POLITICO NIGHTLY: How to tell if Trump is healthy

BY RENUKA RAYASAM

I’M NOT A DOCTOR, BUT … — Tonight President Donald Trump is scheduled to receive a live, on-air medical evaluation on Tucker Carlson’s Fox News show. The choreographed, reality-TV moment is surely meant to reassure the American public that the president is on the mend, that Covid-19 is not that bad and that he can safely resume campaigning with less than four weeks until Election Day. You probably won’t be shocked to learn that a group of medical experts, from different hospitals and from different parts of the country, told Nightly that what we will learn tonight about the president’s health is probably only what he wants us to learn. Memos and status reports from Trump’s medical team have revealed little, often raising more questions than answers. Trump received an aggressive course of treatment but says he’s fine now. A televised remote medical evaluation probably won’t be any more telling. But in a lot of reality TV, there are often unspoken clues about what’s really going on. Here’s a quick guide to how medical experts will watch the president’s medical evaluation tonight, for evidence of how sick the president was and whether his condition is quickly improving: Watch Trump’s face. Covid primarily affects a patient’s lungs. Oxygen saturation levels are the most objective measure of whether a patient’s lung function has returned to normal. Trump’s doctors haven’t given the public any numbers — a level of above 97 percent is considered normal, but below 90 percent spells trouble. “A good internal medicine doctor can tell a lot about how sick a patient is just by looking at them,” said Dean Winslow, an infectious disease physician at Stanford Health Care. People who have trouble breathing often purse their lips and heave their chest. They have trouble speaking in complete sentences without pausing to take a breath. Watch his energy levels. A simple stethoscope could tell whether the president is suffering from Covid heart complications, Winslow said. A high or irregular heartbeat would be a big warning sign. A doctor would also check vital signs like his temperature, pulse and blood pressure. Many Covid patients develop long-term fatigue. The president is already filling his schedule with rallies and other outings for the next few days. If he pares back his travel or rally schedule, it could be a sign his recovery is slow-going. It doesn’t mean that the president is likely to become more ill. If anything, most doctors agree that his condition is probably improving. But there’s no guarantee that his recovery will be quick. Observe his mood. Trump received a steroid, dexamethasone, that’s known to cause mood changes, including a sense of euphoria. Look to see if seems “more agitated than usual” tonight, said Paul Currier a critical care doctor at Massachusetts General Hospital. “Whether he might be somewhat manic, which is sometimes difficult to tell with President Trump, could be a side effect of steroids,” said Currier. There are a lot of things TV can’t tell us. In a routine medical exam, a doctor would ask a recovering Covid patient if they were experiencing a loss of smell and taste or memory problems, to gauge neurological effects. But the doctor probably won’t ask, and there’s no way to know how to trust Trump’s answer. The biggest question doctors raised, especially as the president returns to campaigning, is whether he is still infectious or whether he can be reinfected. A president who refuses to wear a mask, and is surrounded by others who refuse to as well, is potentially vulnerable not only to spreading the virus, but also to getting sick again. So far, Covid reinfections have been rare. But the president’s treatment has been unlike any other patient in the country. He took monoclonal antibodies very early in the course of his illness, raising a question about whether he developed his own antibodies that would protect him from getting sick again, at least in the short term. “Did he develop an immune response, and could he get this again?” asked Kevin Schulman, a professor of medicine at Stanford. “We just don’t know.” Welcome to POLITICO Nightly. Nightly will be off on Monday, but back and better than ever on Tuesday. Reach out rrayasam@politico.com or on Twitter at @renurayasam.

White House National Economic Council Director Larry Kudlow talks to reporters outside the West Wing. Without revealing specifics of the offer, Kudlow said that he, chief of staff Mark Meadows and Treasury Secretary Steven Mnuchin spoke with Trump, and that the president gave approval for a revised coronavirus stimulus legislation. | Getty Images

THE DEBATES

BREAKING THE DEBATE — The Commission on Presidential Debates canceled the second pre-election showdown between Trump and Joe Biden, initially scheduled for Oct. 15 in Miami, according to a person familiar with the situation. FIRST IN NIGHTLY MAKE TRUMP WELL AGAIN — When the president got back from his coronavirus hospital stint, he started ricocheting through his favorite subjects on Twitter: his self-proclaimed achievements; his desire to jail his political opponents; his plea that Americans not be “afraid of Covid.” MAGA world followed right along. Amped up at by the president’s recovery, Trump’s base matched the president’s all-caps energy, White House reporter Tina Nguyen writes. “I will never love another president again,” declared Rep. Matt Gaetz (R-Fla.) the day that Trump went back to the White House. Even when Trump angered significant segments of the broader MAGA world — which he did when he unilaterally cut off, and then restarted, congressional negotiations over coronavirus relief money — the more fervent corners ignored the issue. Others pushed convoluted arguments about Trump’s three-dimensional chess tactics. PALACE INTRIGUE TRUMP HEADS OUT AND ABOUT — Trump will address hundreds of supporters on the South Lawn of the White House on Saturday, before traveling to Florida on Monday for a rally, marking his return to public events after contracting the coronavirus, White House reporter Meridith McGraw reports. Trump is resuming his campaign schedule only 10 days after he was first diagnosed with the coronavirus. While the president’s physician, Sean Conley, has previously said Trump could likely resume such activities starting Saturday, it’s unclear whether the president has tested negative since falling ill, or whether he is still contagious. On Saturday, Trump will speak to a crowd gathered by conservative activist Candace Owens, whose Blexit Foundation encourages Black Americans to leave the Democratic Party. His speech is being billed as “Remarks to Peaceful Protesters for Law & Order,” according to an invitation. He’ll address the crowd from the Truman Balcony off of the Blue Room, a large state room on the main floor of the White House. More than 2,000 guests have been invited, according to a person familiar with the event. In a statement, the White House said attendees will be “instructed” to wear a mask while at the complex, but will only be screened for Covid-19 with a temperature check and “brief questionnaire,” instead of a test. The statement added that attendees will be “strongly encouraged,” but not required, to follow the CDC’s coronavirus guidelines, such as social distancing and mask wearing. “The health and safety of all attendees is our priority,” the statement said. FROM THE HEALTH DESK LAST-SECOND SHOT — Pfizer, the company behind Trump’s last hope for a vaccine by Election Day, has quietly begun courting influential health experts, including some of its toughest critics, to head off charges that it’s moving too fast in the face of intense political pressure, health care reporters Adam Cancryn and Sarah Owermohle write. The campaign by Pfizer comes with growing scrutiny of CEO Albert Bourla’s predictions that the company will know this month whether it has a viable vaccine — making it the only major vaccine developer that says it could know whether its shot works by Nov. 3. And even though chances are slim that the company can meet the FDA’s tough new standards for vaccine safety data by that date, Bourla hasn’t backed down. That could set up a high-stakes clash between a president eager to declare vaccine success and government regulators charged with safeguarding the American public. FROM THE TECHNOLOGY DESK RTS STILL AREN’T ENDORSEMENTS — Twitter is making sizable changes to retweets and other features aimed at making it harder for politicians and other users to spread misinformation about the Nov. 3 election, the company announced today — the latest attempt by Silicon Valley platforms to protect the vote, senior technology reporter Nancy Scola writes. The changes are part of a push to protect the “critical dialogue” on Twitter “from attempts — both foreign and domestic — to undermine it,” said Twitter's general counsel Vijaya Gadde and head of product Kayvon Beykpour in a blog post announcing the moves. The design changes, being rolled out in phases starting next week, are meant to add friction to the distribution of misinformation, conspiracy theories and election interference. Among the most important, Twitter will use warning labels to hide misleading tweets from some accounts, including those of U.S. politicians and people with more than 100,000 followers. Anyone attempting to retweet that post will get a notice indicating that the tweet is “disputed,” and will be prevented from moving ahead unless they add their own commentary. COVID-2020 BIDEN COURTS LADY LUCK — Could Nevada be the Michigan of 2020 — a state Democrats figured they had in the bag but that unexpectedly goes for Trump? One particular stat about the state has troubled Democrats all cycle: Hillary Clinton won it by less than she lost the neighboring battleground of Arizona, national political reporter Laura Barrón-López writes. Guarding against any overconfidence, Biden visited Nevada today. Biden leads Trump in Nevada by an average of 7 points, but the state hasn’t received much attention. Many Latinos within the party have warned that Biden can’t take the state for granted. Despite his fundraising advantage, Biden is poised to spend $2.3 million on TV in the state between now and Election Day, compared to $3.2 million for Trump, according to media tracker Advertising Analytics. (Trump is spending nothing on Spanish-language ads in Nevada, compared to $200,000 by Biden.) Biden is spending more in Arizona: Two weeks in a row, he’s dropped more in the enormous Phoenix media market than in any other market in the country. In September, the Cook Political Report moved Nevada from “likely Democrat” to “lean Democrat.” GOTV HEADS TO THE POLES — As campaigns and organizations across the country try to motivate voters to cast their ballots, one group’s unusual campaign has gone viral: Exotic dancers are encouraging voters to get their “booty to the poll.” Watch the video below to hear from the people behind the video, including their inspiration for the campaign. ASK THE AUDIENCE Nightly asked you: What book, movie or TV show best captures your 2020 experience? Below are some of your lightly edited responses. “Schitt’s Creek: the series is about a family with a lot of problems trying to figure out their new normal and become better people in the process.” — Kismet Lantos-Swett, student, Boston “Gilligan’s Island: We don't know how long we are going to be trapped on this island, and we didn’t pick the people we are trapped with. But we are making the best of it!” — John Godfrey, public affairs, Rockville, Md. “Parable of the Sower by Octavia Butler: Published in 1993, about a small group of survivors of a national pandemic seeking safety in the midst of a divided and terrifyingly violent landscape. Eerily, the title of the opening chapter is ‘2020.’” — Rose Kreher, retired, Snowflake, Ariz. “The Simpsons: Since everything has taken on a tinge of the absurd and since they’ve been so good at predicting the future; I can’t wait to see what happens next!” — DERALD HAGBERG, IT MANAGER, LITTLETON, COLO. “The Plague by Albert Camus: No surprises here. ‘“It was plague. We’ve had the plague here.” You’d almost think they expected to be given medals for it. But what does that mean, “plague”? Just life, no more than that.’” — Bob Gordon, writer, Brantford, Ontario “Wizard of Oz: With flying monkeys, a surreal world, clicking our heels to get back to normal.” — Keith Rutherford, retired, Harrisburg, Pa. “War of the Worlds: We’ve gotta blame somebody, Why not the Martians?” — Greg Dennis, writer, Cornwall, Vt. NIGHTLY NUMBER 50,000 The approximate number of voters who received incorrect absentee ballots in the county that is home to Ohio’s capital, elections officials said today, as they promised corrected ballots would be mailed within 72 hours. With about 240,000 ballots mailed, that meant one in five voters received a wrong ballot. PARTING WORDS

“SHE WAS SUPPOSED TO CURE CORONAVIRUS …” — In a Nightly first, White House reporter Tina Nguyen emails us this review: William Shakespeare wrote King Lear while in quarantine. Albert Camus drew inspiration from the cholera epidemic to write The Plague. And in 2020, romance novelist M.J. Edwards has added a new entry to the literary canon: Kissing the Coronavirus, available on Kindle for $0.99. This baffling erotic novella was brought to my attention by Quartz health and science reporter Katherine Ellen Foley , who found it through the most 2020 way possible: a viral post from a novelty account on TikTok that reviews dinosaur erotica. (Every word of that is true.) It follows the lust of lonely, sex-starved researcher Dr. Alexa Ashingtonford, who has been locked in a lab with a coronavirus sample for so long that she’s starting to develop feelings for it. A PG-13 excerpt: … Alexa knew she had to replicate the results against the original sample. Any excuse to hold that powerful beast in her hands once again — she didn’t need to be asked twice. Alexa took the creamy, bubbling Covid-19 sample from the workbench, holding it close to her quivering breasts as she returned to the samplometer. She ran the sample and it came out exactly as she had hoped. What happens over the next 24 pages is a graphic, NSFW piece of pandemic literature that will either cause you to break down in mind-breaking laughter, as I did, or make you feel real funny, as I also did. Highly recommended reading if you’re an adult who can’t handle the madness of this world anymore. Did someone forward this email to you? Sign up here.   Follow us on Twitter Renuka Rayasam @renurayasam   FOLLOW US

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