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Early in the coronavirus outbreak, US hospitals told patients to avoid going to the emergency room or even the doctor’s office unless they were seriously ill or perhaps having trouble breathing.
Since then, not much has changed.
Most people recover safely at home. Large numbers may not even know they have been infected, as the virus causes no symptoms in up to 40% of patients.
Yet President Donald Trump, who revealed he tested positive for the coronavirus early Friday morning, is likely to be tested more often than almost anyone else in the world. His family, his top aides and staff, and journalists entering the White House, are also frequently screened.
That means the president was likely diagnosed early in his attack with the virus, allowing doctors to closely monitor the infection as it spreads through his body and attempts to hijack healthy cells to create more viruses. And a trip to the hospital on Friday night will give you easy access to two treatments that are now used in patients who become seriously ill.
Trump was airlifted from the White House to the nearby Walter Reed National Military Medical Center in Bethesda, Maryland. He walked from the White House to Marine One, wearing a mask, for the short flight. In a video that he tweeted after his departure, the president said: “I think I am doing very well.”
While the White House has said Trump’s symptoms are mild, the hospital stay raised questions about his condition.
The vast majority of people with Covid-19 do not need to be hospitalized, and those who go to the hospital have a reason to be there, said Michael Ben-Aderet, infectious disease specialist and associate medical director for hospital epidemiology at Cedars Medical Center. Sinai in Los Angeles.
“In my opinion, being hospitalized is a marker of the severity of the disease. I don’t have any details of the severity of the president’s condition, but when I hear that someone is hospitalized with Covid-19, it is an indication that they have a more serious case, ”said Ben-Aderet. “Otherwise, there is no benefit to being in the hospital.”
Three treatments
The three treatments that are available under the US Food and Drug Administration’s emergency use authorization for Covid-19 are only available in the hospital.
The president’s physician, Sean Conley, said late Friday that Trump was being treated with remdesivir from Gilead Sciences Inc., which has been shown to help patients recover and allow them to be discharged more quickly.
“Tonight, I am pleased to report that the president is doing very well,” Conley said in a White House statement. “She does not need supplemental oxygen, but in consultation with specialists we have chosen to initiate therapy with Remdesivir. She finished her first dose and is resting comfortably. “
The steroid dexamethasone is usually given to patients in intensive care whose immune systems are overly active. Another option is convalescent plasma, which has antibodies from the blood of patients who have recovered.
“The fact that the president is going to Walter Reed may mean that his symptoms are now worrisome enough for his medical team that he is hospitalized or going to receive specific treatment, or that they just want to be closely watched. as a precaution, ”Tom Inglesby, director of the Center for Health Safety at the Johns Hopkins School of Public Health, said in a tweet.
Patients receiving drug therapy in the hospital undergo frequent blood tests to monitor their organ function, to make sure they don’t suffer any side effects from the treatment, and to make sure the disease doesn’t get worse, Ben-Aderet said. . Those tests are done so frequently that it would be much easier to be in the hospital, he said.
There is little that clinicians can offer relatively healthy patients, as efforts to find therapies to speed recovery from SARS-CoV-2 have largely failed. Among the drugs that have been tried are HIV treatments and hydroxychloroquine, an anti-malaria drug Trump took earlier in the outbreak when he feared he had contracted the virus from his aides. It never tested positive, and since then clinical trials have shown that the drug does not offer any substantial benefit.
Trump already received another drug on Friday that has shown early signs of promise in the lab.
Regeneron Pharmaceuticals Inc.’s cocktail of experimental antibodies was given to Trump before it was flown to Walter Reed. The infusion is a combination of artificial antibodies that the human immune system normally produces to fight infection.
In the first detailed study of the compound, revealed by Regeneron on Tuesday, patients who produced high levels of their own antibodies improved their symptoms within a week, while those who did not produce their own had symptoms for an average of nearly two weeks. The drug produced the most improvement in people who did not produce their own vigorous antibody response.
Worrying sign
However, the compound is still experimental and some doctors speculated that its use by Trump could indicate that his condition is worse than revealed. Unapproved drugs are administered on a compassionate use basis when the potential benefits are significant and the patient is willing to accept the unknown risks.
“I am very concerned about the president’s team giving him an untested and untested treatment,” said Jeremy Faust, an emergency medicine physician at Brigham & Women’s Hospital in Boston and editor of Brief19, a daily news summary on SARS-CoV-2. and Covid-19 research. “This has not been shown to work in clinical trials.”
Faust said he was concerned that the decision to give Trump the Regeneron drug reflected desperation.
Trump has previously shown his willingness to take risks. He used hydroxychloroquine before he was fully tested. He has also been reluctant to wear masks that may have reduced his risk of infection, and has been critical of others who have advocated for their wide adoption.
Read: Trump tests positive for Covid-19
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