TRUMP HOSPITALIZED WITH CORONAVIRUS VIRUS EXPERTS ANALYZE TRUMP’S PROGNOSIS
President receives experimental drug, expected to remain at Walter Reed for several days UCSD doctors review treatment, including antibody cocktail
Late Thursday night,
President Trump disclosed he had tested positive for
COVID-19. By Friday afternoon, he was being f lown by helicopter to Walter Reed
National Military Medical
Center in Bethesda, Md., for treatment.
The raised new questions about what we know about the novel rapid-fire coronavirus events eight months into the pandemic.
The Union-Tribune discussed the possible meaning of the situation with Dr.
Davey Smith, chief of infectious diseases at UC San Diego, and Dr. Michele Ritter, a
UCSD infectious disease specialist who also leads the
COVID-19
Telemedicine
Clinic for patients recover
ing from at home. Q:
The news about the
president’s diagnosis has really jolted the American public. What is the most important thing people need to
know about this? Ritter:
The COVID-19
pandemic that has taken over world has now aff licted the 74-year-old American president. While science has made some strides in understanding and managing this illness, COVID-19 continues
to be a risk to everyone. Q:
The president was tak
en to Walter Reed. What
does this mean? Ritter:
Generally, pa
tients are hospitalized when their symptoms become more severe or they have new, alarming symptoms.
Most commonly, we send patients to the hospital
WASHINGTON
President Donald Trump was taken to Walter Reed National Military Medical Center on Friday for a stay that was expected to last several days, a move the White House said was made out of an abundance of caution after he tested positive for the deadly coronavirus and experienced symptoms.
“I want to thank everybody for the tremendous support. I’m going to Walter Reed hospital,” Trump said Friday in a videotaped statement released on Twitter less than 24 hours after he and his wife,
Melania, tested positive for the coronavirus. “I think I’m doing very well, but we’re going to make sure that things work out.”
Trump was experiencing fatigue, and the first lady was coughing with a headache on
Friday, the White House doctor said, describing the physical impacts of a White House coronavirus outbreak that has upended the nation’s capital and disrupted American politics one month before a presidential election.
Trump, who is 74, began taking a cocktail of drugs as a
“precautionary measure,” according to doctor Sean Conley, who provided only limited information about Trump’s condition or the reasons for his extended stay at Walter
Reed.
“In addition to the polyclonal antibodies, the President has been taking zinc, vitamin D, famotidine, melatonin and a daily aspirin,” Conley said in a White House memo Friday afternoon, describing Trump as “fatigued but in good spirits.”
Conley said Trump received an 8-gram dose of Regeneron’s polyclonal antibody cocktail via “infusion without incident.”
A few hours later, Trump walked to Marine One wearing a mask, then was transported to Walter Reed.
The president otherwise remained out of sight and
when their respiratory symptoms have progressed to the point where they are experiencing shortness of breath or chest pain.
Q: The White House said that President Trump is being given an antibody cocktail. What is meant by a cocktail? And is it normal procedure to give it this soon after a person has tested positive?
Smith: The cocktail neutralizes the virus. The cocktail used here is a combination of lab-made monoclonal antibodies that fight SARSCoV-2. It was made by Regeneron. There are about 20 different companies who are making similar types of antiCOVID-19 therapies.
The thought here is that multiple antibodies are stronger than one antibody, but that has not been proven yet. In fact, none of these monoclonal antibodies have been clinically proven to help keep someone with COVID-19 well.
There are clinical trials ongoing now to test if these monoclonal antibodies can keep people well, and the ACTIV-2 trial is specifically designed to test the use of these monoclonal antibod
ies in people with early COVID-19, like what Mr. Trump has.
Q: The FDA has authorized two emergency treatments for COVID-19: convalescent plasma and remdesivir. Under what circumstances would President Trump be treated with either?
Smith: Mr. Trump could have chosen to use convalescent plasma, rather than the
monoclonal antibody cocktail, since it has received Emergency Use Authorization (EUA) for the use of COVID-19. Although remdesivir also has this EUA, this drug has to be given intravenously and a few times a day, so it is now only used when someone is so sick as to be in the hospital.
Q: Is it likely that physicians know how much exposure President Trump had
to the virus, and will that be a factor in how sick he might get?
Ritter: The truth is that it takes only a single exposure for someone to get sick with COVID-19. There is no way to know how many people may have exposed President Trump to COVID-19. We only know for certain that he had at least one exposure. There is also no way to predict the severity of his illness based on his exposure(s).
Q. President Trump is 74 years old. Are people in their 70s at greater risk of complications from COVID-19 than those who are younger?
Smith: Yes. People over 55 are generally at increased risk for having bad complications like pneumonia and blood clotting. The risk goes higher every five years after age 55. The main complication is pneumonia. It can cause people to have trouble breathing. In some cases they have to be put on a ventilator.
But, in reality, there’s
only about a 20 percent chance that a person in their 70s who tests positive will need to be hospitalized.
Q. The White House said in June that President Trump, who is 6-feet 3-inches tall, underwent a physical exam that showed that he weighs 244 pounds and that he has a body mass index of 30.49. Do those types of measurements in people make it harder to fight COVID-19?
Smith: People who are heavier and have a body mass index greater than 35 are at higher risk for hospitalization. It is not quite clear why, but people who are heavier are more likely to have a stronger inf lammatory response to the virus, which causes the pneumonia to be worse.
Q: As noted, Mr. Trump took a physical this year that revealed that he weighed 244 pounds. Such weight can put a lot of stress on a person’s heart. Is there evidence that COVID is especially hard on a person’s heart?
Ritter: There is evidence that COVID-19 can have some detrimental effects on the heart, especially in seriously ill patients. But it is also important to note that obesity alone is risk factor for severe COVID-19 disease.
Q: First lady Melania Trump also has tested positive for COVID-19. Does the virus affect men and women differently?
Ritter: The symptoms and course of COVID-19 can be similar in men and women. Though studies have shown that men seem to be at higher risk for severe disease.
Q: Vice President Pence tested negative for the virus after the Trump announcement. Does that mean he is in the clear?
Ritter: Not necessarily. The incubation period for COVID-19 is 14 days. This means that it can take up to
14 days after an exposure for someone to develop symptoms and/or have a positive COVID-19 test.
If the vice president was exposed to the president during his illness, then he will need to quarantine for 14 days from the exposure date. This applies even in the setting of a negative test yesterday.
Q: Mr. Trump initially said on Thursday night that he was going into quarantine. What does that really mean? Is it the same as selfisolation?
Ritter: Isolation and quarantine are two different things. Isolation is for someone who has been diagnosed with COVID-19. A person in isolation stays away from everyone in their household, ideally with their own room and bathroom.
Per the CDC, isolation ends when it has been at least 10 days since a patient’s symptoms began and at least 24 hours of significantly improved symptoms. Quarantine, on the other hand, is what people do when they have had an exposure to COVID-19, but have not yet developed COVID-19 disease.
The quarantine is 14 days from the time of exposure. If the person in quarantine gets sick with COVID-19, they then start their own “isolation” period, as above.
Q. It is not yet known where President Trump contracted the virus. Is it likely that his staff will be able to find out through contact tracing?
Smith: It is unclear if contact tracing will ever to be able to find the complete path that led the infection to the president. I am sure he is in the room with a lot of people who are in other rooms with a lot of other people, etc.