COVID-19 antibodies last at least three months; so do symptoms for many

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

FILE PHOTO: Convalescent plasma samples in vials are seen before being tested for COVID-19 antibodies at the Bloodworks Northwest Laboratory during the coronavirus disease (COVID-19) outbreak in Renton, Washington, U.S. September 9, 2020. REUTERS/Lindsey Wasson

COVID-19 antibodies last at least three months

People infected with COVID-19 develop antibodies targeting the new coronavirus that last for at least three months, according to two reports published on Thursday in Science Immunology. The two studies, together involving nearly 750 patients, both point to immunoglobulin G (IgG) antibodies, which start showing up well after an infection begins, as the longest-lasting. Researchers found IgG antibodies with two targets – a spike protein on the virus that helps it infect cells, and a part of the spike called the receptor binding domain (RBD) – lasted more than 100 days. While the protective effect of COVID-19 antibodies is not completely clear, Jen Gommerman of the University of Toronto, coauthor of the study, said her team also found levels of so-called neutralizing antibodies, which inactivate the virus, “appeared to be very stable.” The other study, from Harvard Medical School, reported similar findings. This means that a properly designed vaccine “should elicit a durable antibody response that has the potential to neutralize the virus,” Gommerman said. Her group also found that antibodies in saliva correlated with antibodies in blood, but at this point the saliva tests are not sensitive enough to replace blood tests. (bit.ly/2GSo5Id; bit.ly/33NEOFE)

COVID-19 symptoms linger for months for many

Three months after becoming ill, many COVID-19 patients still have symptoms, two studies confirm, and the more severe the initial infections, the higher the odds of persistent problems. In Spain, doctors checked back with 108 patients, including 44 who had been severely ill. At 12 weeks after diagnosis, 76% still reported after-effects, with 40% reporting three or more coronavirus-related health issues, doctors said in a paper posted on Thursday on medRxiv ahead of peer review. The most common complaints were shortness of breath, physical weakness, cough, chest pain, palpitations, and psychological and cognitive disorders. In a similar study of 233 U.S. COVID-19 patients – eight of whom had been severely ill – one in four still had symptoms 90 days after first feeling ill. Rates were higher for patients who had been sicker: 59.4% at 30 days and 40.6% at 90 days. “But even for very mild and initially asymptomatic cases, 14.3% have complications persist for 30 days or longer,” the authors reported on Sunday on medRxiv. In the U.S. study, the most common persistent symptoms were impaired smell and taste, difficulty concentrating, shortness of breath, memory loss, confusion, headache, heart palpitations, chest pain, pain with deep breaths, dizziness, and rapid heartbeat. (bit.ly/3iPD2rN; bit.ly/2SKk0IK)

Remdesivir cut COVID-19 recovery time by 5 days

Final data from a large study of Gilead Sciences Inc’s GILD.O

Prodrugs Infusion Beats Oral PD Therapy for Motor Symptoms

A 24-hour continuous subcutaneous infusion of foslevodopa/foscarbidopa improved Parkinson’s disease (PD) motor symptoms during all waking hours for patients with advanced disease, according to a new study.

The beneficial effects of these phosphate prodrugs of levodopa and carbidopa were most noticeable in the early morning, results of the phase 1B study showed.

As PD progresses and dosing of oral levodopa/carbidopa (LD/CD) increases, its therapeutic window narrows, resulting in troublesome dyskinesia at peak drug levels and tremors and rigidity when levels fall.

“Foslevodopa/foscarbidopa shows lower OFF time than oral levodopa/carbidopa, and this was statistically significant. Also, foslevodopa/foscarbidopa (fosL/fosC) showed more ON time without dyskinesia compared to oral levodopa/carbidopa. This was also statistically significant,” lead author Sven Stodtmann, PhD, of AbbVie GmbH & Company KG, Ludwigshafen, Germany, reported in his recorded presentation at the Movement Disorders Society’s 23rd International Congress of Parkinson’s Disease and Movement Disorder (Virtual) 2020.

The analysis included 20 patients, and all data from these individuals were collected between 4:30 AM and 9:30 PM.

Participants were 12 men and 8 women, aged 30 to 80 years, with advanced, idiopathic PD responsive to levodopa but inadequately controlled on their current stable therapy, having a minimum of 2.5 OFF hours/day. Mean age was 61.3 ± 10.5 years (range 35-77 years).

In this single arm, open-label study, they received subcutaneous infusions of personalized therapeutic doses of fosL/fosC 24 hours/day for 28 days after a 10- to 30-day screening period during which they recorded LD/CD doses in a diary and had motor symptoms monitored using a wearable device.

Following the screening period, fosL/fosC doses were titrated over up to 5 days, with subsequent weekly study visits, for a total time on fosL/fosC of 28 days. Drug titration was aimed at maximizing functional ON time and minimizing the number of OFF episodes while minimizing troublesome dyskinesia.

Continuous infusion of fosL/fosC performed better than oral LD/CD on all counts.

“The OFF time is much lower in the morning for people on foslevodopa/foscarbidopa [compared with oral LD/CD] because this is a 24-hour infusion product,” Stodtmann explained.

The effect was maintained over the course of the day with little fluctuation with fosL/fosC, OFF periods never exceeding about 25% between 4:30 AM and 9 PM. For LD/CD, OFF periods were highest in the early morning and peaked at about 50% on a 3- to 4-hour cycle during the course of the day.

Increased ON time without dyskinesia varied between about 60% and 80% during the day with fosL/fosC, showing the greatest difference between fosL/fosC and oral LD/CD in the early morning hours.

“ON time with nontroublesome dyskinesia was lower for foscarbidopa/foslevodopa compared to oral levodopa/carbidopa, but this was not statistically significant,” Stodtmann said. ON time with troublesome dyskinesia followed the same pattern, again, not statistically significant.

Looking at the data another way, the investigators calculated the odds ratios of motor symptoms using fosL/fosC compared with oral LD/CD. Use of fosL/fosC was associated with a 59% lower risk of being in the OFF state during the day compared with

When Symptoms of Covid-19 Don’t Go Away

The range of reported symptoms is vast. They include unusual fatigue from physical or mental activity, brain fog, temperature irregularities, rashes, memory problems and insomnia. It’s as if the body’s immune response to the coronavirus has thrown the nervous system out of whack, according to Dr. Dayna McCarthy, rehabilitation specialist at the Mount Sinai Center for Post-Covid Care.

The lasting effects among those who survived another serious coronavirus disease, SARS, are not very encouraging. As the Mayo Clinic reported, “Many people who have recovered from SARS have gone on to develop chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens with physical or mental activity, but doesn’t improve with rest. The same may be true for people who have had Covid-19.”

The Covid-19 virus can damage the lungs, heart and brain, increasing the risk of persistent health problems. According to the Mayo experts, “Imaging tests taken months after recovery from Covid-19 have shown lasting damage to the heart muscle, even in people who had only mild Covid-19 symptoms.” The illness can cause very small blood clots that can block capillaries in the heart and permanently injure the heart muscle. The disease can also weaken blood vessels and injure the kidneys and liver.

Covid can scar the lungs’ tiny air sacs and cause long-term breathing difficulty even if the scars partially heal. This effect on lung function ended the life of 107-year-old Marilee Shapiro Asher, a celebrated artist in Washington, D.C., who remained professionally active until Covid-19 laid her low in early spring. During five days in the hospital, she recovered from the acute infection, then died several months later with virus-caused damage to her lungs that left them brittle and filled their air sacs with fluid.

With SARS, a 15-year follow-up of patients found that most lung recovery took place within two years, but some mild pulmonary effects remained indefinitely in more than a third of recovered SARS patients.

Brain-related effects of an active Covid-19 infection can include strokes, seizures and a temporary paralysis called Guillain-Barré syndrome. Many Covid patients lose their sense of smell and taste during the acute illness, but for some this neurological effect persisted for months after they had otherwise recovered. And questions remain whether the viral infection also will raise the risk of later developing neurological problems like Parkinson’s disease or Alzheimer’s disease.

People who were severely ill with Covid-19, especially those who spent weeks or longer isolated in intensive care with or without a ventilator, can develop symptoms of post-traumatic stress syndrome and persistent problems with anxiety and depression. Their emotional trauma may cause recurrent nightmares and a fear of being alone and even of going to sleep.

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More than 80% of people with coronavirus had no symptoms: UK study

Local residents and visitors shop in Peascod Street on 27th August 2020 in Windsor, United Kingdom.

Mark Kerrison | In Pictures | Getty Images

So-called “silent spreaders” of the coronavirus could be more common than previously thought, with a U.K. study finding that more than two thirds of people who tested positive for the virus were asymptomatic on the day they took a test.

University College London researchers studied data collected by U.K. statistics body, the Office for National Statistics, which has been regularly collecting coronavirus testing data from thousands of British households during the pandemic as part of its “infection survey.” The survey tests households whether they have symptoms or not.

The study, which was peer reviewed, looked at 36,061 individuals who took a coronavirus test as part of the infection survey between 26 April and 27 June 2020. It found that 86.1% of those who tested positive for the virus did not report “core” symptoms associated with the virus (a cough, fever or a loss of taste and/or smell) on the day they took a test. Out of the 115 people that received a positive coronavirus result, only 16 reported the main symptoms that we associate with the virus.

Researchers Irene Petersen and Andrew Phillips concluded in the study, published in the Clinical Epidemiology journal on Thursday, that “Covid-19 symptoms are poor markers of SARS-CoV-2 (the new coronavirus).”

“To reduce transmission of SARS-CoV-2, it is important to identify those who are infectious. However, little is known about what proportion of infectious people are asymptomatic and potential “silent” transmitters,” the researchers noted.

The results of the study showed that “a more widespread testing programme is necessary to capture ‘silent’ transmission and potentially prevent and reduce future outbreaks,” they argued.

Testing regimes have had mixed success in Europe. While Germany has been praised for its extensive testing program and track and trace system to contain outbreaks, the U.K. took a while to ramp up widespread testing, and has been under pressure from a rapid increase in demand for tests, and delays in processing.

The launch of the U.K.’s track and trace app was also delayed and the government most recently came under fire when it emerged that it had “missed” thousands of positive cases due to a data blunder.

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Early school sports reduce ADHD symptoms for girls in later years

Girls who played after-school sports in elementary school seem to have fewer symptoms of attention-deficit/hyperactivity disorder once they reach middle school, a new study suggests.

The research included both boys and girls, but the effect of sports on attention and behavior symptoms was only significant in girls.

“Girls, in particular, benefit from participation in sport when it comes to ADHD symptoms,” said lead author Linda Pagani. She’s a professor at the University of Montreal School of Psychoeducation in Quebec, Canada.

ADHD is a condition that includes ongoing patterns of inattention, hyperactivity and/or impulsivity — issues that interfere with a person’s functioning or development, according to the U.S. National Institute of Mental Health.

ADHD signs and symptoms include: Making careless mistakes in schoolwork, at work or during other activities; having difficulty paying attention in tasks like a lecture or lengthy reading assignment or during play; seeming not to listen when spoken to directly; interrupting others; fidgeting; leaving one’s seat when staying seated is expected; running around in inappropriate situations or feeling restless, in teens and adults.

The current study included nearly 1,500 children born in Quebec in 1997 and 1998. The group included 758 girls and 733 boys with complete data from age 6.

Parents were asked if kids participated in an extra-curricular physical activity with a coach or instructor between the ages of 6 and 10.

When kids were 12, teachers were asked to compare their ADHD symptoms and behaviors to their peers’. Teachers only looked for symptoms suggestive of ADHD, not a formal diagnosis, Pagani said.

Girls who consistently participated in organized sports were less likely to have ADHD symptoms than girls who didn’t, the study found. The researchers didn’t find a similar link for boys.

Pagani said organized sports likely help reduce ADHD symptoms in several ways: During an organized physical activity, kids have to listen and focus on what their coach is saying. It’s different from an unstructured after-school program where kids can do whatever they want.

Sports also help inhibit distraction and promote planning behavior, Pagani explained. Plus, sports get kids away from their screens and switching from one app to the next, and give them a chance to shake off some energy.

So, why wouldn’t sports make a difference for boys, too?

They probably do, Pagani said, but the upside wasn’t strong enough to be statistically significant.

“Boys are over-identified when it comes to any kind of ADHD symptoms,” she said. “For every three boys with ADHD, only one girl will get identified. Girls may not be getting pharmacology [medications] and psychotherapy that boys often do. In this particular domain, because girls are under-identified and under-treated, they tend to benefit a lot from sports.”

All kids — both girls and boys — can benefit from taking part in organized sports, Pagani said.

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center in New Hyde Park, N.Y., reviewed the findings.

“Although the researchers found an association in girls between organized sports

Trump reports ‘no symptoms,’ returns to downplaying virus

WASHINGTON (AP) — President Donald Trump, said to be making progress in his recovery from COVID-19, tweeted his eagerness to return to the campaign trail even as the outbreak that has killed more than 210,000 Americans reached ever more widely into the upper echelons of the U.S. government.

As Trump convalesced out of sight in the White House on Tuesday, the administration defended the protections it has put in place to protect the staff working there to treat and support him. Trump again publicly played down the virus on Twitter after his return from a three-day hospitalization, though even more aides tested positive, including one of his closest advisers, Stephen Miller.

In one significant national coronavirus action, Trump declared there would be no action before the election on economic-stimulus legislation — an announcement that came not long after the Federal Reserve chairman said such help was essential for recovery with the nation reeling from the human and economic cost of the pandemic. Stocks fell on the White House news.

As for Trump’s own recovery, his doctor, Navy Cmdr. Sean Conley, said in a letter that the president had a “restful” Monday night at the White House and “reports no symptoms.”

Meanwhile, Trump was grappling with next political steps exactly four weeks from Election Day. Anxious to project strength, Trump, who is still contagious with the virus, tweeted Tuesday that he was planning to attend next week’s debate with Democrat Joe Biden in Miami and “It will be great!”

Biden, for his part, said he and Trump “shouldn’t have a debate” as long as the president remains COVID positive.


Biden told reporters in Pennsylvania that he was “looking forward to being able to debate him” but said “we’re going to have to follow very strict guidelines.”

Elsewhere in the government, the scope of the outbreak was still being uncovered. On Tuesday, the nation’s top military leaders including the chairman of the Joint Chiefs of Staff, Gen. Mark Milley, and the vice chairman, Gen. John Hyten, were in quarantine after exposure to Adm. Charles W. Ray, the vice commandant of the Coast Guard.

It was not known how Ray contracted the virus, but he attended an event for military families at the White House on Sept. 27. The Coast Guard said in a statement that Ray felt mild symptoms over the weekend and was tested on Monday.

Also testing positive Tuesday was Miller, a top policy adviser and Trump speechwriter, who has been an architect of the president’s restrictive immigration measures.” Miller’s wife, Katie Miller, who serves as communications director to Vice President Mike Pence, had the virus earlier this year. She had been in Salt Lake City with Pence where he is preparing to debate Democratic vice presidential nominee Kamala Harris, but she left as soon as she found out about her husband’s diagnosis, officials said. She tested negative on Tuesday.

Trump on Monday made clear that he has little intention of abiding by best containment practices when he removed his

Trump Reports ‘No Symptoms,’ Returns to Downplaying Virus | Washington, D.C. News

By ZEKE MILLER, JILL COLVIN and AAMER MADHANI, Associated Press

WASHINGTON (AP) — President Donald Trump, said to be making progress in his recovery from COVID-19, tweeted his eagerness to return to the campaign trail even as the outbreak that has killed more than 210,000 Americans reached ever more widely into the upper echelons of the U.S. government.

As Trump convalesced out of sight in the White House on Tuesday, the administration defended the protections it has put in place to protect the staff working there to treat and support him. Trump again publicly played down the virus on Twitter after his return from a three-day hospitalization, though even more aides tested positive, including one of his closest advisers, Stephen Miller.

In one significant national coronavirus action, Trump declared there would be no action before the election on economic-stimulus legislation — an announcement that came not long after the Federal Reserve chairman said such help was essential for recovery with the nation reeling from the human and economic cost of the pandemic. Stocks fell on the White House news.

As for Trump’s own recovery, his doctor, Navy Cmdr. Sean Conley, said in a letter that the president had a “restful” Monday night at the White House and “reports no symptoms.”

Meanwhile, Trump was grappling with next political steps exactly four weeks from Election Day. Anxious to project strength, Trump, who is still contagious with the virus, tweeted Tuesday that he was planning to attend next week’s debate with Democrat Joe Biden in Miami and “It will be great!”

Biden, for his part, said he and Trump “shouldn’t have a debate” as long as the president remains COVID positive.

Biden told reporters in Pennsylvania that he was “looking forward to being able to debate him” but said “we’re going to have to follow very strict guidelines.”

Elsewhere in the government, the scope of the outbreak was still being uncovered. On Tuesday, the nation’s top military leaders including the chairman of the Joint Chiefs of Staff, Gen. Mark Milley, and the vice chairman, Gen. John Hyten, were in quarantine after exposure to Adm. Charles W. Ray, the vice commandant of the Coast Guard.

It was not known how Ray contracted the virus, but he attended an event for military families at the White House on Sept. 27. The Coast Guard said in a statement that Ray felt mild symptoms over the weekend and was tested on Monday.

Also testing positive Tuesday was Miller, a top policy adviser and Trump speechwriter, who has been an architect of the president’s restrictive immigration measures.” Miller’s wife, Katie Miller, who serves as communications director to Vice President Mike Pence, had the virus earlier this year. She had been in Salt Lake City with Pence where he is preparing to debate Democratic vice presidential nominee Kamala Harris, but she left as soon as she found out about her husband’s diagnosis, officials said. She tested negative on Tuesday.

Trump on Monday made clear that he has little intention

Over 80% of hospitalized coronavirus patients experience neurological symptoms, study finds

While respiratory issues are a well-documented symptom of coronavirus, researchers have found that over 80% of hospitalized COVID-19 patients experience some type of neurological manifestation as well. In examining 509 patients admitted to a Chicago hospital network, researchers found that 419 of them presented a neurological issue at some point during the course of their COVID-19 infection.

“The most frequent neurologic manifestations were myalgias, headaches, encephalopathy, dizziness, dysgeusia [impaired sense of taste] and anosmia [loss of smell],” the authors wrote in their study, which was published Monday in the Annals of Clinical and Translational Neurology. “Strokes, movement disorders, motor, and sensory deficits, ataxia and seizures were uncommon.”

The patients involved in the study were admitted to the Northwestern Medicine Healthcare system between March 5 and April 6, and all had been diagnosed with COVID-19. The team noted neurologic symptoms based on a review of clinical notes, diagnostic studies, and physician-documented diagnoses taken during the patients’ hospitalizations. The patients ranged in age from 16.9 years old to 58.5 years old, and 134 required mechanical ventilation during their stay.

The researchers noted that patients with neurologic symptoms experienced longer hospital stays than those without, but discharge functional outcomes and mortality were not significantly different between those with and without. They also found that those experiencing neurologic issues were found to be younger than those who were not.

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“The fact that any neurologic manifestations as a whole were more likely to occur in younger people is surprising, and could potentially be explained by greater clinical emphasis on the risk of respiratory failure than other symptoms in older patients,” the study authors noted. “Alternatively, early neurologic manifestations such as myalgia, headache, or dizziness may have prompted earlier medical care. In contrast, encephalopathy was more frequent in older patients.”

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The authors also acknowledged that the study has several limitations, including that fewer than 6% of patients were evaluated by a neurologist, were cared for under strict infection control, and that the data is retrospective. However, they say the data did provide a more generalized view of neurologic symptoms that should be further explored.

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“Only 9 months into the pandemic, the long-term effects of COVID-19 on the nervous system remain uncertain,” the authors wrote. “Our results suggest that, of all the neurologic manifestations, encephalopathy is associated with a worse functional outcome in hospitalized patients with COVID-19, and may have lasting effects.”

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They called for long-term follow-up in patients with these symptoms and said that cognitive and neurologic-focused rehabilitation could potentially have a “significant” role in recovery.

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Myocarditis: Causes, Symptoms and Treatments

It seems like we have been in the midst of the COVID-19 pandemic forever, but in reality the disease has been around for less than one year. That’s not a long time, as far as new diseases go, and scientists are learning more and more about it all the time. Indeed, given this relatively short timespan, it’s hard to know what the long-term effects of the coronavirus may be. However, clinicians and researchers are noticing a connection between COVID-19 and heart disease.

(Getty Images)

In particular, patients infected by the novel coronavirus often develop a worrisome inflammation of the heart muscle. Known as myocarditis, this inflammation potentially can produce serious heart disease. In a July 2020 study published in JAMA Cardiology, researchers discovered that 78 out of 100 patients recovering from COVID-19 had some kind of cardiac impairment, and 60 of those had myocarditis after recovering, independent of whether or not they had preexisting conditions or how severe their COVID-19 symptoms were.

“We were not expecting that,” says Dr. Sandra Chaparro, a cardiologist at the Miami Cardiac and Vascular Institute who specializes in heart failure and transplantation cardiology and serves as the director of advanced heart failure. That study’s small sample size makes it hard to know just how widespread the incidence of myocarditis really is, she says. But anecdotal evidence from around the world – including at her institute, which has treated several patients with the condition – suggests it’s worth monitoring.

“We’ve seen it in young and old patients,” Chaparro says. One patient in his 40s recovered from COVID-19 but had signs of heart damage after. However, the connection is still far from clear. “Sometimes it’s hard to figure out if it was caused by something else or a preexisting condition. And we don’t know what the rate (of myocarditis) is of asymptomatic patients,” she adds. But the data and case studies are raising alarms.

What Is Myocarditis?

Myocarditis is any inflammation of the heart muscle, says Dr. Karol Watson, a cardiologist and a professor of medicine/cardiology at the David Geffen School of Medicine at UCLA. This inflammation can have many causes. A virus like the coronavirus is one of the most common causes, but bacterial infections, chemotherapy drugs or a dysfunctional immune system may also be behind it.

Myocarditis can disrupt the heart’s ability to pump blood and impair the electrical signaling that keeps it beating regularly. It can be mild, and most people do not have a lot of symptoms, if any, Chaparro says. In severe cases, myocarditis can cause abnormal heart rhythms, heart muscle disease and heart failure. These patients may need medication and/or mechanical support, like heart pumps, and a small number of patients require heart transplant, she says.

How Does COVID-19 Affect the Heart?

The coronavirus may cause inflammation in up to three ways. “Like any virus, it can directly attack the heart muscle, causing inflammation and myocarditis,” says Watson, who is also director of the UCLA Women’s Cardiovascular Health Center and the

White House physician says Trump reporting ‘no symptoms’ of COVID-19

White House physician Sean Conley said Tuesday that President TrumpDonald John TrumpState Department revokes visa of Giuliani-linked Ukrainian ally: report White House Gift Shop selling ‘Trump Defeats COVID’ commemorative coin Biden says he should not have called Trump a clown in first debate MORE is reporting “no symptoms” after being discharged from Walter Reed National Military Medical Center during his treatment for the novel coronavirus.

“This morning the President’s team of physicians met with him in the Residence. He had a restful first night at home, and today he reports no symptoms,” Conley wrote in a memorandum issued Tuesday afternoon, less than five days after Trump was diagnosed with COVID-19.

“Vital signs and physical exam remain stable, with an ambulatory oxygen saturation level of 95-97%. Overall he continues to do extremely well, I will provide updates as we know more,” Conley wrote.

Trump was diagnosed with COVID-19 on Thursday evening and was transported to Walter Reed on Friday after experiencing a high fever and a drop in his oxygen level that required supplemental oxygen.

Trump has been fever-free since Friday, according to Conley, and otherwise has experienced symptoms of a mild cough, nasal congestion and fatigue.

Conley, who briefed reporters three times over the past three days, consistently described Trump’s symptoms as improving. It is unclear whether Conley, who has evaded some questions about the president’s care and the timeline of his infection, will similarly brief reporters at some point Tuesday on the president’s condition. White House aides have also indicated that Trump could make a public appearance of some kind.

Trump has been treated with an experimental antibody cocktail produced by Regeneron, the antiviral medication remdesivir, and dexamethasone, a steroid used to treat inflammation. Trump was expected to receive his fifth and final dose of remdesivir on Tuesday and will continue to receive dexamethasone.

Conley said Monday that Trump had met or exceeded criteria to be discharged from Walter Reed, though he acknowledged that the president may not be “out of the woods” and said he would be looking for Trump’s condition to remain the same or improve over the coming week.

Trump has been eager to return to normal work at the White House and on Monday released a video urging Americans not to fear the coronavirus or allow it to “dominate” their lives, touting the therapies available in the United States to combat the disease.

He has also indicated he wants to take part in the presidential debate scheduled for next week.

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