Trump's post COVID return to work
As the President’s health continues to dominate the news, scary numbers that point to a worsening pandemic are getting drowned out by a cacophony of nonsense from the White House.
The latest news is that President Trump has tested positive for antibodies and has been cleared by his doctor to return to the campaign trail. What does all of this mean about the superspreader-in-chief’s illness?
The President’s positive antibody test
The TL;DR version here is that Trump’s positive antibody test means that he received an antibody treatment.
Sean Conley’s newest presidential doctor’s note states that the President’s latest round of blood tests showed evidence of antibodies to SARS-CoV-2.
I had mentioned in my newsletter earlier this week that one of his initial treatments was a cocktail of two monoclonal antibodies from Regeneron that provide lab grown antibodies against the virus that causes COVID-19.
So a test that demonstrates antibodies in his blood is no different than an athlete who takes performance enhancing drugs having a positive drug test. A test before he received antibodies did not demonstrate any antibodies. He is almost certainly too early in the course of infection - unless of course the entire timeline is a lie - to have made the antibodies himself.
If you give someone antibodies and a blood test shows antibodies in that person’s blood, the response should be “duh” not “Of note today, the President’s labs demonstrated detectable levels of SARS-Cov-2 IgG antibodies from labs drawn Monday, October 5th; initial IgG levels drawn late Thursday were undetectable.”
While this isn’t quite as absurd as the note “from” Dr. Bornstein during Trump’s initial campaign, the farcical element here remains quite strong.
What about the antibody treatment itself? Did that cure him?
There’s certainly evidence that looks promising enough on some antibody treatments (although that link is for a different treatment than the President received).
A lot of smart people are very optimistic about antibody treatments, which don’t have the same risks of transfusion reaction as convalescent plasma. There’s certainly reason to be optimistic.
Promise aside, it’s ridiculous to claim that this was a cure.
We still don’t know if the treatment made the President better, worse, or didn’t have any impact. Only a randomized trial can tell us this. Unfortunately, the outlandish claims from the White House may ruin the possibility of clinical equipoise on a trial.
Is Trump still contagious?
Probably. But nobody knows. We don’t have a clear timeline of when his last negative test was, so we don’t know precise information about the timing of his infection.
As a consequence of the opaque timeline and the complete lack of disclosure of his disease severity, we’re left guessing about his level of contagion, and thus the risk he poses at work, at rallies, and at any debates.
The more mild your symptoms are, the less length of time you need to isolate after infection. As an aside, isolation is different than quarantine. Isolation is separating from others when you’re infected and contagious. Quarantine is separating from others after you’ve been exposed but aren’t infected.
CDC guidelines recommend 10 days of isolation with mild or moderate disease but about 3 weeks of isolation with severe disease.
If his symptoms of illness started Thursday, October 1, then it’s reasonable to suggest that if his disease was truly mild or moderate, he would be no longer contagious by October 15, which is 2 weeks later.
But if his disease is more severe than they’re admitting, then he may be contagious for longer.
And it’s important to note that steroid treatment with dexamethasone, which he received, likely prolongs the duration of viral shedding.
Bottom line: I certainly wouldn’t get close to the President without an N95, gown, gloves, and eye covering for a couple more weeks.
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