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[camera shutters] [from off-camera] Mr. President, how many staff are sick? How many of your staff are sick? [President Trump] Thank you very much. Thank you. [from off-camera] Do you think you might be a superspreader, Mr. President? [camera shutters]
After spending three nights at the Walter Reed medical center, President Trump returned on Monday evening to the White House, where he will continue to receive treatment for Covid-19. His physician, Dr. Sean P. Conley, had said earlier in the day that the president was not out of the woods yet.
Mr. Trump, wearing a mask and a suit, passed through the hospitals large golden doors, paused atop a flight of steps and pumped his fist a few times at chest level. He did not respond to shouted questions from the news media as he walked past, unaccompanied. Thank you very much, everybody, he said with a wave.
Mr. Trump then boarded a black S.U.V. that drove him to his presidential helicopter, Marine One, for the short flight to the White House. He offered a thumbs-up just before stepping onto his helicopter, which departed just after 6:45 p.m. for the 10-minute flight.
After landing on the South Lawn, Mr. Trump ascended a flight of stairs and then turned to face his helicopter and the live television cameras and removed his mask before giving the departing Marine One a long salute.
He then turned and walked into the White House residence without donning his mask. Several masked people, including what appeared to be an official photographer capturing the moment, were inside.
The three major network newscasts on ABC, CBS and NBC carried it all live, the kind of blanket television coverage that Mr. Trump relishes. But after climbing the stairs, Mr. Trump appeared to be short of breath.
At a briefing earlier in the day, Dr. Conley said, Over the past 24 hours, the president has continued to improve, adding, Hes met or exceeded all standard hospital discharge criteria.
The presidents doctors evaded some key questions about the presidents condition, including his lung function and the date of his last negative coronavirus test before he tested positive. They said that he had received a third dose of the antiviral drug remdesivir, and that he has continued to take dexamethasone, a steroid drug that has been shown to be beneficial to patients who are very sick with Covid-19.
Were looking to this weekend, Dr. Conley said. If we can get through to Monday, with him remaining the same or improving better yet, then we will all take that final deep sigh of relief.
Dr. Conley did not give a firm answer about whether Mr. Trump would be confined to his residence. The West Wing is experiencing a growing outbreak, with Mr. Trumps press secretary, Kayleigh McEnany, joining the list on Monday of his close aides who have tested positive.
The doctors remarks came after Mr. Trump tweeted that he would be returning to the White House, which is equipped with a medical suite. In doing so, as he has throughout the pandemic, he downplayed the seriousness of a virus that has killed more than 210,000 people in the United States, writing in his post, Dont be afraid of Covid. Dont let it dominate your life.
After returning home, the president later posted a video on Twitter, where he again downplayed the virus, saying, One thing thats for certain: dont let it dominate you; dont be afraid of it. Youre going to beat it.
That exhortation quickly resonated, with some Democrats, scientists and relatives of victims denouncing the president as cavalier and dismissive about a disease that has killed so many, sickened more than 7.4 million and upended daily life across the country.
It was not the first time Mr. Trump has drawn criticism for being cavalier about the pandemic. On Sunday, when he left his quarters at Walter Reed to wave to supporters from an S.U.V., some doctors and others noted the irresponsibility of being in a sealed vehicle and potentially exposing Secret Service agents for an unnecessary stunt.
Critics also noted the president is receiving care that isnt available to most people, including an experimental antibody treatment that is still being tested in clinical trials and has been given to only a few hundred people.
The manufacturer, Regeneron, has said that most of those who have gotten the cocktail have done so as participants in the trials, although in a handful of cases they have received it outside of the studies, as Mr. Trump did.
Dr. Conley would not discuss the findings of a scan of Mr. Trumps lungs, which can be affected by the respiratory virus. His doctors had earlier said that his blood oxygen levels had dropped at least twice, and that he had received supplemental oxygen, which would indicate that his lungs were not functioning properly.
There are HIPAA rules and regulations that restrict me in sharing certain things for his safety and his own health and reasons, Dr. Conley said, referring to a federal law that restricts what type of patient information health professionals can share. On Sunday, Dr. Conley was also evasive, avoiding questions about whether any lung damage or pneumonia was revealed by the presidents X-rays.
Mr. Trumps return home was a dramatic turn of events given that just a day earlier, his medical team had presented mixed messages about his condition, saying that the president was feeling well but also revealing that he had been prescribed the steroid dexamethasone, which is typically not used unless someone needs mechanical ventilation or supplemental oxygen.
Some medical experts said on Monday that given Mr. Trumps risk factors he is 74, male and overweight he should be closely watched for at least the first week of his infection because some patients quickly deteriorate several days into their illness.
I think it would be disastrous to be in a situation where he gets really sick at the White House, and youre having to emergency transfer him, said Dr. Cline Gounder of N.Y.U. Grossman School of Medicine, who has been caring for Covid-19 patients. To me, its not safe.
Dr. Mangala Narasimhan, the director of critical care services for Northwell Health, the largest health care provider in New York State, said that if the president does not need oxygen, it may be reasonable for him to go home, given that he can receive medical treatment at the White House.
But she said the information about his condition was too limited to allow outside experts to assess his condition. Were all guessing, she said.
She, too, warned that Mr. Trump was heading into a critical period. There could be a very rapid decline in these patients, she said, adding that some develop blood clots in their lungs and other pulmonary problems, and need to be quickly put on ventilators.
Public health experts had hoped that President Trump, chastened by his own infection with the coronavirus and the cases that have erupted among his staff members, would act decisively to persuade his supporters that wearing masks and social distancing were essential to protecting themselves and their loved ones.
But instead, tweeting on Monday from the military hospital where he had been receiving state-of-the-art treatment for Covid-19, the president yet again downplayed the deadly threat of the virus.
Dont be afraid of Covid, he wrote. Dont let it dominate your life.
The presidents comments drew outrage from scientists, ethicists and doctors, as well as some people whose relatives and friends were among the more than 210,000 people who have died in the United States.
I am struggling for words this is crazy, said Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania. It is just utterly irresponsible.
Fiana Garza Tulip, 40, who lives in Brooklyn and lost her mother to the virus, wrote in a text message that she was reeling after reading Mr. Trumps tweet, which she described as a slap in the face and a painful reminder that our president is unfit for office and that he does not care about human life.
My mom, a respiratory therapist, couldnt get tested at her hospital where she worked, she had to look for two days for a testing site while feeling the effects of Covid, she didnt want to go to a hospital because she said it was worse there and she didnt want to call an ambulance because it was too expensive. So she stayed home for a week and lost her pulse as soon as the medics put her on a gurney.
Shane Peoples, 41, whose parents, Darlene and Johnny Peoples, died of the coronavirus on the same day in September, said the presidents comments were frustrating.
Is he actually trying to put more lives at risk? Mr. Peoples said. He needs to be held accountable for the deaths that could have been prevented if he never downplayed it.
Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical School in Tennessee, called the presidents message dangerous because it encouraged his followers to ignore basic recommendations to keep themselves safe.
It will lead to more casual behavior, which will lead to more transmission of the virus, which will lead to more illness, and more illness will lead to more deaths, Dr. Schaffner said.
Mr. Trump has often ignored the recommendations of public health experts, repeatedly mocking people for wearing masks, for example.
I dont wear masks like him, he said of the Democratic presidential candidate, Joseph R. Biden Jr., at a debate last week. Every time you see him, hes got a mask. He could be speaking 200 feet away from them, and he shows up with the biggest mask Ive ever seen.
Upon Mr. Trumps return on Monday evening from the Walter Reed medical center, he climbed the steps of the White House, turned to face the TV cameras that were carrying the news live, and removed his mask.
Top White House officials are blocking strict new federal guidelines for the emergency release of a coronavirus vaccine, objecting to a provision that would almost certainly guarantee that no vaccine could be authorized before the election on Nov. 3, according to people familiar with the approval process.
Facing a White House blockade, the Food and Drug Administration is seeking other avenues to ensure that vaccines meet the guidelines. That includes sharing the standards with an outside advisory committee of experts perhaps as soon as this week that is supposed to meet publicly before any vaccine is authorized for emergency use. The hope is that the committee will enforce the guidelines, regardless of the White Houses reaction.
The struggle over the guidelines is part of a monthslong tug of war between the White House and federal agencies on the front lines of the pandemic response. White House officials have repeatedly intervened to shape decisions and public announcements in ways that paint the administrations response to the pandemic in a positive light.
That pattern has dismayed a growing number of career officials and political appointees involved in the administrations fight against a virus that has killed more than 210,000 people in the United States.
The vaccine guidelines carry special significance: By refusing to allow the F.D.A. to release them, the White House is undercutting the governments effort to reassure the public that any vaccine will be safe and effective, health experts fear.
The public must have full faith in the scientific process and the rigor of F.D.A.s regulatory oversight if we are to end the pandemic, the biotech industrys trade association pleaded on Thursday, in a letter to President Trumps health secretary, Alex M. Azar II, asking for release of the guidelines.
The coronavirus outbreak in the West Wing continued to spread on Monday, as the White House press secretary and two of her deputies joined the list of aides close to President Trump who have tested positive for the virus, heightening fears that more cases are still to come.
The press secretary, Kayleigh McEnany, announced on Twitter that she had tested positive and would be quarantining. Ms. McEnany said she had previously tested negative several times, including every day since Thursday, but health experts said she may have been infectious for days including when she spoke briefly to reporters without a mask outside the White House on Sunday.
Two other members of the press team, Karoline Leavitt and Chad Gilmartin, who is Ms. McEnanys relative, also tested positive but learned about their status before Ms. McEnany, according to two people familiar with the diagnoses.
The revelations came amid many unanswered questions about whether Mr. Trump could relocate to the White House without endangering himself and others and suggested that the White House does not have control of the virus.
Vice President Mike Pence, who tested negative on Sunday, was scheduled to travel to Utah ahead of Wednesday nights vice-presidential debate. Mr. Pence also plans to attend campaign events in Arizona and Florida this week before stopping in his home state of Indiana to vote early.
His doctor said in a statement on Friday that Mr. Pence was not quarantining because, as of that time, he had not been close enough to any individuals known to have the coronavirus for long enough to qualify as a close contact at high risk of infection.
Despite almost daily disclosures of new coronavirus infections among President Trumps close associates, the White House is making little effort to investigate the scope and source of its outbreak.
According to a White House official familiar with the plans, the administration has decided not to trace the contacts of guests and staff members at the Sept. 26 Rose Garden celebration for Judge Amy Coney Barrett, Mr. Trumps Supreme Court nominee. At least 11 people who attended the event, including the president and the first lady, have since tested positive.
Instead, it has limited its efforts to notifying people who came in close contact with Mr. Trump in the two days before his Covid diagnosis on Thursday evening. The White House official, who declined to be identified because he was not authorized to speak about the matter, said that the administration was following guidelines from the C.D.C.
The contact tracing efforts have consisted mostly of emails notifying people of potential exposure, rather than the detailed phone conversations necessary to trace all contacts of people who have been exposed. These efforts, typically conducted by the C.D.C., are being run by the White House Medical Unit, a group of about 30 doctors, nurses and physician assistants, headed by Dr. Sean Conley, the White House physician.
This is a total abdication of responsibility by the Trump administration, said Dr. Joshua Barocas, a public health expert at Boston University, who has advised the city of Boston on contact tracing. The idea that were not involving the C.D.C. to do contact tracing at this point seems like a massive public health threat.
Two weeks after the Centers for Disease Control and Prevention removed online guidance about airborne transmission of the coronavirus, the agency has replaced it with language citing new evidence that the virus can spread beyond six feet indoors, adrift in the air.
These transmissions occurred within enclosed spaces that had inadequate ventilation, the new guidance said. Sometimes the infected person was breathing heavily, for example while singing or exercising.
Notably, the C.D.C.s new guidance softens a previous statement referring to the coronavirus as an airborne virus, a term that may have required hospitals to treat infected patients in specialized rooms and health care workers to wear N95 masks anywhere in a hospital.
The new version says the virus can be spread by both larger droplets and smaller aerosols released when people cough, sneeze, sing, talk, or breathe. But while the virus can be airborne under some circumstances, this is not the primary way the virus spreads.
The C.D.C.s revisions come as the Trump administration is contending with a rising number of such infections among the presidents inner circle. Kayleigh McEnany, the White House press secretary, announced on Monday morning that she was positive for the coronavirus, the latest in a string of political figures heading into isolation following what may have been a so-called super-spreader event at the White House last month.
Despite the time that former Vice President Joseph R. Biden spent with President Trump during the presidential debate in Cleveland last week, Mr. Biden is continuing to campaign because he did not meet the C.D.C. requirement for close contact less than six feet of distance from an infected person.
But in a statement accompanying the new guidance, the C.D.C. said, People are more likely to become infected the longer and closer they are to a person with Covid-19.
Mr. Trump talked loudly and at length during the debate, which experts said could have released 10 times as much virus as breathing alone.
On the schools in these areas not all of them have been tested. So we dont have data on all of the schools in these hotspot clusters that troubles me. They have sampled some schools in the clusters, but not all the schools. And these are the hotspot clusters, right? So you have to prioritize testing. You want to go to these schools first because you know they are in hotspot clusters. So some schools in those clusters we have not yet done testing on. Better safe than sorry. I would not send my child to a school in a hotspot cluster that has not been tested, where I did not have proof that the infection rate was low in that school. I would not send my child. I am not going to recommend or allow any New York City family to send their child to a school that I wouldnt send my child. Were going to close the schools in those areas tomorrow.
Gov. Andrew M. Cuomo of New York refused on Monday to allow New York City to close nonessential businesses in nine hot spots in Brooklyn and Queens where the coronavirus has spiked, pre-empting a plan announced the day before by Mayor Bill de Blasio.
The governor suggested that the ZIP codes that were being used to identify hot spots were too imprecise to guide shutdowns. The more pressing problem, he said, lay in schools and houses of worship, including many that cater to Orthodox Jews, rather than businesses that are not large spreaders.
The dissonance in messages from the states two most prominent politicians created confusion for residents, business owners and parents in the affected areas and drew scrutiny to the conflict between city and state over how to tackle early signs of a second wave of the virus in its onetime epicenter.
The governors announcement also seemed to be yet another manifestation of his long feud with Mr. de Blasio. Mr. Cuomo has frequently second-guessed or overruled the mayor, who is also a Democrat, during their tenures. Those clashes were cast in sharp relief during the early days of the pandemic, with the city and state at odds over the timing of shutting down the citys businesses and its schools, among other issues.
On Monday, that disconnect continued, as Mr. Cuomo accelerated the mayors plan to close schools in newly hard-hit areas, moving the closure date up a day to Tuesday, and forcing parents in those areas to again rejigger their schedules to accommodate changes in their childrens routines. Mr. Cuomo said he spoke with Mr. de Blasio and Michael Mulgrew, the president of the citys teachers union, among other local officials, on Monday morning and added that all were in agreement on the need for additional data on cases at specific schools.
Mr. Cuomo did not rule out closing nonessential businesses or public spaces in the near future, and top aides suggested a state plan could be unveiled as soon as Tuesday. Mr. Cuomo said his administration was reviewing how best to do it without relying on geographic delineations from ZIP codes, which he said were arbitrary and might not accurately capture the areas where new cases are going up.
A ZIP code is not the best definition of the applicable zone, he said. If you have to circumscribe an area, make sure you have the right boundaries.
Cuomo administration officials later suggested that the boundaries for business closures could even exceed the ZIP codes where the increases are now occurring.
On Monday afternoon, not long after the governors news conference, Mr. de Blasio said at a news conference of his own that he still planned to close nonessential businesses in the nine ZIP codes. He added later that we obviously will follow state law, and if the state does not authorize restrictions were not going to act. But I find that very unlikely at this point.
Mr. Cuomo had also announced that the state would take over supervision of enforcement of mask and social-distancing rules in the hot spot clusters, presumably putting the State Police in charge of New York City Police Department officers. He added that local governments would need to provide personnel.
The mayor said that he did not believe that the state could seize control of enforcement from local governments but that he agreed with Mr. Cuomo on the need for aggressive enforcement and stronger restrictions that will allow us to turn the tide.
President Trumps declaration that he would leave Walter Reed National Military Medical Center, where he was being treated for the coronavirus, left health professionals stunned. But even if he were not the president, his doctors would have to take extraordinary measures to keep him in the hospital against his will.
Under ordinary circumstances, a patient who wanted to leave the hospital against the recommendation of his or her doctor might be asked to sign a discharge form acknowledging that he or she was declining further treatment. At times, psychiatrists are called in to determine if the patient is capable of making such a decision.
In the medical lexicon, this is called leaving A.M.A. against medical advice. Roughly 2 percent of all patients do so, for varying reasons, often because they need to juggle work and home obligations. If the patient leaving against medical advice had a contagious disease, he or she would be asked to pledge to follow public health guidelines to keep those around him or her safe.
Having an infectious illness itself is not a reason to keep someone in the hospital, said Dr. Leana Wen, a former commissioner of health for the city of Baltimore. But if there is a suspicion that a patient will knowingly and purposefully endanger others, there would need to be a discussion had about keeping that patient in the hospital against his will.
That discussion would be a complicated legal one, governed by state and local public health laws and the Constitution. Both Dr. Wen and Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee, raised tuberculosis a highly infectious disease as an applicable analogy.
In Baltimore, Dr. Wen said, the public health department routinely stepped in to ensure that patients in the hospital for tuberculosis treatment were kept there if they gave us reason to believe that if they were to leave that they would not take the medications that were prescribed and then they would be at high risk for infecting others. She said law enforcement often became involved.
In Tennessee, Dr. Schaffner said, doctors would be required to seek permission from a judge. The burden of proof is on the health care system, he said, to document that the person is a substantial hazard to others and then they can be confined until they complete their therapy.
The federal Centers for Disease Control and Prevention has published a handbook on tuberculosis control laws as a guide for medical professionals. Courts have struggled to determine when government authority to promote the populations health justifies encroaching upon established individual rights, the handbook says.
The White House physician, Dr. Sean P. Conley, told reporters on Monday that Mr. Trump had not pushed his doctors to do anything that was beyond safe and reasonable practice. And he noted that at the White House, Mr. Trump would have 24-7 world-class medical care surrounding him.
Even so, Dr. Conley acknowledged that Mr. Trump is not yet in the clear, and said he would not take that final deep sigh of relief until at least next Monday, because the next few days will be critical. Other experts have raised blunt questions about why Mr. Trump would go home even to the White House so soon after diagnosis, especially given the unpredictable course of Covid-19, the disease caused by the coronavirus.
Im worried about in two days he might suddenly crash and then on an emergency basis he would have to be rushed back, Dr. Schaffner said.
He also raised questions about the presidents decision to leave Walter Reed for an impromptu ride in a motorcade through surrounding Bethesda, Md., on Sunday afternoon. Ordinarily doctors want patients to self-isolate until they are 10 days from the onset of symptoms, and three days without symptoms.
Id be surprised if it were with medical concurrence, Dr. Schaffner said.
Dr. Sean P. Conley runs the White House Medical Unit and holds the title of physician to the president. He is also a commander in the Navy, which means his patient is also his commander in chief. The arrangement turns the traditional power dynamic between doctor and patient on its head, with Dr. Conley ultimately forced to choose between compliance and disobedience should President Trump disagree with his recommendations.
The president has been a phenomenal patient during his stay here, and hes been working hand in glove with us and the team, Dr. Conley said at a news conference at Walter Reed National Military Medical Center in Bethesda, Md., hours before the presidents departure from the hospital Monday afternoon. Dr. Conley refused to answer some of the questions asked by reporters, citing medical privacy laws.
That right to privacy under the 1996 Health Insurance Portability and Accountability Act can be waived by patients if they so choose, allowing doctors to share otherwise protected information with the public. It appears that Mr. Trump has waived only information that supports the idea that he is rapidly returning to good health.
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