Trump's doctors are targeting a 'sweet spot' in fighting COVID-19 by using experimental treatments early, but physicians caution the data is limited
President Donald Trump is taking several drugs to combat COVID-19, a combination approach that critical care doctors called rational but untested.
Over the past few days, the president confirmed his diagnosis, was injected with an experimental antibody cocktail, transported to Walter Reed Medical Center, and given an IV infusion of the antiviral drug remdesivir.
In a memo released Friday night, the White House physician Sean Conley said Trump is "doing very well."
Giving the antibody drug and remdesivir early on should help COVID-19 patients in fighting the disease, physicians told Business Insider.
But the two drugs have not been tested in combination. "We are clearly in a data-free zone right here," said Dr. Taison Bell, an infectious-disease expert and critical-care physician who has studied remdesivir.
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President Donald Trump has now received two experimental treatments for his coronavirus infection, a combination that doctors say is logical but untested.
After being flown to Walter Reed Medical Center, President Donald Trump received an IV infusion of the antiviral drug remdesivir, the White House physician said Friday night. He previously got a dose of an experimental antibody cocktail.
"We are maximizing all aspects of his care, attacking this virus in a multi-pronged approach," Trump's physician, Dr. Sean Conley, said in a briefing on Saturday. "As the president, I didn't want to hold anything back. If there was any possibility it would add value to his care and expedite his return, I wanted to take it, and the team agreed, and that's how we proceeded."
The use of remdesivir marked the latest in a rapid escalation of Trump's treatment plan. On Friday, the president publicly confirmed his diagnosis and was flown to Walter Reed. Trump, who is 74 and obese, is at an increased risk of a serious case of COVID-19.
After testing positive for the coronavirus, Trump had a fever, a mild cough, nasal congestion, and fatigue, Conley said. The timeline on when exactly the president tested positive was not immediately clear, but Conley said the COVID-19 diagnosis was confirmed via testing on Thursday.
Conley added Trump's symptoms have resolved or are improving. He also said that Trump isn't currently receiving extra oxygen. The Associated Press reported Saturday the president received supplemental oxygen on Friday at the White House before going to the hospital.
Shortly after Conley provided an update on Trump's health Saturday, an anonymous source familiar with the president's health appeared to contradict the physician's assessment.
"The president's vitals over the last 24 hours were very concerning and the next 48 hours will be critical in terms of his care," the source said, according to the White House press pool. "We're still not on a clear path to a full recovery."
There are good reasons to use experimental treatments early
Trump's age and weight are good reasons to treat him early, doctors told Business Insider. They also said that there's reason to think that giving remdesivir and the antibody cocktail early on is the right approach, but they cautioned that there's no data on using the two treatments together.
"The thought is if you can reduce the viral burden with an antiviral early on, then maybe the progression will be halted in some way," Dr. Mangala Narasimhan, an intensive care doctor who oversees ICU care at Northwell Health, told Business Insider on Saturday.
"Given the fact he's 74, a male, and obese, I think he's in a higher-risk category, so his chances of getting sick from this are higher," she added. "They are trying to prevent that from happening"
Remdesivir is a virus-fighting drug that was first tested against Ebola. In studies, the drug helped hospitalized patients with COVID-19 recover faster and the Food and Drug Administration has given an emergency ok for the drug's use in hospitalized patients.
The antibody treatment is made by the biotech company Regeneron and is not approved by the FDA. The experimental treatment aims to boost the body's immune response to help in fighting the virus.
'We are clearly in a data-free zone right here'
Regneron provided a description of preliminary results on September 29 for the treatment that was generally seen by experts as encouraging. But it's too early to say for sure if the drug works. There are no clinical trials that are specifically studying taking the two drugs in combination.
Remdesivir was primarily studied in sicker patients, with the trials focusing predominantly on COVID-19 patients requiring extra oxygen.
"We are clearly in a data-free zone right here," Dr. Taison Bell, an infectious-disease and critical-care physician at the University of Virginia's medical center told Business Insider on Saturday. "What his medical team is doing is trying what they can. The more we learn about these different combinations, the more we'll be informed. Right now, it's kind of like we're driving in the dark."
Still, Bell explained that there's good reason to give the president remdesivir now. Bell said there is a "sweet spot" in using remdesivir that Trump likely falls in — having symptoms that make him not too sick and not too healthy.
"It's right at that cusp where someone is sick or starting to get sick, but they aren't quite super sick," said Bell, who was a principal investigator for a National Institutes of Health trial that tested remdesivir.
Narasimhan said COVID-19 becomes "very hard to stop" as the disease progresses and patients get sicker.
"The thought is these drugs will work best if given early on before someone gets very sick," she said.
While Trump is 'doing very well,' physicians watch for steroid use as sign of disease progression
Both physicians emphasized the lack of publicly available, detailed information on Trump's health.
"The administration is being very cagey about what his symptoms are and what his clinical status is," Bell said. "We don't know what his chest x-ray looks like, we don't know what his oxygen saturation is. They are telling us that he's not on any oxygen, but it would be helpful to know if he's symptomatically short of breath, or if his oxygen saturation is low but not quite requiring oxygen."
Bell and Narasimhan both said there is no reason to not believe the health reports are accurate.
A possible sign that Trump's condition is worsening would be if he begins to receive steroids, the doctors said.
"If he gets steroids next, then we'll start being a little bit concerned about his respiratory status," Narasimhan said. "That will be the next treatment and that really is indicated for patients who are needing oxygen."
Read the original article on Business Insider
