After being treated for COVID-19 at Walter Reed National Military Medical Center for three days, President Donald Trump returned to the White House on Monday evening.

Once he was discharged from the hospital, Trump flew in the Marine One helicopter to the White House lawn. He then climbed the steps to the White House entrance, removed his face mask and gave a thumbs up to reporters.

Public health experts immediately reacted with outrage to the removal of his face mask while he is still contagious.

“I am struggling for words — this is crazy,” Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania in Philadelphia, told The New York Times. “It is just utterly irresponsible.”

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical School in Tennessee, told the newspaper that the president’s decision to remove his mask was “dangerous” because it encourages Americans to ignore social distancing guidelines to keep themselves safe.

“It will lead to more casual behavior, which will lead to more transmission of the virus, which will lead to more illness, and more illness will lead to more deaths,” Schaffner said.

Earlier Monday, Trump’s medical team delivered an update on his condition, saying he would receive his fifth and final dose of the antiviral drug remdesivir at the White House on Tuesday. His physician, Dr. Sean Conley, noted that Trump hasn’t had a fever in 72 hours. In addition to remdesivir, Trump was given an experimental antibody cocktail and is taking the steroid dexamethasone, a drug typically used to treat severe COVID-19.

Notably, Conley evaded some key questions about the president’s condition, including his lung function and the date of his last negative coronavirus test.

Some medical experts said Monday that Trump should be closely watched for at least the first week of his infection, given that some patients can quickly deteriorate several days into their illness, the Times reported.

“I think it would be disastrous to be in a situation where he gets really sick at the White House, and you’re having to emergency transfer him,” Dr. Celine Gounder, a clinical assistant professor of medicine and infectious diseases at the NYU Grossman School of Medicine, told the Times. “To me, it’s not safe.”

Gounder also noted that dexamethasone can cause a false sense of euphoria. “A lot of people will just feel really great. If you had any aches and pains, they will disappear. If you had a fever, that will disappear,” she explained. “People can become somewhat manic, grandiose.”

Based on his doctors’ earlier accounts, Trump’s symptoms quickly escalated after he announced early Friday morning that he had tested positive for the coronavirus. He was first taken to Walter Reed Friday evening.

Trump experienced a “high fever” on Friday, and there were two occasions when his blood oxygen levels dropped and he was given supplemental oxygen, on Friday and again on Saturday, the Times reported. Trump’s oxygen saturation level was 93% at one point, his doctors said. Ninety-five percent is considered the lower limit of the normal range.

White House blocks tougher FDA vaccine rules

Top White House officials are blocking strict new federal guidelines for the emergency release of a coronavirus vaccine, the Times reported Tuesday.

The key sticking point is a provision that would almost certainly guarantee that no vaccine could be authorized before the election on Nov. 3, people familiar with the approval process told the newspaper.

The U.S. Food and Drug Administration, which developed the new rules, is seeking other ways to toughen the vaccine approval process, the Times reported. One move would be to share the new standards with an outside advisory committee of experts that is supposed to meet publicly before any vaccine is authorized for emergency use in hopes the committee will enforce the guidelines, the newspaper said.

The FDA submitted the guidelines to the Office of Management and Budget for approval more than two weeks ago. But the new guidelines stalled when they reached the office of Mark Meadows, the White House chief of staff, and their approval is now seen as highly unlikely, the Times reported.

The recommendation that seems to be the main point of contention is a rule that volunteers who have participated in vaccine clinical trials be followed for a median of two months after the final dose before any authorization is granted, according to a senior administration official and others familiar with the situation, who spoke on the condition of anonymity, the Times reported.

Given where most of the vaccine trials are at right now, that two-month follow-up period would all but preclude any emergency vaccine approval before Election Day, the newspaper said.

Trump himself has cast doubt on whether the guidance would be approved, telling reporters in September that, “We may or may not approve it.”

Trump has repeatedly promised a major breakthrough in vaccine development as early as this month. But no clinical trial in the United States has yet advanced far enough to prove that any vaccine is safe and effective, although Pfizer has said it hopes to have interim results soon from its vaccine trial, the Times reported.

COVID continues to spread around the globe

The global coronavirus pandemic reached a grim new milestone last week: One million dead.

Americans made up more than 210,000 of those deaths, or one in every five, according to a running tally comprised by Johns Hopkins University.

“It’s not just a number. It’s human beings. It’s people we love,” Dr. Howard Markel, a professor of medical history at the University of Michigan, told the Associated Press. He’s an adviser to government officials on how best to handle the pandemic — and he lost his 84-year-old mother to COVID-19 in February.

By Tuesday, the U.S. coronavirus case count neared 7.5 million while the death toll passed 210,000, according to a Times tally.

According to the same tally, the top five states in coronavirus cases as of Tuesday were: California with over 837,700; Texas with more than 806,000; Florida with nearly 718,000; New York with over 470,000; and Georgia with more than 307,500.

Curbing the spread of the coronavirus in the rest of the world remains challenging.

By Tuesday, India’s coronavirus case count passed 6.6 million, just over one month after hitting the 3 million mark, the Times reported.

More than 103,500 coronavirus patients have died in India, according to the Hopkins tally, but when measured as a proportion of the population, the country has had far fewer deaths than many others. Doctors say this reflects India’s younger and leaner population.

Still, the country’s public health system is severely strained, and some sick patients cannot find hospital beds, the Times said. Only the United States has more coronavirus cases.

Meanwhile, Brazil passed 4.9 million cases and over 146,600 deaths as of Tuesday, the Hopkins tally showed.

Cases are also spiking in Russia: The country’s coronavirus case count has passed 1.2 million. As of Tuesday, the reported death toll in Russia was over 21,500, the Hopkins tally showed.

Worldwide, the number of reported infections passed 35.5 million on Tuesday, with over 1 million deaths, according to the Hopkins tally.

More information

The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.