Trump’s Covid Therapies Recommend a Severe Situation

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Trump's Covid Treatments Suggest a Serious Condition

President Trump will stay at Walter Reed Military Hospital indefinitely, his doctor said Saturday, undergoing five-day antiviral medication for Covid-19, which indicated his condition could be more serious than publicly announced. On Thursday he received another therapy that is still in the early testing phase.

Medical experts, who have followed the White House and Walter Reed's sketchy, contradicting details about the president's condition, disagreed over the experimental treatments 74-year-old Trump received. And while they said it was difficult to comment on Mr. Trump's condition or evaluate his treatment given the limited and conflicting information, some said they were concerned.

At a press conference outside the medical center on Saturday, Dr. Sean P. Conley, Mr. Trump's doctor, a very positive result Picture of the state of the president stating that he is fine, has no fever and does not need supplemental oxygen.

Immediately thereafter, White House chief of staff Mark Meadows disagreed, saying that Mr. Trump's vital signs had been "very worrying" for the past 48 hours and that the next two days would be critical.

Many doctors emphasized the critical time – around seven to ten days after infection – during which a patient's condition can worsen. Some people respond to infection with an overly exuberant immune response that can make their illness worse and even fatal.

Dr. Peter Chin-Hong, an infectious disease specialist at the University of California at San Francisco, said he would be surprised if Mr. Trump got better as soon as Dr. Conley had suggested. What often happens, he said, is that a patient is discharged from the hospital, but then, a week later, becomes much worse and has to be readmitted.

"What we call 'falling off a cliff' usually lasts a week to 10 days," he said.

However, medical experts generally welcomed the president's close monitoring at the military-medical complex and noted his risk factors – he is an older man who is easily obese – for developing a more severe form of the disease.

"Transferring him to Walter Reed was the right thing to do," said Dr. Carlos del Rio, Professor of Medicine at Emory University in Atlanta. "Because any of us who have seen patients with Covid, especially patients his age, can say that they are fine one minute and not the next."

Doctors at the press conference avoided questions about whether the president had ever needed oxygen. wouldn't tell how high his temperature or oxygen supply had been in the past few days; and offered a confusing schedule for diagnosing his illness, which conflicted with Mr Trump himself disclosing at 1 a.m. Friday, about 36 hours before the press conference, that he had tested positive for the coronavirus.

Dr. Conley later issued a correction that was consistent with the previous White House Publications drawing the public's attention to Mr. Trump's disease and treatment process.

"It's a very strange situation," said Dr. Andre Kalil, an infectious disease specialist at the University of Nebraska Medical Center. "Is it being over-treated or under-treated? We do not know it. "

One of the therapies given to Mr. Trump, a cocktail of monoclonal antibodies from Regeneron, is in its earliest stages of testing and there is only one recent press release from the company regarding its effectiveness. In one trial, the cocktail is administered to recently exposed or infected individuals, especially those who may not be able to induce a strong immune response on their own. By age and gender, Mr Trump falls into the subgroup of people whose immune systems may not be able to fight off the virus on their own.

Some experts are optimistic that the Regeneron drug will work, and they support giving patients therapy that attacks the virus directly. Monoclonal antibodies are generally pretty safe, experts said, and similar ones have been used to target patients with H.I.V. and Ebola.

"It's justified and low risk," said John Moore, a virologist at the Weill Cornell School of Medicine.

Other experts were skeptical.

"In my opinion, these antibodies are experimental," said Dr. Kalil, a lead researcher on the federal study, which showed the other treatment, remdesivir, given to Mr Trump, accelerated recovery in hospitalized Covid patients.

"I don't know how safe you are for the President," said Dr. Kalil. "They shouldn't be given outside of a clinical trial."

Remdesivir is currently the standard treatment for some Covid patients, so some participants in a Regeneron study with Covid patients in the hospital have likely received both.

One important piece of information is the level of oxygen in Mr. Trump's blood. Doctors said his level was 96 percent when he was walking around on Saturday morning. Normal pulse oximeter readings are usually between 95 and 100 percent. Values ​​below 90 percent are considered low.

Dr. Rochelle Walensky, director of the infectious diseases division at Massachusetts General Hospital, said that while Mr. Trump's scores were "not perfect," some elderly people with other medical conditions could have scores when they walk around.

The oxygen content is an important indicator of whether the disease is moving into a severe phase.

When asked if Mr Trump would be given supplemental oxygen, Dr. Conley: "He's out of oxygen right now," and "He didn't need any this morning."

"They went out of their way to tell you when he was out of oxygen," said Dr. Walensky. “That means he had oxygen. Maybe he's having symptoms so bad that he's getting oxygen, or maybe his oxygen levels have dropped so much that they felt he needed oxygen. "Or she said," It could be that they only gave him a minimal amount of oxygen in transit. "

"It doesn't help that he dodge," she said, referring to Dr. Conley.

Covid-19 has two phases in the seriously ill, said Dr. Robert Finberg, Professor and Chair of the Medical Department of the University of Massachusetts Medical School.

First the virus replicates and then the immune system overreacts to the virus, creating another type of disease that can be difficult to control. Chemicals released by white blood cells can cause severe inflammation of organs, especially the lungs and heart, a reaction that can be fatal.

Both monoclonal antibodies and remdesivir attack the virus, added Dr. Finberg added. Hence, it should be best to start using them early on while the disease is still being caused by the virus itself.

Mr Trump took the first experimental therapy on Thursday – the Regeneron combination of two antibodies. Each of the antibodies is a strong blocker of the virus in laboratory studies. Like all antibodies, these are proteins – one was isolated from a patient who had recovered from Covid and the other was made by Regeneron in a mouse with a human immune system.

Mr Trump started taking the second drug, remdesivir, on Friday. It penetrates infected cells and blocks virus replication.

The Regeneron antibody cocktail has not been approved or approved by the Food and Drug Administration for emergency use. This designation enables a company to sell a promising drug while it is still being tested. But patients can sometimes get experimental drugs from a company if a doctor tells them and the F.D.A. and the company agrees. This is how Mr. Trump got the antibodies from Regeneron.

The company released a press release last month citing preliminary data from an ongoing study suggesting the drug might help people with the onset of the disease, and also suggests that if not given early, the drug is likely not before a patient develops antibodies it is worth giving, noted Dr. Walensky.

It is unclear how long Mr Trump was infected. Doctors did not disclose when he received his last negative test result; He participated in a fundraiser Thursday, despite aides said he showed some possible symptoms Wednesday and Thursday.

Gilead makes Remdesivir, an antiviral drug developed by the F.D.A. as Covid therapy. Dr. Blood tests mentioned by Conley are used to monitor remdesivir. Mr Trump had one IV and will be given five in total as usual.

What is not known, however, is whether the combination of remdesivir and monoclonal antibodies is the best way to fight the virus.

That combination, said Dr. Michelle Prickett, a lung and critical care specialist who has treated hundreds of Covid-19 patients at Chicago's Northwestern Memorial Hospital, is "uncharted territory."

Mr. Trump's doctor also stated in a press release that the president was taking a combination of over-the-counter drugs: zinc, vitamin D, famotidine, or pepcid – a drug that blocks stomach acid production – as well as melatonin and aspirin.

Infectious disease experts looked askance.

Zinc, vitamin D and famotidine have been touted as means of fighting the coronavirus, but the evidence is far from rigorous.

"They are not helpful for Covid," said Dr. Kalil. And he added, "they might have interactions" that make the disease worse.

“There are drugs that can have harmful effects in Covid and are not harmful in other situations. I would suggest avoiding them. "

Dr. Finberg agreed.

"If it were me, I wouldn't take it," he said.

Denise Grady contributed to the coverage.

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