President Trump: I came here. I wasn't feeling so well. I feel much better now. We're working hard to get me all the way back. I have to be back.

Tanzina Vega: President Trump, one of Walter Reed Medical Center's COVID-19 patients tried to reassure the American public that he's on the road to recovery in a video released over the weekend. The President's sudden hospitalization and the unclear timeline of when he was infected with the virus, as well as other unanswered questions about the President's health has led to a yawning truth gap between what the White House knows about his condition and what the media and the public know.

On Sunday, the President's team of doctors provided a brief update on the course of his illness.

Sean Conley: Regarding his clinical status the patient continues to improve. He has remained without fever since Friday morning. His vital signs are stable. From a pulmonary standpoint, he remains on room air this morning and is not complaining of shortness of breath or other significant respiratory symptoms. He's ambulating himself, walking around the White House medical unit without limitation or disability.

Tanzina: While most Americans' healthcare issues are protected by federal privacy laws like HIPAA, questions remain about how much privacy should be afforded to the President, who remains ill days after announcing he had the virus. What should the public know about the President's health and when do we get to know it? I'm Tanzina Vega and that's where we'll begin our show today on The Takeaway.

To help answer that question, and so much more, I'm joined by Professor Barbara Perry, the director of presidential studies at the University of Virginia's Miller Center. Barbara, welcome back to the show.

Barbara Perry: Thanks so much happy to be with you.

Tanzina: Also joining us is Dr. Dhruv Khullar, a physician and assistant professor of medicine and healthcare policy at Weill Cornell Medical College. Dr. Khullar, thank you for being with us.

Dr. Khullar: Thanks very much for having me.

Tanzina: Dr. Khullar, let's start with you. The President's physician Dr. Sean Conley announced yesterday that the President was being given a drug called dexamethasone. Is that a standard treatment for COVID-19?

Dr. Khullar: Thanks very much for asking. Yes, it's a really important question. We know a few things about this drug, dexamethasone. The first is that it has been shown to be effective in helping patients with COVID-19. Importantly, it's effective for patients who have a severe case of the disease, so in patients whose oxygen levels have dropped to dangerously low levels, where they're not able to get enough oxygen to their vital organs.

The use of this medication suggests that the President does indeed have a severe case of COVID-19. It doesn't mean that he won't get better. A lot of patients that I have seen, that other doctors around the country have seen received this medication and then recover in the coming days. It does mean that the disease is not what we think of as a mild case, it's an important development in the President's condition.

Tanzina: We've also been hearing, at least bits and pieces, about the President's blood oxygen levels, which apparently are a critical piece of understanding how severe one's case of COVID-19 is. What do we know about that so far, doctor?

Dr. Khullar: That's exactly right. The blood oxygen levels are one of the most important markers we have of the severity of COVID-19 illness. We know that on at least two occasions, the President's oxygen levels have dipped low enough that he's needed supportive oxygen therapy. Generally, we think that oxygen levels need to remain in the 90s. We use 92%, 93% as a marker.

The use of supplemental oxygen suggests that his oxygen levels were actually lower than that. That has happened on at least two occasions, over the weekend. Dr. Conley initially was evasive, there were some conflicting reports about whether or not the President needed oxygen but it was later confirmed that he did indeed, at least on two occasions, starting Friday morning require supplemental oxygen to keep his oxygen levels high enough in his blood.

Tanzina: Barbara, on The Takeaway, one of the pillars, the editorial pillars, that grounds my version of the show is how this country struggles with a truth gap. How is the public reacting to what they're being told about the President's illness? Do they believe what they're hearing?

Barbara: Well, the polls are showing probably not, and that's understandable given the fact that leading up to this episode and this affliction for the President, the public was not trusting him on issues related to COVID. About two-thirds of the American people were saying, according to the polls, that they didn't trust him on the information that he was giving to them on COVID. Even more specifically, they didn't trust him about a vaccine and its development. It's just carried over into his own case of COVID.

Tanzina: What about the medical professionals though, Barbara, shouldn't the American public have a little bit more faith in what we're hearing from medical professionals? I feel like there are some people who are saying, "Are they telling us the truth?"

Barbara: One would like to think that people generally do have faith in medical professionals. I think polls over the years would show that. There have been polls taken for years about do people have faith in the media, in teachers, in the military, in religious figures. I'm sure that the medical professionals would come at or near the top, but it's the fact that this person who's leading the team, the physician for the President, is probably being told by the President what he can and cannot say, and how he should brief the public.

I think that's where the skepticism is coming in. Also, given the fact that just generally if you follow The Washington Post's tally of the President's lies and prevarications over his time in office, it's up to 25,000.

Tanzina: 25,000 is a lot of lies at this point. Dr. Khullar, let's pick up on what Barbara and I were just talking about there because I want to know, what is the American public supposed to know about a US president's health?

Khullar: That's a great question. I think the public deserves a high level of transparency and forthrightness about the President's health. We really should have clear and consistent communication about the basic aspects of how his care is going, how his medical condition is evolving. Unfortunately, we have not had that yet. In any doctor-patient relationship, there are concerns around privacy and confidentiality, of course, that's part of any doctor-patient relationship but this situation is different.

Mr. Trump is the President of the United States, the public needs to know some degree about how the President is doing. It's important for all sorts of reasons. The communication we've had from the President's physician has not been clear and consistent. On Sunday, he suggested that he wanted to paint a rosy picture, which is not necessarily a true picture of how the President's doing. There's a lot we don't yet know, and there's a lot more that we deserve to know.

Tanzina: Are doctors bound to confidentiality in this instance, Dr. Khullar, is it as Barbara suggested, could it be the president saying I don't want this information released and doctors are bound by that or does the President have a special relationship? Because as you said, he is the president and so his health really affects the health of the country.

Khullar: Of course, when you put a white coat on, your first responsibility is to the patient. Part of that is to protect their privacy and confidentiality. This situation is very different. When someone is in a high level of power, when someone is the President of the United States, the public has a competing demand to understand how the President is doing, whether he is fit to continue to serve, what they can expect in the days going forward and all those things are our intention.

What I would say is that on the spectrum of where we are in terms of knowing exactly how the President is doing, we're far too far away from having clear, consistent, transparent, and forthright communication and there's a lot more than needs to be done.

Tanzina: Barbara, we're in the final stages of a very, very bitter presidential race. What is the incentive for President Trump to be honest about his health right now?

Barbara: I think, in his mind, it is zero. He has zero incentive and probably for most presidents, they would have zero incentive. To be completely honest, this close to an election, we're down to fewer than 30 days until November the 3rd, and they want to be reelected. All presidents want to be reelected, and they're human. They don't want to be releasing information that would cause people to have doubts about their ability to carry on with their duties now or for a second term.

Tanzina: Barbara, last night, the President surprised his supporters outside of Walter Reed by having a drive-by visit,. He was in an SUV, he waved to supporters, the windows were closed, everyone inside the vehicle was wearing a mask, and yet the president is infected with the COVID-19 virus. The President has also repeatedly ridiculed wearing a mask. I'm wondering, what does all of this tell us? What is this moment that we're living in where we're seeing the President wearing a mask and yet infected with COVID-19 and yet going back to try and engage with supporters? What is the message that we're getting at this point? Because it seems very conflicting.

Barbara: Mixed, I think we would call that a mixed message but not surprising coming from this president given that just this past week, in the debate, as you say, he had mocked Joe Biden's wearing of a mask, saying, "Even when he's within 200 feet of people he's wearing a mask and it's the biggest mask I've ever seen." At least the President on his way to the hospital and in this ride around the hospital was wearing a mask, so at least he is moving forward in his thinking on this.

Who can blame him for wanting to be out among the people and the fact that people had gathered outside the hospital to support him. This is where he gets his energy, and some might even say it would be good for his health to be out and about. I did notice that on some of the stations yesterday on TV that the caller said the President is joyriding around the hospital. Which the term joy riding leads one to think of a teenage boy taking his parents' car and driving around town and doing things that are irresponsible.

Tanzina: Dr. Khullar, I'm sure medical professionals were also deeply concerned about what they saw as a person who has COVID-19, who really should be quarantining during this time, while they remain infected, getting into a vehicle with multiple other people. It was that not a concern in terms of spreading the virus?

Dr. Khullar: It was certainly a concern, and it was deeply irresponsible for several reasons. The first is that the President himself needs close monitoring, or he wouldn't be admitted to the hospital. We know that his oxygen levels have dropped from time to time, and for him to go out, it may be dangerous for himself. Secondly, he really placed at risk the health of those that were around him, inside the car, anyone that he interacted with along the way. We know that he was wearing a mask, but masks are by no means 100% protective either for the people wearing them or anyone else.

Wearing a mask was was a step in the right direction. Overall, this was a very irresponsible set of behaviors that he demonstrated over the course of the last day. I think public health officials and medical professionals feel very strongly about that.

Tanzina: Dr. Khullar, even if the President's doctors are unable to or unwilling to divulge every aspect of his medical care to give him some modicum of privacy, do those doctors have a duty to be completely honest about the things they do disclose to the public?

Dr. Khullar: They do have a duty, to be honest. There's several things that would be important for us to know. We want to know basics about the President's oxygen levels, but we also want to know information about potentially his X-rays and CT-scans. We want to know whether there's damage to the lungs or other organs. Importantly, we want to know when he last tested negative, when did his illness start, when did he know that he was exposed to the virus, and when did he know that he actually had the virus? Did he continue to meet with other people during that period of time? It seems that that is potentially likely now.

That carries all sorts of both clinical implications but also ethical implications. We really need a lot more transparency, a lot more understanding about the basics about how the President is doing. We don't need to know every single lab value. We don't need to know every single detail about what has happened over the course of a day, but we need a clear and forthright communication about the basics. We just haven't had that yet.

Tanzina: We're going to be talking a lot more about the history of presidents and illness in just a moment. Professor Barbara Perry is the director of presidential studies at the University of Virginia's Miller Center, and Dr. Dhruv Khullar is a physician and assistant professor of medicine and healthcare policy at Weill Cornell Medical College. Thanks to you both.

Dr. Khullar: Thanks very much.

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