Trump does NOT require ‘any supplemental oxygen’, but started on Remdesivir antiviral therapy – White House physician

 


President Donald Trump, who has Covid-19 and was taken to Walter Reed National Military Medical Center on Friday, is "doing very well" and does not require any supplemental oxygen, his physician said Friday night.

"This evening I am happy to report that the President is doing very well," White House physician Dr. Sean Conley said in a statement. "He is not requiring any supplemental oxygen, but in consultation with specialists we have elected to initiate Remdesivir therapy."

Remdesivir is an experimental antiviral therapy. Trump has completed his first dose and was resting comfortably, Conley said in the statement, which was tweeted by White House Press Secretary Kayleigh McEnany.

Trump also tweeted Friday night: "Going welI, I think! Thank you to all. LOVE!!!"

Earlier Friday, the White House said that Trump received an experimental drug, "a single 8-gram dose of Regeneron's polyclonal antibody cocktail," and that the president completed the infusion without incident.

 

President Trump will be staying in the presidential suite at the Walter Reed National Military Medical Center for the next few days, according to the White House.

The president's doctor said he is experiencing "mild symptoms" after testing positive for the coronavirus. But Trump has already received a single dose of Regeneron's polyclonal antibody cocktail, an experimental drug that has shown promise in initial trials in improving symptoms and reducing virus levels in the body. The drug is currently being evaluated but has not received Food and Drug Administration approval.

Trump "completed the infusion without incident," White House physician Sean Conley wrote in a memo released Friday, adding, "As of this afternoon, the President remains fatigued but in good spirits."

But given the president's age, 74, and his weight, 244 pounds, doctors said he's at higher risk of serious illness. The Centers for Disease Control and Prevention has found that patients in their early to mid-70s are five times more likely to be hospitalized, and much more likely to die, compared with people in their 20s.

With a body mass index of just over 30, Trump is technically obese. And though he does not drink alcohol or smoke, he has other possible risk factors. The president has a history of elevated cholesterol, which he takes a statin medication to control. In addition, his doctors have reported calcium buildup in his blood vessels in the mild to moderate range.

COVID-19 is unpredictable, ranging from very mild to severe cases, so it's not yet clear how Trump will fare in the coming days. Experts said Trump's doctors will likely monitor him closely and can consider a range of treatments and therapies, beyond Regeneron's antibody cocktail if his condition deteriorates.

Here's a list of things doctors will be watching for:

What treatments and therapies are Trump's doctors likely to consider?

In addition to the antibody cocktail, Trump's physician said the president has also been taking zinc, which is known to affect the immune system and vitamin D supplements.

For now, the president will likely be getting supportive care, said Colleen Kraft, an infectious disease physician, and associate chief medical officer at Emory University Hospital in Atlanta.

For a fever, he'd be given fever-reducing medicines, such as Tylenol. And doctors said it's important for Trump to get plenty of rest, drink lots of fluids and eat well. Doctors will likely monitor the president closely and hold off on any other medicines or therapies unless his condition deteriorates.

If Trump were to get sick enough to need supportive oxygen, that's when doctors might turn to therapies such as remdesivir, which is delivered intravenously, or the steroid dexamethasone, said Panagis Galiatsatos, a pulmonary and critical care physician at Johns Hopkins School of Medicine, who has been treating COVID-19 patients. "If his X-rays look horrible like pneumonia has developed, he's getting antibiotics."

Symptoms can change quickly, so how will the president's doctors monitor any changes?

Trump's medical team will likely monitor his temperature, heart rate, blood pressure, and oxygen saturation.

"They'll be paying attention to all of his vital signs," Galiatsatos said.

Since some people with COVID-19 have had low oxygen levels before they noticed a shortness of breath, monitoring the blood oxygen with a pulse oximeter can help detect a problem sooner. Galiatsatos said, "What we have recognized with COVID-19 is that the majority of patients, when they get sick, [don't have an] all-at-once decline." Symptoms can progress gradually, so constant monitoring is key.

What tests will Trump's doctors consider?

Trump "is a high-risk patient," said Dr. Faisal Masud, medical director of critical care at Houston Methodist Hospital, so a range of tests would be appropriate. Masud said if he were on the president's medical team, he would do a CT scan of the chest to check his lungs and an ultrasound of the heart to help evaluate his heart function. He'd also order blood tests to check a number of markers for inflammation and would check markers for kidney function.

Do Trump's current mild symptoms indicate anything about his prognosis?

No. "Having mild symptoms on Day 1 does not mean you're going to have mild symptoms for the rest of your course," Galiatsatos said.

Of course, it's possible that Trump may not develop any further symptoms, Galiatsatos added. But he said that given Trump's age, his weight and his gender (men tend to do worse than women), the president has "several strikes against him."

"These are strikes that raise the probability that his COVID-19 may go from mild to severe," Galiatsatos said.

However, even if Trump's symptoms do get worse, doctors have learned a great deal about treating COVID-19 in the last 10 months, Emory's Kraft said. And as president, she noted, Trump is expected to get the most sophisticated care currently available. "I expect that the president, with the attention that he will get, should do well," Kraft said.

Kellyanne Conway, a former top aide to President Trump, said in a tweet Friday she tested positive for the coronavirus — the latest person to have attended the White House event where Amy Coney Barrett was nominated to fill the open Supreme Court seat.

"Tonight I tested positive for COVID-19. My symptoms are mild (light cough) and I’m feeling fine. I have begun a quarantine process in consultation with physicians. As always, my heart is with everyone affected by this global pandemic," she said. 

Image: President Trump Announces His Supreme Court Nominee To Replace Justice Ginsburg
From left, White House Chief of Staff Mark Meadows, Attorney General William Barr, and Counselor to the President Kellyanne Conway talk in the Rose Garden at the White House on Sept. 26, 2020.Chip Somodevilla / Getty Images

 

Conway, who departed the White House last month, is among a group of several White House officials and lawmakers who tested positive after mingling with guests in the Rose Garden last Saturday when President Trump nominated Barrett to the Supreme Court to replace the late Justice Ruth Bader Ginsburg. Many guests were not wearing masks and were talking or touching each other in close proximity and seats were not socially distanced.

Those who attend the event and tested positive include the president and first lady, as well as Sens. Thom Tillis, of North Carolina, and Mike Lee, of Utah. 

Conway's daughter broke the news in a TikTok video in which she complained that her mother attended the event. 

President Donald Trump has received an unproven antibody treatment for Covid-19 following a test confirming that he was infected with the SARS-CoV-2 virus, White House physician Sean Conley said in a letter Friday afternoon.

The treatment was developed by the biotech company Regeneron. “Following PCR confirmation of the president’s diagnosis, as a precautionary measure he received a single 8-gram dose of Regeneron’s polyclonal antibody cocktail,” Conley wrote.

Later in the day, Trump flew to Walter Reed Medical Center, just outside Washington, DC, where officials say he will stay for a few days. “Out of an abundance of caution, and at the recommendation of his physician and medical experts, the President will be working from the presidential offices at Walter Reed for the next few days,” press secretary Kayleigh McEnany said.

There is currently no treatment approved by the Food and Drug Administration to treat Covid-19, though the agency has granted emergency use authorizations to the antiviral drug remdesivir and to convalescent plasma. However, Regeneron therapy was given to Trump under compassionate-use guidelines, which are considered on a case-by-case basis.

Regeneron’s antibody-based treatment, called REGN-COV2, is classified as experimental and is still in clinical trials. The company reported in a September 29 press release that the drug improved symptoms and reduced the viral load in Covid-19 patients who were not hospitalized.

“The greatest treatment benefit was in patients who had not mounted their own effective immune response, suggesting that REGN-COV2 could provide a therapeutic substitute for the naturally-occurring immune response,” said George D. Yancopoulos, president and chief scientific officer of Regeneron, in a statement.

In March, Christos Kyratsous, vice president for infectious disease research and viral vector technologies at Regeneron, told Vox in March that this treatment could also be used prophylactically to prevent infection, in addition to being used as a treatment for ongoing infection.

Antibodies are proteins produced by the immune system’s B cells that attach to a pathogen like a virus or to an infected cell. By attaching, they can either inhibit the target from doing damage or flag the target for destruction by other immune cells.

In Regeneron’s case, the company started with mice that were genetically engineered to have human immune systems. After the mice were exposed to the virus, they produced human antibodies that bind to the spike protein of the virus. The spike is what the virus uses to enter human cells, so blocking it with antibodies can inhibit an infection. A cocktail of two of these antibodies was then harvested from the mice and is being given to humans in clinical trials, and now to President Trump.

This type of treatment is a bit different from convalescent plasma, another experimental treatment for Covid-19, which is taken from people who were infected with Covid-19 but recovered. Plasma is the liquid part of blood, including proteins used for clotting, and when harvested from convalescents, it contains antibodies to the virus. So transfusing plasma from someone who recovered to someone who is sick could help them get better, or prevent them from getting sick in the first place.

However, the evidence to support either of these treatments is weak. The National Institutes of Health criticized the FDA’s emergency use authorization for convalescent plasma. “There are insufficient data to recommend either for or against the use of convalescent plasma for the treatment of COVID-19,” the agency wrote in a blunt letter in September.

As for Regeneron’s therapy, the best evidence right now is a press release citing results drawn from an early-stage trial of just 275 people. Without peer review of the findings or even published data, all we have is the company’s word that this works. “There’s nothing bad about these results, you just can’t say much about how transformative this is going to be,” Eric Topol, director of the Scripps Research Translational Institute, told Stat News.

Some doctors took to Twitter to criticize the decision to administer an experimental drug with limited evidence for its effectiveness to the president of the United States.

Receiving any kind of experimental treatment is a risk, but Trump does have significant factors that put him at greater risk of a severe course of the disease, including his older age, his obesity, and his gender. And it’s not clear whether the decision to administer the treatment came from Conley or from the president. However, earlier on Friday, Matt McCarthy, an infectious disease doctor, appeared on Fox Business and brought up the idea of using Regeneron’s antibody therapy.

Regeneron CEO Leonard S. Schleifer told the New York Times that the company received a call from the White House Friday requesting access to the drug. “All we can say is that they asked to be able to use it, and we were happy to oblige,” he said. “When it’s the president of the United States, of course, that gets — obviously — gets our attention.”

The Times also reported that Schleifer knows Trump personally and has been a member of Trump’s golf club in Westchester County in New York.

The Secret Service will not say how many employees have tested positive for the coronavirus or how many have been quarantined, according to a Secret Service spokesperson.

“For privacy and operational security reasons, the Secret Service is not releasing how many of its employees have tested positive for COVID-19, nor how many of its employees were, or currently are, quarantined," said the spokesperson.

"The Secret Service has well established COVID-19 protocols in place and continues to take every precaution to keep our protectees, employees, and families, and the general public, safe and healthy."

"We follow Centers for Disease Control and Prevention protocols, to include testing, conducting contact tracing related to confirmed and suspected exposure, and immediate isolation of any employee who tests positive for COVID-19."