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disconnect between trump treatment and what his doctors say: expert

trump's doctors offered an upbeat assessment of his health sunday, saying he may head home from hospital on monday

by tom blackwell

oct 4 2020
read time 4 minute read
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donald trump’s doctors offered another upbeat assessment of his health sunday, saying the president may be heading home from hospital monday, three days after he tested positive for covid-19 and sent shock waves through u.s. politics.
but they also admitted to earlier being less than forthcoming about his condition, neglecting to mention that trump’s blood-oxygen levels had twice dropped below normal and that he was briefly on supplemental oxygen.
meanwhile, news that he had been given a steroid treatment proven effective for the sickest of patients left some canadian experts scratching their heads.
either the president is in worse shape than described, or the steroid therapy was offered too early in the illness, said the infectious-disease specialists.
“essentially, they’re treating him like he has severe covid-19, but intimating he has only mild disease, (a) fundamental  disconnect,” said dr. gerald evans, head of queen’s university’s infectious diseases division. “the fact that he has worrisome features like high fever and hypoxemia (low blood-oxygen levels) early in his illness, suggests the possibility that a more severe second course may yet be in the future.”
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in fact, the trial that found steroid dexamethasone was useful in treating hospitalized patients on oxygen suggested it was a double-edged sword, actually increasing the risk of death slightly in those with normal blood-oxygen levels.

based on his doctors’ rosy description of trump’s state, “he would not probably qualify for any of these treatments ” said dr. zain chagla, a mcmaster university infectious disease specialist. “as much as more may be better, there may actually be some downsides to giving more aggressive therapy just for the sake of giving more aggressive therapy.”
the news sunday added to a confusing few days of sometimes-conflicting information about the president and the severity of his case.
underlining the importance of trump’s prognosis to the campaign — barely four weeks before the u.s. election — a phalanx of doctors clad in identical white lab coats stood at attention outside walter reed medical center to brief reporters sunday on their patient. trump was dramatically airlifted to the military hospital on friday.
there have been ups and downs, as expected with any illness and especially with someone being monitored so closely, but he has been steadily improving, said white house physician dr. sean conley.
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“the fact of the matter is that he’s doing really well,” said conley.
he had made similar comments in a news conference on saturday, and seemed to dodge questions about whether trump had been on oxygen, only to have mark meadows, the white house chief of staff, tell reporters in a separate briefing that their boss’s vital signs had been concerning.
conley was more transparent sunday, indicating that the president had twice had episodes of falling blood-oxygen levels. those levels are important because they indicate how much oxygen the lungs are transferring into the blood supply, crucial for keeping the body’s various systems functioning.
the first time oxygenation dropped, late friday morning at the white house, trump briefly and reluctantly received oxygen, his levels rising again within a minute, said conley.
there was another dip on saturday, but he couldn’t say if the president had received oxygen then.

trump has also received a battery of largely experimental treatments. they include a cocktail of “monoclonal antibodies” whose manufacturer, regeneron, says can help reduce the viral load, based on small study that has yet to be published or peer-reviewed.

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he is also being treated with remdesivir, another new medicine that has shown some promise.
and conley said trump had received a dose of dexamethasone.
the physician admitted he had not revealed the whole story earlier, editing his comments for the president’s sake.
“i didn’t want to give any information that might steer the course of illness in another direction,” said the doctor. “in doing so, it came off that we were trying to hide something, which wasn’t necessarily true.”
the remdesivir, though expensive and currently in short supply in canada, makes sense as a treatment earlier in the illness, as it combats the virus itself, said dr. lynora saxinger, an infectious disease specialist at the university of alberta. the monoclonal antibodies serve a similar function, though there is insufficient evidence yet to prove they actually work, she said.

dexamethasone — used to fight an exaggerated immune response and inflammation later on — stood out to her, given that data from britain’s respected recovery trial indicate it is effective for patients who have been sick at least seven days and need oxygen.

“maybe his lungs are worse than they’re suggesting, or they’re using it a little outside of what the evidence would support,” said saxinger. “they might have jumped the gun a little bit.”

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chagla said his reading of the publicly available information suggests trump does have a relatively mild case of covid-19, one that in a regular patient would call just for supportive care and no drugs yet. but, the physician acknowledged, trump is no ordinary patient.
“all of these treatments that he got, given his condition, were probably above and beyond what would necessarily be indicated,” said chagla. “(but) he’s being monitored so, so carefully, with such precision, that any twinge of anything wrong pushes him into that category of more treatment.”

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