What We Still Don’t Know About President Trump’s Medical Condition

The President of the United States has been hospitalized with a virus that has already killed more than 200,000 Americans, 31 days before an election, as the country faces a sputtering economy, racial justice protests and wildfires in the West. Every detail about President Trump’s health is a matter of urgent national and international concern. But there is a lot the public doesn’t know about Trump’s current health and how he got sick.

As an overweight 74-year-old male, Trump is particularly susceptible to the ravages of COVID-19, which can trigger a supercharged immune response that can damage the lungs and cause a person to effectively drown on dry ground. According to his doctors, President Trump’s condition had improved on Saturday. He didn’t need supplemental oxygen, his fever had subsided, and he was not having trouble breathing. He’s been told to stay hydrated and walk around while he can, because, given the usual course of COVID-19, his condition could get a lot worse in the next four to seven days.

White House physician Dr. Sean Conley gave an upbeat assessment of Trump’s condition on Saturday, saying, “This morning the President is doing very well.” But there was a lot he omitted or wouldn’t answer. How had the President been infected? When was the last time Trump tested negative for COVID-19 before falling ill? Had the President needed supplemental oxygen at the White House the day before? How high was his fever on Friday? How low did his blood oxygen level go?

With those questions unanswered, the American people have been left relying on piecemeal, sometimes anonymous, statements from a White House that routinely misleads the public and has refused to give a clear on-the-record timeline of the President’s illness. Adding to the confusion, almost immediately after the doctors spoke, Trump’s Chief of Staff Mark Meadows gave reporters a starker version of Trump’s condition, saying Trump’s vitals over the last 24 hours were “very concerning” and he’s “not on a clear path to a full recovery,” according to the Associated Press.

We do know that Trump’s physicians have launched him on an aggressive and experimental treatment for the disease, which critical care doctors have learned a lot about in the eight months since the novel coronavirus first appeared in the U.S. Trump was given a high dose—8 grams—of a new antibody therapy by the biotech firm Regeneron on Thursday night, designed to bolster his body’s ability to combat the virus. On Friday, doctors started the first of five intravenous infusions of Remdesivir, a treatment for suppressing the body’s dangerous immune reaction to the disease.

Here are several questions we don’t know the answer to:

When did Trump first test positive for COVID-19?

This question is critical for understanding when the White House knew Trump had contracted COVID-19 and whether the testing regime protecting the President and his staff has been accurate enough to detect sick people who might come in contact with Trump.

Trump first revealed his diagnosis at 12:54 a.m. on Friday, tweeting that he and First Lady Melania Trump had tested positive that night. But on Saturday, Conley said Trump was “72 hours” into his diagnosis, which would have put the positive diagnosis on Wednesday, not late Thursday night. Conley also said that Trump was tested “Thursday afternoon” after his physicians learned of a “close contact” and had “clinical indications” for concern, and that he got a positive test result “late that night.” The late Thursday result was from a PCR test, a more accurate test than the 15-minute rapid tests used to screen White House staff and people meeting with the President. Trump had tested positive on the rapid test earlier that evening shortly after he arrived in the White House, a White House official said, sparking his doctors have the more reliable PCR test done. The White House won’t release a detailed timeline of Trump’s COVID-19 testing and won’t say when Trump had taken a test prior to Thursday, or what the result was.

Later on Saturday, Conley released a statement purporting to clarify the timeline. Conley said he “incorrectly” said “72 hours” when what he meant was “day three,” and that Trump was “first diagnosed with COVID-19 on the evening of Thursday, October 1st.”

When did Trump get sick?

Trump’s doctor said that on Thursday the President had a mild cough, fatigue and nasal congestion. That day he had flown to his golf club in Bedminster, New Jersey for a $250,000-per-person fundraiser and taken photos with dozens of people. His close aide Hope Hicks tested positive just as Trump was departing for the trip. The night before, Trump spoke outdoors to a rainy and windy rally at an airport in Duluth, Minnesota. He spoke for about 45 minutes, about half as long has his usual winding speeches, drawing some speculation that he may have not had his usual amount of energy.

During his press briefing Saturday, Conley would not say when Trump’s last negative test was. That means that even if Trump tested positive for the first time on Thursday night, as Conley later claimed, Trump may have gotten sick or developed symptoms beforehand. Numerous people besides Trump and the First Lady who were at the White House on Sept. 26 when Trump nominated Judge Amy Coney Barrett to the Supreme Court, or with him at a rally later that evening, have since tested positive for COVID-19, including the president of University of Notre Dame and Senators Mike Lee of Utah and Thom Tillis of North Carolina. Chris Wallace, the moderator of Tuesday’s presidential debate, revealed that the candidates had arrived too late to get tested, so there was an “honor system” about negative tests. Hicks tested positive on Thursday, and had reportedly begun showing symptoms on Wednesday.

In other words: Trump could have become contagious or symptomatic any time between Saturday Sept. 26—a day where multiple people in his orbit seem to have been exposed to the virus—and Thursday, Oct. 1, when he received his own positive result. Trump made multiple trips outside of Washington and was in contact with numerous people during that time.

Read more: What If Trump’s Condition Worsens? ∙ Mike Pence Steps Into the Spotlight ∙ Physician Briefing Raises More Questions Than Answers ∙ Trump’s ‘Unprecedented’ COVID-19 Treatment ∙ White House’s Silence Worries Diplomats ∙ U.S. Adversaries Exploiting Trump’s Illness ∙ How Trump’s Diagnosis Could Change the Campaign ∙ Aides Wonder If More Could Have Been Done to Protect Trump ∙ What to Know About Regeneron ∙ Where Trump Has Been Since Monday ∙ What History Can Teach Us About Presidential Health Crises

How often was the President tested?

The White House refuses to give specific details about how often Trump gets tested for COVID-19 or what kind of tests are performed. Visitors to the White House, staff and reporters scheduled to enter a room with Trump are routinely pulled aside in the morning for a rapid test, their nasal passages swabbed for signs of the virus. But there has never been transparency about the testing regime for the President himself, or the results.

Asked on Saturday how often Trump has been tested for COVID-19, Conley said, “I’m not going to get into all the testing going back, but he and all the staff routinely are tested.” In May, Trump and White House Press Secretary Kayleigh McEnany contradicted each other about the frequency of testing. McEnany said Trump was tested “multiple times a day”; Trump said he had been receiving “on average a test every two days, three days.”

How is Trump feeling now?

Conley said that the President had “a mild cough and some nasal congestion and fatigue” on Thursday, but is feeling better today. The President had a fever Thursday into Friday, but has been fever-free since Friday morning, Conley said. Conley would not specify how high temperature the president’s fever had been. Dr. Sean Dooley, another member of Trump’s medical team, said that Trump told him on Saturday that he felt like he “could walk out of here today.” But with the more dire image painted by Meadows’ comments about Trump not seeming on the “path to a full recovery,” it’s not clear what the reality is of how sick Trump felt on Saturday.

Was Trump given supplemental oxygen?

Critical care physicians often give patients additional oxygen when the level of oxygen in their blood falls below 90%. People who have contracted COVID-19 can often have trouble breathing because of the disease’s impact on the lungs, and they can require either a low flow of oxygen through a tube under the nose, or a larger mask pushing oxygen into their lungs.

Conley was evasive when asked about whether Trump was ever given supplemental oxygen. The doctor repeatedly said Trump is not on oxygen “right now.” When pressed by reporters, he allowed that Trump had not needed oxygen at all on Saturday, and he said, “Thursday. No oxygen. None at this moment… And yesterday with the team when we were all here, he was not on oxygen.” Conley’s answer left open the possibility that Trump was given supplemental oxygen while he was at the White House on Friday before being taken by helicopter to Walter Reed.

The question is important because the need for oxygen can be one indicator of the severity of the COVID-19 illness.

Why is Trump using experimental treatments?

Trump’s doctors have said the President has received an experimental antibody cocktail treatment. According to Conley, Trump took the Regeneron antibody therapy on Friday, Oct. 2. At the Saturday press briefing at Walter Reed, Dr. Brian Garibaldi, another member of the president’s medical team, said, “The president received a special antibody therapy directed against the coronavirus. And we’re working very closely with the company to monitor him in terms of that outcome.”

Regeneron’s product has not been authorized for emergency use by the Food and Drug Administration (FDA), but it has shown promising results in trials. According to the company’s chief executive, the President’s medical team asked for permission to use it, and that it was approved by the FDA, according to the New York Times. “All we can say is that they asked to be able to use it, and we were happy to oblige,” Dr. Leonard S. Schleifer told the Times. “When it’s the president of the United States, of course, that gets—obviously—gets our attention.”

How long will he stay at Walter Reed hospital?

Conley declined to give a timeline for how long Trump will remain at Walter Reed. But he said that days 7 to 10 of the illness can be critical, and the president is currently on day three. Garibaldi also noted that they are planning to give Trump a five day treatment course of Remdesivir, and Trump received his first dose yesterday. Conley said Trump will leave the hospital when his medical team deems it “safe and appropriate.”

“Every day we’re reviewing with the team his needs for being here,” Conley said on Saturday. “And and as soon as he gets to the point where it’s not a requirement, he may still need some care but if we can provide that downtown at the house, then we will transition at that point.”

Whatever next steps are taken for the President’s treatment, the public will be watching closely, and looking for clear answers.

Correction, Oct. 13

The original version of this story misstated in one instance the date on which U.S. President Donald Trump tested positive for COVID-19. That date was Oct. 1, not Oct. 8.