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Brian: Brian Lehrer on WNYC. We'll talk now about some of the medical aspects of president Trump's COVID and related issues, including his press secretary Kayleigh McEnany announcing in just the last few minutes that she has tested positive for COVID. My guest is Dr. Krutika Kuppalli, infectious disease physician, and professor of medicine in the Division of Infectious Diseases at the Medical University of South Carolina. Among other things, she has testified before Congress twice about COVID-19. Dr. Kuppalli, thanks for this consultation today. Welcome back to WNYC.

Dr. Kuppalli: Hi, thanks for having me.

Brian: I see you have already tweeted a reaction to Kayleigh McEnany's COVID test. What are you thinking?

Dr. Kuppalli: I have a lot of thoughts about this. First of all, I don't quite understand why she was not self-isolating given her exposure to the president who we know already is positive. She should not have been in contact with other members of the press corps. She should not have been putting them at risk. I believe that if I'm correct, she was also having these encounters by not wearing masks therefore increasing the risk of her transmitting infection. I was also looking and seeing that she said that she's being tested every day. What I think that a number of people in the administration don't seem to understand is when you get tested, that test is telling you that you are negative at that point in time. If you are incubating the virus, it will not tell you that you're incubating the virus. That seems to be a disconnect amongst some people in the administration.

Brian: What can we learn medically from the progression of Kayleigh McEnany's tests? Because if she was with the president on those other occasions where exposure and spread seemed to be happening like at the debate or debate prep or the Amy Coney Barrett unveiling. I don't know exactly if she was in the president's company at those things, but obviously, she was in the president's company frequently around those things and then she tested negative on some days, but then boom, today she tested positive. What does that show us about the progression of the disease in our bodies from the time we're exposed and actually contract it from somebody to the time it'll show up as a positive test?

Dr. Kuppalli: Sure. I think that's a wonderful question. We know that the incubation period for this virus is anywhere up to 14 days. What that means is, is that it looks like as far as we can tell that the White House Rose Garden Event from last Saturday, that's what started this outbreak. My recommendation would be that anybody who was at that event, that they self-isolate and they do so for 14 days and that they get tested particularly if they develop symptoms. My other recommendation is that if you've been in contact with people who've been in contact with some of these high profile people who we know have had COVID, you also need to be self-isolating for up to 14 days. This is also why we recommend some of the things that we've been talking about, wearing masks, maintaining social distance, maintaining good hand hygiene. These are the things that will also prevent you from getting COVID if you're in the presence of somebody who may have the disease. This is why contact tracing is extremely important. We need to understand who the people who are positive have been in contact with so they can be appropriately notified and know if they need to self-isolate so we don't continue to have onward propagation of the disease.

Brian: On the mix of drugs-- Oh and by the way, Kayleigh McEnany spoke maskless to reporters just yesterday and does so many days. I saw a video myself on TV yesterday of her walking to the podium where she was going to brief reporters with a mask and as soon as she got to it, she took off her mask. I don't know what this indicates for how members of the White House press Corps are going to have to behave now. They were outdoors. I'm not sure exactly if they were no closer than six feet to her, in all cases, I think they probably were further than six feet, but nevertheless, she keeps doing these briefings to a lot of reporters without masks, and now Kayleigh McEnany is positive too. Let me ask you about the mix of drugs being used right now on the president and even the hospitalization itself. Some media people have used the term "Throwing the kitchen sink at Trump." I don't know if that's a medical term, doctor, but how would you compare his treatment to other COVID patients with similar symptoms and risk factors?

Dr. Kuppalli: Sure. That's a great question. I think I've been guilty of using that term "Throwing the kitchen sink at President Trump" as well. The treatment the president is getting is-- Let's not make no mistake, he's getting this treatment because he's the president of the United States. He has access to anything and everything he wants. I think that that's something that people need to keep in mind. He's getting the best medical care. He's getting continuous medical care. This is not treatment you, I, nor any other people would have access to. He got the Regeneron antibody cocktail just right after there was some preliminary data released about it. This drug is not even available for emergency use authorization. He's getting Remdesivir, he's getting dexamethasone. We have maybe studied some of these drugs individually, but these drugs have not been studied together. He is my understanding the first person who's received this combination of drugs which again is notable and important for people to understand that this is not something that most people are going to have access to. It's hard for people to have access to one of these therapeutics, let alone all three of them.

Brian: For you as an infectious disease physician, if a regular American you were treating, let's say an Amazon warehouse worker with health insurance or a domestic worker without health insurance and you as their doctor wanted them to go to the hospital and get the same treatment, would you be able to get them admitted? Would you be able to get them these treatments?

Dr. Kuppalli: If I was taking care of a patient, first off being able to get them admitted would depend on how sick they were. I don't know that getting them admitted would be that hard, but definitely getting them these therapies would be very difficult. I think Remdesivir is more available now than it had been previously given Gilead ramping up production of the drug and some of the restrictions having been lifted. Dexamethasone and others, corticosteroids, the class of drugs that that is in. Those are drugs that we use not infrequently for a various amount of diseases, but a drug like Regeneron that again is still being studied in an adaptive phase trial that we don't have much data on that would not be a drug that I would be able to get for my patients.

Brian: I asked you even about getting admitted to the hospital because Chris Christie tweeted on Saturday night, "In consultation with my doctors, I checked myself into Morristown Medical Center this afternoon, sounds like a hotel, while I'm feeling good and only have mild symptoms due to my history of asthma, we decided this is an important precautionary measure." That really made me wonder, could you put that in the context of all the COVID patients who came before him in similar circumstances, if they had wanted to just check themselves into the hospital as preventive care,

Dr. Kuppalli: Well, won't it have been great if we could have used the same precautions and abundance of precaution for all of our patients who had COVID and for the over 200,000 patients who have now died from COVID perhaps we wouldn't be looking at such grave statistics in the United States. Again, first off I think Governor Christie was probably sicker than he was letting on just as President Trump was likely sicker than he went on when they said that they were admitting him to Walter Reed for an abundance of precautions. We know Chris Christie, he's got numerous medical comorbidities that increases risk of having adverse outcomes from COVID-19. If I'm correct, he is also now receiving Remdesivir as well. I think that what we're seeing happening, in reality, is not consistent with what they're saying. I think people need to keep that in mind and these are people who have access to pretty much anything and everything that they want and that's not what you, me, or other people would have. I think that needs to be something that everybody keeps in mind. Another point that I think that people need to keep in mind is even if president Trump is-- discharged today from Walter Reed, he's still receiving Remdesivir, he's still receiving dexamethasone. He's going back to a residence where he will be highly monitored, that has pretty sophisticated medical abilities right then and there as well. People don't have that at their house.

Brian: People are calling in with some interesting questions. We'll take them after a short break. I also want to ask you more about that steroid treatment that the president is getting, dexamethasone, and what that indicates as we continue with Dr. Krutika Kuppalli, infectious disease physician and professor of medicine at the Medical University of South Carolina, and who has testified before Congress twice about COVID-19. 646-435-7280. Right after this. [advertisement] Coming up at noon on All Of It with Alison Stewart with Rumaan Alam, talks about his acclaimed new novel, Leave the World Behind about a couple staying at a luxury rental on long Island who receive a mysterious visit from the homeowners warning them of an apocalyptic event. Coming up at noon on 93.9 FM AMA 20 or Astro smart speaker to play WNYC. [music] Brian Lehrer on WNYC with Dr. Krutika Kuppalli and Duke in Jersey city you're on WNYC with Dr. Kuppalli. Hi.

Duke: Brian, how are you?

Brian: Good. What's your question?

Duke: Okay. Listen, Brian. I don't mean any disrespect to you, your show. I'll let you know I love you and your guests, but my question or my statement here is if we just look at the situation with Trump right now. You just announced that his press whatever name is, McEnany, she just tested positive.

Brian: She announced it herself.

Duke: We see all of these people testing positive and virtually nobody is sick. It seems like we're looking at something that nobody wants to really ask the question. It's like there's an elephant in the room that we're looking at that depending on your political spin you want to address.

Brian: That's very interesting too. We know that Trump is sick. He said it himself. He wasn't feeling well. He's starting to feel better. We know that Chris Christie by his own words has been sick but what about the rate? We know Melania Trump also has symptoms. There is a question here and I think if the president gets better, assuming he gets better he's going to come out there and say, "Look this is why we don't shut down the economy. Look at me at my age and Chris Christie with his comorbidities and we got sick and we got better. COVID is a thing, but let's not go crazy here." What would you say to that?

Dr. Kuppalli: Sure. I think that those are all fair points. First of all, anything that Trump or Christie might say, I would say back to them, "Well, you're getting medical care that 99.9% of the population is not going to get. I can tell you that. I see that with my patients. I see that with the communities I serve." That would be my first remark. Secondly, we do know that COVID and 80% of people, they do have mild disease. It's the 20% of people who develop severe disease. Mind you we are still in the early days of this outbreak at the White house. We don't know who else is going to test positive. We don't know what the further repercussions of this are going to be. I would also caution you to say that it looks like everybody appears to be like that they are doing well. We have not gotten a lot of transparency as to what's going on with people who are ill already. I think those are some points that we need to make. Finally, COVID is not just about whether or not if it kills you or if it doesn't kill you. What we have seen with patients who have COVID even to those who have asymptomatic disease, those who never develop symptoms, we do see findings of changes on their chest X rays, their CT scans. They develop pulmonary complications, shortness of breath. They develop problems with their heart. People develop neurological issues. I have colleagues that have had COVID months ago that are still struggling to recover from that. The long-term consequences of having this disease that we're still learning about could have implications on our healthcare system and on people in terms of their disability. It's not a cut and dry situation as some people want to make it out to be.

Brian: Tell me about the steroid that the president is on, dexamethasone, which has been shown to be beneficial in some people with severe COVID-19 because it can stop the immune system from going into overdrive. What does the fact that he's getting that indicate about his condition? I've heard a lot of people talking about potential side effects from that steroid even cognitive and temporary mental health ones.

Dr. Kuppalli: Sure. President Trump is getting dexamethasone. It's a steroid. There was a study that came out earlier this year called the recovery trial that shows that in patients who were receiving invasive mechanical ventilation who received steroids, they had improved mortality at 28 days and also those who received supplemental oxygen had improved mortality at 28 days. The recommendations have said from both WHO, from the Infectious Disease Society of America is that if you have what is designated as severe or critical COVID that you would be somebody to be considered to get dexamethasone. Based on what we've been told by Trump's treating physicians that he's had a few episodes of where his oxygen level has fallen, that was why they decided to give him the dexamethasone. It is a drug that again, is not completely benign. It can cause problems with your blood sugars getting very high. We'll have to monitor that and sometimes they'll have to give you medications to control your blood sugars. Because it affects the inflammatory response and the immune system, it can predispose people to developing secondary infections like bacterial infections and fungal infections. Then as you alluded to it can cause what we call confusion and delirium. Delirium is again, another word for altered mental status. In some people, it can cause what we call steroid psychosis. It just makes them basically like a psychotic. It can have a range of effects on people. Again, the president is elderly. We know infections tend to affect elderly more severely and they can be confused. We know SARS-CoV-2, the virus that causes COVID-19 has caused some neurologic issues in some people. I can't say if the president has that or not, but then you're taking all that and then you're adding a drug that potentially could cause some confusion or problems with mentation. Those are all things to be cognizant about.

Brian: There we will have to leave it with Dr. Krutika Kuppalli, infectious disease physician and professor of medicine in the Division of Infectious Diseases at the Medical University of South Carolina. Thanks for all that information doctor, we really appreciate it.

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