President Donald Trump has returned to work in the Oval Office less than a week after announcing he had been diagnosed with COVID-19 and just two days after leaving the hospital.
The president’s physician said he has been symptom-free for 24 hours and the president himself has said that he feels great.
However, given the medications the president has been given, it is possible that he is still ill. When present, symptoms generally last for about one to two weeks. About 20% of the time, people will have symptoms for as long as a month.
"Steroids can mask the symptoms," said Dr. Bob Wachter, Chair of the Department of Medicine at University of California, San Francisco, referring to the dexamethasone that the president’s doctors say they prescribed over the weekend. "Steroids frequently do that. People will say 'I just felt great.'"
Patients who receive the drug are known to feel euphoria despite their illness.
Dexamethasone is only recommended in serious cases, when the patient’s immune system can overreact to the infection and cause harm. It is also normally prescribed further into the course of the illness. The drug is not recommended for patients with mild cases of COVID-19 as it suppresses the immune system and can cause harm in those cases.
"That’s where this whole ambiguity about how much oxygen he really required and what the number really were may seem trivial but turns out to be quite important," Dr. Wachter told KCBS Radio's "Ask An Expert."
The treatment raises concern about how ill the president was over the weekend, and the likelihood that he could have recovered as quickly as officials claim.
"We don’t know what’s going to happen, particularly when he comes off the steroids," said Dr. Watcher. "He could have a fair number of issues."
There are also questions about the president’s mental acuity.
"We know from good studies that about 20% of patients with moderate to severe COVID - enough to make you go to the hospital - had some level of cognitive impairment," said Dr. Watcher. Steroids can compound that effect. "Many, many people get a little goofy, a little euphoric, judgement is a little off, they feel like they can fly, there’s a whole lot of stuff that can happen."
Those risks increase with the patient’s age.
"You’d have to say that he has a significant chance of having real impairment both from the disease and from steroids," Wachter concluded. "And that’s not to say I am sure he does; I have not examined him, I don’t know. But it is to say it’s a perfectly reasonable concern."