WASHINGTON – President Donald J. Trump was more ill with Covid-19 in October than was publicly recognized at the time, with extremely low blood oxygen levels at one point and a lung problem associated with coronavirus pneumonia, according to four people familiar with the disease.
His prognosis became so worrying before he was taken to the Walter Reed National Military Medical Center that authorities believed he would need to be placed on a ventilator, two people familiar with his condition said.
People familiar with Trump’s health said he had pulmonary infiltrates, which occur when the lungs are inflamed and contain substances such as fluids or bacteria. Its presence, especially when the patient has other symptoms, may be a sign of an acute illness. They can be easily detected on an X-ray or scan, when parts of the lungs appear opaque or white.
Trump’s blood oxygen level alone was of extreme concern, dropping in the 1980s, according to people familiar with his assessment. The disease is considered serious when the level of oxygen in the blood drops to the age of 90.
It was previously reported that Mr. Trump had difficulty breathing and a fever on 2 October, the day he was taken to the hospital, and the types of treatment he received indicated that his condition was serious. But the new details about his condition and the effort within the White House to give him special access to an unapproved drug to fight the virus help reveal one of the most dire episodes of Trump’s presidency.
The new revelations about Trump’s fight with the virus also underscore the limited and sometimes misleading nature of the information released at the time about his condition.
The former president resisted being taken from the White House to Walter Reed, yielding when advisers told him he could leave on his own, or risk waiting until the U.S. Secret Service was forced to carry him if he got sick, two times. known people with said events.
While Trump was hospitalized at Walter Reed, his medical team sought to minimize the seriousness of the situation, saying he was on the rise. At 74 years old and overweight, he was at risk of serious illness and was prescribed aggressive treatment. He left the hospital after three days during which, at one point, he took a brief ride in his armored sport utility vehicle to wave to the crowd of supporters outside the building.
A person close to the former president denied that he had been seriously ill, echoing Trump’s own comments after he fell ill.
There are still unanswered questions about whether Trump was already sick with Covid-19 when he participated in a presidential debate on September 29, just two days before the public announcement that he had been diagnosed with the disease and three days before his worsening condition o forced to go to Walter Reed.
Mr. Trump’s doctor, Dr. Sean P. Conley, has repeatedly played down concerns about Mr. Trump’s condition during his illness. At a meeting, Dr. Conley said that Mr. Trump was receiving X-rays and CT scans. But when asked if there was evidence of pneumonia or tissue damage, he just said there were “expected results, but nothing of major clinical concern”.
Dr. Conley also told reporters that while Trump’s oxygen level has dropped to 93 percent, it has never dropped to “below 80”.
Mr. Trump had trouble breathing at the White House. He received oxygen twice before being taken to Walter Reed, as Dr. Conley acknowledged after it was reported by The New York Times.
Still at the White House, Trump received a drug developed by the biotechnology company Regeneron Pharmaceuticals. The antibody cocktail – not widely available at the time – helps people infected with the virus to fight it.
After Mr. Trump was hospitalized, he started a regimen with a steroid, dexamethasone, which is generally recommended only for patients with Covid-19 who have severe or critical forms of the disease, usually those who need mechanical ventilation or supplemental oxygen.
And he received a five-day course on antiviral remdesivir. Medical experts at the time believed that his course of medication was a clear sign of significant lung problems.
At press conferences outside the hospital that weekend, Dr. Conley offered data that made it look like his patient was recovering quickly. He noted that Trump did well on a spirometry test, which measures lung capacity. “He’s pushing the limit,” said Conley. “He’s doing great.”
Medical experts say a spirometry test is virtually meaningless with patients with Covid-19.
When Mark Meadows, the White House chief of staff, quietly tried to tell reporters that the situation was more dire, Trump burst into anger, according to people who spoke to him.
On Sunday, October 4, Dr. Conley acknowledged that he had given an optimistic version of Trump’s condition.
“I was trying to reflect the optimistic attitude that the team, the president, his illness course had,” he said. “I didn’t want to give any information that could direct the course of the disease in another direction, and in doing so, you know, I discovered that we were trying to hide something, which was not necessarily true.”
Trump’s medical team said that Friday he had a “high fever” and that his oxygen level had dropped, requiring him to receive oxygen. Trump’s oxygen level dropped again on Saturday.
Mr Trump still seemed to be battling the disease when he returned to the White House, where he stood on a balcony in a choreographed scene, tearing off his mask and greeting his helicopter. Doctors at the time observed how Trump used his neck muscles to help him breathe in those moments, a classic sign that someone’s lungs are not absorbing enough oxygen.
On the night of his diagnosis, October 1, White House officials struggled to get the Regeneron antibody cocktail – not authorized at the time by the Food and Drug Administration for treatment – for Trump.
A senior attorney in the White House Council Office, Patrick F. Philbin, called Dr. Stephen M. Hahn, the FDA commissioner at the time, to discuss how the agency could approve the use of the drug by two senior administration officials. that he didn’t want to identify, according to a person who heard about the call.
Mr. Philbin was exploring how the president could gain quick access to the drug through normal FDA procedures. Regeneron had already approved the use of the doses, Philbin told Dr. Hahn.
Dr. Hahn and other FDA officials, including Dr. Patrizia Cavazzoni, the main federal drug regulator, worked to release the drug through a standard process known as an emergency application of a new experimental drug, often used for very young patients. patients who agree to take an experimental drug still undergoing clinical testing. The agency analyzes these patients’ medical histories to identify whether there may be serious risks for treatment.
Regeneron dispatched a dose package that included extras, “in the case of any administrative problem,” said a company spokesman.
Extras were never returned. Dr. Conley told his associates that they were sitting in a refrigerator at the White House doctor’s office.
Only in the days following approval of the request did White House officials recognize that the doses were for Trump and First Lady Melania Trump, who also tested positive for coronavirus, but refused the drug, which is infused intravenously for about one hour . The person close to the former president also denied that Mrs. Trump refused the drug.
At that time, when others close to Trump began to become ill, their son-in-law and senior advisor, Jared Kushner, offered to make it easier for them to get Regeneron treatment, two people with knowledge of the discussions said. An adviser to Kushner contested that he had made such an offer at that time.
In the weeks after his hospitalization, Mr. Trump was convinced that the Regeneron treatment had saved his life, saying to his aides, “I am proof that it works.”
This phrase became a recurring joke among top health officials, who wondered if anyone would tell Mr. Trump that he was, in fact, a result of a failed clinical trial for Regeneron, since the goal is to prevent people from hospitalized after receiving it, said a former senior administration official.
Noah Weiland, Mark Mazzetti and Annie Karni reported from Washington, and Maggie Haberman of New York. Katie Thomas contributed reporting from Chicago, and Denise Grady of New York.