In the early morning hours of Friday, October 2nd, 2020, the public received word that the President of the United States, Donald J. Trump, tested positive for Covid-19. The health of the president is considered a national security issue. Later in the day, the president was admitted to Walter Reed National Military Medical Center. This news was revealed on the heels of over 209,000 deaths and 7.4 million deaths in the U.S. as well as over 1 million deaths and 34.9 million cases worldwide from a highly contagious disease for which we have no cure, no prevention and limited treatment options.
In this case, treating Covid-19 may not be the biggest challenge faced by healthcare professionals.
Providing medical care to individuals like Mr. Trump can be a daunting task. Dealing with Very Important People or Patients (VIPs), can pose several challenges. According to experts at Brigham and Women’s Hospital, VIP syndrome in medicine refers to the tendency to treat influential or famous patients differently. In some cases, VIPs may demand preferential treatment for themselves and their families. In other situations, the physician may assume that VIP status warrants special management and privileges. Either way, the clinician often feels pressured to diverge from data-driven protocols just to please or appease the VIP.
“We need to check our responses to the VIP – our emotions, our assumptions – in order to identify them and to keep them apart from our medical thinking,” states Candida Fink, MD, a psychiatrist in New Rochelle, NY.
We’ve already witnessed evidence of political pressure on federal health agencies. During the summer, top White House officials pressured the Centers for Disease Control and Prevention (CDC) to minimize the risks of sending children back to school. The Food and Drug Administration (FDA) was pressured to issue an Emergency Use Authorization (EUA) for the use of convalescent plasma despite clear warnings against this decision by the National Institutes of Health (NIH).
Less than 24 hours after Mr. Trump presented to the hospital, the president’s personal physician, Sean Conley, DO, led a medical press conference – more like a White House briefing in white coats – which raised more questions than it answered. For instance, he refused to address the use of supplemental oxygen, which could provide insight into the severity of the president’s illness (it was later revealed that supplemental oxygen was administered). Dr. Conley also declined to answer the specific date of Mr. Trump’s diagnosis of Covid-19.
For most of us, our medical information is considered confidential and is not disclosed for privacy reasons. While the president also deserves privacy, in this case, specific clinical details were withheld for different reasons. I suspect that the president himself and/or top White House officials are influencing the messaging to the public, veering away from the science. Patients with VIP status are afforded this opportunity. Politics rather than science has been shaping – and confusing – the narrative since the start of the pandemic.
“VIPs or their people try to infiltrate medical decision-making with high-intensity demands,” Dr.Fink reminds us.
Trump is not alone. Many high-profile individuals displayed VIP syndrome. Michael Jackson was receiving home infusions of propofol, an anesthetic typically used in operating rooms and ICUs. Tom Petty, Prince and Whitney Houston never received evidence-based treatment for their substance use disorders – a sad reality driven by VIP syndrome, shame and stigma of addiction, and a lack of knowledge about effective treatment options for opioid use disorder such as buprenorphine (a.k.a. ‘Suboxone’) and methadone. If they had, each of them might be alive today.
On the surface, it may seem as though a VIP’s social, political and economic influences can “buy” the most expensive, state-of-the-art care. But is it the most effective? According to David Alfrandre, MD, MPH, “The quality of care may be inferior because health care professionals may deviate from standard practices when caring for them.” We saw this happen when the Mr. Trump began taking hydroxychloroquine despite a clear lack of therapeutic benefit against Covid-19. .
The challenge of caring for the president as a patient isn’t just that he’s considered a VIP, but he’s considered the leader of the Western world. This means that misinformation from him is ALL the more dangerous: millions of people avoided masks because they followed the president’s mockery of masks. He also repeatedly undermined well-respected, careered physician-scientists like CDC Director, Dr. Robert Redfield, and NIAID director, Dr. Anthony Fauci. In fact, a recent peer-reviewed study showed that Trump is the leading driver of misinformation about Covid-19.
As a result of this VIP’s powerful influence, millions of people became infected with the novel coronavirus because they did not apply the only two lifesaving, evidence-based preventive measures we have: masks and physical distancing. As a physician and public health advocate, this reality is both infuriating and heartbreaking.
According to the President’s niece, Mary Trump, weakness was unacceptable in her family. Becoming sick is perceived as weakness by Mr. Trump, and this perception is most likely driving the altered communication from his hospital medical team. VIP syndrome at its full, unadulterated glory.
Following his Covid-19 diagnosis, the president received a single dose of an experimental monoclonal antibody therapy by infusion. A treatment, of note, that has not been FDA-approved but rather granted access by the agency’s compassionate use program which refers to last-resort therapies, used when all other options have failed and the patient faces a high risk of dying without the treatment. A description inconsistent with the president’s clinical status as reported by his physician, Sean Conley: he is “doing very well.”
While the president has repeatedly displayed defiant and entitled behavior related to the pandemic, he occasionally listens to scientists. For example, he undergoes frequent testing at the White House, although this might be his illogical justification for not wearing masks. And to be clear, testing is a diagnostic tool, not a preventive one. Right now, while the leader of the Western World is hospitalized, nobody really knows how he is “behaving” as a patient. Is he listening to doctor’s orders and nurses’ instructions? Or is he and his people pressuring the medical team and manipulating care? For his sake – and for the sanctity of science and medicine – I hope it’s the former rather than the latter.