Yale doc: Oxygen points to ‘severe’ case

NEW HAVEN — The fact that President Donald Trump has required oxygen in the treatment of COVID-19 means he is experiencing a “severe,” case, according to a Yale New Haven Health official.

Dr. Thomas Balcezak, chief clinical officer at Yale New Haven Health, said that is the correct term to use as defined for the disease by the World Health Organization and the Federal Drug Administration.

While White House officials are carefully parsing their words, Balcezak said the fact that his oxygen saturation level, according to some reports, had fallen to 93 percent, it made sense to give him the steroid. In a normal range of saturation, the level should not fall below 95 percent.

“There is a good study now that people who need supplemental oxygen, because the COVID-19 symptoms are severe, actually benefit — a survival benefit — when they get steroids,” Balcezak said.

The president’s physician, Dr. Sean P. Conley, said that the president had been given the steroid

dexamethasone on Saturday.

Dr. Sten Vermund, dean of the Yale School of Public Health, said dexamethasone is “a pretty powerful steroid that surpresses the host’s immune system. What they are doing is to try and prevent a cytokine storm.”

Cytokines are chemicals produced by the immune system to communicate with other immune cells, he said.

“It seems to work very effectively in younger per

sons, but in older persons we have seen the immune system disregulate. The proper regulation of the immune system is like a well-tuned orchestra. You could say the disregulation ... is like an orchestra out of tune,” Vermund said.

He said what happens is “the immune system will continuously send a signal to battle the virus in the lungs and it recruits more and more cells, more and more fluid and you end up drowning,” the dean said.

Balcezak said the trials of remdesivir, an antiviral drug, which the president is also taking, are less impressive. The president is

on a five-day course.

“The only thing they were able to demonstrate was a shorter length of stay for hospitalized patients. They were unable to show a mortality difference in that study,” Balcerzak said.

Vermund agreed that remdesivir is a “mildly effective antiviral. The field is working on better antivirals, but that is the best we have at this minute.”

The last medication is the Regeron drug, a double monoclonal antibody, which is not an approved drug, but according to reports, the president’s physicians sought Federal Drug Administration ap

proval before giving it to him.

Balcezak said the study on Regeron showed “the circulating virus” fell substantially.

“I don’t know what that means clinically. I don’t think anybody knows what that means clinically, whether that is good ... just because the amount of virus fell doesn’t necessarily mean that you survive longer or you do better. That is not truly a hardend point,” Balcezak said.

Balcezak said confusing information is out in the public about the president’s condition.

The White House an

nounced early Friday morning that Trump had tested positive for COVID-19 Thursday, but there are reports that the Sept. 26 event, where his Supreme Court nominee, Judge Amy Coney Barrett, was introduced, may have been the super- spreader function were other close aides and several Republican lawmakers contracted the disease.

Personally, Balcezak said, the hospitalization, the high fever, the need for oxygenization three days into his illness, “if he truly only tested positive on Thursday ... that is a rapid onset of pretty severe

symptom,” indicating a “serious condition.”

“The rapidity is concerning,” he said.

He said typically this disease follows a “bimodal course,” which means commonly people feel sicker in the beginning, but after four to five days, they feel a little better. It is day seven, eight or nine when “they crash and that is when they have a rapid deterioration.”

Balcezak said the days to watch are seven through 10.