In photos and videos released by the White House, there has been hardly any sign that President Trump is sick, and painting in the broadest of strokes, his doctors have offered a fairly rosy portrait of his condition.
But to some outside experts who examined that portrait closely, some things seemed off.
How much, for example, should people make of the president’s fluctuating oxygen levels? And why did his doctors decide to begin treatment with a steroid drug?
To some infectious disease experts, there were signs that Mr. Trump may be suffering a more severe case of Covid-19, the disease caused by the coronavirus, than his physicians have acknowledged.
“This is no longer aspirationally positive,” Dr. Esther Choo, a professor of emergency medicine at Oregon Health & Science University in Portland, said of the doctors’ statements. “And it’s much more than just an ‘abundance of caution’ kind of thing.”
Based on his doctors’ account, Mr. Trump’s symptoms appear to have rapidly progressed since he announced early Friday that he had tested positive for the coronavirus.
Mr. Trump had a “high fever” on Friday, and his blood oxygen levels dropped on two occasions, his doctors said, including to a level that can indicate that a patient’s lungs are compromised. The symptom is seen in many patients with severe Covid-19.
The president’s medical team also said that he had been prescribed dexamethasone. This is a steroid used to head off an immune system overreaction that kills many Covid-19 patients. And it is generally reserved for those with severe illness.
“The dexamethasone is the most mystifying of the drugs we’re seeing him being given at this point,” said Dr. Thomas McGinn, a top physician at Northwell Health, the largest health care provider in New York State.
The drug, he said, was normally not used unless the patient’s condition seemed to be deteriorating.
“Suddenly, they’re throwing the kitchen sink at him,” Dr. McGinn said. “It raises the question: Is he sicker than we’re hearing, or are they being overly aggressive because he is the president, in a way that could be potentially harmful?”
Of course, given the patient, there may be another explanation.
Some experts raised an additional possibility: that the president is directing his own care, and demanding intense treatment despite risks he may not fully understand. The pattern even has a name: V.I.P. syndrome.
Early Monday, Mr. Trump fired off more than a dozen tweets — most of them written in his signature all-caps style — listing key Republican topics like the Second Amendment, religious freedom and abortion — followed by “VOTE!”
As President Trump and some of his associates test positive for the coronavirus, the number of new cases reported each day across the United States has been slowly rising.
The country is at a key moment in the pandemic, and spread of the virus could worsen significantly through the autumn, experts fear, as colder weather forces people indoors. Every day, some 43,000 new cases are being reported — far fewer than during the surge in the summer, but still an uncomfortably large number.
Some of the country’s least populous states are now seeing their highest infection rates.
When coastal cities suffered in the spring, cases remained relatively scarce across most of the nation’s midsection. But since late summer, North Dakota and South Dakota have added more cases per capita than any other state.
Utah recorded 1,387 new cases on Sunday, a single-day record. Four states — Wisconsin, Indiana, Montana and Wyoming — have added more cases in the last week than in any other seven-day stretch of the pandemic.
One significant change from the spring and early summer has been the return of college students to campuses.
The New York Times has identified more than 130,000 cases at more than 1,300 American colleges since the pandemic began.
Some of the worst trouble spots have calmed. Florida is now averaging about 2,300 new cases a day, roughly one-fifth of what it was seeing at its worst. In Arizona, daily case reports have dropped to about 500 on average, down from more than 3,600.
New infections have also plunged in Georgia, Louisiana and South Carolina. Mississippi and Alabama have made significant progress since midsummer as well, though case numbers there remain high.
California and Texas have also seen drops in case numbers. Both states, however, have recorded more than 800,000 cases.
Over a busy weekend of medical briefings, the American public has been looking to Dr. Sean P. Conley — a Navy commander and doctor of osteopathy who has been the White House physician since 2018 — for reassurance about President Trump’s condition.
Instead, experts say, Dr. Conley has delivered confusion and obfuscation. He even confessed that he had misled the public on Saturday about Mr. Trump’s treatment to reflect the “upbeat attitude” of the White House.
On Saturday, he ducked questions about whether Mr. Trump had been on oxygen, then revealed on Sunday that indeed, the president had been on oxygen — an indicator that Mr. Trump’s illness may be classified as “severe.” On Sunday, Dr. Conley was similarly evasive, sidestepping questions about whether the president’s X-rays revealed any lung damage or pneumonia. “I’m not going to get into specifics of his care,” he said.
Caring for any president presents unique challenges. Like all doctors, Dr. Conley is bound by oath to respect his patient’s wishes for privacy and to keep secret that which “ought not to be spoken of outside.” He is also a Navy officer caring for the commander in chief, whose orders he is obliged to follow.
But all of that must be balanced against the public’s right to have information about the health of one of the world’s most powerful leaders. And this particular leader, Mr. Trump, is well known for not wanting to look weak.
Dr. Conley is supervising a team of medical experts at Walter Reed National Military Medical Center, including Dr. Sean Dooley, a pulmonologist, as well as an outside expert, Dr. Brian Garibaldi, the director of the biocontainment unit at Johns Hopkins Hospital in Baltimore.
To the surprise of many in medicine, one doctor not being consulted is Dr. Anthony S. Fauci, one of the world’s leading experts on infectious diseases. (Dr. Fauci is on the White House coronavirus task force, but he was sidelined when his statements about the virus irritated the president.)
No matter what Dr. Conley says or does not say, his colleagues in medicine agree on one thing: If he is going to put himself in the position of answering questions about the president’s care, he has to answer truthfully and to the fullest extent possible.
“You can’t both wear the white coat and lie, evade, obfuscate the situation,” said Dr. Ezekiel Emanuel, a bioethicist at the University of Pennsylvania, “because you are using the white coat to give yourself credibility.”
Bars in Paris will close for two weeks starting on Tuesday, the authorities there announced on Monday, as France tries to stem a surge of coronavirus cases in its capital. Restaurants will be able to remain open if they follow a strict health protocol.
Paris joined a handful of other French areas that have been placed on maximum alert because of a continued rise in infections, especially among older people. Local health authorities said the capital had been above the thresholds for the top alert level — more than 250 coronavirus cases per 100,000 people generally, more than 100 per 100,000 in the elderly, and more than one-third of intensive care beds used for Covid-19 patients — since last Thursday.
On average, there are over 3,500 new infections a day in Paris and 203 active clusters, especially among young people for whom the incidence rate is over 500 infections per 100,000 people. In France generally, the seven-day average for new daily cases is above 11,000. The Paris region has as many patients hospitalized for coronavirus as it did in May, when the country was just exiting its two-month lockdown.
Mayor Anne Hidalgo and the head of the Paris police said at a news conference on Monday that the bar closures would apply to Paris and the surrounding suburbs. Gyms, dancing halls and enclosed swimming pools will be closed to adults, though minors will be allowed to use gyms and pools.
“The epidemic is going too fast,” said Didier Lallement, the Paris police chief. “We need to brake now before our health system is submerged.”
Restaurants will have to keep registers of customers for contact-tracing, distance tables by one meter, keep seating to no more than six per table and take payments at the table.
Those restaurant rules will also apply in other maximum-risk areas, including the southern cities of Aix-en-Provence and Marseille, where the authorities had closed restaurants under a tightening of restrictions last month. But bars in those two cities will remain closed for at least another week.
Starting on Tuesday, new restrictions will also apply to universities in areas on high alert, with classrooms and lecture halls operating at half capacity or below. Retirement home visits will become appointment-only, and with a maximum of two people per visit.
“Living with it and protecting, that’s the goal we must have,” Ms. Hidalgo said, adding that she hoped she would be able to come back in 15 days with good news about “the epidemic’s front line.”
New York City police officials have instructed all officers to wear masks in public or risk discipline, as the department faces mounting criticism over officers’ failure to comply with a state mandate that people wear face coverings in public when social distancing is not possible.
The Police Department’s directive, issued on Friday in memos and a video, came after elected officials repeatedly called out the police for flouting the mask mandate they are supposed to enforce. About 400 officers have been assigned to nine neighborhoods in Brooklyn and Queens where there have been upticks in coronavirus cases and where the city plans to close nonessential businesses and schools this week.
Terence A. Monahan, the chief of department and the highest-ranking uniformed officer, appeared in a video sent to officers on Friday instructing them to wear masks in public areas, department facilities and where they cannot be socially distanced.
“It is our responsibility to set the example for our great city and do everything we can to help ensure that we do not have another hospitalized member bring this deadly infection into our homes or have another funeral,” he said.
A memo sent later in the day added that the requirement applies to shared offices, elevators, halls and bathrooms, and at all times in the first 14 days of an officer’s return from places with a travel advisory. But officials carved out exceptions when officers are eating and drinking, adjusting their masks or having difficulty breathing.
global roundup
Six months ago, for the first time in its history, the Peace Corps suspended all operations as the coronavirus raced around the globe. Now it is preparing to send volunteers back into the field.
But the planning for the redeployment of Americans around a world shaken by the pandemic comes as the agency faces renewed questions about the quality of its medical care, touched off in part by the death of a 24-year-old volunteer from undiagnosed malaria.
The volunteer, Bernice Heiderman, died alone in a hotel room in Comoros, off Africa’s east coast, in 2018, after sending desperate text messages to her family. She told them that her Peace Corps doctor was not taking her complaints seriously.
An investigation by the agency’s inspector general documented a string of problems. Ms. Heiderman’s doctor, the investigation found, had “limited training in tropical medicine,” and failed to test for malaria — an obvious diagnosis. And the agency’s medical experts in Washington, with whom he consulted, never asked him to.
“Had she received timely treatment,” the inspector general concluded, “she could have made a rapid, full recovery.”
In March, the Peace Corps evacuated more than 7,000 volunteers from more than 60 countries. It is now accepting applications for them to return to service. If conditions permit, officials said, some may return to their posts by the end of the year, and new volunteers may begin as early as Jan. 1.
The agency said in an emailed statement that it “continues to grieve the tragic loss of volunteer Bernice Heiderman” and that it had “initiated several steps to further strengthen health care for volunteers.”
In other global developments:
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Ireland is considering reimposing a national lockdown for four weeks, after concern from public health officials over rising infections. Under the proposed restrictions, which local media said government leaders would discuss with the country’s chief medical officer on Monday, most people would be barred from leaving home except to exercise or for essential reasons. Almost 1,000 new cases were reported from the weekend as of Sunday. Ireland has recorded a total of 38,032 cases and 1,810 deaths.
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New Zealand will lift restrictions on Auckland, its most populous city, from midnight on Wednesday, joining the rest of the nation. Restrictions had been reinstated after a cluster of infections emerged, but after the city reported no new infections for 10 consecutive days, Prime Minister Jacinda Ardern said on Monday that a second wave there had almost certainly been “eliminated.”
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Pope Francis criticized the lack of unity in the world’s response to the coronavirus pandemic in a document released on Sunday. “Aside from the different ways that various countries responded to the crisis, their inability to work together became quite evident,” Francis said in the encyclical, the most authoritative form of papal teaching. “For all our hyperconnectivity, we witnessed a fragmentation that made it more difficult to resolve problems that affect us all.”
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With President Trump hospitalized with Covid-19, Secretary of State Mike Pompeo will cut short a trip to Asia this week, canceling stops in South Korea and Mongolia but continuing with a visit to Japan. Mr. Pompeo earlier alluded to the possibility of curtailing his Asia visit because of the infections in the president’s circle, but a State Department spokeswoman, Morgan Ortagus, did not specify why the schedule had been changed in a statement on Saturday.
“I learned a lot about Covid,” the president of the United States assured his fellow citizens, looking straight into the camera on Day 3 of his stay at the Walter Reed National Military Medical Center.
But what have Americans learned?
It may just be how little they still seem to know about the virus — and about the most famous patient in the world.
When did President Trump and his aides first realize he might be infected? When exactly did his treatment begin? Did he know he might be ill and meet with supporters anyway? And were his doctors being fully forthcoming about just how he sick he might be?
There were questions, too, about just what a president who has mocked mask wearing, encouraged crowded political rallies, advanced dubious treatments and at times even dismissed the seriousness of the virus threat has learned from his own personal encounter with Covid-19, the disease caused by the virus.
“I get it, and I understand it,” Mr. Trump said in the video he posted from the Walter Reed military hospital in Bethesda, Md., late Sunday afternoon. But it was anyone’s guess if he was chagrined at the situation he now found himself in. Officials on his campaign have continued to defend his flouting of public health guidelines; over the weekend, they refused to acknowledge that it could have led to his infection and the infections of other Republicans.
The president did not use the video as an opportunity to urge people to be careful: to wear masks and maintain social distance. He did use it to laud his political supporters, some of whom were gathered outside the hospital complex.
Then, seasoned reality show performer that he is, he broke the fourth wall, confiding to viewers that he planned to pay those supporters a surprise visit.
A little while later, he made good on his word. The president infected with a disease that has killed more than 200,000 Americans got into a tightly sealed S.U.V. accompanied by Secret Service agents for a quick drive-by wave.
The death of 19-year-old Chad Dorrill, a student at Appalachian State in North Carolina, has shaken the rural campus in the Blue Ridge Mountains, prompting questions about whether the college is doing enough to keep its students and faculty safe.
Young people have generally been at lower risk of developing severe Covid-19, and there have been only a few student deaths linked to the coronavirus. But Mr. Dorrill’s death has made the virus real for his classmates.
“It’s not a hoax, that this virus really does exist,” said Emma Crider. “Before this, the overall mentality was ‘out of sight, out of mind.’”
As if to underscore that point, cases at Appalachian State, part of North Carolina’s state university system, spiked sharply last week. On Thursday, the school canceled a football game and announced outbreaks in four residence halls, two fraternity houses, the volleyball team and the football program. The school’s dashboard shows more than 700 confirmed Covid-19 cases since early June, across a 20,000-student campus.
Appalachian State has not conducted the kind of costly, widespread mandatory testing and tracing of people with and without symptoms that has helped control the virus at some campuses. Rather, the school has offered voluntary testing at its student health center and at “pop-up” test sites where students can walk up and be tested twice weekly.
That approach, the school’s website says, is based on C.D.C. guidance, which has advised against testing all students upon arrival. Health experts have criticized that guidance as weak and confusing, but many large public colleges have used it as the basis of their approaches.
In the wake of Mr. Dorrill’s death and the spike in cases, tensions are rising over whether Appalachian State needs to take stronger measures to contain the virus.
“There has been polarization between those who say, ‘Just wear a mask, we’ll be OK,’ and the faculty who just don’t want to be in the room,” said Rick Rheingans, chairman of Appalachian State’s department of sustainable development, who has been tracking the school’s health measures. “My argument has been that we need rigorous testing and active tracing, quarantining and isolation. We can’t reopen if we’re not safe.”
— Cristina Bolling and
Most shoppers these days are able to routinely buy common household items like toilet paper, paper towels, pasta and beans that were in short supply in the early weeks of the pandemic. But Clorox wipes remain stubbornly elusive.
With cleanliness on the minds of many guarding against the virus, the wipes have become the pandemic version of the must-have toy of the holiday season. Across social media, shoppers share where and when to find wipes made by Clorox, or Lysol — which is owned by Reckitt Benckiser Group — or wipes from other brands. (Only Clorox and a handful of other wipes have been approved by regulators to kill coronavirus.)
All of the hullabaloo around its disinfecting wipes has been a strange turn of events for Clorox, which started making and selling liquid bleach as a household cleaning product back in 1916, and presents a big challenge for Linda Rendle, a 17-year veteran of the company who took over as its chief executive officer in mid-September.
The company said it was struggling because demand for the wipes had surged 500 percent in the past few months. After increasing production, Clorox is making one million canisters of disinfecting wipes each day. (Executives wouldn’t say how that compared with before the pandemic.) It plans to further increase production early next year.
Before the pandemic, Clorox — which also makes Glad trash bags, Kingsford charcoal and Pine Sol cleaner — told Wall Street analysts that, at best, the company would see a 1 percent increase in sales for its fiscal year 2020.
Some doctors, nurses and therapists have a prescription for helping us through this pandemic: Try a little laughter.
Humor is not just a distraction from the crisis, said Dr. Michael Miller, a cardiologist at the University of Maryland School of Medicine in Baltimore. It’s a winning strategy to stay healthy in the face of it.
“Heightened stress magnifies the risk of cardiovascular events, including heart attacks and strokes,” Dr. Miller said. “Having a good sense of humor is an excellent way to relieve stress and anxiety and bring back a sense of normalcy during these turbulent times.”
Laughter releases nitric oxide, a chemical that relaxes blood vessels, reduces blood pressure and decreases clotting, Dr. Miller said. An epidemiological study of older men and women in Japan confirmed that those who tend to laugh more have a lower risk of major cardiovascular illness. Possessing a healthy sense of humor is also associated with living longer, an epidemiological study from Norway reported, although the correlation appears to be stronger for women than for men.
Armed with this growing body of research, Dr. Miller prescribes “one good belly laugh a day” for his patients. It’s not just going “ha, ha,” he explained, but a “deep physiological laugh that elicits tears of joy and relaxation.”
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