Ever since US President Donald Trump tested positive for COVID-19 on Friday, 2 October, there have been various speculations around his treatment regimen and condition. Even though his health has shown ‘ups and downs’, the President is now in a better state than he was when he was first hospitalised, his doctors have said.
In a press briefing, White House physician Dr Sean Conley informed that Trump is ‘continuing to improve’ but, as with any illness, ‘there are frequent ups and downs’. “Late Friday morning when I returned to the bedside, the President had a high fever and his oxygen saturation was transiently dipping below 94 percent,” Dr Conley said.
According to reports, Trump is being administered various drugs and therapies (including investigational) in order to relieve his symptoms and fasten recovery from the infection. We break down what these medicines are and how they work.
Dexamethasone
“Over the course of his illness, the President has experienced two episodes of transient drops in his oxygen saturation. We debated the reasons for this, and whether we'd even intervene. It was a determination of the team, based on the timeline from the initial diagnosis, that we initiated dexamethasone,” Conley said.
"We decided that in this case the potential benefits early on in the course probably outweighed the risks," he added.
Dexamethasone is a widely available steroid drug. As we had discussed in a previous explainer, it falls under a class of drugs known as corticosteroids and is used to treat a range of inflammatory conditions including arthritis and other rheumatic problems, swelling in the brain, allergies, asthma and other breathing difficulties. Even eye and dental inflammation is often treated by the steroid.
In the context of COVID-19, the drug typically works in specific clinical settings on patients with breathing difficulties who are either on ventilators or need oxygen therapy. Doctors have claimed it has no benefit whatsoever on patients with mild symptoms.
Speaking to FIT, Dr Sumit Ray, critical care specialist in Delhi who looks after COVID patients, had this to say:
As part of the dexamethasone study in UK’s RECOVERY trial, 2104 patients received dexamethasone 6 mg once per day (oral or intravenous) for ten days and 4321 patients received usual care alone.
Dexamethasone reduced deaths by one-third in patients on ventilators and by one fifth in patients receiving oxygen only. No benefit was seen in those who required no respiratory support.
Remdesivir
The President is being administered a five-day course of remdesivir drug, as has been confirmed by one of the doctors treating him, reported CNN.
Dr Brian Garibaldi at the Walter Reed National Military Medical Center told reporters on Saturday,
Yesterday evening he received his first dose of IV remdesivir and our plan is to continue a five-day treatment course for remdesivir.Dr Brian Garibaldi
Remdesivir, an experimental anti-viral drug that was initially developed by ‘Gilead Sciences’ to work against Ebola, has been at the centre of discourse on potential COVID-19 treatments. While multiple trials on the drug are still underway, the evidence so far has been divided on its efficacy.
In the US, remdesivir was issued an Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) to treat severe patients in hospital settings in early May, which was later extended to all hospitalised patients regardless of disease severity.
Monoclonal Antibody Cocktail
President Donald Trump was also treated with an 8-gram dose of the experimental antibody therapy cocktail made by Regeneron.
The scientists at the biotech company selected two antibodies that worked most efficiently at neutralising a version of SARS-CoV-2 in the lab, and copied these two to make a COVID-19 treatment called REGN-COV.
The investigational drug has been in clinical trials since June. Even though early results from a trial with around 300 non-hospitalised COVID patients showed the drug was safe and could reduce viral levels and improve symptoms, the data is yet to be peer-reviewed.
According to CNN, the treatment is not yet approved for any use from the US FDA. The company, however, is in talks for an emergency approval. Regeneron has also confirmed that it had provided the drug under a ‘compassionate use’ request for President Trump from the doctors.
Alexandra Bowie, a Regeneron spokesperson, said that nearly 10 other people had received the treatment in “rare and exceptional circumstances, reported National Geographic.
Supplemental Oxygen
In COVID patients who experience difficulty in breathing, oxygen can be delivered through tubes or face masks to manage hypoxemia (or a low oxygen level in the blood) - which is observed among many infected individuals.
White House physician Dr Sean Conley said during the briefing on Sunday that Trump had been given supplemental oxygen and had been through two episodes of transient drops in his oxygen levels.
On Friday morning, "the President had a high fever and his oxygen saturation was transiently dipping below 94%.” This is below the normal level - 95% or above.
Conley also said that the President was initially ‘fairly adamant that he didn’t need oxygen,” CNN reported. “He was not short of breath. He was tired, had the fever, and that was about it," he added.
And after about a minute on only two liters, his saturation levels were back over 95%. He stayed on that for about an hour maybe, and was off and gone.Dr Sean Conley
The President is reportedly not on oxygen currently and this therapy had not been administered during his hospital stay, Dr Conley informed.
Other Supplements: Zinc, Vitamins, Aspirin
The White House physician also said in a letter that Trump has taken zinc, vitamin D, drug famotidine, melatonin and daily aspirin.
As FIT had earlier reported, while zinc is known to have anti-inflammatory effects in general and is also given to diarrhoea patients, there is no evidence for its antiviral benefits, especially in the COVID setting.
No large and well-planned human trials have been conducted to see to what extent their anti-inflammatory properties work. We don’t have clear-cut evidence. And if we speak particularly about COVID, there have been no strong studies to suggest that zinc or vitamin C can stop or reduce the viral load in people.Dr Sumit Ray, Critical Care Specialist
“There are trials on vitamin C for the common cold, but even in those, there is no clarity on the reason why it seemed to help.”
He added that although zinc and vitamin C may not harm COVID-19 patients if given in prescribed doses, the evidence for them preventing or treating the infection is not strong enough. It is important to remember that solid proof is needed before verifying a medical claim.
Similarly, there is also no evidence for Vitamin D working as a COVID treatment. Even the FDA has issued warnings to companies that have tried to claim their zinc and vitamin D products can reduce the risk of COVID-19, CNN reported. In fact, too much of either of the two can prove damaging to one’s health.
The other drug, famotidine, helps in reducing acid in the stomach and is used for ulcers, heartburn and indigestion. A small study found that patients getting treated at home found relief after taking the drug, but large scale research into the medicine is still awaited.
(The article was first published in FIT and has been republished with permission)
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