vox--2020-10-05--One Good Thing: The wonderful sci-fi novel A Memory Called Empire makes diplomacy enthralling

One Good Thing is Vox ’ s recommendations series .
In each edition , we ’ ll tell you about something from the world of culture that we think you should check out .
Arkady Martine ’ s A Memory Called Empire , which recently won the Best Novel award at science fiction ’ s prestigious Hugo Awards , reads like its author was simultaneously influenced by Game of Thrones , histories of the Cold War , various anti-colonialism writings , and the Star Wars prequels .
It ’ s a grand , galaxy-spanning space opera that is mostly about @ @ @ @ @ @ @ , it ’ s an impressively wonky novel about galactic geopolitics that just happens to feature spaceships and aliens .
I love it .
It ’ s difficult to talk about A Memory Called Empire without spoiling some of its best surprises because the core of the book sounds impossibly dry .
But let me give it a shot anyway , because the best way to read this book is to know almost nothing about what happens after its first few chapters .
Mahit Dzmare is just 26 years old , and she @ @ @ @ @ @ @ mighty Teixcalaanli Empire .
She grew up on tiny Lsel Station , a space station near extremely important jumpgates that allow the Teixcalaanli people to travel easily to other parts of the galaxy .
The control of those gates has allowed Lsel to maintain independence rather than being sucked into the empire .
( In this far-future world , humanity has carved out its own corner of the Milky Way , but life on various planets and space stations has created impressive genetic variance as natural selection does its thing .
Mahit , @ @ @ @ @ @ @ average Teixcalaanli citizen . )
Like others from Lsel Station , Mahit ’ s brain contains something called an “ imago , ” a machine that gives her access to the memories and feelings of her predecessor , Yskander , just as he had access to the memories of his predecessor , and so on , back through several ambassadors .
The people of Lsel Station use these imagos to create long lines of knowledge and intelligence , a kind of institutional memory turned very literal .
Such neurological enhancements are illegal within @ @ @ @ @ @ @ ’ t the empire like to get its hands on them anyway ?
But Mahit ’ s imago is out of date .
Yskander died — or maybe ( probably ) was murdered — before he was able to update his imago with the last 15 years of his ambassadorship .
She only has five years of memories , and they are woefully incomplete , leaving her reeling when forced to navigate situations that Yskander would have known how to handle but that she does not .
That ’ s probably all you @ @ @ @ @ @ @ Martine takes that basic premise and weaves it into an addictive tale of political intrigue , espionage , and interstellar war .
The story remains firmly within Mahit ’ s point of view as Teixcalaanli society stands on the brink of catastrophe and Mahit tries to untangle a web of promises made and deals cut by Yskander , who was almost certainly killed because of the many different diplomatic balls he kept trying to juggle .
Can Mahit avoid the same fate ?
What ’ s impressive to me about A Memory Called @ @ @ @ @ @ @ of the above — which could sound like impenetrable sci-fi nonsense that only the devoted and/or diehard diplomacy wonks would be able to wade through — and grounds it in recognizable human traits .
For all of its big , exciting plot devices , the book is most concerned with the ways that gigantic empires gobble up local cultures almost without trying .
Mahit spent most of her life studying Teixcalaanli culture , not because she ever expected to be an ambassador but because it seemed so much more exciting and glamorous than @ @ @ @ @ @ @ ’ s actually embedded within the empire , she longs for home all the same , and her imago becomes a kind of link to a place she might never see again , both literally ( imagos only exist in Lsel ) and figuratively ( it ’ s a deep , psychological connection to the history of her people ) .
When you live in a place filled with power and wealth , it can be difficult to see how power and wealth breed destruction radiating out from the center .
The empire @ @ @ @ @ @ @ smaller , independent nations , because even when it doesn ’ t try to , its pop culture and brand of politics infect everything around it .
Smaller nations can stay alive through crafty diplomacy or military might or some combination of the two , but they still have to coexist in a world built by people who don ’ t realize how much chaos they ’ ve caused .
The chaos becomes oxygen .
It ’ s all around , so it must be normal .
What ’ s even more impressive @ @ @ @ @ @ @ Martine weaves a conflict between a colonial power and the not-yet-but-probably-some-day colonized , alongside a conflict about the political struggles within the empire , struggles that move toward the book ’ s forefront as they continue , with Mahit and her imago right in the middle .
She can ’ t stop what ’ s coming , but she can maybe influence it via crafty diplomacy and some light espionage .
And in so doing , she might buy a little more time for Lsel , which is all she can ever ask @ @ @ @ @ @ @ , from the idea of a city as a single algorithm that can be corrupted to the way Teixcalaanli citizens name themselves — with a number and then a noun ( the novel ’ s most important supporting character , for example , is Three Seagrass ) .
And sometimes this world-building happens almost as a grace note at the novel ’ s edges , as do the numerous examples of Teixcalaanli poetry she includes .
Mostly , however , A Memory Called Empire offers a reflection on what it means to know @ @ @ @ @ @ @ ’ s hurt people you love , while still longing to , in some ways , be of that place .
Mahit doesn ’ t want to be a Teixcalaanli citizen , yet she can ’ t help but wish she could all the same .
It would make so many things so much easier .
And yet it would also be a betrayal .
So , ever the diplomat , she seeks a middle ground , as everyone around her tries to knock her off the razor-thin wire she balances upon .
@ @ @ @ @ @ @ bookshop.org and all major booksellers , though I had to wait a bit to get a copy , due to the novel ’ s popularity in the wake of the Hugo win .
A sequel will arrive in 2021 .
Help keep Vox free for all Millions turn to Vox each month to understand what ’ s happening in the news , from the coronavirus crisis to a racial reckoning to what is , quite possibly , the most consequential presidential election of our lifetimes .
Our mission has never been more vital @ @ @ @ @ @ @ to empower you through understanding .
But our distinctive brand of explanatory journalism takes resources .
Even when the economy and the news advertising market recovers , your support will be a critical part of sustaining our resource-intensive work .
If you have already contributed , thank you .
If you haven ’ t , please consider helping everyone make sense of an increasingly chaotic world : Contribute today from as little as $ 3 .

One Good Thing is Vox’s recommendations series. In each edition, we’ll tell you about something from the world of culture that we think you should check out.
Arkady Martine’s A Memory Called Empire, which recently won the Best Novel award at science fiction’s prestigious Hugo Awards, reads like its author was simultaneously influenced by Game of Thrones, histories of the Cold War, various anti-colonialism writings, and the Star Wars prequels. It’s a grand, galaxy-spanning space opera that is mostly about diplomacy. Or, if you prefer, it’s an impressively wonky novel about galactic geopolitics that just happens to feature spaceships and aliens. I love it.
It’s difficult to talk about A Memory Called Empire without spoiling some of its best surprises because the core of the book sounds impossibly dry. But let me give it a shot anyway, because the best way to read this book is to know almost nothing about what happens after its first few chapters.
Mahit Dzmare is just 26 years old, and she’s been named ambassador to the mighty Teixcalaanli Empire. She grew up on tiny Lsel Station, a space station near extremely important jumpgates that allow the Teixcalaanli people to travel easily to other parts of the galaxy. The control of those gates has allowed Lsel to maintain independence rather than being sucked into the empire. (In this far-future world, humanity has carved out its own corner of the Milky Way, but life on various planets and space stations has created impressive genetic variance as natural selection does its thing. Mahit, for instance, is taller than the average Teixcalaanli citizen.)
Like others from Lsel Station, Mahit’s brain contains something called an “imago,” a machine that gives her access to the memories and feelings of her predecessor, Yskander, just as he had access to the memories of his predecessor, and so on, back through several ambassadors. The people of Lsel Station use these imagos to create long lines of knowledge and intelligence, a kind of institutional memory turned very literal. Such neurological enhancements are illegal within the empire, but goodness, wouldn’t the empire like to get its hands on them anyway?
But Mahit’s imago is out of date. Yskander died — or maybe (probably) was murdered — before he was able to update his imago with the last 15 years of his ambassadorship. She only has five years of memories, and they are woefully incomplete, leaving her reeling when forced to navigate situations that Yskander would have known how to handle but that she does not.
That’s probably all you should know before starting this book because Martine takes that basic premise and weaves it into an addictive tale of political intrigue, espionage, and interstellar war. The story remains firmly within Mahit’s point of view as Teixcalaanli society stands on the brink of catastrophe and Mahit tries to untangle a web of promises made and deals cut by Yskander, who was almost certainly killed because of the many different diplomatic balls he kept trying to juggle. Can Mahit avoid the same fate?
What’s impressive to me about A Memory Called Empire is the way it takes all of the above — which could sound like impenetrable sci-fi nonsense that only the devoted and/or diehard diplomacy wonks would be able to wade through — and grounds it in recognizable human traits. For all of its big, exciting plot devices, the book is most concerned with the ways that gigantic empires gobble up local cultures almost without trying.
Mahit spent most of her life studying Teixcalaanli culture, not because she ever expected to be an ambassador but because it seemed so much more exciting and glamorous than her own. But now that she’s actually embedded within the empire, she longs for home all the same, and her imago becomes a kind of link to a place she might never see again, both literally (imagos only exist in Lsel) and figuratively (it’s a deep, psychological connection to the history of her people).
When you live in a place filled with power and wealth, it can be difficult to see how power and wealth breed destruction radiating out from the center. The empire can’t help but knock over smaller, independent nations, because even when it doesn’t try to, its pop culture and brand of politics infect everything around it. Smaller nations can stay alive through crafty diplomacy or military might or some combination of the two, but they still have to coexist in a world built by people who don’t realize how much chaos they’ve caused. The chaos becomes oxygen. It’s all around, so it must be normal.
What’s even more impressive about A Memory Called Empire is how Martine weaves a conflict between a colonial power and the not-yet-but-probably-some-day colonized, alongside a conflict about the political struggles within the empire, struggles that move toward the book’s forefront as they continue, with Mahit and her imago right in the middle. She can’t stop what’s coming, but she can maybe influence it via crafty diplomacy and some light espionage. And in so doing, she might buy a little more time for Lsel, which is all she can ever ask for.
Martine does some impressive world-building, from the idea of a city as a single algorithm that can be corrupted to the way Teixcalaanli citizens name themselves — with a number and then a noun (the novel’s most important supporting character, for example, is Three Seagrass). And sometimes this world-building happens almost as a grace note at the novel’s edges, as do the numerous examples of Teixcalaanli poetry she includes.
Mostly, however, A Memory Called Empire offers a reflection on what it means to know everything about a place and how it’s hurt people you love, while still longing to, in some ways, be of that place. Mahit doesn’t want to be a Teixcalaanli citizen, yet she can’t help but wish she could all the same. It would make so many things so much easier. And yet it would also be a betrayal. So, ever the diplomat, she seeks a middle ground, as everyone around her tries to knock her off the razor-thin wire she balances upon.
A Memory Called Empire is available through bookshop.org and all major booksellers, though I had to wait a bit to get a copy, due to the novel’s popularity in the wake of the Hugo win. A sequel will arrive in 2021.


vox--2020-10-05--The Nobel in Medicine went to 3 scientists who co-discovered hepatitis C

The Nobel Prize in Physiology or Medicine went to three scientists on Monday for their discoveries that led to the identification of the hepatitis C virus , which affects more people than HIV worldwide .
Harvey J .
Alter , Michael Houghton , and Charles M. Rice “ made a decisive contribution to the fight against blood-borne hepatitis , ” the Nobel Assembly said in a press release .
Alter is an emeritus researcher at the the National Institutes of Health and Rice is a virologist at Rockefeller University .
Houghton is a British virologist at the University of Alberta @ @ @ @ @ @ @ kronor ( or $ 1,118,000 ) prize was announced at the Karolinska Institute in Stockholm , Sweden .
Hepatitis refers to inflammation of the liver .
There are two main forms : acute and chronic .
The acute form of the disease is caused by the hepatitis A virus , which is spread through contaminated water or food .
Hepatitis B and C can cause chronic liver disease , and together , “ are the most common cause of liver cirrhosis and cancer , ” according to the World Health Organization ( WHO @ @ @ @ @ @ @ people have chronic hepatitis C virus infection , the WHO estimates , and the disease is linked to 400,000 deaths .
Hepatitis B can be spread through numerous bodily fluids , including semen and blood .
The C virus is transmitted only through contact with the blood of an infected person — often via dirty needles , infected blood products , or sexual contact .
Some people exposed to the virus spontaneously clear their infection without experiencing any disease .
In others , the virus can lurk silently , with symptoms of chronic @ @ @ @ @ @ @ the virus .
Before the Nobel winners ’ discovery of the virus , no one knew why many people receiving blood transfusions appeared to develop chronic hepatitis .
“ After hepatitis A and B were discovered in the 1970s , it was clear there was still at least one other virus or more that were causing liver damage , ” Will Irving , a virologist at the University of Nottingham , told the AP .
“ We knew there was a virus in the blood supply , because when people had blood transfusion @ @ @ @ @ @ @ was recognized as a risk but there was nothing we could do .
We didn ’ t know what the virus was and we couldn ’ t test for it.
” The work of Alter , Houghton , and Rice — in the 1970s and ’ 80s — “ revealed the cause of the remaining cases of chronic hepatitis and made possible blood tests and new medicines that have saved millions of lives , ” the Assembly said .
As for their individual contributions , Alter hypothesized that a then-unknown virus was an @ @ @ @ @ @ @ Houghton isolated the genome of the new virus .
Rice “ provided the final evidence showing that hepatitis C virus alone could cause hepatitis , ” the Assembly said .
There ’ s currently no vaccine for hepatitis C , but medications — known as “ direct-acting antivirals ” — can now cure the disease .
One such cure , branded as Sovaldi in the US by the drugmaker Gilead , ignited a controversy over pharmaceutical price gouging when it debuted in 2013 with an $ 84,000 price tag for a 12-week course @ @ @ @ @ @ @ hepatitis C drugs , including lower price generics , have entered the market .
The competition “ has been very effective putting the price down close to $ 20,000 , ” said Craig Garthwaite , director of the program on health care at Northwestern University ’ s Kellogg School of Management .
“ That is still high , but well within cost effective price range.
” Indeed , a 2020 study on hepatitis C drug pricing said “ cost remains a key barrier to access for many patients and for scale-up in many @ @ @ @ @ @ @ free for all Millions turn to Vox each month to understand what ’ s happening in the news , from the coronavirus crisis to a racial reckoning to what is , quite possibly , the most consequential presidential election of our lifetimes .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
But our distinctive brand of explanatory journalism takes resources .
Even when the economy and the news advertising market recovers , your support will be a critical part of sustaining @ @ @ @ @ @ @ already contributed , thank you .
If you haven ’ t , please consider helping everyone make sense of an increasingly chaotic world : Contribute today from as little as $ 3 .

The Nobel Prize in Physiology or Medicine went to three scientists on Monday for their discoveries that led to the identification of the hepatitis C virus, which affects more people than HIV worldwide.
Harvey J. Alter, Michael Houghton, and Charles M. Rice “made a decisive contribution to the fight against blood-borne hepatitis,” the Nobel Assembly said in a press release.
Alter is an emeritus researcher at the the National Institutes of Health and Rice is a virologist at Rockefeller University. Houghton is a British virologist at the University of Alberta in Canada. The 10 million Swedish kronor (or $1,118,000) prize was announced at the Karolinska Institute in Stockholm, Sweden.
Hepatitis refers to inflammation of the liver. There are two main forms: acute and chronic. The acute form of the disease is caused by the hepatitis A virus, which is spread through contaminated water or food.
Hepatitis B and C can cause chronic liver disease, and together “are the most common cause of liver cirrhosis and cancer,” according to the World Health Organization (WHO). Globally, some 71 million people have chronic hepatitis C virus infection, the WHO estimates, and the disease is linked to 400,000 deaths.
Hepatitis B can be spread through numerous bodily fluids, including semen and blood. The C virus is transmitted only through contact with the blood of an infected person — often via dirty needles, infected blood products, or sexual contact. Some people exposed to the virus spontaneously clear their infection without experiencing any disease. In others, the virus can lurk silently, with symptoms of chronic liver disease appearing years after exposure to the virus.
Before the Nobel winners’ discovery of the virus, no one knew why many people receiving blood transfusions appeared to develop chronic hepatitis. “After hepatitis A and B were discovered in the 1970s, it was clear there was still at least one other virus or more that were causing liver damage,” Will Irving, a virologist at the University of Nottingham, told the AP. “We knew there was a virus in the blood supply, because when people had blood transfusion they would get liver damage ... It was recognized as a risk but there was nothing we could do. We didn’t know what the virus was and we couldn’t test for it.”
The work of Alter, Houghton, and Rice — in the 1970s and ’80s — “revealed the cause of the remaining cases of chronic hepatitis and made possible blood tests and new medicines that have saved millions of lives,” the Assembly said.
As for their individual contributions, Alter hypothesized that a then-unknown virus was an important contributor to chronic hepatitis, while Houghton isolated the genome of the new virus. Rice “provided the final evidence showing that hepatitis C virus alone could cause hepatitis,” the Assembly said.
There’s currently no vaccine for hepatitis C, but medications — known as “direct-acting antivirals” — can now cure the disease. One such cure, branded as Sovaldi in the US by the drugmaker Gilead, ignited a controversy over pharmaceutical price gouging when it debuted in 2013 with an $84,000 price tag for a 12-week course of treatment.
Since then, additional hepatitis C drugs, including lower-priced generics, have entered the market. The competition “has been very effective putting the price down close to $20,000,” said Craig Garthwaite, director of the program on health care at Northwestern University’s Kellogg School of Management. “That is still high, but well within cost-effective price range.” Indeed, a 2020 study on hepatitis C drug pricing said “cost remains a key barrier to access for many patients and for scale-up in many national health programs.”


vox--2020-10-05--Is Trump sicker than his doctors are saying? His treatment regimen raises questions.

Sunday ’ s press conference on President Donald Trump ’ s status as a Covid-19 patient raised just as many new questions as answers , leaving many medical experts concerned that the public still isn ’ t getting a complete or accurate picture of the commander-in-chief ’ s health .
At the briefing at Walter Reed National Military Medical Center , where the president is being treated , his doctors said Trump is “ doing very well ” and had improved so much he could be discharged as soon as Monday .
Yet the optimistic report on the president ’ @ @ @ @ @ @ @ by his physician , Sean Conley , that Trump had needed supplemental oxygen on Friday and that his blood oxygen saturation had dropped to worrisome levels twice in the past three days .
Conley said he ’ d withheld details about this at Saturday ’ s press briefing because he wanted to “ reflect the upbeat attitude that the team , the president ” has had about the course of Trump ’ s illness .
The president ’ s medical team also reported that Trump on Saturday started yet another drug to fight @ @ @ @ @ @ @ been shown in clinical trials to improve outcomes — but is only recommended for patients with severe or critical Covid-19 .
It ’ s also the third Covid-19 drug to be administered to the president , following an experimental monoclonal antibody treatment given Friday and an ongoing , five-day course of the antiviral remdesivir .
But dexamethasone can also have serious psychiatric side effects , and the decision to use it so early in the president ’ s infection sparked a new round of speculation about the severity of his illness .
Vox @ @ @ @ @ @ @ care doctors about the news to try to make sense of it .
They said either Trump is sicker than the White House is saying , or his doctors are over-treating their high-risk , 74-year-old VIP patient .
“ I can tell you how I would approach the treatment of a patient or family member — it would be different , ” said intensive care doctor Lakshman Swamy , who works with the Cambridge Health Alliance .
“ The challenge is that when you are a VIP patient , it doesn ’ t @ @ @ @ @ @ @ — it just means you get more care.
” One thing everyone agreed on : Trump ’ s health status today , whatever it is , doesn ’ t say anything about how he ’ ll be doing a week from now , given the unpredictability of this disease .
What we know about Trump ’ s health If we go by the official reports from the White House , Trump has been improving and was doing just fine as of Sunday morning — but he had a bad Friday .
That was @ @ @ @ @ @ @ oxygen levels dropped for the first time .
Conley said Trump ’ s “ oxygen saturation transiently dipped below 94 percent .
... And after about a minute with only two liters , [ it was ] back over 95 percent.
” After an hour , Trump was off the oxygen , Conley added .
On Saturday , Trump ’ s blood oxygen saturation level again dropped to 93 percent for a short period — but Conley wouldn ’ t confirm whether the president required oxygen then , too .
Instead , since @ @ @ @ @ @ @ improved so much , his doctors said , he may head back to the White House as soon as Monday .
His doctors also said he hasn ’ t had a fever since Friday morning , his vitals are stable , and he ’ s not experiencing any shortness of breath any longer .
Conley did not provide details about the results of the president ’ s chest CT scan , prompting Bob Wachter , chair of the Department of Medicine at the University of California San Francisco , to wonder if they @ @ @ @ @ @ @ other manifestations of Covid-19 lung involvement , or inflammation .
Meanwhile , Trump has been given at least three new drugs — that are all still being tested — to treat Covid-19 and its symptoms .
On Friday , Trump ’ s doctors say they started administering the intravenous antiviral remdesivir and a cocktail of experimental monoclonal antibodies — medicines that are supposed to stop the virus from replicating and progressing into cells .
We learned Sunday he also started taking dexamethasone — a steroid that reduces inflammation associated with Covid-19 .
( @ @ @ @ @ @ @ vitamin D , famotidine , melatonin , and daily aspirin — though it ’ s not clear whether those drugs are for Covid-19 specifically , since there ’ s no conclusive evidence to back their use for the novel coronavirus . )
Of the three Covid-19 drugs , dexamethasone has the strongest evidence behind it .
“ It ’ s the only drug to show improvement — overall improvement — in Covid-19 , ” said Joshua Barocas , an assistant professor of medicine at Boston University and infectious disease physician at Boston Medical @ @ @ @ @ @ @ published in the New England Journal of Medicine .
It showed randomly chosen patients who received dexamethasone experienced a reduced risk of death versus those who didn ’ t get the drug — but only when they were either intubated or receiving supplemental oxygen .
In patients who aren ’ t on oxygen , the risks associated with the drug ’ s use may outweigh the harms .
Among the particularly worrisome side effects : confusion , delirium , mania , and a higher risk of other infections .
The drug can even @ @ @ @ @ @ @ suppressing the immune system ’ s virus-fighting response .
The Covid-19 treatment guidelines only call for dexamethasone in seriously ill patients .
“ I wouldn ’ t be giving it to someone who is not on oxygen , ” Swamy said .
“ It ’ s not a completely benign choice of medication , ” Jen Manne-Goehler , an infectious disease doctor at Brigham and Women ’ s and Massachusetts General hospitals , added .
“ It ’ s either over-treatment or he ’ s much more ill that [ the White House @ @ @ @ @ @ @ , a professor of medicine in Munich , Germany , who treated the country ’ s first Covid-19 patients .
Trump is also on a five-day course of remdesivir — an antiviral developed by Gilead Sciences that ’ s supposed to stop the virus from replicating .
There is published evidence for the use of remdesivir — in hospitalized patients , it shortened their recovery time compared to the placebo group — but it ’ s not yet fully approved by the Food and Drug Administration and no one knows what happens when @ @ @ @ @ @ @ Trump is taking .
As for the experimental cocktail of monoclonal antibodies : In theory , the treatment is supposed to work by neutralizing the coronavirus .
But monoclonal antibodies for Covid-19 have not even been fully tested in humans .
( We ’ ve only got published studies on hamsters and monkeys , and unpublished efficacy data from an ongoing human trial , according to Science magazine . )
“ What ’ s confusing or surprising is [ why ] you would use something so early ... with no efficacy data out @ @ @ @ @ @ @ monoclonal antibodies .
From a scientific standpoint , she reasoned , starting on the drug early might make sense if you ’ re trying to prevent the virus from entering cells .
“ But what ’ s odd is as a clinical doctor , I don ’ t jump to [ prescribing ] things I have little real-life efficacy data [ on ] in a person who is not super sick.
” Even if the experimental drug looks promising in early research , Swamy noted , “ people said the same thing about @ @ @ @ @ @ @ to be ineffective for Covid-19 .
He added : “ We don ’ t know enough about it.
” So one could read the use of unapproved drugs typically given in severe cases as a sign that Trump is sicker than the White House is acknowledging .
Or maybe it ’ s just because the patient is the president , said Peter Hotez , dean of the National School of Tropical Medicine at Baylor College of Medicine .
“ You know he ’ s got risk factors .
He ’ s starting to @ @ @ @ @ @ @ and an oxygen requirement .
The question is what do you do ?
” Hotez said .
“ If something were to happen to the president — whether he becomes incapacitated or worse — that ’ s a huge national security threat.
” All the doctors said it was difficult from the limited information being released from the White House to know what ’ s truly going on .
What is clear : Trump ’ s doctors were veering far from the Covid-19 guidelines , with the multiple therapies — some unproven — @ @ @ @ @ @ @ line : It ’ s too soon to tell if Trump is on the road to recovery Trump ’ s health status now — even if he ’ s discharged from Walter Reed Medical Center on Monday — tells us little about how he ’ ll fare over the next week .
Patients “ can be doing fine , requiring a little bit of supplemental oxygen , and then very rapidly deteriorate to mechanical ventilation — that ’ s one of the scariest things about this virus , ” Barocas said .
Manne-Goehler @ @ @ @ @ @ @ is that who falls off a cliff — and who doesn ’ t — still can be difficult to predict.
” She recently cared for a patient who was similar to Trump in terms of his age and underlying health risks , Manne-Goehler said .
“ He looked pretty bad , he got to the edge of the cliff and got better .
But there are people who just blow through anything we try to do [ for them ] and do terribly .
That script — even with what we understand about @ @ @ @ @ @ @ scares the medical community.
” Trump ’ s doctors have also gone off script for his treatments , which makes applying what we know about how patients fare to the president even more challenging .
Overall , though , people with Covid-19 are generally doing better now than they did mere months ago , because doctors have refined their approach to treating the disease .
And while Trump has an elevated risk of complications and death — because of his age , sex and underlying medical conditions — the odds of survival are @ @ @ @ @ @ @ will have to wait until at least 10 days after his symptoms began for a clearer picture .
That ’ s when patients — if they are doing well — are usually thought to be in the clear .
If we assume the White House ’ s Friday timeline is accurate , that brings us to October 11 .
Until then , Manne-Goehler said , the disease is “ a roller coaster.
” Help keep Vox free for all Millions turn to Vox each month to understand what ’ s happening in the @ @ @ @ @ @ @ a racial reckoning to what is , quite possibly , the most consequential presidential election of our lifetimes .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
But our distinctive brand of explanatory journalism takes resources .
Even when the economy and the news advertising market recovers , your support will be a critical part of sustaining our resource-intensive work .
If you have already contributed , thank you .
If you haven ’ t , please consider helping everyone make @ @ @ @ @ @ @ Contribute today from as little as $ 3 .

Sunday’s press conference on President Donald Trump’s status as a Covid-19 patient raised as many new questions as answers, leaving many medical experts concerned that the public still isn’t getting a complete or accurate picture of the commander in chief’s health.
At the briefing at Walter Reed National Military Medical Center, where the president is being treated, his doctors said Trump is “doing very well” and had improved so much he could be discharged as soon as Monday.
Yet the optimistic report on the president’s prognosis also came with an admission by his physician, Sean Conley, that Trump had needed supplemental oxygen on Friday and that his blood oxygen saturation had dropped to worrisome levels twice in the past three days. Conley said he’d withheld details about this at Saturday’s press briefing because he wanted to “reflect the upbeat attitude that the team, the president” has had about the course of Trump’s illness.
The president’s medical team also reported that Trump on Saturday started yet another drug to fight Covid-19: dexamethasone. The steroid has been shown in clinical trials to improve outcomes — but is only recommended for patients with severe or critical Covid-19. It’s also the third Covid-19 drug to be administered to the president, following an experimental monoclonal antibody treatment given Friday and an ongoing, five-day course of the antiviral remdesivir.
But dexamethasone can also have serious psychiatric side effects, and the decision to use it so early in the president’s infection sparked a new round of speculation about the severity of his illness.
Vox spoke to five infectious disease and intensive care doctors about the news to try to make sense of it. They said either Trump is sicker than the White House is saying or his doctors are overtreating their high-risk, 74-year-old VIP patient.
“I can tell you how I would approach the treatment of a patient or family member — it would be different,” said intensive care doctor Lakshman Swamy, who works with the Cambridge Health Alliance. “The challenge is that when you are a VIP patient, it doesn’t always mean you mean you get better care — it just means you get more care.”
One thing everyone agreed on: Trump’s health status today, whatever it is, doesn’t say anything about how he’ll be doing a week from now, given the unpredictability of this disease.
What we know about Trump’s health
If we go by the official reports from the White House, Trump has been improving and was doing just fine as of Sunday morning — but he had a bad Friday. That was when he experienced a fever and his oxygen levels dropped for the first time.
Conley said Trump’s “oxygen saturation transiently dipped below 94 percent. ... And after about a minute with only two liters, [it was] back over 95 percent.” After an hour, Trump was off the oxygen, Conley added. On Saturday, Trump’s blood oxygen saturation level again dropped to 93 percent for a short period — but Conley wouldn’t confirm whether the president required oxygen then, too.
Instead, since then, Trump’s health has improved so much, his doctors said, he may head back to the White House as soon as Monday. His doctors also said he hasn’t had a fever since Friday morning, his vitals are stable, and he’s no longer experiencing any shortness of breath.
Conley did not provide details about the results of the president’s chest CT scan, prompting Bob Wachter, chair of the Department of Medicine at the University of California San Francisco, to wonder if they’d found signs of pneumonia, other manifestations of Covid-19 lung involvement, or inflammation.
... But it seems far likelier that they found evidence of pneumonia or other manifestations of Covid lung involvement or inflammation, which is serious and raises the level of concern and risk. (4/8) — Bob Wachter (@Bob_Wachter) October 4, 2020
Meanwhile, Trump has been given at least three new drugs — that are all still being tested — to treat Covid-19 and its symptoms.
Trump’s treatment protocol, explained
On Friday, Trump’s doctors say they started administering the intravenous antiviral remdesivir and a cocktail of experimental monoclonal antibodies — medicines that are supposed to stop the virus from replicating and progressing into cells.
We learned Sunday he also started taking dexamethasone, a steroid that reduces inflammation associated with Covid-19. (He had also been taking zinc, vitamin D, famotidine, melatonin, and daily aspirin — though it’s not clear whether those drugs are for Covid-19 specifically, since there’s no conclusive evidence to back their use against the novel coronavirus.)
Of the three Covid-19 drugs, dexamethasone has the strongest evidence behind it. “It’s the only drug to show improvement — overall improvement — in Covid-19,” said Joshua Barocas, an assistant professor of medicine at Boston University and infectious disease physician at Boston Medical Center.
Barocas referred to a study published in the New England Journal of Medicine. It showed randomly chosen patients who received dexamethasone experienced a reduced risk of death versus those who didn’t get the drug — but only when they were either intubated or receiving supplemental oxygen.
In patients who aren’t on oxygen, the risks associated with the drug’s use may outweigh the harms. Among the particularly worrisome side effects: confusion, delirium, mania, and a higher risk of other infections. The drug can even complicate a patient’s recovery by suppressing the immune system’s virus-fighting response. The Covid-19 treatment guidelines only call for dexamethasone in seriously ill patients.
“I wouldn’t be giving it to someone who is not on oxygen,” Swamy said.
Dexamethasone can cause frank mania, or more severe depressive states. Added to the risk of COVID related neuropsychiatric symptoms/severe delirium the press ought to be asking the medical team how they are formally monitoring his mental status @maggieNYT @jonathanvswan — Paul Summergrad (@paulsummergrad) October 4, 2020
“It’s not a completely benign choice of medication,” Jen Manne-Goehler, an infectious disease doctor at Brigham and Women’s and Massachusetts General hospitals, added.
“It’s either overtreatment or he’s much more ill that [the White House] said,” said Clemens Wendtner, a professor of medicine in Munich, Germany, who treated the country’s first Covid-19 patients.
Trump is also on a five-day course of remdesivir, an antiviral developed by Gilead Sciences that’s supposed to stop the virus from replicating.
There is published evidence for the use of remdesivir — in hospitalized patients, it shortened their recovery time compared to the placebo group — but it’s not yet fully approved by the Food and Drug Administration and no one knows what happens when patients get the medication in conjunction with the others Trump is taking.
While we don’t know all the details here, I’ll say this— if you’re having dropping oxygen levels and being started on #dexamethasone, your discharge day shouldn’t be tomorrow. #covid19 — Dr. Abraar Karan (@AbraarKaran) October 4, 2020
As for the experimental cocktail of monoclonal antibodies: In theory, the treatment is supposed to work by neutralizing the coronavirus. But monoclonal antibodies for Covid-19 have not even been fully tested in humans. (We’ve only got published studies on hamsters and monkeys, and unpublished efficacy data from an ongoing human trial, according to Science magazine.)
“What’s confusing or surprising is [why] you would use something so early ... with no efficacy data out there,” said Manne-Goehler of the monoclonal antibodies. From a scientific standpoint, she reasoned, starting on the drug early might make sense if you’re trying to prevent the virus from entering cells. “But what’s odd is as a clinical doctor, I don’t jump to [prescribing] things I have little real-life efficacy data [on] in a person who is not super sick.”
Even if the experimental drug looks promising in early research, Swamy noted, “people said the same thing about hydroxychloroquine,” a drug now known to be ineffective for Covid-19. He added: “We don’t know enough about it.”
So one could read the use of unapproved drugs typically given in severe cases as a sign that Trump is sicker than the White House is acknowledging. Or maybe it’s just because the patient is the president, said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
“You know he’s got risk factors. He’s starting to get sick. Has had a fever and an oxygen requirement. The question is what do you do?” Hotez said. “If something were to happen to the president — whether he becomes incapacitated or worse — that’s a huge national security threat.”
All the doctors said it was difficult from the limited information being released from the White House to know what’s truly going on. What is clear: Trump’s doctors were veering far from the Covid-19 guidelines, with the multiple therapies — some unproven — being administered in combination.
The bottom line: It’s too soon to tell if Trump is on the road to recovery
Trump’s health status now — even if he’s discharged from Walter Reed medical center on Monday — tells us little about how he’ll fare over the next week.
Patients “can be doing fine, requiring a little bit of supplemental oxygen, and then very rapidly deteriorate to mechanical ventilation — that’s one of the scariest things about this virus,” Barocas said.
Manne-Goehler agreed: “What makes Covid scary is that who falls off a cliff, and who doesn’t, still can be difficult to predict.”
She recently cared for a patient who was similar to Trump in terms of age and underlying health risks, Manne-Goehler said. “He looked pretty bad, he got to the edge of the cliff and got better. But there are people who just blow through anything we try to do [for them] and do terribly. That script — even with what we understand about risk factors — is part of what scares the medical community.”
Trump’s doctors have also gone off script for his treatments, which makes applying what we know about how patients fare to the president even more challenging.
Overall, though, people with Covid-19 are generally doing better now than they did mere months ago because doctors have refined their approach to treating the disease. And while Trump has an elevated risk of complications and death — because of his age, gender, and underlying medical conditions — the odds of survival are in his favor.
But the public will have to wait until at least 10 days after his symptoms began for a clearer picture. That’s when patients, if they are doing well, are usually thought to be in the clear. If we assume the White House’s timeline is accurate, that brings us to October 10 or 11. Until then, Manne-Goehler said, the disease is “a roller coaster.”