White House Doctor Sean Conley (R) briefs on the condition of U.S. President Donald Trump on October 3, 2020 at Walter Reed Medical Center in Bethesda, Maryland.
Brendan Smialowski | AFP | Getty Images
president Donald TrumpDoctors are using almost every drug in the Covid-19 arsenal to treat him and some doctors fear that they may go overboard for being a VIP.
Trump’s medical team at Walter Reed National Military Medical Center said over the weekend that the president has taken Gilead ‘s antiviral drug remdesivir, Regeneron‘s antibody cocktail and the steroid dexamethasone in the past few days to treat his case of coronavirus.
The president could very well be the only Covid-19 patient to have received all three treatments, said Dr. Leana Wen, former Baltimore health commissioner. She added that this could be due to a medical phenomenon known as “VIP syndrome,” where pressures to treat high-profile patients could lead to experimental treatments and possible errors.
“After working in the emergency room, I have certainly treated a number of people who would qualify as VIPs,” said Wen, emergency physician and public health professor at George Washington University. “These patients expect the best treatment, but often it leads to over-treatment and that poses a risk.”
The latest drug to be given to Trump is Regeneron’s experimental monoclonal antibody treatment, which has only been given to a few hundred patients in a clinical trial to date and has not yet been approved for use in patients by the Food and Drug Administration. Regeneron said the treatment early last week improved symptoms and reduced viral load in non-hospitalized patients with mild to moderate Covid-19. This was based on the results of the first 275 patients without hospitalization.
However, according to Regeneron, the average age of the patients in this study was 44 years, well below the 74-year-old Trump. The company said it continues to test the drug to treat hospital patients and to prevent infections in people who have been exposed to a patient.
While antibody cocktails have long been used to treat other infectious diseases and doctors have viewed them as a promising potential treatment for Covid-19, every drug has side effects, Wen said. She added that there is no research on how this drug interacts with the other treatments the president has received, which could raise more questions about how effective and safe the treatment regimen is.
The The use of the steroid dexamethasone also raises questions. The cheap and widely used drug was found in clinical trials to help reduce the risk of death for seriously ill Covid-19 patients. However, according to the World Health Organization, it can “increase the risk of death when given to patients with mild cases of the disease”.
“There is no clear reason for us to believe that there is some adverse interaction they are having with one another,” Wen said of the various treatments. “But it is a question that needs to be raised: Do we want to use experimental therapies with the President of the United States?”
Trump’s doctor, Dr. Sean Conley, vowed Saturday that he and his team would “maximize all aspects of his care and attack this virus in a multi-faceted approach”.
“This is the president and I didn’t mean to hold anything back,” he added. “If there was a way that this could add value to his care and speed his return, then I wanted to take it.”
Conley is treating the President along with a team of Walter Reed doctors. However, Wen pointed out that more medication does not necessarily mean better care; rather, more and more doctors do not come up with the best strategy.
“VIPs usually have a lot of doctors looking after their care, including many different specialists and people who would claim they are the person in charge of caring for the patient,” Wen said. “So when you take care of this patient, coordination is pretty challenging too.”
Dr. Lewis Kaplan, president of the Society of Critical Care Medicine and a surgeon at the University of Pennsylvania Hospital, said VIP syndrome occurs when “the usual nursing process derails.”
It is difficult for him or an outside doctor to judge if this is happening to Trump because of some questions about whether the White House has correctly relayed information about his condition, Kaplan said. If Trump is critically ill, the treatments may be useful, but if the president recovers quickly, he may have been over-treated.
“This could mean he is way sicker than what has been portrayed, or it could be that this is a judgment based on his being the sitting head of state. We just don’t know,” he said, adding added, “we don’t.” I really have evidence of the melange of this particular brew. It can be perfect. It can’t be right. We just don’t know. “
Kaplan emphasized the importance of well-designed clinical studies that provide hard data and evidence of the safety and effectiveness of drugs. He added, however, that studies do not always reflect the real-world situation of a patient’s treatment and that it is not uncommon for doctors to use drugs “off label”. Using drugs like Regeneron’s antibody cocktail could be an extension of that kind of thinking, Kaplan said, adding that he didn’t think this was the best way to treat it.
“It’s risky,” he said. “And if he’s not that sick or isn’t in intensive care with a lot of extra oxygen, he doesn’t need mechanical ventilation. One wonders why because I don’t understand.”
The president’s appetite for experimental drugs is well documented. At the beginning of the pandemic, Trump publicly pressured the FDA to approve the use of hydroxychloroquine in an emergency. Prescriptions for the 60-year-old drug rose 2,000% in March, but later studies found it actually accelerated death in some patients, and the FDA withdrew its emergency approval in June.
Trump, who once publicly asked if Covid-19 patients could inject disinfectants to treat the disease, was not prescribed hydroxychloroquine.
“The person who has a strong belief in science is in the process of receiving science-based therapeutics. I find that an ironic comparison,” said Kaplan. He added that perhaps if the drugs work for Trump he could be “like the youngest convert” developing a stronger belief in science.
“That would be the best result of this interesting combination therapy, which may or may not be justified,” said Kaplan.