Covid-19: What you need to know today
US President Donald Trump’s Covid-19 infection and the treatment he is receiving is a good opportunity to revisit the science behind some aspects of the viral disease and the therapies and drugs used to treat it.
We know Trump used to take hydroxychloroquine (HCQ), once widely considered a prophylactic for Covid-19, before science showed that it (probably) wasn’t. Sure, it wasn’t as straightforward as that — there were missteps along the way, including research that used dodgy data, but the current scientific thinking is that HCQ does not help prevent the coronavirus disease.
Trump admitted he had been taking HCQ for a few weeks in a May meeting that was widely reported. Interestingly, the details of his current medication released by his physician do not mention HCQ. They do mention zinc — considered by some to be a prophylactic against Covid-19, in particular, and a general immunity booster —but it isn’t clear whether he has been taking this to ward off the coronavirus disease or it is part of his daily vitamin supplements (which, as we all know, the Americans are particularly big on).
In addition to this, we know Trump was put on oxygen at least once (although his blood oxygen level dropped twice). This is common in people with moderate Covid-19 infections. The condition is hypoxia, literally low oxygen, and is a sign of the infection starving the body of oxygen. Both anecdotal medical evidence and research has shown that, in some cases, Covid causes silent hypoxia — which means the patient doesn’t exhibit the symptoms hypoxia usually comes with (including incoherence, which usually accompanies altitude sickness).
Trump’s doctor also said the US President has been put on a dose of remdesivir. This is an injected antiviral which has been shown to benefit mild-to-moderate infections of Covid-19, in the early stages of hospitalisation. Patients get five shots of remdesivir as part of the treatment.
Interestingly, Trump’s doctor also said the US President has been put on dexamethasone. This is a steroid whose use is recommended only in severe cases of Covid-19, and whose benefits have, again, been proved by research. It isn’t clear why Trump is being given this if his infection is, as the White House claims, mild; nor is it clear whether dexamethasone can provide any relief at all to early-stage patients. Worryingly, we do not know if the steroid has any adverse effect when given to patients who do not really need it. Indeed, some media reports in the US have used this fact to ask whether the US President’s infection is more severe than what is being claimed.
In a classic example of throwing the kitchen sink at the infection — I notice several doctors have actually used the same term — Trump’s doctor has also revealed that the US President has taken an experimental antibody cocktail made by Regeneron. Previous editions of Dispatch have talked about Regeneron, whose cocktail of two monoclonal antibodies targets the spike proteins of the Sars-CoV2 virus. Keeping with the kitchen sink metaphor, it has been revealed that Trump received a more powerful dose of the cocktail (eight grams as compared to the 2.4 grams the company said was usually effective). The US President received this drug through the so-called “compassionate use” route, which allows for the use of experimental drugs that are yet to be approved (and do not even have an emergency-use clearance). Regeneron has released early data from a clinical trial underway that shows that the monoclonal antibody cocktail works in patients with no antibodies against Covid-19 and who are either asymptomatic or have a mild or moderate infection. It still isn’t clear whether this treatment can work in the case of severe infections. That’s a lot of treatment options.
So, is there anything left?
Well, China’s Sinopharm disclosed recently that several hundred thousand people have already been injected with its experimental vaccines, and Russia has approved the Gamaleya Research Institute’s Sputnik-V vaccine — but it is unlikely that the US President would allow himself be injected with an unproven vaccine from a rival power.
The US drug regulator has also approved convalescent plasma therapy, and that too is a treatment option yet to be used by Trump’s medical team. The US President has talked up plasma therapy in the past, despite a panel of experts put together by the US National Institutes of Health in early September saying more evidence is needed before plasma therapy can be recommended for Covid-19 patients.
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