“Let Me Take You Down”: Trumpedelic Medicine in the Time of Coronavirus

“Nothing is real, and nothing to get hung about.”

President Trump’s medical treatment in early October 2020 for his COVID-19 infection seemed, to us laypeople, shambolically psychedelic. It was shrouded in mystery, confusion, and magick with the impenetrable Iron Curtain of HIPAA pulled around it.

But step Through the Looking-Glass, as Lewis Carroll aficionado John Lennon often did, and a different picture emerges.

Trump didn’t “fake” COVID-19 — it’s not necessary to “go there.”

It’s just that Trump was never all that “ill” in the first place. Trump is neurotic: a psychosomatic case/hypochondriac/hysteric. What hypochondriacs *perceive* strongly influences the course of their “illness.” Trump believed that he was seriously ill, and panicked.

Trump’s Magical Mystery Tour through the COVID-19 looking-glass created both a medical problem and a political problem for Trump. An inveterate con artist surrounded by highly-skilled grifters, Trump has once again converted an imminent and mortifying defeat into an epic victory . . . provided that we all fall (once again) for the con.

Trump loves playing the “strong man,” but Trump is profoundly weak — Here, There, and Everywhere. https://link.medium.com/k2RMSUkxlab

“Coming to take you away“

Remember that in late May during the George Floyd protests in front of the White House, Trump demanded 10,000 soldiers on the streets — and tanks (TANKS!) — merely because a few protestors were throwing half-full plastic water bottles and a few bricks and a couple of them got momentarily over the fence (and were immediately subdued). Media reports at the time stated that Trump and his family were frightened, as if the United States is Revolutionary France circa 1789. Trump and family were taken to the Bunker on the night of Friday, May 29. Trump was so unnerved that he raged on Twitter the next morning that he would unleash “vicious dogs” and “ominous weapons” on the protestors. It was far out, man.

On June 1, Milley and Esper were able to talk Trump out of invoking the Insurrection Act only by agreeing to his plan to walk “heroically” out of the White House. Jared and Ivanka and Hope Hicks — and Trump — secretly plotted to have Trump stand in front of the church for the Bible fauxto op. Milley and Esper were tricked into believing that Trump was going out to greet local law and security enforcement. Ivanka hid the Bible in her purse. Protestors were gassed and beaten.

This lurid spectacle of faux “bravery” happened because Trump was uncontrollably enraged about the media’s portrayal of his simpering cowardice. Trump’s inadequacies are so emasculating that they cause him to act out with ludicrous projections of power and dominance. It’s extraordinarily dysfunctional.

“Dying to take you away”

Trump is a notorious germaphobe. As former Trump administration official Olivia Troye has told us, Trump’s germaphobia is so pathological that it caused Trump to make the appalling statement that the coronavirus is “maybe a good thing” because it means that he no longer has to shake the hands of his “disgusting” supporters.

Based on Trump’s morbid germaphobia and other things we know about Trump’s psychological profile, it is highly likely that after Trump learned on the evening of October 1 about his positive COVID-19 PCR test result, he panicked again.

We learned from media accounts published during the weekend that Trump was at Walter Reed that White House insiders reported that (at some unspecified point in time) after learning of his positive COVID-19 test result, Trump bayed, mournfully, “Am I going out like Stan Chera? Am I?” referring to his New York real estate magnate friend who died from the coronavirus in April — which we know has haunted Trump. An important detail in the media accounts is that Trump asked this (“Am I?”) repeatedly.

The most likely explanation for when Trump panicked is when White House physician Dr. Sean Conley administered supplemental oxygen to Trump on Friday, October 2nd before Trump went to Walter Reed Hospital. (More on this issue below.) Most likely, Trump’s fear of infection coupled with a medical procedure associated in everyone’s mind with very serious lung damage, triggered Trump’s panic. Our evidence of this is circumstantial, but circumstantial evidence can be just as strong as direct evidence. This is what makes sense.

We also learned from media accounts that Trump was afraid to go Walter Reed. Trump’s doctors had to coerce him into going by pointing out that if he waited and his symptoms worsened, it would look bad politically to be carried out on a stretcher. Pathetically, Trump associated going to the hospital with dying.

“‘Roll up, roll up for the mystery tour“

Trump’s quick course through Walter Reed is puzzling because his doctors acted as if Trump had a severe case of COVID-19.

We learned that Trump had a temperature as high as 103 degrees, coughing, general body ache, fatigue, and — importantly — drops in his blood oxygen level, one of the more important clinical signs of *potential* lung damage resulting from COVID-19 infection. (Also importantly, the blood oxygen level drops were described as only “transient.”) Trump was also said to have had heart palpitations. (More on this below.)

“Roll up (We’ve got everything you need)”

At some point on Friday, Oct. 2nd Trump was given an antibody cocktail (made by Regeneron), the antiviral remdesivir, and the steroid dexamethasone. These are all cutting-edge therapies for treating COVID-19 viral infections and thought of by the layperson public as reserved for serious cases of coronavirus infection. It all sounded impressive, and scary.

But things are not always as they “seem.” Pay attention to what we did *not* learn. Trump’s doctors were relentlessly cagey about several medical issues, especially about the findings on imaging scans of Trump’s lungs. Dr. Conley said only that there were “expected findings, but nothing of any clinical concern.”

The classic COVID-19 imaging findings are “ground-glass”-looking opacities in the lungs, evidence of serious lung damage. But keep in mind that if Trump actually had serious lung damage, the therapeutics administered to him wouldn’t have magically “cured” that damage in two or three days — that’s not how this works.

The way the antibody cocktail works (if it works) is by reducing viral load over time, not by healing damaged lung tissue. It’s more prophylactic than curative, although it may have some curative effect (it’s not clear yet). The studies completed to date have observed the viral load reduction pattern in both animals and humans given the antibody cocktail and have seen that the reduction pattern is more progressive for the groups that received the antibodies than for the groups that received the placebo. This pattern and contrast did not hold up 100% but it held up “good enough” to warrant additional trials.

“Roll up (Satisfaction guaranteed)”

We learned on October 10 that, according to Dr. Conley, testing showed that Trump’s viral load decreased over time, consistently with the design and purpose of the antibody therapy. But we still don’t know whether the antibody therapy caused the viral load reduction versus whether Trump’s viral load would have similarly reduced over time without the antibody treatment — by a completely natural process. It’s all still very speculative, but this data allowed Trump and his supporters to claim that the Regeneron therapy worked as a prophylactic “cure” to prevent Trump from becoming seriously ill — and thus might work for others (and, shows that we don’t have to wait for a vaccine).

This is why the dozens of doctors consulted by the news media — highly-regarded specialists in epidemiology, pulmonary medicine, and other relevant disciplines — expressed persistent bewilderment about Trump’s symptom and treatment course. It didn’t match what they’ve seen in their own patients or in the medical literature. It didn’t even come close.

“Living is easy with eyes closed, misunderstanding all you see.”

For several days after Trump was discharged from Walter Reed on October 5, 2020, it *looked* to many like Trump’s doctors might be hiding worrisome findings and symptoms that are hallmarks of serious COVID-19 cases — especially to those who suspect the worst about those who surround Trump. The Twitterverse exploded with mockery predicting that Trump would soon have a disastrous setback. People speculated about Trump having apparent “trouble” breathing. Trump opponents counted their chickens and clucked with expectation.

But Trump’s “setback” never happened. Instead, with each successive new day, Trump appeared to be generally healthy, and within a short time Trump returned to and then dramatically intensified his rallies, which require stamina and health.

Trump’s adversaries simply got it all wrong.

“The man with the foolish grin is keeping perfectly still.“

There’s a simple explanation for all of this, and the clues are in between the lines.

Remember that Trump is morbidly pre-occupied with germs, and panics when others are calm. For an explanation (not exactly on point, but suggestive of what’s likely going on here) see this description of how “preoccupation with physical symptoms” can trigger fear of infection: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166302/

Most of the symptoms Trump was reported to have had can be caused by psychological stress. Body temperature, for example, is sensitive to stress. So is the feeling of body achiness. Coughing and fatigue can both be psychogenic, that is, caused by stress or by the perception that one has an ailment. Everyone knows this from common life experience with hypochondriacs.

Heart palpitations are classic symptoms of panicky hypochondriacs. Trump’s people put out the story that Trump’s heart palpitations may have been caused by one of more of the therapeutics, but conspicuously missing is a timeline: did the palpitations start before the therapeutics, or only after? More importantly, why did Trump’s advisors take pains to offer this “explanation” for Trump’s heart palpitations? Why was that detail so important that it *needed* to be “explained?” (More on this below.)

The symptom of drop in blood oxygen level is more complicated because panicked breathing, by itself, won’t change oxygen saturation. However, Trump’s close associate Rudy Giuliani has publicly reported that Trump suffers from asthma, which in an “attack” can reduce oxygen saturation. Stress-induced asthma can cause drop in oxygen saturation.

There could be other explanations for drops in Trump’s oxygen saturation, such as pulmonary emboli — we don’t know whether Trump has this condition. Why Trump went to Walter Reed in November 2019 with Pence being told to be on standby to serve as Acting President remains a mystery to the public (but Trump’s doctors know the reason). The larger point is that there can be other causes for drops in oxygen saturation than the coronavirus.

In any event, the drops in Trump’s oxygen saturation were transient and not particularly worrisome, they merely needed to be attended to and managed. And if there actually was evidence of lung damage on imaging of Trump’s lungs, such as ground-glass opacities, that certainly would be “of clinical concern.” There were no such findings.

“I mean it must be high or low.”

What everyone seems to have missed is the simple fact that Trump’s risk of having a serious (life-threatening) COVID-19 infection was very low: around 5%, even accounting for Trump’s advanced age, obesity, and other known risk factors for Trump. https://www.msnbc.com/am-joy/watch/trump-calling-regeneron-covid-19-cure-debunked-by-expert-doctor-93603909633

In other words, there was a 95% chance that Trump would have fully recovered, fairly quickly, with no treatment whatsoever. COVID-19 is a very deadly virus, but it is not deadly or highly threatening for everyone.

This medical fact conflicts with the anti-Trump narrative because that narrative is dependent on excoriating Trump for his stupendously inept handling of the pandemic threat. Yet, it can be true that Trump is a failure as a political leader and a failure in his inability to manage his own insecurities.

We should keep in mind that the hydroxychloroquine therapy was also, earlier this year, thought to be very promising not merely by Trump and his acolytes but also by many science-grounded doctors and hospitals, based on promising initial testing (like there has been for the Regeneron antibody therapy). Hydroxychloroquine was widely prescribed in the US and around the world for many months, only to be found in later robust randomized controlled testing to be of no beneficial effect in prevention or healing of COVID-19 infection.

One of the therapeutics given to Trump, remdesivir, recently failed to show efficacy in a large-scale trial (although some experts argue that the jury is still out). https://www.nytimes.com/2020/10/15/health/coronavirus-remdesivir-who.html

Will Regeneron’s therapeutic meet a similar fate when large-scale randomized controlled testing of its antibody therapy is completed? Only time will tell. It’s worth noting that Dr. Conley prescribed hydroxychloroquine for Trump earlier this year, but not during Trump’s treatment after Trump tested positive for COVID-19. It’s important to be skeptical lest we all continue to chase after the latest shiny object and risk missing what’s really important.

Moreover, if Trump actually did have lung damage from COVID-19, he would have needed ongoing supplemental oxygen by intubation, hyperbaric oxygen therapy, a respiratory machine (ECMO), or some other oxygen delivery system. Ongoing oxygen delivery did not occur — it was only transient.

Remember that the findings on imaging of Trump’s lungs were “expected” yet “nothing of clinical concern.” We don’t know why the findings were “expected” — Trump’s doctors won’t say, though they could if Trump would waive HIPAA about that issue. It could be that what Trump’s doctors “expected” to find in imaging of Trump’s lungs were findings that pre-existed Trump’s COVID-19 infection.

The studies done to date have shown only moderate efficacy of the therapeutics administered to Trump, although certainly much better than no efficacy. Cause-and-effect are still unsubstantiated by large-scale randomized and controlled (using placebos) studies. Also, Trump was given supplemental oxygen only transiently (briefly) and only a couple of times, which is completely inconsistent with serious lung disease such as pneumonia. Although Trump’s “illness” talked like a duck, it didn’t walk like a duck.

“They can see that he’s just a fool.”

The upshot is that Trump’s symptom-pattern is consistent with either a potentially worrisome COVID-19 infection, or with a panic response to fear of the virus. Which is the more likely explanation?

Applying Occam’s Razor, the most likely explanation is that Trump panicked when he tested positive, for a very mild case of the coronavirus.

Continuing to apply Occam’s Razor, the most likely explanation for the seemingly serious therapeutics is that they were administered for two purposes: (1) just in case they were medically necessary, and (2) in the event that they were not medically necessary, as placebo psuedo-”remedies” administered to influence Trump’s perceptions. This is sound, competent medicine. Although the therapeutics have known side-effect risks, those risks are manageable and Trump is under the care of an extraordinarily skilled team of doctors.

“The little children laugh at him behind his back.”

Dr. Conley himself provided the most telling clue-— perhaps unwittingly. Asked on Sunday October 4th why he had not the day before provided reporters with certain information about Trump’s oxygen levels, Dr. Conley remarked, “I didn’t want to give any information that might steer the course of the illness in another direction.” Dr. Conley knew that Trump was watching the Saturday medical press conference on television. Information given to the public could not possibly “steer the course of the illness” in any direction. But information given to Trump, watching the medical press conference, could.

This— the patient’s perceptions and beliefs — is the key to psychosomatic medicine. If you have, say, a broken bone, your doctor telling you just how badly your bone is broken cannot make the fracture any worse. But if your “illness” is created, or influenced, by your mind and your emotions, what your doctor tells you can have a powerful physical effect.

It’s important to observe that news reports on Sunday, October 4th described Trump insiders relating that Trump was “bored” in the hospital. This was the day after the conflicting optimistic picture painted by Dr. Conley in his Saturday press conference versus the pessimistic picture conveyed immediately thereafter to the press by Trump’s chief of staff Mark Meadows.

Dr. Conley was merely stating medical fact. Meadows, however, could see the political implications of Trump “miraculously” recovering in less than 36 hours from what had been initially portrayed as a possibly dangerous medical situation for Trump — “dangerous” enough to warrant the high drama of airlifting Trump to Walter Reed. It didn’t pass the smell test.

Meadows gave a grimmer assessment to the press on Saturday October 3rd to keep us from understanding the situation accurately: that Trump had panicked during the day on Friday, but had quickly “recovered” by Saturday morning (or Friday night) once “remedies” were administered and his symptoms began to wane in lockstep with the quieting of his fears.

Walter Reed served the same essential function as the Bunker had on May 29.

This is also why Trump’s people put out the “cover” story that Trump’s heart palpitations might have been caused by the therapeutics — yet, tellingly, provided no timeline that would allow that story to be validated, or refuted.

Another similarity to the Bunkering is this: Trump spent his weekend at Walter Reed not worrying that he was actually seriously ill, but instead strategizing with his advisors about whether he should carry out the plan he hatched in his “bored” mind to emerge from Walter Reed on Monday, October 5th and rip open his shirt, revealing a Superman costume underneath. Trump’s feeling of emasculation was deepened by his dim understanding (on some level) that his hypochondria and weakness were the true causes of all the drama. Like when Trump held the Bible (as protestors were being gassed and beaten), Trump’s “Superman” plan was ludicrous in the extreme.

“And he never seems to notice . . .”

Most likely, Trump’s doctors are allowing Trump to believe that he had a serious case of COVID-19 and has manfully defeated it. Trump believes in The Power of Positive Thinking (TM) and the medical efficacy of magical remedies like hydroxychloroquine. And Trump has a deep-seated need to believe that he is not weak, coupled with lack of self-insight. This makes Trump the ideal patient for the well-intended but sham “remedies” of psychosomatic medicine.

The Hippocratic Oath is to “do no harm.” It isn’t to tell no lies. Doctors do whatever they need to do to. “Treat the patient not the disease.”

A key feature of psychosomatic medicine is that the doctor must keep the true nature of the “illness” hidden from the insight-lacking patient. Otherwise, the patient is likely to suffer a collapse of morale, frustrating the course of “recovery.” Remember Dr. Conley’s tell: it’s right between the lines.

“I think, er, no, I mean, er, yes . . .”

It’s not necessarily a binary choice of either worrisome coronavirus infection or psychogenic “illness.” Both could be what happened. But each successive day that Trump appears to be healthy and is not taking an ominous turn for the worse increasingly validates the hypochondriac theory as the more persuasive explanation for the symptom-pattern and miraculous “cure,” and strongly rebuts the competing theory that Trump had (and has) a serious illness that is being hidden from us for political purposes by his doctors.

“Don’t you think the joker laughs at you?”

We have a long and nauseating history of caginess and deception about the medical condition of our presidents. Trump’s associates are no outliers in that sorry respect.

But before we condemn Trump’s doctors for hiding the truth from us, let’s remember that their fealty is to their patient’s health, not to the public. Trump’s doctors are hiding the truth, but only from Trump. Yet, to maintain the facade necessary to “heal” the patient (and to keep Trump from catching on that they deceived him, albeit benevolently), Trump’s doctors had to persist in their caginess and half-truths with us. Most of the weirdness of Trump’s treatment and “recovery” course is due to Trump’s doctors scrupulously honoring the “HIPAAcratic” Oath. On that, Trump called the shots.

Consider the contrast between what we learned in “real time” about President Reagan’s wounding to what we learned in “real time” about Trump’s COVID-19 infection.

We learned from the media that as they were driving Reagan back to the White House, the Secret Service noticed that Reagan had specks of frothy bright red blood coming from his mouth, indicating a possible lung wound. We were told that once this worrisome symptom was noticed, Reagan was rushed to a hospital, exploratory surgery was performed, a bullet fragment was removed, internal bleeding was stopped, and Reagan’s surgical wounds were sutured. When Reagan achieved a good recovery, it all made sense — to everyone.

Contrast that with what we know about Trump. Think about that contrast.

“But it’s alright, that is I think it’s not too bad.”

Trump is “okay.” But, we’re not okay — we’ve elected a Sheep in Sheep’s Clothing. Trump himself is manageable — he’s all talk and no action. That’s not true of his most unhinged followers: they’re extremely dangerous. Yet if we correctly understand what is really going on, we’ll be okay on November 3rd. If we could all “get this” we could rid ourselves of Trump and maybe — just maybe — quiet down some of his followers afterwards. Who would want to continue to follow, in defeat, a Big Sissy?

This insight could also help us better understand how to more quickly grasp how emotionally-disturbed people become messiah figures. Much of the attraction is that they are so strikingly outre, so willing to say and do the daring, aggressive things that their weak followers only fantasize about. The psychogenesis of that “attractive strangeness” lies in their profound insecurities. By thinking of messiah-figures as only menacing, we risk missing opportunities to show just how weak they truly are.

“That is I think I disagree.”

Although Trump’s “miraculous” recovery caused his gullible MAGA-supporters to worship Trump with hosannas of praise and admiration, what happened during Trump’s weekend at Walter Reed was simply a manifestation of Trump’s extraordinary psychological vulnerabilities.

But, it was certainly a spectacular Magical Mystery Tour, and that’s what made it all so epically Trumpedelic.