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Dr. Rai explains President Trump’s therapeutic treatment, recovery

Published: Oct. 6, 2020 at 7:50 AM CDT
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GREEN BAY, Wis. (WBAY) - President Donald Trump is back at the White House after his hospitalization for COVID-19.

Prevea Health President and CEO Dr. Ashok Rai joined us on Action 2 News This Morning Tuesday to discuss the therapeutics given the president and what’s next in his recovery.

Dr. Rai joins us each Tuesday and Thursday on Action 2 News This Morning. Have a question for the doctor? Email news@wbay.com

PRESIDENT TRUMP’S EXPERIMENTAL TREATMENT

"He definitely received a lot of therapeutics. The first being something that none of us really have access to at this point. Still in the early research phases. The monoclonal antibodies that he received. He also received dexamethasone which is a steroid at a high dose. And remdesivir, which is the medication we’ve talked about a lot. Trying to attack the virus from three different components. One directly, the other trying to prevent its replication, and the third trying to prevent that inflammatory response that it causes. All of which are given when somebody, usually the reason we would give it is somebody is requiring oxygen is kind of the indicator to go into the hospital and need those medications.

SERIOUS SITUATION

"Any time we have a COVID patient in the hospital it’s serious. And it usually means they’re requiring oxygen which we would consider serious, because they can continue to get worse. May not get worse in five days, may get worse in 10 days. But the traditional pattern, if we don’t do something to intervene, they’ll get worse. His physicians must have seen something that concerned them. Either oxygen saturations, a CT scan, a chest x-ray. Something triggered the need to prevent the virus from getting worse in the president, and they did their best to do that.

TRUMP LEAVES HOSPITAL

“I think for the general person going home and the president going home are two different things. He’s still receiving IV medications, which we can do for people at home here, but he has a medical team that’s surrounding him at the White House. That’s generally not something that somebody would have here. So does he meet the standard for a normal hospital discharge? Probably not. But a White House hospital discharge, with all of the care that he gets, which is what the president would normally get no matter who it is, is what’s going on there.”

IS PRESIDENT’S RECOVERY TYPICAL?

“Some of it has to do with the therapeutics and coming off oxygen so quickly, it’s a great sign. The dexamethasone, specifically, the thing that prevents that inflammatory response, kind of gives you a little bit of a high. You feel good after a steroid injection. I think other people who have received steroids know that feeling. Then you worry about that almost post-caffeine crash at some point. You come down off the steroids. You feel a little worse. But generally, the body does well during that time period.”

DEBATE

Will President Trump be OK to attend the Oct. 15 debate with Joe Biden?

“We’ve said this since the CDC guidelines have been adjusted. It’s 10 days once your symptoms start that you need to be worry about being out in public. After that 10 days, if you’re feeling good, the last 24 hours your symptoms are better, you don’t have the respiratory symptoms, you don’t have a fever, you are good to go in public. It’s actually one of the safest people to be around at that time for at least 90 days. So after 10 days, which I think the debate would be after that 10-day mark, he should be good.”

ADVICE FOR PATIENTS IN RECOVERY

“He (President Trump) needs to be monitored carefully, which he is. The important thing to remember with COVID is everybody talks about the breathing and the lungs and the oxygen, but remember, this virus has been extremely deadly in other ways. Blood clots are the most common second thing we look for. Heart issues. So he needs to be closely monitored, especially as that cytokine storm, as they’ve reduced it with that dexamethasone, as that wears off, what is the inflammatory response he could have? So he needs to be watched very closely.”

WAS THE ROSE GARDEN EVENT A SUPERSPREADER?

Several people who were at a Rose Garden event to introduce Supreme Court nominee Amy Coney Barrett have tested positive for COVID-19.

"A lot of people are focused on the fact that people didn’t have masks on. We should be wearing masks when you’re that congregated for that long a period of time. Even if outside. This isn’t being outside and exercising or a casual conversation. This is shoulder to shoulder for a long period of time. That’s one thing to look at. The other thing that I think that people have completely missed in this situation are what are the five categories of a big exposure and COVID-19? Touching being number two. There was a lot of hand shaking, hugging, kissing on the cheek. That’s a very dangerous thing to do in those congregant settings. That can create that superspreader event. "

COLD TEMPERATURES AND COVID-19

“We look at viruses and we see if they’re hearty or not in weather, and so far COVID-19 has proven itself through, almost an entire, coming up on a year of different seasons to transmit in pretty much every temperature. What actually really concerns us about the cold weather is human nature. Remember, this virus needs humans to live and it’s transmitted from human to human. In the winter time, what do we do in Wisconsin? We go inside more than we do in the summer time. So we’re actually more worried about the virus actually spreading more as we get colder. And we’re seeing some evidence of that right now than actually becoming less virulent.”

COVID AND THE WORKPLACE

An employee returns to work after testing positive and quarantining. Should co-workers be concerned?

"We should always be maintaining those safe practices of washing your hands, wearing your mask and staying six feet away. But the risks definitely go down if somebody has recovered from COVID-19. Recovery is 10 days if they’re not severely immuno-compromised. So the standard person, 10 days after the onset of symptoms with the last 24 hours them being essentially symptom free. They’re done. There’s no testing after that point. Tests can continue to be positive, but them actually being able to transmit the virus to anybody, you’re done after 10 days. So that’s a safer environment, but you should still maintain your good habits.

MEDICAL PROCEDURES

“One of the things we learned in the spring is at that point, we needed people to wait because we needed to understand the virus more and create safe environments for people to have those procedures. All that’s done now. The safe environments exist. What we’re more worried about in the hospital is if you need a bed after surgery. That’s a little tricky with the current volumes that we’re seeing. But a procedure that doesn’t require a hospital stay, such as minor back surgery, or a colonoscopy, which you should be having done on time, are things we really want you to have done. We don’t want people to go without their medical care. That delay can cause bad problems for people down the road.”

OUTDOORS AND MASKING

"Masking outside comes up a lot. We’ve encouraged outdoor activities as much as we can, even in the winter time and fall we still encourage that. Masking outside, per the CDC, per even our own state mask mandates, is not something that’s always recommended. Obviously if you’re outside but you’re sitting in say, a lawn chair for graduation, and you’re shoulder to shoulder to shoulder for a long period of time, that’s a situation where a mask could be beneficial. But generally when you’re outside, you’re moving a lot more, it’s transient, and you have mother nature’s air conditioning system and circulation, so the virus isn’t as concentrated. So the risk is lower. You know, being outside in the summer time, sitting by a pool, maskless, fine. Being outside, walking on a trail, maskless, fine. Once again, congregating without a mask, that’s an area that we probably would want you to wear one.

SCHOOL VIRUS IMPACT

“Right now, anything that reduces congregation of people will help us slow down this virus. We’re at such a high level that even the smallest groups of 10 or 15 or 5 people that don’t live together create an opportunity for spread because so many people have it. So having the schools go virtual for a short time will help that. There are other activities the rest of us need to do to get the kids back to school, as far as stopping to congregate.”

MASKS AND CHILDREN WITH SPECIAL NEEDS

A school bus driver transports children with special needs who cannot wear a mask. What should she do to reduce her risk?

“You are doing everything right. You’re having the windows open as long as you can and you’re masking. Understand there are certain circumstances with special education children where they can’t wear a mask. That’s where we really rely on the parents to make sure they’re screening those children before they get on the bus. Any symptoms, any type of temperature, they shouldn’t be riding the bus.”

DENTAL PROCEDURES

“Dental health is really important, oral health is really important. As a physician, we really want our patients to go to the dentist. We just want you to be safe about it. Making sure that dentists, most if not all, are doing the right things. They’re following the CDC guidelines. Their staff, themselves, are masking at all times. If you have any type of symptom or have been exposed to COVID-19, delay your appointment for a couple weeks. Make sure you’re tested. Make sure you’re not exposing them.”

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