospital, Lang said, “my sense is that the president would not go against him.”
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