The Presidential COVID-19 Treatment Explained
Overview
Only days after the first Presidential Debate (September 29th, 2020) between President Donald Trump and Vice President Joe Biden, President Trump tested positive for SARS-CoV-2 and was diagnosed with COVID-19. He was quickly admitted into Walter Reed Hospital where he received a variety of treatments for COVID-19, some of which were experimental. New treatments used for the President is already a cause for concern. However, President Trump’s recovery sparks more interest in what these experimental treatments were. This article will dive into the science of the different treatments that President Trump received while at Walter Reed Hospital and the likeliness of these treatments moving to an open market.
Dexamethasone
President Trump received dexamethasone, a steroid commonly used to treat the symptoms of an infection. More specifically, the drug is a corticosteroid, similar to a steroid the body produces in the adrenal glands, that helps diffuse inflammation. It should be noted that dexamethasone can be helpful in comforting a patient, but if administered at an inappropriate stage of infection, it could weaken the immune system and make the infection worse.
A study conducted by RECOVERY Collaborative Group about the efficacy of a 10-day treatment of dexamethasone in hospitalized COVID-19 patients indicates that the steroid is able to lower the mortality rate in patients who required mechanical ventilation or oxygen alone while patients with no respiratory support saw no benefit, but potential harm with drug use. In their discussion, researchers also note the importance of dosage, timing, and the patient. High doses can cause more harm than benefit. If administered too early, it could exacerbate symptoms that lead to organ failure. And if the patient isn’t expressing respiratory distress or high inflammation, drug use could also cause more harm.
What does this mean for President Trump? As clearly indicated above, the use of dexamethasone should be determined by the respiratory distress of the patient. Yet, the knowledge of whether the President received oxygen support during his COVID-19 treatment was unknown due to multiple denials by his primary physician, Dr. Sean Conley. It wasn’t until near the end of the treatment where an inside source confirmed President Trump’s oxygen support. Based on sources and research articles, the use of dexamethasone in the Presidential Treatment was an appropriate decision if and only if the President required oxygen.
Dexamethasone is already on the market as a steroid used in a variety of illnesses. Therefore, it’s highly likely for patients to receive dexamethasone as a regular part of COVID-19 treatment.
Remdesivir
Remdesivir, brand name Veklury®, was one of President Trump’s experimental drug treatments. It works by targeting a specific enzyme in RNA viruses, permitting it to only function for a certain class of viruses. Although Remdesivir is an antiviral drug, It had no evidence before 2020 that shows whether it works effectively against SARS-CoV-2 or any other coronavirus, hence its label of “experimental.” Remdesivir came into question as early as April and May as a potential treatment for anyone infected with SARS-CoV-2. And since then, many clinical trials have started testing its efficacy, physicians began prescribing it, and the FDA approved it for emergency use.
Initial findings from a randomized and placebo-controlled trial indicate that a 10-day treatment of remdesivir might have a moderate clinical benefit and an effect of lowering mortality. However, this research experiment was not observer blind, indicating large potential bias by physicians to best care for individuals who received a treatment of remdesivir. The same researchers from the previous study conducted another clinical trial that was randomized, placebo-controlled, and double-blind. The Final results of a 10-day treatment indicate that the remdesivir has shown to reduce the recovery time for individuals diagnosed with COVID-19 and had lower respiratory infections. Yet, there was no indication of a reduced death rate. The study was unable to conclude accurate results for individuals with more serious illnesses (requiring ventilation or ECMO) due to a large margin of error.
In contrast to the results above, the World Health Organization (WHO) released interim results of a global study on the effects of 4 potential COVID-19 treatments, including remdesivir. They concluded that none of the drugs in question had an effect on the initiation of ventilation or hospital duration, nor reduction in mortality.
What does this mean for President Trump? Even though the drug is still experimental, the FDA has issued emergency use of the medication. Fortunately, studies have yet to show any severe adverse effects of the drug beyond nausea, constipation, and symptoms at the injection site. The duration of President Trump’s treatment is unknown. And although studies do show evidence that his early treatment could have played a role in shortening the length of his hospital stay at Walter Reed and symptomatic infection of SARS-CoV-2, there's not a certainty that President Trump received a full 10-day treatment as studies suggest is necessary for the best outcome. Overall, there’s still questioning as to whether Remdesivir was the factor that improved the President’s condition.
Since Remdesivir is under EUA from the FDA, the drug might be used in COVID-19 for the regular patient. However, doctors are uncertain as to who qualifies for receiving such treatment. Therefore, Remdesivir is available, but more likely to be administered on a case-by-case basis.
Regeneron Antibody Cocktail
The company, Regeneron, developed an antibody cocktail, called REGN-CoV2. This treatment includes a mixture of lab-created antibodies designed to bind to the SARS-CoV-2 virus and assist in the body in destroying the infection. REGN-CoV2 includes two antibodies, REGN10933 and REGN10987. This mechanism of treatment is passive immunity, where it can also be conducted by immune individuals donating their antibodies for treatment.
REGN-CoV2 is still an experimental drug, awaiting results from its multiple clinical trials. In one of the Phase 1/2 clinical trials, results indicate that the treatment reduced the viral load in non-hospitalized patients who had no neutralizing antibodies and a high viral load. Moreover, these patients had greater symptom alleviation compared to their placebo-treated counterparts. Other Phases plan to test the effects of REGN-CoV2 as a treatment for COVID-19 and as a prevention method in a household environment.
On Friday, October 30th, Regeneron announced that the company paused one of the clinical trials that involves the treatment of the most severe COVID-19 cases, requiring mechanical ventilation or intense oxygen.
What does this mean for President Trump? REGN-CoV2 is not authorized by the FDA for use. However, President Trump received the treatment under a Compassionate Use request by his administration. Specifics into the President’s health during his COVID treatment are unknown, yet they must’ve been indicative of a need for Regeneron’s Antibody Cocktail. It’s important to show caution for the President’s treatment as the drug is experimental and has minimal scientific support for its safety and benefit for infected individuals. Moreover, the most recent news from Regeneron might attest to the premature use of an unauthorized drug on the President of the United States.
Conclusion
Currently, President Trump is assumed to be recovered from COVID-19 due to his return from Walter Reed Hospital. However, his short residence at the hospital calls into question the severity of his sickness and the effectiveness of the treatments he received. Although it has been dictated that President Trump’s admittance to Walter Reed was “out of an abundance of caution”, his need for oxygen insinuates a more severe form of COVID-19.
The President’s health was in danger and he required intense treatment to return his health to normal. However, with the combination of three drugs, two of which are still experimental, an argument can be made that the President’s life was put into more danger. Remdesivir and the Regeneron Antibody Cocktail are in clinical trials and awaiting results to enlighten their effects. But the trials do not account for added variables, such as combination of drug treatment. Although the drugs have different mechanisms for functioning and interactions might not be apparent, there is much crossover in these systems, leaving room for unfavorable drug interactions and adverse side effects.
Overall, the Presidential COVID-19 Treatment produced surprising results. It included a large risk of combining three medications with unknown drug interactions. However, after admittance into the hospital and receiving oxygen, the President recovered within less than a week. And although the President’s health has assumed to have returned to normal, his quick recovery frames COVID-19, in America, as a non-threatening disease. This was a perfect moment to address the 210,000+ Americans who have passed due to COVID-19; currently jumping to 235,000+ as of Nov. 1st. Yet, with no mention of these losses and as the country is headed into winter, the number of deaths will only increase while the American hope for ending the pandemic dwindles.
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