The president’s doctor, Sean Conley, isn’t providing a complete picture of Trump’s condition. The timing doesn’t make sense. And the treatment doesn’t make sense. What do we know about an outbreak coverup in the West Wing?

Staff writer James Hamblin and executive producer Katherine Wells discuss on the podcast Social Distance. Listen here:

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What follows is a transcript of their conversation, edited and condensed for clarity:

Wells: For the first time maybe since we started this podcast, I don't have any questions. This feels like the least surprising thing that's happened. It feels like the logical conclusion of the last six months. The whole thing is sort of like strangely unsurprising. Has this raised new questions for you?

Hamblin: Well, I have a lot of questions. The first thing we learned he was taking was this antibody cocktail made by a company called Regeneron—which in that same week had done a big PR push behind their early results, saying that they were better than they actually were. They're making these synthetic monoclonal antibodies. But the only way for normal people to receive them is to be in a clinical trial. [Trump]      was given it for reasons we don't quite understand, under a special exemption to that law.

Wells: As much as I'm curious about the process ... he's the president. It doesn't seem that complicated.

Hamblin: Well, it's curious because the early trials are just not that promising. It's probably not going to be harmful, but it's unclear. And then you combine that with the fact that he also took another experimental (but slightly more substantiated) treatment, an antiviral called remdesivir.

It's very expensive, but it will have some use cases where it can help people. We don't know enough about the president's course of disease to know if he's in the category that would likely be helped by it. But we know he was given it.

Wells: And there's a third drug, which seems to be the one that's the most alarming, right?

Hamblin: Yes, on Saturday they started him on the steroid dexamethasone. But there is this really important tension: steroids calm the immune system, so when your body's trying to clear an infection, you don't want to be on steroids. It can make you more susceptible to infection, or to that infection progressing. So doctors try to balance its use, and that's the challenge in treating COVID-19.      

Wells: Sometimes it's your immune response that kills you.

Hamblin: Yeah. And from what we were told, he started these antivirals at almost exactly the same time he started the dexamethasone. That timing is curious, as well as the decision to start dexamethasone at all because it's not recommended except in severe or critical cases, which is at odds. If your lungs have enough inflammation that you are unable to oxygenate your blood and your blood oxygen levels are dropping significantly, that's an indication that you've pushed into this stage of inflammation where it's logical to start steroids and try to pull that back.

The public is being told that that was not happening to the president. There were two brief instances in which he temporarily had slightly low levels. But also, the decision was made to start dexamethasone.

So the very logical question is: what was happening that made you think this was a way to go? And the president's doctor has deflected on that. When you say you started the president on dexamethasone, all of a sudden, you've implied it's a severe or critical case. There's a need to know more.

Wells: What are you wondering about specifically?

Hamblin: I mean, clearly, there was a cover up.

Wells: Of?

Hamblin: Of information. We know that. Within 24 hours we learned: the president had a high-risk exposure. The president is positive. The president has symptoms. The president has received an experimental therapy. And the president is going to be hospitalized for a few days.

That is not how this disease works. And no one should be tested or monitored more frequently than the president and the people close to him. So there had to be knowledge that there was some high-risk exposure. There had to be a positive test. There had to be symptoms we didn't know about. And this remains to be litigated, but the president was out and about during a time when he was either not tested for a few days or he had a positive test and went out anyway.

Wells: Obviously it's been very alarming, but also somehow tragically unsurprising. What do you think are the important questions for the public right now?

Hamblin: It would be significant to know that a president knew that he was positive. The ethics of whether or not you immediately tell the public is one thing. You might want to do a confirmatory test and lay low. But he didn't lay low. So either he wasn't tested or he was positive. And that is a massive scandal in the middle of a pandemic.

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