Last week, President Trump announced that he and First Lady Melania Trump had tested positive for Covid-19. Since then, all eyes have been on the President’s health as he spent several days in Walter Reed National Military Medical Center before returning to the White House Monday evening. The President’s doctors have given briefings on his condition and which medications he is taking every day, though they have often dodged questions about key information for determining the progression of his condition, such as medical images and other laboratory results.
Here’s what we do and don’t know about the President’s current treatment, and why his doctors have chosen these medications.
The President’s Doctors Are Likely Using A “Kitchen-Sink” Approach
Even though the status of the President’s disease has been described as both “mild” and “moderate,” he has already taken several medications for Covid-19. It could be that his symptoms are more severe than his doctors are letting on, or his doctors might be using a “kitchen-sink” approach and trying any medication that they think will help him. Currently, the president’s doctors say he has taken: an experimental antibody cocktail from Regeneron Pharmaceuticals, infusions of the antiviral medication remdesivir, the corticosteroid dexamethasone, supplements including zinc and vitamin D and supplemental oxygen.
Some Of These Medications Are Only Supposed To Be Used For Patients With Severe Covid-19
The National Institutes of Health Covid-19 treatment guidelines say that both remdesivir and dexamethasone should only be administered to hospitalized patients who require supplemental oxygen, which usually indicates a moderate or severe course of illness. “Dexamethasone is reserved for sicker patients,” says Megan Ranney, an emergency room physician in Rhode Island, “because it actually causes harm in patients with mild disease.”
The President’s doctors have said that he has received supplemental oxygen, but did not elaborate on when and how much oxygen the president required or his respiratory rate, a key marker of differentiating between moderate and severe illness.
“What’s a bit confusing about this is the fact that he’s gotten all three medications in such a short period of time,” says Céline Gounder, an infectious disease physician in New York City, “it doesn’t match how we would normally give these medications.”
Not All Of The Treatments Have Been Fully Studied
Remdesivir, an antiviral drug originally developed to fight against Ebola, is probably the most well-studied of all the president’s current medications when it comes to Covid-19. Researchers began studying it in February, and since then there has been increasing evidence that it can help patients recover faster from the disease. In May, the FDA said data from a study commissioned by NIAID that found remdesivir sped up recovery by four days was good enough evidence to add the drug to the regular standard of care for patients with a severe case of the disease. Currently, the FDA has issued an Emergency Use Authorization for remdesivir for the treatment of Covid-19 patients. Remdesivir doesn’t have a formal approval for any condition, though Gilead, which manufactures the drug, has submitted an application for approval.
Dexamethasone, a corticosteroid that’s used to reduce inflammation in the body, has been suggested as a powerful tool against Covid-19. Originally approved by the FDA as a longer-lasting steroid medication, some researchers believe this drug can help Covid-19 patients by suppressing the immune system and preventing a potentially deadly cytokine storm. Based on a study performed in the U.K. that was published in July, dexamethasone can also help prevent death in hospitalized patients who need supplemental oxygen. Though the findings were encouraging, it was an “open-label” study, meaning that both patients and doctors knew they were receiving the drug. The “gold standard” for determining the effectiveness of a drug is a double-blind, randomized controlled study (RCT), where some patients receive the drug and others get a placebo, and neither patient nor doctor knows what they’re getting. There are several current blinded clinical trials testing the effectiveness of dexamethasone alone and with other drugs, but they are still being completed.
“No one else on the planet has gotten this combination of medications; we have no data on how this works.”
President Trump’s other treatments have less data to support their use. It was only last week that Regeneron announced preliminary results from its first clinical trial for its antibody treatment. While that data was positive, it was only from the first 275 patients who took the drug. Additionally, those results have not yet been published in a peer-reviewed journal.
Evidence for using vitamin D and zinc to treat or prevent Covid-19 is even more scarce. There are some clinical trials looking at vitamin D use in Covid-19 patients, but so far the NIH says there is insufficient evidence to recommend its use. The organization also recommends against using zinc supplements to treat Covid-19 unless someone is participating in a clinical trial. But, “if taken in moderation, [these supplements] have few if any side effects, so there’s no real harm in adding them,” Ranney says.
We Don’t Yet Know How These Medications Interact With Each Other
According to Gilead Sciences, the manufacturer of remdesivir, using dexamethasone at the same time as remdesivir should not impact how remdesivir works. But there are no current clinical trials in which the two drugs are purposefully used together or used in combination with Regeneron’s antibody cocktail. “No one else on the planet has gotten this combination of medications,” says Gounder, “we have no data on how this works.”
We also don’t know the full list of the president’s medications, some of which could conceivably lead to side effects or interactions when paired with these experimental drugs. Gounder points out that while it has been reported that President Trump takes a statin to lower his cholesterol, that drug was omitted in a recent list of the president’s medications. “We’re clearly getting an abridged medication list,” she says.
These Medications Can Have Significant Side Effects
So far, remdesivir and the Regeneron antibody cocktail seem well tolerated in clinical trials, but that doesn’t mean there are no side effects. Regeneron reports that there have been a few adverse reactions, but they were mild. However, that was from a small group of patients.
More is known about remdesivir side effects. Studies of the drug have reported that patients may experience nausea, pain at the injection site and liver damage. Additionally, patients receiving remdesivir need to get frequent blood draws to check for kidney and liver function.
Side effects for dexamethasone are the most well known, as well as potentially the most severe. Though it is generally safe if used for a short period of time, side effects can include high blood sugar, high blood pressure and psychological effects including mood swings, irritability and confusion.
The President Isn’t Taking Medications He’d Previously Recommended
For months President Trump has been touting the benefits of an anti-malarial drug called hydroxychloroquine when it comes to treating Covid-19. In fact, several months ago he said that he was taking the drug himself as a preventative measure against the virus despite the fact that multiple studies found it ineffective against Covid-19. But now, the President’s doctors make no mention of him taking this medication.
There remain many open questions about the President’s condition and how he’s being treated. Without transparent information from the White House not only about his medications, but also his vital statistics, it’s impossible to tell from afar how well he may or may not be doing.