President Trump’s Covid-19 Diagnosis: Implications for Transmission, Treatment, and Prognosis

In this special UCSF Medical Grand Rounds, UCSF experts discuss President Trump’s Covid diagnosis, his prognosis, the therapeutics available to him, and the implications of all of this for the public and for policy. The session is moderated by UCSF Department of Medicine chair Bob Wachter.
Program
Bob Wachter: Introduction
00:02:15 - 01:23:22 - Panel discussion with Drs. Chin-Hong, Langelier, Luetkemeyer, and Rutherford
Bob Wachter: Closing
See previous Covid-19 Medical Grand Rounds:
• September 24: San Francisco and Covid-19: What Went Right and Lessons Learned
• San Francisco and Covi...
• September 17: In Search of a Vaccine for Covid-19: Science and Politics
• In Search of a Vaccine...
• September 10: Covid-19: Current State, Falling Mortality Rates, and “AeroNabs"
• Covid-19: Current Stat...
• August 13: New Approaches to Covid-19: Rapid Testing, Herd Immunity, and the Role of Narrative
• New Approaches to Covi...
See all UCSF Covid-19 grand rounds, which have been viewed over 1M times, here: medicine.ucsf.edu/covid-19-ne...

[@bobs4429]

Brilliant. Thank you UCSF School of Medicine for making these videos (and this one in particular) public.

[@crystalmckendrick8576]

Excellent presentations Wish the antimaskers would watch

[@earthangel2524]

Please do a primary-care discussion on how to aggressively treat the viral stage and keep people out of hospital.

[@fernie5128]

This was great. As a retired ICU nurse whose mantra was/is: education, education, education how can we get this information out to the general public in language they can understand? I guess that would need a top-down approach...

[@lornajoy1455]

This round-table is interesting. Still, many people have very strong opinions about not wearing masks. I'm 81 and I wear one to protect myself and others. But, most of us are not rich like the President. He is not an example of what average people have to pay for treatment. I'm very tired of the arguing and my sympathies go out to families of those who have died or have damaged bodies from Covid. It is not "nothing". 🙏🦅

[@earthangel2524]

True, POTUS gets rich-man's cure. But IMO the most important thing he got was EARLY INTERVENTION. There are cheap outpatient remedies for the rest of us to fight the virus during the early stage. The problem is getting a primary-care physician to work with you dosing at home instead of advising "WAIT' until you are deathly ill to begin medication.

[@operasinger2126]

perhaps this can help. Help for coronavirus until end of pandemic. healing is more than taking a vitamin or supplement. Thoughts and prayer improve health. Meditation, Prayer and Spiritual Healing: The Evidence From NCBI www.ncbi.nlm.nih.gov/pmc/articles/PMC3396089 Speak quietly out loud or in normal voice "God, please make my health perfect and eliminate harmful virus. Thank you." Repeat every 1-2 hours (8-16 times a day) as long as the pandemic lasts and until a safe vaccine or cure is available. God is love. This helps. No cost. "A problem exists today regarding some know how to call on God for help while others do not. This loving help is available to all of us regardless of moral character, religious views, and personal beliefs. God does not punish and helps anyone asking correctly. God is love." www.howtocallongodforhelp.com Social distancing helps prevent infected droplets, splatter, and aerosol particles from entering the lungs and eyes. Reducing viral concentration will give the body better odds at handling infection. First line workers are at high risk because of continuous exposure to the virus, thus greater susceptibility to Covid19. Fever, cough, shortness of breath, and sudden loss of smell and taste are common characteristics of the coronavirus. Covid19's cytokine storm can cause long term tissue and organ damage and mental health problems. From Mayo Clinic www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351 Masks, face shields, washing hands and disinfecting surfaces prevent spread of this virus. Look into foods high in Vitamin C (avoid harmful synthetic Vitamin C supplements), Vitamin D (20 minutes daily sunlight or Vitamin D supplement with Vitamin K2 to prevent possible calcification), and zinc. Vitamin C supplements may cause harm www.sciencedaily.com/releases/2008/02/080229075222.htm Synthetic vitamin C supplements (Ascorbic Acid) kzbin.info/www/bejne/inrNgp54f96fgJo Vitamin D and coronavirus www.webmd.com/lung/news/20200907/too-little-vitamin-d-might-raise-odds-of-coronavirus-infection#1 Please share. Thank you. ❤

[@heaven7360]

old people don't matter in San Francisco. Anyway...maybe everywhere who knows. I see many young people outside eating in my neighborhood in SF and all are sitting around 3 ft away from each other drinking and having a great time. This would be at "The Page" a bar and restaurant, on Page and Divisidero. We will NEVER be without Covid with these type of people who absolutely NEED to yammer with their friends rather than help to defeat Covid. So that's my two cents. Anyway.......I wonder why trump got well so quick? I can't stand that insect.

[@jewellevy]

@@operasinger2126 pray to the god who sent this plague? Are you nutz? God is a bronze-age fairy tale as real as santa and the easter bunny.

[@annalopezwooden]

Great round table! Thank you for your work UCSF!

[@poppyflower7873]

FLCCC, Dr. Marik, Dr. Kory and other highly respected doctors.

[@randmorf]

Very nice presentation. I should wait till I have watched all the video before starting my comments as your presenters did get round to what I wanted to say and expressed themselves more precisely than I was able to. Will watch this a time or two again to better absorb it all.

[@buzzpedrotti5401]

Very interesting... I like your humor, professional outlook and kindness. You also managed any personal opinions, if it they existed, very well. This always makes the information most credible. Your warnings are very credible. Typical UC... fine work. We too are grateful and fortunate.

[@valereehansen1277]

Appreciate this information. Having interviewer expertise leading representatives from four areas of specialization, gives me width and depth in understanding of what's going on. Thank you for this video.

[@Zt_physco34]

Excellent

[@double2mo382]

Thank you. Very interesting.

[@oregoneyes6673]

Really good!

[@ovrjoyd]

Thank you for acknowledging us, long haulers. I am at 292 days. I want to scream when I hear people are only sick a few weeks out.

[@tefwright]

This was great and thank you.

[@kw7807]

Not playing initially -must be a lot of people accessing the file..

[@krinkle909]

What is this obsession with something being full proof. The information about glasses is very helpful. It's the first time I find myself thinking "oh wow, my myopia is helping me."

[@dorasmith7875]

Trump wasn't tested on Tuesday though people thought he was. Two people who were close to Trump early in the week but not at the Saturday event got covid by Friday.

[@valarielacasse803]

I dont care about the subject I wish covid issues could be addressed minus him he gets the best care the well being of others does not matter to him. The average citizens will never get that intense care unless they privileged

[@corryjookit7818]

@@valarielacasse803 Sorry for this about him. I don't believe he had Covid19. I think he was trying for sympathy. Look at the posing he did in the dark with the light behind him, ( his tv experience will have given him lighting knowledge ) and someone looking from the window with the curtain pulled back, making a big show of his breathing attempts then putting the mask in his pocket, when he should have still worn it. I don't think his wife had it either. Perhaps that's just me. The Doctor who treated him at that hospital might have a great story to tell. Might come out someday.

[@diannaholiday9086]

The ten percent household spread number sounds very low. I would like to see some data on that.

[@MartineReed]

Dianna Burdick I agree. I know several families that the virus attacked 50%, including asymptomatic.

[@kamwolf3960]

Seriously, what kind of crap is that?

[@muma8207]

How can it be said that anyone is out of the woods if they are still out in the world, mingling and interacting?

[@leannedeco9484]

Easy - if people are out in the world, mingling and interacting - and the Death (not the pcr test results) are not going up significantly or rapidly en masse - then it signals that human beings as mass majority 95% are able to survive this in similar fashion as previous pathogens - asymptomatic, few light symptoms, more serious symptoms, hospitalization - but all with a recovery either without therapeutics or when necessary with therapeutics - all of this does not sound or appear to be something more egregious than what human beings have had to deal with.

[@buzzpedrotti5401]

Has anyone employed NAC clinically to help with thrombo-pathology? Dr Schuelte (UCR ) at MedCram explained NAC helps with some aspects of clotting pathology.

[@bigoldgrizzly]

have a look here where the subject is discussed in depth by Dr Mobeen Sayd kzbin.info/www/bejne/gWnOfIqdqKx8i5o

[@Wildernut]

Question. How can it be said that aerosol infections can be counted on one hand, then say it is unknown if it is droplets or aerosol causing infections? It seems to me that aerosol transmission would be quite prevalent in recirculating air systems or closed environments. Why os there reluctance to admit there’s aerosol transmission, when it’s really quite obvious?

[@kamwolf3960]

Agreed. This is untrustworthy information. Deception, and I really don't understand why. This is ucsf, for God's sake. What is the agenda here? Why are they minimizing now?

[@valereehansen1277]

PS: I'm on my TV, nearing the end @ 1:19:12/1:23/59. Have to say that, for me, this is the most informative Covid video I've watched since February 2020. Many, many thanks to all 5 for their expertise and communicative skills. Also, it would be easier on the ears if Dr Peter had a better microphone.

[@SaamantaSerna]

could you please caption this video?

[@gloriannepapolis6525]

maybe, probably, hard to know, assume , not sure, hard to tell.. who will 'man' up, well would u invite him to your house for a meal??? I think not,

[@rwil6969]

I understand that they screened invitees using rapid tests for the Rosebowl event and then allowed the invitees to take off masks during the event. The question is was everyone tested and if so then the rapid test failed to pickup the infected person.

[@SMorrisRose]

We learn from the Rutherford section early in the video that about 60% of the interval where a normal infectee is shedding virus is before or after a PCR test would be positive. We also learn that the sensitivity of the rapid tests, which we presume the Rose Garden event attendees took, is one or two decimal orders of magnitude less than that of a PCR test. So - there is no guarantee or even informed expectation that a cohort of those with negative rapid tests won't include some shedding virus. When you say "the infected person" you are assuming that there was but one - that's not been shown.

[@22cjk22]

From the content of this video it sounds like attendees should have been taking the rapid test daily for 3-5 days before the event.

[@SMorrisRose]

@@22cjk22A PCR test is always the best choice when you have time to run one because of the much greater sensitivity. The key charm of a rapid test is turnaround time, but you don't need rapid turnaround if you test even a day before you need the result. I presume all of these people could jump the line because privilege.

[@dr.pearson2221]

Suggest that the team give up front the limits of their expertise. I continue to be surprised how little the medical community (doctors and academia) is aware of holistic health and the immune system which, of course, are the keys to most diseases. Too much focus on the pill and vaccine which is driven by the boxes we place by career choice. Pills and vaccines have an important role in exceptional disease cases and then only as a complement to holistic health and the immune system.

[@allenm721]

I didn't think that flu shots were recommended for people who are immunocompromised? Doesn't having CoVID compromise your immune system for a time?

[@user-ge4ku3ph1o]

Great discussion, thanks. LATERAL flow not LAMINAR flow.

[@thetruegoldenknight]

Thanks for the Twitter link, Doctor. A big theme through this whole chat has been "We Don't Know", and I don't think y'all at the 45 minute mark calculated a "grand total chance for Trump to die by COVID". I agree about one point near the end, though, that our government (and its loyal fans) are refusing to acknowledge: PLEASE respect the Coronavirus. It's not a joke, and this is NOT the time for "Normal".

[@valarielacasse803]

There are more important peole in our lives he has the best so he might have had it or not

[@meeshgh3854]

Thank you for such a great work. Please reply to the below question. Since the President took the antibody cocktails and steroid in early stage, what is the chance that his own immune system generated natural antibodies such IgG, IgA and T-Cells?

[@bengtkling2763]

You do not know when the president got the virus

[@corryjookit7818]

His immune system must be awful, given his diet. I think this panel doesn't wholeheartedly think he did have Covid.

[@patriciahoke4722]

The president is now saying, "I want everybody to get the same treatment as your president," - love the thought. It's a great thought. He may be pushing Regeneron, illegally. I would love it if he could make drugs like Remdesivir available on an outpatient basis. There is no question that we need outpatient treatment, as opposed to waiting until we are severely infected. He is saying, at least, the right thing. There is however a huge disconnect between his aspirations and actions. I expect nothing to come of this, in other words.

[@bigoldgrizzly]

You hit the nail on the head You get tested, probably do not get the result for several days and there is no treatment offered until you are sick enough to go to hospital ... sadly, often too late. You are right, you will most likely not be able to get the new so called big pharma 'wonder drugs' but you can get other simple OTC medications and supplements which will give your body the material it needs to give it the best chance of fighting off this vile disease. Have a look at the videos of Dr Mobeen Sayd on Prophlaxis and early outpatient treatment, including interviews with Dr Paul Marik and Dr Zolenski. here - kzbin.infoplaylists look at playlist 'all covid19 videos'

[@marygem]

Trump makes money everytime the drugs he mentions are used. He owns stock in both pharma companies.

[@DemocracyUS]

Hope UCSF has Black experts as well for next time. Blacks need to be supported into these positions. Thank you for your insights, Peter about conventional treatment.. Bottom line, this president hasn't revealed enough and guides his own treatment and discharge. Likely aggressively. Not a good practice for anyone. He looked "softly" what? The audio dropped out on the report about that tweet. Enjoyed the presentation.

[@dr.pearson2221]

Patients need safety and availability and a reason to believe enough in efficacy to justify the cost. Scientists married to research grant$ and must have "double blind proof" before availability is granted by higher authorities other than their doctor is not playing well with the public's health.

[@MdAlamin-xg8nn]

MGR Naman good morning sir

[@Bettybop49]

I don't know is a good answer, sometimes

[@annechen868]

Hello ,everyone, thanks for your reading. More details of the eto machinewww.anjiumedical.com/

[@carmenmarialinne2650]

Evidently it is impossible for the Medical community to stick to their 'medical profession' and give listeners a 100% scientific overview. Would be nice if there were zero 'little puns' that are obviously not necessary. Both the Media and Medical community have failed Americans over this last year. The CDC. The WHO. Lots of $$$ they have access to yet huge mistakes, lack of honor and failed moments. I do appreciate the conversation; but doubt all the 'guessing' and '2nd guessing' is relevant. I think respecting the Doctors who 'made their decisions' for the President's care are the only ones who can speak correctly to the issue of the President's care.

[@alexanderruedagarcia1662]

Taxpayers will pay the bill. The average hospital stay for severe Covid patients is 75,000 to 150,000. So 34 people at this rate can be from around $2,550,000 US Dollars to $5,100,000 US Dollars. I wonder how much would be the bill for Trump's hospital stay?

[@Bettybop49]

You all know darn well a virus is hard to combat. I think the President has done a great job and done everything he can to fight it. Just putting that out there.

[@gustavderkits8433]

!!!At just before or about 33:00 there is a discussion of whether the debate should happen next week. The term “infectious” is used as a binary variable. It is not. There is a continuum of states. If there is a 0.1% chance of Trump infecting someone, especially Biden, at the debate, that is too great, considering the stakes, even if he were not clinically “infectious” at a Fisher nominal 5% or whatever criterion you are thinking of. In addition, the Whitehouse is now a hot zone. There are daily reports of infection among the staff, perhaps the second and third generation of the super spreader event. The risk to Biden is too high!

[@maryshaffer8474]

It came from somewhere to spread around the world. China maybe?

[@punkrachmaninoff]

""Psycho Killer" but it's "Stephen Miller" and the fa's are ha's." - Cody Johnston (host of 'The Worst Year Ever' Podcast)

[@judyfauth208]

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[@modgiemodge261]

Smart people know it's shite

[@meemeechen8803]

Early on Taiwan health minister had rejected testing for all because of the false negative test result. There are many cases one being in Germany that a German man had many negative test results until 50 some days later. Taiwan has a few cases that asymptomatic persons tested negatives for three times prior to a positive showed up. Mask is important but public place like supermarket, airport, train station, buses, schools, offices should be thoroughly sterilized. Can’t believe we still debate testing aspect when other nations have pretty good data about it. Not sure why doctor here still referred to China’s data. China still would not let us know whether this virus is a man made and whether the virus is a mixture of SARS virus and AIDS.

[@margartroger513]

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[@giannagonzalez4707]

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[@elizabethlohn6044]

The ten percent household spread number sounds very low. I would like to see some data on that.

[@lmlarratt8271]

Excellent presentations Wish the antimaskers would watch

[@DanielTorres-td1gd]

Trump wasn't tested on Tuesday though people thought he was. Two people who were close to Trump early in the week but not at the Saturday event got covid by Friday.

[@xsagdt645]

How can it be said that anyone is out of the woods if they are still out in the world, mingling and interacting?

[@puropesado5581]

How can it be said that anyone is out of the woods if they are still out in the world, mingling and interacting?

[@erthamishina2886]

How can it be said that anyone is out of the woods if they are still out in the world, mingling and interacting?

[@DanielTorres-td1gd]

maybe, probably, hard to know, assume , not sure, hard to tell.. who will 'man' up, well would u invite him to your house for a meal??? I think not,