Oregon Emergency Room Physician Dr. Esther Choo Offers a Frank Appraisal of President Trump’s Health

Choo says she started speaking up about Trump’s health because the actions of the president’s doctors didn’t match their words.

SECOND OPINION: Dr. Esther Choo cautions that she’s offering her own medical opinions, not those of Oregon Health & Science University.

When the White House press corps wants a frank assessment of President Donald Trump's struggle with the coronavirus, reporters don't look to his doctors. Instead, some of them call an Oregon emergency room physician.

In the days following Trump's positive test for COVID-19, Dr. Esther Choo has emerged as one of the most outspoken long-distance observers of the president's disease course. Choo, 48, is an emergency medicine professor at Oregon Health & Science University. She also sees patients in the ER atop Marquam Hill, including "dozens" of people suffering from COVID-19 since the pandemic began.

But none of them had the profile of Trump, 74. The world leader who downplayed the dangers of the disease has now fallen prey to it—and continues to scoff at its effects and toss aside his face mask, even as he receives oxygen and steroids. His doctors at Walter Reed Medical Center offer incomplete and conflicting accounts of his health, leaving the nation speculating just how sick the president is.

Choo, who has 166,000 followers on Twitter, is one of the handful of prominent doctors willing to offer public assessments of Trump's condition. On Oct. 4, Choo told The New York Times the president's treatment no longer matched typical precautionary measures—which meant Trump was probably more ill than he let on.

Choo says she started speaking up about Trump's health because the actions of the president's doctors didn't match their words, and the public deserved some clarity. But this isn't her first foray into politics. In 2018, she led a social media campaign of doctors advocating for gun control. ("We are not anti-gun," she wrote, "we are anti-bullet holes in our patients.") This time, however, the spotlight and the stakes are enormous—and the patient may be the nation's greatest threat to public health.

WW spoke with Choo about what Trump's treatment indicates about his illness, why she's willing to discuss the health of someone she hasn't treated, and the taboo question on everyone's mind: Would Trump's death finally make America take COVID-19 seriously?

WW: The president says he has no symptoms left and he feels great. Is he better?

Dr. Esther Choo: It's really hard to say, for a couple reasons. One is that we're only getting partial information. We heard a range for his oxygen saturations, but we didn't hear whether that's on supplemental oxygen, meaning that he dipped lower at different times. And we didn't hear the full set of vital signs. We didn't hear specifically what symptoms he does not have. Has a shortness of breath completely resolved? Has his fever completely resolved?

The other reason we don't know how he's doing is because it's still really early in the course. One of the classic patterns that has emerged in COVID-19 is that you can feel pretty good, or just feel like you have a cough or a regular flu early on. And then some patients will go on to get precipitously worse between Day 7 and 10. So those of us who have been treating COVID patients and really following the literature on the course of this disease, are just sitting back and waiting to see what happens as we get into Week 2.

He's also had steroids. What are the usual effects of steroids administered to a COVID patient or someone else experiencing a respiratory disease?

The reason that we give them is because they can modulate inflammation. The really damaging effects of COVID have been not just the virus itself but the body's immune response. We tend to have this really vigorous immune response, and that causes damage to the lungs. The steroid course is intended to interrupt that immune response. Of course, steroids of all kinds come with side effects. They can really affect your mood. You can feel manic or super hyperactive. It also can actually change your mental status and make you psychotic.

I can see the downside of having a psychotic president.

There might be a downside, since they're in charge of a lot of things.

What's your letter grade so far for his doctors?

What the doctors have described compared to the treatment that he's on has been very inconsistent. From the beginning, they've been saying he's totally fine. He feels great. He's high energy—nothing to worry about. And then he went on this escalating, very aggressive treatment plan that you would normally only give to a patient who has moderate to severe COVID.

The possibilities are [either] they're giving him treatment that is not standard of care or they're giving him standard of care treatment and their assessment at the bedside was that he was sicker than they were willing to let on. But it's clear that they weren't giving a very lucid or consistent story.

Are you worried about armchair diagnosing the president of the United States?

Many of us in the medical field kind of stepped up to try to fill in the blanks and explain what's going on, because it was so puzzling. We certainly tried to steer clear of armchair diagnoses but rather give people an idea of the spectrum of possibilities when somebody has COVID. Some of those possibilities cross over into things that have relevance to all of us: international security. And I think it's important to create some sort of framework, so that it's not a bunch of nonmedical voices trying to sort through all the information that was coming from the medical team at the White House, particularly when that information was so very confusing.

The president's approach to being a patient probably leaves something to be desired. What kind of model do you think he's setting for the rest of the country right now?

What do people think when the president, during his hospitalization, takes a joy ride around the hospital, putting the people in the car at direct risk? What does it say when he comes out of the hospital with active COVID—like, actively infectious—and the first thing he does at the steps of the White House terrace is rip off his mask? And what does it mean for millions of lives out there when he says it's not a big deal, don't let it dominate your life? Seeing all those things, I felt very discouraged. All of us working together collectively—epidemiologists, virologists, public health advocates, nurses, contact tracers—we've all been working so hard to try to get these simple messages out there. He can destroy that work in a moment or two.

How much damage do you think he's done this week to that public health messaging?

We'll never be able to quantify it exactly, but it will lead to illness and death. I'm certain of it. When Trump says anything, whether it's about a medication or behavior, you can see that ripple effect of other people emulating that behavior. When he advocates for hydroxychloroquine, it flies off the shelves. When he talked about bleach, there was almost immediately an attempted bleach ingestion. He really is a viral communicator.

If he dies, what does that do for public health?

Oh, boy. I've been afraid to go there mentally, frankly, because it is so destabilizing for our country to have something like that happen. I think that would be a real come-to-Jesus moment for people about the impact of this virus and how it does not see status. The virus does not care who is influential. I feel like that would be a really sobering moment for people who have been inclined to downplay the impact of the disease. Whether we like it or not, for many Americans who haven't been touched directly by this:  A nameless, faceless 210,000 people dying may actually weigh less than having this one person, who has such outsized importance, succumbing to this disease.

But the president, despite having multiple risk factors, has gotten a really aggressive world-class treatment and is being monitored from minute to minute. Statistically speaking, he's still most likely to survive and do well.

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