Dr. Janette Nesheiwat: Trump and COVID-19 — some encouraging signs so far
I was worried when I learned that President Trump was hospitalized Friday with COVID-19. At 74, his age, gender and weight are risk factors for complications of COVID although the mortality rate is low. But reports from doctors Saturday encourage me to believe he has a good chance of making a full recovery, although we won’t know for sure for a few more days.
I am not the president’s doctor, have never examined him, and don’t have access to his medical records. But as a family and emergency medicine physician, I can use my experience and training to evaluate information the media is reporting about the president’s health status.
It seems clear that on Saturday the president was on an encouraging path to improvement that hopefully will continue throughout this week and end his hospitalization.
The president experienced fatigue, fever, cough, mild difficulty breathing and a drop in his oxygen saturation level on Friday, prompting his doctor to recommend his admission to Walter Reed National Military Medical Center in Maryland.
Admitting the president to this outstanding hospital was a smart move. The president’s health – whoever the president is – is, after all, a matter of national security. At Walter Reed he can be closely monitored, given every useful test to determine his exact health condition, get the most advanced treatment, and instantly receive intensive care should that become necessary.
President Trump’s amazing medical team at Walter Reed, working closely with White House physician Dr. Sean Conley, started him on an excellent treatment regimen including zinc, vitamin D, blood thinners, antivirals and antibody medication.
President Trump did not require oxygen supplementation Saturday and was free of fever – both very encouraging signs.
In a video recorded at the hospital Saturday where he spoke briefly about how he was feeling better, the president looked strong and healthy. He sounded well and he did not look fatigued or in respiratory distress.
Still, COVID-19 is a very serious disease that has claimed more than 209,000 lives in the U.S. So doctors are right to keep the president in the hospital for now, where he can continue to be closely monitored and evaluated.
Doctors will keep a close eye on President Trump’s vital signs, including his oxygen saturation level, temperature, heart rate and blood pressure. He also has to be monitored for signs of allergic reactions or side effects of the medications he is receiving, which include an experimental treatment called Regeneron.
Regeneron consists of monoclonal antibodies (proteins) that bind to the corona spike of coronaviruses to deactivate them. If this therapy works, it will reduce the viral load in the president’s body. Delivering a knockout blow like this to the coronaviruses infecting President Trump will be an important step to returning him to full health.
Of course, we must keep in mind that experimental therapies like Regeneron are new and not yet proven to be effective. Clearly, doctors feel the treatment has a good chance of helping the president, but we can’t say for sure that it will work as well as hoped.
These next few days will be telling. It takes a week to about 10 days in most cases for the coronavirus to cause the peak level of inflammation and damage to the lungs and organs. Given that the president is receiving aggressive treatment with drugs, we’ll have to see what happens in his case.
Regeneron has only been tested on 275 patients and is being administered to the president under a compassionate care exemption because it has not yet been approved for general use by the Food and Drug Administration.
The antibodies in Regeneron are like soldiers deployed against enemy force – the coronavirus invaders that have infected President Trump’s body in this case. If the Regeneron therapy works, it will enable the president’s immune system to defeat the invaders.
The president also received his second round of the antiviral medication Remdesivir on Saturday. This drug received emergency use authorization in May. It was previously used to treat Ebola and has been shown to reduce the duration of illness by about four days.
Remdesivir interferes with the ability of the coronavirus to multiply. The medication is generally started when patients require supplemental oxygen or have an abnormal chest X-ray or CT scan. Fortunately, it was started early enough in the care of President Trump to be effective.
I believe that in the coming months we will have the knowledge and tools to defeat this opportunistic virus.
Just as starting Tamiflu within 48 hours of diagnosis of influenza is important because you are treating before the virus can overwhelm and burden the body by replicating, it is important to start Remdesivir before the coronavirus has spread too widely in the body to be eliminated by the drug.
Most patients will receive Remdesivir for five or 10 days. The president will be receiving a five-day course. This means he will probably need to remain hospitalized at least through Tuesday if all goes well, since he has already taken two rounds of the drug.
Based on the positive reports from doctors, along with President Trump’s video in which he says he is feeling better, something seems to be working to reduce his symptoms. What is the drug helping most? We simply don’t know if it is Regeneron, Remdesivir, zinc, vitamin D, melatonin or famotidine – or a combination of them all. Each drug is believed to work in different ways to help the body fight off the coronavirus invaders.
Doctors and medical researchers around the world have learned an enormous amount in the past seven months about the coronavirus that causes the insidious disease COVID-19.
I believe that in the coming months we will have the knowledge and tools to defeat this opportunistic virus. We know how it thrives. We know how it spreads. So right now all of us need to work together to impede its transmission by wearing masks and social distancing as we await a vaccine that is proven to be safe and effective.
When will get this vaccine? Most experts believe it will be either near the end of this year or in 2021. We are all tired of the ways the coronavirus pandemic has changed our lives and want the vaccine available as soon as possible, but we need to make sure any vaccine given to millions of people in the U.S. and billions around the world is both safe and effective.
Several vaccines are in final-phase trials. With the flu season upon us, getting a safe and effective coronavirus vaccine is now more urgent than ever. Having both the flu and COVID-19 simultaneously can double your risk of death. This makes it especially important for us all to get the flu shot this year.
While doctors, nurses and other medical professional work to restore President Trump to full health – and while we get nearer to the day when a vaccine can eradicate COVID-19 – we shouldn’t panic. We will defeat the coronavirus. It’s just a matter of time.
And in the next few days, we should all pray for President Trump’s full and speedy recovery.