Trump Leaves Hospital, Minimizing Virus and Urging Americans ‘Not to Let It Dominate Your Life’

WASHINGTON — President Trump returned to the White House on Monday night after three days in the hospital with the coronavirus in a defiant, made-for-television moment in which he ripped off his face mask and then urged the nation to disregard the risks of the virus that has swept through his own team and return to work.

On the same day that his press secretary and two more aides tested positive, making the White House the leading coronavirus hot spot in the nation’s capital, Mr. Trump again dismissed the pandemic that has killed 210,000 in the United States, telling Americans “don’t be afraid of Covid” and to live their lives, making no effort to urge precautions. The words and visuals were only the latest ways the president has undermined public health experts trying to persuade Americans to take the pandemic seriously.

“We’re going back to work. We’re going to be out front,” Mr. Trump said in a video shot immediately after his return and then posted online. “As your leader, I had to do that. I knew there’s danger to it, but I had to do it. I stood out front. I led. Nobody that’s a leader would not do what I did. And I know there’s a risk, there’s a danger, but that’s OK. And now I’m better and maybe I’m immune, I don’t know. But don’t let it dominate your lives.”

Mr. Trump’s words were meant to cast his illness as an act of courage rather than recklessness and demonstrated that he intended no pivot in his handling of the pandemic despite his own medical crisis. The message, in effect, was that Americans should live their lives and not worry about catching the virus because “we have the best medicines in the world.”

The president’s dismissal of a virus that in recent weeks has been killing another 700 people each day in the United States set off alarm bells among health specialists who worried that it would send the wrong message to the public.

Kristin Urquiza, who addressed the Democratic National Convention after her father died of the coronavirus, responded on Twitter to the president’s admonishment to Americans not to be afraid of Covid-19, the disease caused by the coronavirus. “At this point the only thing we should be afraid of is you,” she wrote.

Mr. Trump pressured his doctors to release him from Walter Reed National Military Medical Center in suburban Maryland, but his return home did not indicate that he had escaped jeopardy, only that he could be treated at the White House, where he has 24-hour medical care. Dr. Sean P. Conley, the White House physician, acknowledged that the president “may not entirely be out of the woods yet,” adding that it would be another week until doctors could feel confident that he had passed the danger point.

“We all remain cautiously optimistic and on guard because we’re in a bit of uncharted territory when it comes to a patient that received the therapies he has so early in the course,” Dr. Conley told reporters outside Walter Reed. “So we’re looking to this weekend. If we can get through to Monday with him remaining the same or improving, better yet, then we will all take that final deep sigh of relief.”

Doctors said the president had gone 72 hours without a fever and had normal blood oxygen readings after two earlier bouts of falling levels that led to him being given supplemental oxygen. But they refused to discuss scans of the president’s lungs, which independent medical experts said could mean he has pneumonia, and would not disclose when he had his last negative test.

Mr. Trump emerged from Walter Reed around 6:30 p.m. wearing a dark suit, a blue tie and a white face mask and boarded Marine One for the short flight back to the White House. After landing on the South Lawn, the president climbed the steps to the balcony over the Diplomatic Entrance, where four American flags had been placed, took off his mask, flashed two thumbs up and saluted twice for the benefit of television cameras on the ground below.

He then entered the building without immediately putting his mask back on even though staff members were nearby and he could still be contagious, according to medical studies of the virus timeline. At that point, he evidently filmed the video, which was quickly uploaded to Twitter. So was a separate video, set to triumphal music, of Marine One landing and him saluting.

The president appeared stronger than he did on Friday when he was first taken to the hospital, but he did appear to breathe heavily once reaching the top of the White House stairs. He has been taking steroids that are known to produce a feeling of energy, even exhilaration, while suppressing pain or discomfort.

After largely laying off Twitter, his favorite form of communication, for three days, Mr. Trump woke up Monday morning and began blasting out a string of messages in all capital letters in machine gun fashion shortly after 6 a.m., amplifying campaign messages like “LAW & ORDER. VOTE!” and “SAVE OUR SECOND AMENDMENT. VOTE!” By afternoon, he added, “Don’t be afraid of Covid. Don’t let it dominate your life.”

With the election 29 days away and polls showing him trailing former Vice President Joseph R. Biden Jr., the Democratic nominee, Mr. Trump appeared eager to be back at the White House and dispel any questions about his capacity in light of his illness.

“I was glad to see the president speaking and recording videos over the weekend,” Mr. Biden said in a speech in Miami, wearing a mask. “Now that he’s busy tweeting campaign messages, I would ask him to do this listen to the scientists: Support masks. Support a mask mandate nationwide.”

He added, “I hope the president’s recovery is swift and successful but our nation’s coronavirus crisis is far, far from over.”

Mr. Trump has long preferred to project strength regardless of the circumstances — what his disaffected niece, Mary L. Trump, a clinical psychologist, has called “toxic positivity” — and may fear that any concession to the virus would validate widespread criticism of his handling of the pandemic, which could be the defining issue of the election on Nov. 3.

Throughout the weekend, Mr. Trump told the small group of aides with him as well as other advisers and allies he spoke with that he wanted to leave Walter Reed. He felt trapped in the hospital, the type of setting he’s typically hates, and pushed to be released on Sunday, only to meet resistance from his doctors, according to people familiar with the discussions. Instead, the medical team cleared him to take a brief ride in his armored sport utility vehicle to wave at the crowd of supporters outside the building.

At the White House, some staff members fretted that Mr. Trump was being allowed to leave too soon, and by late Monday afternoon, advisers had not been given guidance about what to expect when he returned. A preliminary plan called for confining Mr. Trump to the White House residence until he is no longer contagious and keep him away from the West Wing, where the Oval Office is.

But advisers said Mr. Trump wanted to demonstrate from the Oval Office that he was back and healthy, and they were unsure they would be able to keep him from doing that. Mr. Trump is particularly eager to show that he is a viable candidate for re-election, and advisers said he still planned to go ahead with the second debate with Mr. Biden scheduled for Oct. 15.

While not as equipped as Walter Reed, the White House has a medical office fully staffed by military doctors and assistants around the clock and capable of providing care to the president. With private examination rooms, a supply of medicine and a crash cart for emergency resuscitation, it has been described by one former White House physician as “like a mini urgent-care center.”

The outbreak in the West Wing continued to spread on Monday as Kayleigh McEnany, the White House press secretary, and two of her deputies tested positive for the virus, heightening fears that more cases were still to come.

Ms. McEnany said she had tested negative several times, “including every day since Thursday,” but health experts said she may have been infectious for days — including when she spoke briefly to reporters without a mask outside the White House on Sunday.

Two more members of the press team, Karoline Leavitt and Chad Gilmartin, who is Ms. McEnany’s relative, also tested positive but learned about their statuses before Ms. McEnany, according to two people familiar with the diagnoses.

The three infected aides join a growing list of people around the president who have tested positive, including Melania Trump, the first lady; Hope Hicks, a senior adviser; Nicholas Luna, the director of Oval Office Operations; Bill Stepien, the president’s campaign manager; Ronna McDaniel, the chairwoman of the Republican National Committee; Kellyanne Conway, the president’s former counselor; former Gov. Chris Christie of New Jersey, the president’s debate coach; and at least three White House reporters and two members of the residence staff.

The culture of the White House under Mr. Trump is not to talk about the coronavirus tests. When he received his own initial positive result on a rapid test last Thursday shortly after returning from Bedminster, N.J., he wanted it kept quiet, according to people close to him. Likewise, the two members of the residential staff who tested positive a few weeks ago were advised by colleagues to “use discretion” in discussing it, people familiar with the conversations said.

Those staff members were part of the housekeeping team and work on the third floor of the residence. Residence staff at the White House typically work there over many years across multiple administrations for modest wages and often cannot afford to take time off.

Vice President Mike Pence, who tested negative on Sunday, was scheduled to travel to Utah ahead of Wednesday night’s vice-presidential debate. Mr. Pence also plans to attend campaign events in Arizona and Florida this week before stopping in his home state, Indiana, to vote early.

His doctor said in a statement on Friday that Mr. Pence was not quarantining as of now because he had not been close enough to any individuals known to have Covid-19 for long enough to qualify as “a close contact” at high risk of infection.

Attorney General William P. Barr, who had attended an event at the White House on Sept. 26 linked to the outbreak, quarantined himself over the weekend and was at home on Monday with no symptoms, but he planned to return to work this week in defiance of Justice Department guidance that employees exposed to people with the virus should stay away for 14 days.

Mr. Trump’s upbeat mood, though, could be a product of his medication. Medical experts said that patients who are given steroids like dexamethasone can experience a sense of well-being and euphoria, in which aches and pains disappear for a time. They can also disrupt sleep and, in some cases, they may cause psychiatric effects, leading to feelings of grandiosity and mania.

The effect of combining several drugs is not well understood, especially because two of the drugs Mr. Trump has taken — remdesivir and a monoclonal antibody cocktail — are still experimental. Giving patients multiple treatments at once can increase the chance of harmful interactions or reduce their effectiveness, doctors said.

Mr. Trump’s risk factors — he is 74, male and overweight — mean that he should be closely watched for at least the first week of his infection because some patients quickly deteriorate several days into their illness. Dr. Céline Gounder, of N.Y.U. Grossman School of Medicine, who has been caring for coronavirus patients, said Mr. Trump could rapidly deteriorate at the White House and require an emergency transfer back to Walter Reed. “To me, it’s not safe,” she said.

Dr. Abraar Karan of Brigham and Women’s Hospital and Harvard Medical School, said even if he was feeling better, Mr. Trump needed “extremely close monitoring as these next few days are critical.” He said the second week is often the most worrisome, “as we have seen that patients recover briefly and then either continue improving or have a more sudden and abrupt decline.”

Peter Baker reported from Washington, and Maggie Haberman from New York. Reporting was contributed by Katie Thomas from Chicago, and Katie Benner, Michael Crowley and Eileen Sullivan from Washington.

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