To treat his Covid-19, President Trump has started receiving dexamethasone, a common steroid that has been shown to be helpful in people with severe cases of the disease but that doctors warn should not be used early in the course of the illness.

The announcement from Trump’s medical team Sunday morning that the president is on dexamethasone is sure to increase speculation about the president’s illness and was at odds with the generally upbeat description of his condition provided by his physicians. His doctors said Trump had not had a fever since Friday morning and did not have any shortness of breath. One even said that, if Trump “continues to feel and look as well as he does today,” their goal was for him to return to the White House on Monday.

Dexamethasone is generally reserved for patients who have serious disease. The National Institutes of Health’s treatment guidelines for Covid-19 say dexamethasone should be used only in hospitalized patients who are on ventilators or who require supplemental oxygen, and specifically “recommends against using dexamethasone for the treatment of Covid-19 in patients who do not require supplemental oxygen.”

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Trump’s doctors confirmed that the president received oxygen for about an hour on Friday after a temporary drop in his oxygen levels — something they danced around saying during a Saturday briefing. Sean Conley, the president’s physician, told reporters on Sunday outside Walter Reed National Military Medical Center, where Trump is being treated, that the president also experienced a “transient” drop in oxygen levels Saturday but said that he wasn’t sure if oxygen was given.

Conley said that drop in Trump’s oxygen saturation to 93% on Saturday morning prompted the decision to initiate the steroid therapy, believing “the potential benefits early on in the course” outweighed any downsides.

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“Our plan is to continue that for the time being,” Brian Garibaldi, another of Trump’s doctors, said about the dexamethasone.

Ethan Weiss, a cardiologist at the University of California, San Francisco, who went to New York to treat critically ill Covid-19 patients during the city’s surge, told STAT, “Nothing matches up.” Weiss said that Trump’s medical team had “an impossible job,” but that “you can’t say he’s fine and he’s going home tomorrow and by the way he’s getting dexamethasone, which was shown in [a clinical trial] to be helpful in only the sickest patients.”

The concern with dexamethasone is that it can suppress the immune system’s activity broadly. While that can be helpful in severe illness — which is typically caused by the immune system overreacting to the infection, not the virus itself — giving the steroid too soon could hinder the immune system from fighting the virus in the first place.

“You don’t want to give it to a patient too early,” Nahid Bhadelia, the medical director of Boston Medical Center’s Special Pathogens Unit, told STAT Friday about dexamethasone. “It’s a blunt instrument, so it may suppress a good immune response as well as a bad one.”

In a clinical trial, dexamethasone reduced deaths by a third in patients hospitalized with Covid-19, but the benefit differed depending how sick patients were. In patients not receiving supplemental oxygen, the study showed no benefit and potential harm.

“Those patients who were not requiring oxygen actually had a statistical trend toward worse outcomes — the dexamethasone was only beneficial in patients who were requiring oxygen,” said C. Michael Gibson, a professor of medicine at Harvard Medical School. He also noted that the effect for dexamethasone was only seen in patients who had been sick for longer than seven days. Trump started feeling sick Thursday, his doctors have said.

Trump is also in the middle of a five-day course of the intravenous antiviral remdesivir. His doctors said the president could continue receiving the infusions at the White House if he were discharged from Walter Reed.

Overall, Trump’s medical team continued to portray Trump in good spirits and relatively good health. But as during a Saturday press briefing, Conley answered questions about certain aspects of Trump’s condition vaguely. He was asked several times about potential damage to the president’s lungs and said “there are some expected findings” without giving additional details.

Conley was also asked why he had avoided saying during the Saturday briefing whether Trump had ever been given supplemental oxygen.

“I was trying to reflect the upbeat attitude the team, the president through his course of illness has had,” Conley said. “I didn’t want to give any information that might steer the course of illness in another direction, and in doing so it came off that we were trying to hide something, which wasn’t necessarily true.”

Damian Garde and Matthew Herper contributed reporting. 

  • David is right on point with his commentary. He is your president and deserves respect and privacy from us all. Stop being such hypocrites, stop bashing your own country, stop separating everyone into categories. It is appalling that our brightest and most successful individuals can’t help but sow such dissent among their own peers.

  • Conley is just as much a con-artist as a whole lot of other WH related characters : his un-will to disclose when Trump last tested negative means that he was not negative while traveling to large gatherings in the week before the positive test. He has infected many around him, and people in inner circles clearly KNOW this. Anyone not wearing a mask or keeping physical distance is as nuts as him. This man got pumped full of drugs that are NOT available to any other American in such short time, so his “experience” with Covid is totally irrelevant. But of course he abuses it. His show of mask removing upon return to the WH is the ultimate of low, disgusting, selfish disrespect – and lacks any smidgeon of understanding of what millions of people around the world suffer. He is crazy, and totally out of touch with reality.

  • Do we know how Trump is receiving steroids? In IV or pill form? I would think if he is getting them through an IV, he would be more seriously ill, as IV steroids are far more powerful than pills.

  • What if this fake news? How do we know for sure that he was positive for COVID and he received all those medications given to extremely sick patients ?

  • The average American citizen does not have a team of 10+ doctors and a state of the art ICU! Nor do we have access to experimental drug cocktails. So his COVID is not the average Americans COVID. And to say so and believe what he is saying is beyond ludicrous and immensely ignorant to the scientific FACTS. We are not privy to an alternate reality. All we have is the TRUTH!!

  • “ USUALLY given to to patients with severe Covid-19“
    Note the word “ Usually “ . Not all physicians wait until the patient is half dead before administering it !
    If dexamethasone were given to ill patients sooner , a lot of people WOULDN’T have died!
    That goes for other drugs and therapeutics available to treat covid.
    It’s no secret that the sooner covid patients are treated, the better the outcome. Trump is a perfect example of that !
    Politicians AND physicians are playing politics with peoples lives. This must end !
    I know many doctors , nurses and hospital administrators whose hands have been tied by the politics of treatment protocols for Covid. I know many people who have contracted covid, some died , and I FIRMLY believe they would be alive today if they had been treated sooner, and with the proper treatments.
    I am beyond disgusted that that some people have such hatred for Trump that they would sooner see innocent people die than have him look good.
    As proven by Trumps swift recovery, EARLY AND AGGRESSIVE treatment works !
    Misleading articles like this are part of the reason why people are unnecessarily dying of Covid!

    • Trump is espousing that Covid is easily fought, that people shouldn’t wear masks and that the economy would be fine if only people would quit being fearful…
      Trouble is, NO ONE else in the USA would receive the aggressive & costly treatments, or gotten immediate approval by the FDA for the experimental cocktail.
      I noticed he didn’t inject bleach or discuss hydroxychloroquine.
      He’s an abomination and the Anti-Christ. Read revelations.
      BTW, I’m an Independent voter who didn’t vote for Hillary and won’t vote for Trump.

  • Can we at least give the man his Hipaa rights media? These kind of questions the media is asking shows little respect for people’s medical privacy regardless whether he’s president or not. Everybody has to give their two cents. If any of these other doctors cured Cancer I will listen to their opinion but since nothing’s cookie cutter and everybody’s body reacts differently to things maybe they should just shut the hell up. I’m not a Republican and lately I have been despising Democrats for their lack of professionalism look at how they tried to turn around Nancy pelosi’s special haircut making it act like she got trapped. I called bs across the board. Republicans with your selfrighteousness
    Democrats with your shame game and stat twisting it’s all political nonsense I want more choices than two white seventy-year-old men. Can we finally get some eff real candidates? By the way it goes without saying I personally believe Trump will fully recover, I hope he has an easy go of this non-deadly disease.

    • IT IS A DEADLY VIRUS! 200, 000 people strong snd growing DEAD! Hopefully With what you said you are taking the scientific directives.

    • I think we have a right to know if the President is healthy to do his job. Unless he hand Pence the wheel, we should know. He’s taking an extremely powerful drug that effects decision making.

    • David, I agree with you 150% that we need more candidate choices! What about starting a NEW party that combines some liberal as well as conservative views???

      I just don’t get the two parties NOT being able to work together! It’s shameful, it’s outrageous, and a very SAD state of affairs!

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