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5 big questions on the White House’s botched handling of Trump’s coronavirus diagnosis

President Trump’s team of doctors at Walter Reed hospital said on Oct. 4 that he was given doses of the experimental drug, remdesivir and oxygen. (Video: The Washington Post)

On Saturday, White House physician Sean Conley stepped forward ostensibly to provide some clarity on the condition of the coronavirus-stricken President Trump. As with the doctors who came before him, though, what we have gotten from him over the past 24 hours is decidedly not that.

Conley’s comments Saturday and at a follow-up briefing Sunday have combined with other conflicting signals to yet again provide a hazy and misleading picture of the president’s health. But unlike his predecessors, this time we get it at a particularly precarious juncture in his presidency, when it’s literally a matter of national security.

As with previous flaps over Trump’s health, there is clearly tension between projecting the kind of strength he likes to see and providing actual, sober-minded details — a tension that White House Chief of Staff Mark Meadows seemed to acknowledge in his own updates on Trump’s situation.

Speaking to reporters Saturday, Meadows acknowledged that Trump was probably watching him on TV and “probably critiquing the way that I’m answering these questions.”

As of Sunday afternoon, there are very valid questions about whether anyone providing details of Trump’s health, including Conley and Meadows, can be trusted. Let’s run down the major questions and contradictions.

1. The oxygen question

At the start of Saturday’s briefings, Conley said Trump “this morning is not on oxygen, not having difficulty breathing or walking around the White House Medical Unit upstairs.”

But that seemed carefully worded. So he wasn’t on oxygen that morning, reporters noted, but what about before?

Conley repeatedly avoided a direct answer, focusing on the present tense:

QUESTION: And he is receiving no — he has not received any supplemental oxygen?
CONLEY: He is not on oxygen right now, that's right.
QUESTION: He has not received any at all?
CONLEY: He has not needed any this morning today at all. That’s right. Now he’s —
QUESTION: Has he ever been on supplemental oxygen?
CONLEY: Right now, he is not on oxygen.
QUESTION: I understand. I know you keep saying right now. But should we read into the fact that he had been previously —
CONLEY: Yesterday and today he was not on oxygen.
QUESTION: So, he has not been on it during his covid treatment?
CONLEY: He is not on oxygen right now.

When you keep dodging a question like that, it’s for one of two reasons: a) You don’t know the answer (which seems extremely unlikely given that this is Trump’s White House doctor), or, the much-more-likely b) Trump was on oxygen at some point, but Conley was trying to avoid acknowledging that.

The White House later confirmed, anonymously, that Trump was given oxygen at the White House on Friday before going to Walter Reed National Military Medical Center. But if that’s the case, it contradicts one of Conley’s answers, when he said, “Yesterday and today he was not on oxygen.”

Conley on Sunday also acknowledged Trump had been on oxygen, while building on his increasingly bizarre commentary. He said that he was “not necessarily” intending to mislead and that he wanted to be publicly “upbeat.” But he added that he didn’t want to say anything Saturday “that might steer the course of illness in another direction” — as if acknowledging the truth could worsen Trump’s condition.

White House physician Sean Conley explained his contradicting statements on President Trump’s covid-19 symptoms at Walter Reed hospital on Oct. 4. (Video: The Washington Post)

So for all intents and purposes, he was being deliberately misleading. That alone should call the White House’s candor on this stuff into extreme question. And why wouldn’t the same motivations apply to Sunday’s and future briefings? Are we to now believe that Conley isn’t putting the same rose-colored filter on everything?

It also bears noting that one of the experimental treatments Trump took, remdesivir, is generally used on and is most effective in patients who require supplemental oxygen. Ditto a steroid Conley said Sunday that Trump had taken, dexamethasone.

2. How bad off has Trump been?

There are other reasons to believe Trump has been in bad shape — even worse than acknowledged. But that emerging reality doesn’t really comport with what the White House was saying at the time.

Meadows said Saturday night on Fox News that there was a point at which Trump’s blood oxygenation plummeted and repeated that there was plenty of “concern.”

“Yesterday morning, we were real concerned with that,” Meadows said. “You know, he had a fever and his blood oxygen level had dropped rapidly.”

He added at another point: “The next 48 hours or so, with the history of this virus, we know can be tough. But he’s made unbelievable improvements from yesterday morning, when I know a number of us — the doctor and I — were very concerned.”

Likewise, after declining to detail Trump’s fever on Saturday, Conley said Sunday that it had been “high” and that Trump’s oxygen levels had dropped again Saturday. He added that Trump’s lungs had been scanned and that it showed the “expected findings,” without explaining what that meant. He also disclosed the use of dexamethasone, which the World Health Organization says is meant for severe cases.

None of that sounds much like what the White House was saying Friday. Its first statements on Trump’s condition said that he was experiencing “mild symptoms” and that he would remain at the White House while convalescing. But by Friday afternoon, that changed, with Trump being transported to Walter Reed.

Even at the time, though, the White House repeatedly said that this was done out of an “abundance of caution” and that Trump had only mild symptoms.

“President Trump remains in good spirits, has mild symptoms, and has been working throughout the day,” White House press secretary Kayleigh McEnany said about 5 p.m. Friday. “Out of an abundance of caution, and at the recommendation of his physician and medical experts, the president will be working from the presidential offices at Walter Reed for the next few days.”

So which was it? Extreme precautions will always be taken with the president’s health, but “mild symptoms” don’t sound anything like the reality we’re now learning about.

3. When was Trump diagnosed?

That wasn’t Conley’s only flub. He described Trump as being “just 72 hours into the diagnosis now.” Except 72 hours would’ve placed that diagnosis around midday Wednesday — before Trump traveled to Minnesota for a Wednesday rally and well before he traveled to New Jersey for a Thursday fundraiser. But Trump’s diagnosis had been announced in the wee hours of Friday morning.

A reporter pressed Conley on that Saturday, and he adjusted the timeline:

QUESTION: When was the positive diagnosis made? You said 72 hours. That would put it at Wednesday.
CONLEY: So, Thursday afternoon, following the news of a close contact, is when we repeated testing and, given clinical indications, had a little bit more concern. And that’s when — late that night we got the PCR confirmation that he was.

There were already questions about the decision to press forward with Thursday’s event, given that close Trump aide Hope Hicks had fallen ill in Minnesota and tested positive Thursday morning.

Conley soon issued a memo cleaning it up — explaining that by “72 hours” he simply meant “Day 3,” given that Trump was diagnosed Thursday night. But in Conley’s answer, he referred to “PCR confirmation,” referring to polymerase chain reaction, a more sensitive method of detecting the virus. The word “confirmation” could be read as verifying a previous test.

Given that the White House has access to rapid-response tests, was Trump given one of those earlier Thursday, after news of Hicks’s diagnosis? That would seem like a very logical time to want to test the president.

It also bears noting that Trump’s late-night appearance Thursday on Sean Hannity’s Fox News show sounded a lot like he thought he had already contracted the virus, but he indicated at the time that he was still awaiting his results.

And it’s not just about evaluating the wisdom of Thursday’s trip. Whenever Trump tested positive or began having symptoms is relevant to determining who around him might have been exposed, given you generally focus on contact tracing for 48 hours before the earlier of the two events.

4. What’s going on with Conley?

But even in that brief two-sentence clarifying statement, Conley committed two more errors.

He misspelled the maker of the antibody cocktail Trump was given, spelling it “Regeron” instead of “Regeneron.”

He also described the treatment as a “polyclonal antibody therapy.” Regeneron clarified that is not actually the case.

“It is a combination of two monoclonal antibodies — meaning each was produced by making identical copies, or clones, of an antibody gene in a single B cell,” Regeneron’s Alexandra Bowie told NBC News. “Polyclonal antibody cocktails refer to antibodies made by mixtures of B cells.”

These may seem like pedantic quibbles, but they yet again raise questions about how rigorous the White House’s review of the situation has been, along with Conley’s attention to detail when it comes to informing the public about it.

5. Is it safe for Pence to go about his business?

The White House decisions that have led to the growing outbreak have already been put under a microscope. In addition to Trump traveling to New Jersey after Hicks’s diagnosis Thursday, the White House held a largely mask-free announcement for Supreme Court nominee Amy Coney Barrett last weekend.

Several people who attended the outdoor event and then an indoor reception have since tested positive, including two GOP senators who sit on the committee that will consider Barrett’s nomination. And another person who attended, University of Notre Dame President John I. Jenkins, has said attendees “were told that it was safe to remove our masks” because they had been tested beforehand. Health officials have long said that negative tests are not guarantees that you are virus-free, given that there is an incubation period of several days and tests may not be 100 percent accurate.

Despite all this and despite the growing number of infections among people who have been around Trump, the White House has determined that one high-ranking official can continue business as usual: Vice President Pence.

“Under the guidelines of the Centers for Disease Control, the vice president is not considered a close contact with any individuals who have tested positive for the coronavirus, including President Donald Trump,” Pence’s doctor, Jesse T. Schonau, said Friday, noting that Pence had tested negative. “Vice President Pence does not need to quarantine. Vice President Pence remains in good health and is free to go about his normal activities.”

The Centers for Disease Control and Prevention defines “close contact” as being within six feet of someone who has been infected for at least 15 minutes, and it recommends quarantining for anyone who has been around an infected person in the two-day period before their symptoms begin or before they test positive.

Depending upon when Trump first developed symptoms — which is also the subject of uncertainty — that would require Pence not having been in close contact with him since early last week. It would also mean Pence wouldn’t have been in close contact with anyone else. Pence also attended the events surrounding Barrett’s announcement, including the indoor reception, though that falls outside the 48-hour window.

While perhaps justifiable under CDC guidelines, we’re also dealing with a situation in which the number of infected people in the White House and around Trump continues to grow — a universe that could at some point include someone with whom Pence has had more recent close contact. Pence is also second first in the line of succession, making his health paramount in the event that Trump can’t carry out his duties.

This post has been updated with Conley’s comments Sunday.