October 5, 2020
On October 2 at 12:54 AM, President Trump tweeted that he had tested positive for Covid-19. This announcement was immediately corroborated by the White House physician. Immediately, numerous questions surfaced regarding the actions of the President and his medical care. With more information available, now revealed actions of the Administration can be analyzed to assess the potential value of Cleared4Work when the Covid-19 affected the workplace. Here at Cleared4Work, we will try to answer now the common questions that have been posed to our medical leaders.
If the White House used Cleared4Work, how would have events been different?
If the White House had been using and following the guidance of Cleared4Work, the President would have cancelled his donor event on October 1, 2020 in Bedminster, New Jersey.
Here is an explanation.
On October 1, 2020 at 10:54 PM, it was announced that Hope Hicks tested positive for Covid-19. Therefore, anyone who answered Cleared4Work the next morning would have had to answer that a response had changed from the previous day and would have to take the full survey. When all these individuals took their survey on October 2, they would have answered “Yes” to question 18:
“Have you tested positive or had any prolonged (over 15 minutes) close contact with anyone who has tested positive for Covid-19 or has suspected Covid-19 in the last 14 days?”.
The identical question is question 2 of the short survey.
This “Yes” answer would have prompted the following question on both surveys:
"Have you been within 6 feet of this individual for over 15 minutes, or provided home care to them, or had direct physical contact with them, or shared utensils for eating or drinking with them, or been sneezed or coughed upon by them?"
We can assume a “Yes” answer here would have been the response for the President and the First Lady, First daughter and son-in-law, Kayleigh McEnaney, Kellyanne Conway, campaign manager Bill Stepien, and multiple other aides and security personnel. The White House essentially followed this directive and events for the President were cancelled on October 2 by which time the President had already tested positive.
However, Cleared4Work would have been even prescient for the employees with its unique tagging system. Ms. Hicks was reporting symptoms on the night of September 30. With the Cleared4Work tagging system, individuals associated with her “tags” would have received alerts on the morning to quarantine on the morning of October 1 because they had an association with symptoms (they would have most likely received an orange level). She would have had multiple tag groups including those in the White House, the campaign, and the First Family. These individuals would have needed quarantine before Ms. Hicks’s test results returned since Ms. Hope was having symptoms.
We can assume then with the Cleared4Work suggestive quarantine, all events on October 1 would have been cancelled, including the President’s trip to Bedminster, NJ for a fund raiser. Currently, extensive criticism is attacking the President and his team for allowing his attendance at that fund raiser and posing for pictures with high-end donors. Cancelling his presence at this event would have prevented this potential superspreader event from becoming magnified.
On October 2, the First Lady, Ms. Conway, and Mr. Stepien tested positive. Later multiple others including Senators Mike Lee, Thom Tillis, and Ron Johnson, Gov.Christie, along with three White House reporters and others also tested positive. We do not know their exact distance or time spent with the President or their symptoms prior to their test results. However, we do know that their presence in Bedminster may have contributed to more spreading of Covid-19. This feature of Cleared4Work that quarantines notable contacts prevents further dissemination of Covid-19.
The benefit of Cleared4Work when used properly is its objectivity. Tags are set up by individuals who understand exposure likelihood and may be periodically changed. These associations allow better decisions to be made without the emotion of the real-life pressures (“We need to go to that fund raiser, they are expecting us!”)
Here are some questions and answers regarding other issues:
Why did the President get hospitalized?
Normally, people get admitted to the hospital for Covid-19 symptoms for the severe illness, severe risk for worse outcome such as those with preexisting conditions, the need for oxygen, need for fluids, or close monitoring for someone perceived to have the potential to become increasingly ill within a short time. The President has obesity as a preexisting condition and his physicians may be thinking he needs close monitoring. His team may also feel he can work more efficiently without the spectre of going back and forth to the hospital for follow up tests and treatment.
What medicine did he receive? Remdesivir and REGN-CoV2 initially and later dexamethasone. Remdesivir is an approved anti-viral drug by Gilead. REGN-CoV2 is an unapproved drug by Regeneron in clinical trials now that is a monoclonal antibody "cocktail" given to help individuals who may have insufficient numbers of antibodies needed to fight Covid-19. He also initially received zinc, famotidine, vitamin D, aspirin, and melatonin. Later he received dexamethasone.
Did he need these drugs?
The President was said to have “mild” symptoms, now clarified to include nasal congestion, a cough, and possibly a fever. Remdesivir shows a benefit in moderate to severe hospitalized patients with lower respiratory symptoms from Covid-19. The President was not in this category when the decision was made to give the drug so one could conclude (if they believe the public issuance regarding his status) he may not have needed the drug. However, the drug is an antiviral agent and may be shown beneficial from future studies.
Regeneron interestingly released data very recently on their experimental drug. No firm conclusions on its value were noted and the study was inconclusive. However, close analysis of these data reveal that the drug may help those Covid-19 patient with symptoms and low viral loads. We have no public information on the viral load of the president. The drug importantly did appear safe.
Dexamethasone showed a major benefit in ventilated patients according to a British study. The President was never on a ventilator but the drug may also be beneficial in severely ill patients. He was never thought to be "severely ill" so many were critical that he needed all three major Covid-19 drugs (remdesivir, monoclonal antibodies, and dexamethasone) that have never been shown to be safe or effective together.
Did he receive oxygen?
Initially he was not reported to have received any oxygen but later it was said he received oxygen on two occasions.
Did he receive hydroxychloroquine?
Not reportedly, though he has said he has taken it in the past. This drug would not be indicated for his present condition.
What are the chances President Trump will die?
His age and obesity increase his chances of dying from Covid-19. According to a Spanish study, a male in his age group would have roughly a 5% chance of dying. Since he was detected almost immediately and he will receive the best possible medical care in the United States, this estimate might be decreased but this is offset by his increased chances by obese.
What could be signs he is getting worse?
The White House may announce he is having more symptoms such as fevers, need for oxygen, need for a ventilatory support (invasive or non-invasive), or that he is going to an ICU.
What are signs he is getting better?
Announcement of a hospital discharge.
When will he be out of the woods?
While many individuals have reported breathing and exercise difficulties for months after Covid-19 illness, there are minimal reports of mortality 2 weeks after hospital discharge.
Will there be a debate October 15?
An in-person debate on this date is unlikely to be recommended by most physicians but the White House is saying it will occur.
Will more individuals in the Trump Administration or event attendees test positive?
Potentially yes, since a Covid-19 test can sometimes become positive up to 2 weeks after exposure or more.
Did President Trump having Covid-19 affect the 2020 Presidential election?
Las Vegas odds on October 2 suggest a 65% probability that former Vice-President Biden will win. This figure increased from a 60% probability for Mr. Biden over the last 2 weeks. The etiology of this possible sentiment change could be multifactorial.