For the past several days, President Donald Trump has had COVID-19. It’s unclear for how many days, because the president’s physician, Sean Conley, refuses to share that information. When asked again yesterday, Conley told reporters, “I don’t want to move backwards.” In fact, Conley has shared very little about the course of the president’s illness. On Friday, the same day Trump informed Americans that he had tested positive, he was taken to the hospital “out of an abundance of caution,” according to his press secretary. By the next morning, the narrative had shifted. Conley said that Trump was “doing much better,” but relative to what, exactly? Then, on Monday, Conley told reporters that the president was to be discharged to the White House. “He’s back,” Conley said with a smile.
To hear Conley tell it, Trump was also never gone. The story of his illness jumped from “nothing to see here” to “mission accomplished.” Trump reportedly worked out of the presidential suite at the military hospital as the White House reassured Americans that his job could be done well from there. It released images of him in a suit at a desk, next to a telephone. Now, according to Conley, the president is back at the White House, where he can get “world-class medical care, 24/7.” (Conley could not be reached directly, and the White House did not immediately respond to a request for comment.)
Last night, Trump was helicoptered back to the White House, crossing the lawn and removing his mask to salute Marine One in a spectacle that quickly was turned into a gauzy campaign-style video. The president is declaring victory. “Don’t be afraid of COVID,” he tweeted earlier in the day. “Don’t let it dominate your life.”
This is a dangerous narrative, and Trump’s doctor has helped to shape it. Conley has served as Trump’s publicist in a white coat, reassuring Americans at every turn that Trump is doing well, while leaving out conspicuous details. His vaguery and obfuscation have repeatedly undermined these reassurances. His ethical obligation to his patient is in direct conflict with the basic moral imperative not to lie, by omission or otherwise. Any physician has a duty to the public as well, specifically when dealing with a patient who poses a direct threat to others. Conley is seemingly intent on informing the country how strong the president is, making him complicit in the downplaying of this disease when what the country needs is the bare truth.
The American people still do not know when the president was infected with the coronavirus. We know little more than Trump’s age, his current vital signs, and some of the medications he is taking. Just since Saturday, Conley has declined to answer the most basic questions: Does the president have pneumonia? Why did he start taking dexamethasone? What blood tests have been abnormal? When asked by reporters for discrete data such as the president’s oxygen-saturation levels, Conley said, “Less than 94.” If there is one value that a doctor should know precisely about a patient who is being monitored for respiratory failure—for which the low 90s constitute an unstable zone—it’s this number.
Conley has changed the story. In a press conference on Saturday, he said that Trump was not on supplemental oxygen, and then conspicuously avoided three direct questions as to whether he ever had been. But then, on Sunday, he claimed that the president had received supplemental oxygen in two instances during his illness. Conley said that he had concealed the fact before because he “was trying to reflect the upbeat attitude that the team, the president, [and] his course of illness has had … In doing so, you know, it came off that we were trying to hide something, which wasn’t necessarily true.”
Maybe the biggest lingering question surrounding Conley’s statements is the decision to start Trump on dexamethasone, even while Conley has repeatedly denied that the president has had significant respiratory issues. Dexamethasone is a commonly used steroid, sometimes prescribed for COVID-19 patients in an attempt to tamp down the immune response that can cause them to crash after an initial phase of mild symptoms. But the Infectious Disease Society of America does not recommend the drug for patients who are not in “severe” or “critical” stages of COVID-19. When reporters asked Conley to explain this treatment decision on Monday, he expressed indignation at the question: “I’m not going to go into specifics of what he is and is not on.”
Conley has also referenced “expected” findings in Trump’s chest-imaging tests, but that’s different from “normal,” the term doctors use to denote that nothing is wrong. “Expected” findings are not necessarily good. Conley repeatedly declined to elaborate. He also mentioned abnormal blood tests, but would not say more. On Monday, he alluded to abnormalities in Trump’s kidney functioning, saying that blood tests showed the president had been “dehydrated,” but that this test had returned to normal.
For dehydration to temporarily impair the kidneys is not uncommon. It’s not typically concerning. What is concerning is Conley’s unwillingness to just say that, instead resorting to dodges like “I’m not going to get into operations” and invoking HIPAA when asked about abnormal findings. Every patient has a right to privacy, and there are some issues that the president may not want to go into extreme detail about. It’s possible that Trump directed his doctor not to talk about certain findings. As the president’s physician, Conley is not an elected official: His primary duty is to Trump. He may consider himself to be a responsible citizen and doctor as long as he is leaving the American people with a basic feeling that the president is doing fine.
But a doctor who is at liberty to discuss only normal and positive findings should not be holding a press conference. The job of a physician is not to reflect an upbeat attitude. It is not to conflate optimism with obfuscation. The job of a physician is to deal in reality—to neither minimize threats nor overemphasize them.
The unique bioethical dilemma of the moment is that we are in the middle of a pandemic. Accepting reality, and a shared set of facts, is vital. And there is one crucial exception to a doctor’s obligation to protect a patient’s privacy: when that patient is a threat to others.
On Monday, when Conley told reporters that he had given Trump the go-ahead to return to the White House, he could not say whether or how Trump would isolate himself for the rest of his illness. He is presumably still contagious (unless he has already had the virus for 10 days). That is: The president, in the throes of COVID-19, was being discharged back to the very site of a major coronavirus cluster. Why send a contagious person back to the place where an outbreak is still unfolding, if he is able to quarantine and execute his duties in his presidential suite at Walter Reed?
Conley even defended the president’s decision on Sunday to break quarantine and go on a car ride with Secret Service agents, which an attending physician at Walter Reed called “insanity.” At the very least, the appropriate response from Conley would have been to say “I advised against that.”
Statistically, Trump is most likely to continue recovering uneventfully. This decision to return home is not clearly medically unwise for him. But the declaration of victory and the overall downplaying of Trump’s medical status do a grave disservice to the public. And though it is within Trump’s purview, going back home is, at the very least, inconsiderate of the staff at the White House. That creates risk not just for those who work there, but everyone who has contact with those people, and then everyone who has contact with those people. As the current cluster at the White House has made abundantly clear, a single negligent act can end up leading to multiple cases.
Such acts are preventable. Most happen because of failures to take basic precautionary measures. Since the beginning of the pandemic, Trump has repeatedly failed to take such measures, and he continues to dismiss the threat, denying simple facts and implying that some form of exceptionalism will exempt Americans from suffering. Meanwhile, more than 200,000 Americans have died from COVID-19. Conley has had ample opportunities to do what Trump hasn’t done—speak objectively about the medical facts. Simply doing so would emphasize the importance of wearing masks and taking the virus seriously.
Instead, Conley has opted for complicity, becoming a mouthpiece for Trump’s show of personal strength. Americans are left to speculate about Trump’s health based on what they see in curated videos and press photos—none of which show him in a hospital gown or even in a medical setting. In another time and place, it may be fine to respect a president’s privacy regarding medical issues that have no bearing on ability to govern. But downplaying Trump’s case of COVID-19 in this unique moment has widespread consequences. The hundreds of millions of Americans who are still at risk of contracting this disease could have seen the realities of what it is like, and better understood the value of stopping the virus. Instead, they have been shown that the consequences of negligence are cinematic helicopter rides and a weekend spent wearing a suit in the hospital.