University of Pittsburgh Medical Center's Dr. Steven Shapiro says President Trump's steroid treatment and opaque lung scan report hints at a more serious lung infection and raises questions over his physicians' reports. (Oct. 5)
STEVEN SHAPIRO: Right now, early in the disease, it makes sense to target the virus. And the two medicines that he's getting, Remdesivir and the antibody, although not often used this early in the disease, it's very reasonable to do so. One scratches one's head a little bit when we hear that the president has been put on dexamethasone, because usually that is reserved for a later point in time.
First you want to go after the virus, but then when you turn the corner, if the virus would get into the lungs or other organs, and as the inflammatory and immune response is starting to destroy and attack the lung, that's when you turn off that inflammatory response with dexamethasone. But if he's not hypoglycemic, then that generally is too early to give that drug in our experience.
It's a little difficult to understand exactly how compromised his lungs are with COVID-19. We're told he had two episodes of transient drops in oxygenation, but not enough that he needs oxygen routinely. And we generally wouldn't give steroids for that. There was the sort of strange statement that his chest CT findings, which is a very detailed fine picture of the lungs, as expected findings.
I would expect the findings to be normal. But my sense is, they meant expected with COVID-19 pneumonia. And if that's the case, then it's possible that they're basing some of the treatment decisions, such as the dexamethasone, on these X-ray findings. Doctors shouldn't be treating X-ray findings, but the patient. And these are fine doctors and they know all this. So they're weighing all these different things, which we have only partial access to, and somehow decided that it was enough lung damage, I presume, to treat with dexamethasone.
One thing we know, is that he's getting a lot of therapy. And sometimes VIPs get almost too much care. And he's the ultimate VIP with a lot of opinions. The fact that he's not getting hydroxychloroquine suggests the doctors are holding their own and holding firm and most of what he's getting makes a lot of sense. But there is always the risk of over-treatment with the ultimate VIP.