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AT THE HOSPITAL: Donald Trump received treatment for Covid-19 and had conference calls at Walter Reed Military Hospital in Maryland. Photo: Scanpix
Parts of the experimental treatment President Trump has received can be dangerous, both for the president and for society, says OUS chief physician Jon Henrik Laake.
The president of the United States has had access to the best of both medical personnel and medicines after he became infected with the coronavirus, and on Monday night Norwegian time, it was learned that he is being discharged from Walter Hospital. Reed.
But few of the drugs Donald Trump has been treated with are recognized as treatment methods that actually have an effect.
To date, only the steroid dexamethasone has a documented effect in patients with severe corona.
VG has reviewed what is known about the course of treatment together with one of the doctors in Norway who has the widest experience with patients with Covid-19, Rikshospitalet’s chief physician and specialist in anesthesiology and intensive care, Jon Henrik Laake.
* Remdesivir: Experimental
As early as Saturday, it became clear that the president was receiving treatment with Remdesivir. When Trump’s doctors held a press conference on the president’s discharge Monday night, they said Trump will receive his fifth and final dose of Remdesivir on Tuesday, but then from home, and not at the hospital.
– Yesterday my team and I talked about the many small drops in oxygen level that the president has had. We decided to start treatment early, should it continue, Trump’s doctor Sean Conley said of the Remdesivir treatment at the news conference in connection with Trump’s discharge from hospital on Monday.
This is a drug that prevents the virus from making copies of itself, Laake explains. The drug enters and blocks the formation of new viruses. The drug is approved for use in Norway, but is only available to patients participating in the WHO solidarity study.
– The effect of Remdesivir is uncertain. Only one large study of the drug has been published, showing a shorter course of the disease, but not lower mortality. Treatment should be given early to patients who need to be hospitalized but are not seriously ill. So there is a fairly modest group to whom this drug can be offered, explains Chief Physician Laake at OUS.
He adds that the WHO study is expected to clarify the long-term efficacy of the drug.
ISOLATION: The President of the United States has been working from a conference room in the hospital while receiving treatment. Photo: Scanpix
* Dexamethasone
Trump’s doctors treated him with a steroid called dexamethasone, after his blood oxygen saturation dropped a couple of times while he was hospitalized.
Dexamethasone reduces the inflammation that can be triggered by coronary infection in the lungs and prevents the immune system from racing.
It is a so-called corticosteroid, which is closely related to drugs that are known to many Norwegian patients, namely hydrocortisone or prednisone, explains the superior. This group of drugs has a general anti-inflammatory effect, but it does not treat the virus itself, Laake tells VG.
It is only recommended for patients who are seriously or critically ill with Covid-19.
– Treatment is only relevant for a minority of patients, that is, those who need supplemental oxygen or a respirator. If American doctors have followed the guidelines on when to use dexamethasone, it indicates that Trump has been perceived as seriously ill, the intensive care physician tells VG.
* Cocktail of experimental antibodies: no documented effect
On Friday afternoon, the White House wrote in a letter that President Trump was treated with an eight-gram dose of an experimental antibody cocktail offered by the biotech company Regeneron. According to the magazine Sciences is the dose Trump received, multiplied by what the company indicates as the standard dose.
– This is a type of treatment that currently has no documented effect, but where studies are ongoing. Trump could have played on the medical science team by being open to participating in a study, but we don’t know that he did. If Trump recovers, many will seek his treatment. But drugs don’t act like an on / off button. It takes a large number of patients to see if one form of treatment is better than the other. It is unfortunate that heads of state are not involved in the studies, like most others, Laake believes.
Chief physician Jon Henrik Laake believes, along with several of his colleagues, that it can be dangerous when so-called VIPs like Trump get “everything,” both documented and undocumented drugs, when treated.
– It can be dangerous both for the interested party and for society. The symbolic effect of important people receiving special treatment creates the impression that you are receiving treatment that others cannot; it is a dangerous attitude.
INFECTED: Trump with press secretary Kayleigh McEnany three weeks ago. Now both are infected with the coronavirus. Photo: SAUL LOEB / AFP
* Oxygen treatment: documented effect
The president received oxygen twice, the president’s doctor, Sean Conley, said Sunday afternoon in an update on President Donald Trump’s health.
For oxygen treatment, there is starting to be pretty good documentation on what kind of level to go to, explains Chief Medical Officer Laake.
– Independent evidence-based guidelines have been issued stating when oxygen should be used in acute illness, also for patients with acute respiratory failure. The guidelines are pretty good to use as a starting point to assess who is seriously ill and who is not, Laake tells VG.
CORONALEGE: Jon Henrik Laake, Rikshospitalet’s chief physician and specialist in anesthesiology and intensive care, is critical of parts of the experimental treatment Trump has received. Photo: E vivos Griffith Firewood
* Mix of zinc, vitamin D, famotidine, melatonin and aspirin: No documented effect and, according to the doctor, misleading.
Trump’s doctor, Sean Conley, said Friday that the president had also taken a mix of zinc, vitamin D, famotidine, melatonin and aspirin on a daily basis.
– This is just an invention, because these preparations have no documented effect on anything in the course of the disease. I wouldn’t give it to my patients. And then it’s disturbing, because it creates the impression that this is something that people should have, Laake says.
Famotidine reduces the production of hydrochloric acid in the stomach and is something that is used to a small extent in Norway.
– You can of course give it if you have stomach ulcers, but it has no effect on the disease of corona patients. Hundreds of studies have been done on dietary supplements for various diseases and to the extent that it works, it is mostly negative. And the fact that one should need zinc has also come out of nowhere, is the judgment of the OUS chief physician.
WELL TAKEN CARE OF: A great team of doctors, nurses, and physical therapists have taken care of Trump while he’s been in the hospital. Photo: Evan Vucci / AP
– Medicines that are not the most important
The most important message from seasoned senior Laake is that the quality of non-drug treatment for Trump and all other Covid-19 patients is more important than drugs.
Isolation, rest and rest, supplementation with oxygen and fluids, mobilization, and care, under the supervision of professional nurses and physicians, are very important factors. Trump is surrounded by the best doctors, nurses, and physical therapists who maintain a high level of professionalism. The sum of these factors is really what is important. The drug fetishism that has surrounded the entire Covid-19 segment makes me a bit boring, says the superior.
Critically ill patients should have intensive care that is in line with current guidelines, he adds.
