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.”
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.
“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.
About the Author Reprints
Fed up with the hipe an the so call experts on the president’s treatment. STOP IT YOU ARE NOT ON HIS TEAM AND ARE NOT TREATING HIM.
It’s not hype. Physicians know how COVID-19 should be treated, and they are bothered by seeing things mishandled. Getting dexamethasone too early can make a person sicker, so these are fair concerns.
What proof has anyone seen that the president tested positive for coronavirus and that he has taken any treatment(s) for it?
What are the effects of steroids on monoclonal antibodies? What drugs does trump use regularly? BP, adderall, statin, aspirin?
Over what period of time is blood oxygenation measured to determine it is low?
Is it not a fact that pulse ox readings of 93 is normal when sleeping?
Not to argue politics, political arguments by medically uninformed people has damaged StatNews comments as a source of information – BUT – there is a need for the President to appear strong, because enemies of the US will immediately start to do mischief if they believe they can. Instantly, that is very important to emphasize. Instantly. Instantly.
On the one hand, you can argue he owes us candor, on the other hand, NO, he must keep any severe illness totally secret. Please think about it carefully
I appreciate Statnews giving me, a layman, a lot of valuable information on the epidemic. It has been very comforting and helpful.
Even with my limited knowledge, the dexamethasone made no sense from the get go if he had not been very sick, or if the infection was not further along than they claimed. I do think we are being lied to – this may be self serving on Trump’s part but I also wish to say – he believes in keeping your spirits up with rallies and such, and believes the country needs that, too. So, misguided or not, it may be well intentioned. Anyway, if he did get the Regeneron antibodies very early on, we will see how it works. It seems odd they did not give him the Lilly product because I saw more data on it – anyone have a guess as to how that choice would be made?
It appears that Regeneron had received a while ago 600 millions $ from the gov to develop the antibodies
Is there any information available on the dosages of remdesivir and dexamethasone that were administered? The regeneron dose was disclosed.
“So it came off that we were trying to hide something, which wasn’t necessarily true.” Oh, I think it was absolutely true, Dr. Conley.
It appears some people (trump supporters) see what they want to see. Reading this article above, the only takeaway I find is that NOTHING concerning trump’s COVID-19 “infection” makes sense. There’s no transparency coming from the WH! We’re getting mixed messages from trumps spin doctors and his campaign team. Not to mention, trump has lied to the American People for the past 3 years and 8 1/2 months! It’s time to make a change in the WH and finally get some straight talk and honesty! I’m so exhausted from all trumps lies!
https://www.google.com/amp/s/www.latimes.com/opinion/story/2020-04-02/coronavirus-department-of-justice-terrorism%3f_amp=true
Well take a nap and relax. The President is fine.
V what’s wrong with putting your name out there, if your going to make a dum comment about our President. I love our President and our Country.
no
Norma — Because there are a lot of Right Wing “Enthusiasts” that are quite willing to hunt down, literally, those that actually believe in free speech and democracy. If any of these enthusiasts wanted too, they could get your home address, place of work, and more and threaten your life in a matter of hours. Just from posting something that they don’t like. There are many cases of this. In fact, just by posting, I could have someone obtain my information and then distribute it widely to right wing enthusiasts via internet postings , social media, etc. and I could be threaten and injured. The hard part of this, is that the person that got my information and disseminated it with a request to harm me, would not be held liable for their actions. How willing would you be if your actions would result in harm, both physical and emotionally, to you and your family? Freedom of speech and other freedoms we take for granted are threaten in Trumps’ America on a level that is only seen in autocratic regimes. Maybe that is what you want? Maybe you no long want there to be a democratic America…
The media disgusts me! They act like they cant stand good news of the President’s condition. Rather than accept it, they insinuate the doctors are hiding something. They’re also rude! I cant stand the way they behave at press conferences about the POTUS. I no longer believe anything they report,print,tweet or post!!
Troll
Della, I know it is hard…but try to watch something other than Fox news… the Fox is tricking you. It was interesting to note a good number of right leaning individuals that observed Joe Biden in the debates either though he was on something (another Fox news unfounded conspiracy theory) or he was coached, had an earpiece…or just really, really had a good day. This unanticipated surprise to the right is probably due to the fact that their field of reference on how Biden should perform is warped by their skewed point of reference due to the fact their perception is tainted by Fox news filtered snippets of gaffes by Biden…He’s got a good number of them, no doubt…but he can also be lucid, caring and factual. But if you are only shown the bad…you are surprised by his normal performance at the debates. Open up…and let the marketplace of ideas work…expand your horizons.
Funny, Della, your last sentence is how I feel about your president. I say “your president” because he has never included “Democrats” as a part of his realm.
Taking dexsmethasone and talk of ‘discharge’ is not necessarily contradictory. If Trump had been symptomatic for the last 7-10 days, then he would normally ‘feel better’ and if past 10 days, he may be discharged. But if during this critical period he declines, thats when dexamethasone would be given. Maybe Trump ‘s been showing symptoms since last weekend but covered it up so he can go debate Biden on Tuesday.
He’s a criminal