White House doctors are treated President Donald Trump with Regeneron’s experimental coronavirus antibody cocktail drug, but he is now being transferred to Walter Reed National Medical Center where he will be monitored and treated.
Regeneron’s antibody cocktail has shown promise in early trials but the drug is very much experimental and the tests were only done in patients that did not need to be hospitalized.
If President Trump’s condition worsens, he may be treated with other drugs that have been tested in severely ill patients and improved their survival odds and recovery times.
Because Trump is 74 and obese, he is five times more likely to develop severe enough coronavirus to be hospitalized for coronavirus compared to someone in their 20s.
His age also makes him 90 times more likely to die of COVID-19 than someone between ages 18 and 29, according to data from the Centers for Disease Control and Prevention (CDC).
As president, Donald Trump is sure to get the most promising treatments for COVID-19 – but only a handful have shown promise to bat back the disease.
Since announcing that he and first lady Melania Trump announced they had tested positive for coronavirus late Thursday night, the president has begun exhibiting mild ‘cold-like’ symptoms, according to the New York Times.
Currently, only the antiviral remdesivir and plasma from COVID-19 survivors have been given emergency use authorization to treat coronavirus by the Food and Drug Administration (FDA).
And with his risks, drugs to keep the president’s blood pressure and cholesterol may also be important to how well he copes with COVID-19.
DailyMail.com breaks down how the president might be treated for COVID-19.
President Trump currently has mild symptoms of coronavirus, meaning his is not yet a good candidate for treatment with the antiviral remdesivir (file)
So far, the Food and Drug Administration (FDA) has only given emergency use authorization (EUA) – an expedited, interim form of approval with a lower standard – just three therapeutics to treat coronavirus.
The agency has already revoked its EUA for hydroxychloroquine, the malaria drug that Trump infamously promoted, and took himself as an unproven preventive.
That leaves just two authorized treatments: remdesivir and convalescent plasma.
REMDESIVIR COULD HELP KEEP THE PRESIDENT’S VIRAL LOAD LOW AND SHORTEN HIS ILLNESS
Gilead’s antiviral remdesivir is the most well-proven treatment for coronavirus that has received the FDA’s emergency approval.
Remdesivir was originally developed to treat Ebola, but failed to help patients in clinical trials.
The shelved, experimental drug was dusted off and repurposed by its developer, Gilead, when the coronavirus pandemic emerged earlier this year.
The drug appears to help stop the replication of viruses like coronavirus and Ebola alike.
It’s not entirely clear how the drug accomplishes this feat, but it seems to stop the genetic material of the virus, RNA, from being able to copy itself.
That, in turn, stops the virus from being able to proliferate further inside the patient’s body.
Gilead’s antiviral remdesivir is the most well-proven treatment for coronavirus that has received the FDA’s emergency approval
HOW DOES CORONAVIRUS PROGRESS AND WHEN IS IT LIFE-THREATENING?
By Natalie Rahhal, US Health Editor
Most people who contract coronavirus develop symptoms between two and 14 days after they are infected, and symptoms stay mild for the first few days.
If COVID-19 is going to become severe, patients tend to take a turn for the worse between days five and 10 of the illness.
It’s during this period that patients – especially older ones like Trump, or those with underlying conditions like high blood pressure or diabetes – may develop respiratory issues that can leave them struggling to breathe as the virus attacks the lungs and oxygen levels plummet.
What remains unclear is when Trump was actually infected and started to show signs of COVID-19. Hope Hicks was on Air Force One without a mask with thep president on Tuesday. She began to feel ill Wednesday, and Trump became ‘lethargic’ Thursday before testing positive.
Coronavirus symptoms may start out much like those of other respiratory infection.
Many patients, like President Trump, first notice they are fatigued. They may develop a dry, persistent cough, and spike a fever.
Symptoms often appear like those of the flu, and may include a headache, shortness of breath and body aches.
The CDC added loss of smell or taste as a tell-tale sign of coronavirus over the summer, and recent research suggests these may be earlier, more reliable indicators of COVID-19 than a cough.
But we now know that although coronavirus is spread like other respiratory infections – primarily transmitted when people inhale droplets expelled by someone with the virus – it attacks many parts of the body, including the cardiovascular and digestive systems and the brain.
So not everyone’s first symptoms are respiratory ones like shortness of breath or coughing.
Scientists at King’s College London have split COVID-19 into six different ‘types,’ with progressions from mild or moderate illness to severe:
- (‘flu-like’ with no fever): Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever.
- (‘flu-like’ with fever): Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite.
- (gastrointestinal): Headache, loss of smell, loss of appetite, diarrhea, sore throat, chest pain, no cough.
- (severe level one, fatigue): Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue.
- (severe level two, confusion): Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain.
- (severe level three, abdominal and respiratory): Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhea, abdominal pain.
A crucial sign for the turn of coronavirus from mild to severe is the decline of blood oxygen levels.
Normal blood oxygen levels are considered to between 95 and 100 percent, as measured by a pulse oximeter.
Anything below that is a worrying sign. Low blood oxygen levels usually come with shortness of breath and chest pain, but many doctors have reported that COVID-19 patients appear unaffected – talking, texting and sitting up in their hospital beds – despite having dangerously low blood oxygen levels.
Inflammation is also a crucial factor in the severity of COVID-19 infection.
As the immune system attempts to mount a defense against coronavirus, the body can become overrun with cytokines, immune cells that can go haywire and cause dangerous inflammation.
This poses a particular threat to people who are obese or have underlying health conditions because they have higher baseline levels of inflammation.
Some doctors also use blood tests to detect high levels of D-dimers, which indicate high risks of blood clots and may indicate severe COVID-19.
People over 65 become sick enough to be hospitalized for coronavirus about five times as often as people in their 20s do, and are 90 times more likely to die of the infection. Men also account for 70 percent of US COVID-19 deaths.
Patients who don’t become severely ill tend to start recovering within a week to 10 days of their first symptoms.
After this period of improvement, the CDC advises that people are likely no longer infections 10 days after their symptoms began and after they’ve gone 24 hours without a fever.
In April, Gilead announced the results of a clinical trial testing the drug in people severely ill with coronavirus.
Half of the 397 patients, who were sick enough to need additional oxygen, but not to be placed on ventilators, improved within 10 days of a five-day treatment course and those who were on a 10-day regimen were better by the eleventh day.
More than half of the patients were discharged from the hospital within two weeks.
The National Institutes of Health’s (NIH) own 1,063-person trial of remdesivir showed that severely ill patients who received the drug recovered 30 percent more quickly than those who got a placebo.
Patients who got remdesivir were also 40 percent less likely to die of COVID-19, compared to those who did not get the drug.
Data has since suggested that the drug works best when given early, but timing is key because it is most effective in severe cases.
As President Trump has only had mild symptoms so far, he may not be a good candidate for treatment with remdesivir.
Gilead also announced Thursday that the drug is on the cusp of full FDA approval, which would make it the first and only therapeutic to get regulators’ seal of approval so far.
FDA OFFICIALS APPROVED PLASMA FROM COVID-19 SURVIVORS TO TREAT THOSE STILL SICK AMID OUTCRY THAT ITS BENEFITS MAY BE LIMITED
Plasma is rich in immune cells developed by the body as it combats coronavirus and some studies have suggested that transfusions of the blood component can bolster the immune systems of the sick.
Specifically, plasma contains antibodies, immune cells that the body generates in response to particular pathogens, including SARS-CoV-2, once a person has had the infection.
FDA officials issued an EUA for so-called convalescent plasma in August, but it was met with criticism from scientists – including NIH director Dr Francis Collins – that the emergency approval was premature.
Most research suggests that levels of antibodies in plasma start to decline three months after the donor developed symptoms.
And plasma transfusions may do little to help someone with COVID-19 unless the donated blood component has high levels of antibodies.
Plasma transfusions have been used for more than a century to treat infections, and is considered generally safe if the donated plasma has been screened for other diseases, but it just may not be a particularly worthwhile treatment.
OVER-THE-COUNTER ACETAMINOPHEN MAY HELP COMBAT INFLAMMATION IN AT-RISK PATIENTS LIKE TRUMP
Inflammation is a particularly dangerous symptom in coronavirus patients.
The body’s immune response to the utterly foreign virus often runs off the rails and the ‘cytokine storm’ – a deluge of inflammatory immune proteins – can overwhelm and inadvertently damage healthy organ tissues.
French physicians suspected early on that the anti-inflammatory drug ibuprofen might actually make coronavirus patients worse.
That’s now thought unlikely, but the World Health Organization (WHO) recommends acetaminophen as a first-line over-the-counter anti-inflammatory in case there was validity to the observation that patients given ibuprofen fared worse.
But officials add that people who can’t take acetaminophen (due to kidney or liver problems) can likely substitute ibuprofen.
DEXAMETHASONE IS PROMISING FOR TREATING SEVERE COVID-19 – BUT IT COULD BE DANGEROUS FOR TRUMP TO TAKE IF HIS CASE STAYS MILD
A University of Oxford study found in July that, for patients so ill that they need to be on ventilators, dexamethasone can cut the risk of death by more than a third.
Dexamethasone is a type of steroid widely used to tamp down inflammation, which can become severe and prove fatal in later stages of COVID-19.
About 2,104 patients given the drug were compared to 4,321 patients getting usual care.
It reduced deaths by 36 percent for patients sick enough to need breathing machines: 29 percent on the drug died versus 41 percent given usual care.
It curbed the risk of death by 18 percent for patients needing just supplemental oxygen: 23 percent on the drug died versus 26 percent of the others.
However, it seemed harmful at earlier stages or milder cases of illness: 18 percent of those on the drug died versus 14 percent of those given usual care.
For patients so ill that they need to be on ventilators, dexamethasone can cut the risk of death by more than a third – but it may make the illness worse in people with milder cases
The clarity of who does and does not benefit ‘probably will result in many lives saved,’ Dr Anthony Fauci and his colleagues wrote in response to the findings.
But timing is crucial to effective treatment with dexamethasone, data suggests.
Severely ill patients fare best when treated early, but some research has suggested that the drug may actually worsen COVID-19 for patients who are mild or moderately ill.
For now, President Trump is only mildly ill from coronavirus, but because he is obese and at-risk for heart disease, he is also be at high risk for developing severe COVID-19.
DRUGS THAT TRUMP ALREADY TAKES INCLUDING STATINS AND ASPIRIN MAY HELP HIM SURVIVE CORONAVIRUS
Former White House physician Dr Ronny Jackson revealed in 2018 that Trump takes a handful of medications on a regular basis.
He takes aspirin to reduce his risks of having a heart attack or stroke, and a statin called Crestor to keep his cholesterol at bay.
Being at risk for heart disease means that the president is also at risk for severe COVID-19 because the virus that causes the infection is now known to attack the cardiovascular system as well as the lungs and airway.
President Trump already takes the statin Crestor to lower his cholesterol and it may improve his odds against coronavirus (left). He also takes aspirin to reduce his heart attack and stroke risks, which may in turn reduce his otherwise high risk for severe COVID-19 (right)
The cholesterol-lowering drug, Crestor, could be key to combating the dangerous effects of coronavirus on the president’s cardiovascular system.
Recent research conducted by Chinese researchers in collaboration with University of California, Los Angeles, scientists found that people treated with statins were 45 percent less likely to die of COVID-19 than were people not taking the drugs.
However, these drugs act on a group of cell receptors known as ACE receptors. Coronavirus attacks cells via ACE-2 receptors, and early data suggested statins may actually give the virus more targets.
But now scientists are beginning to think the benefits outweigh the risks.
They also have anti-inflammatory effects which could be crucial if Trump’s immune system mounts a cytokine storm.
Because Trump is technically obese, with a BMI over 30, he is particularly at risk for this deadly complication.