Local doctors suggest case appears serious
Houston doctors said Friday that President Donald Trump stands a good chance of recovering from COVID-19, but they added that his hospitalization and quick treatment with an experimental drug suggest his case is more serious than initially assumed.
Trumpwas taken by helicopter to Walter Reed Hospital in Bethesda, Md., hours after the
White House called his symptoms mild and said he would “continue carrying out his duties without disruption while recovering.” He has fever and fatigue, two classic symptoms of the disease.
“That he’s hospitalized means his condition isn’t mild,” said Dr. Faisal Masud, medical director of critical care at Houston Methodist Hospital. “Given the toll fever and fatigue can take on an obese 74-year-old, his case will require high level of monitoring and care.”
The diagnosis of Trump, who flouted his own experts’ advice about the coronavirus, nevertheless shocked conservatives and liberals alike, partly because of the pandemic’s recent decline in many parts of the country, Houston and Texas among them.
It also showed the extraordinary speed atwhich things can go wrong if people don’t follow the recommended preventative steps — the White House spread,
Trump’s progression from asymptomatic to mildly symptomatic to hospitalization in no more than a couple days.
“Here’s the lesson to be learned,” said Dr. James McDeavitt, dean of clinical affairs at Baylor College of Medicine. “The virus is still as active, virulent and infectious as ever. It’s also very democratic: It can impact the most powerful person in the world and the most disadvantaged. If we don’t mask up, we may have to shut down again.”
Though 40 percent to 50 percent of people infected with COVID-19 never develop symptoms and 80 percent of those who do recover, the odds get worse for people when they’re older and heavier. Masud, for instance, rates Trump’s chances as “good, not excellent” because he’s in his mid-70s and has a body mass index of 30, a number that fits into the obese classification.
According to the Centers for Disease Control and Prevention, people 65 to 74 years of age have a 90 times greater likelihood of dying from COVID-19 than those 19 to 28. People 75 to 84 have have a 220times greater likelihood.
Also, that Trump developed symptoms so quickly suggests that he has an abundance of the virus, said one doctor. Such a “high viral load” is typically more difficult to treat.
But doctors interviewed by the Chronicle acknowledged Trump may have indeed been taken to Walter Reed “out of an abundance of caution,” as a White House statement said. Robert Atmar, a Baylor infectious disease doctor, said that “on the plus side, the infectionwas identified early, Trump was started on potentially effective therapy and he has top doctors taking care of him.”
The choice of an experimental treatment, a monoclonal antibody cocktail, was something of a surprise given first-line, early-stage therapy is typically two drugs granted emergency approval — remdesivir, an anti-viral developed for Ebola that has shown modest benefits; and convalescent plasma therapy, which is based on the idea that transfusing patients with the blood plasma of recovered patients transfers its healing power. Plasma therapy has received a lot of attention, but the evidence for it is still limited.
Doctors said the antibody cocktail — Regeneron’s REGN-COV2 — was a reasonable choice. Though still in clinical trials, it is considered highly promising, particularly after a recent company news release reported that trial participants who got the cocktail cleared the virus and got over their symptoms significantly faster than those on a placebo. The trial has not yet been published.
Methodist and McGovern Medical School at UTHealth are participating in REGN-COV2 trials.
Antibody cocktails are synthetically produced versions of proteins made by the immune system that target the spike protein that the virus uses to attach to and infect cells. Ed Jones, director of the Methodist Research Institute, calls it “the next evolution of plasma therapy, more specific to the virus, able to get more shots on goal.” He said that’s what he would recommend to friends if they get COVID-19.
Trump’s physician confirmed that Trump was given REGN-COV2 intravenously at the White House. He did not confirm a report Friday that Trump was also given remdesivir. The two drugs are considered compatible, oneworking on the virus, the other with the immune system.
White House officials said Trumpis not taking hydroxychloroquine, the antimalarial drug he claimed to be using as a preventative during the summer. Stella Immanuel, the Houston doctor-minister who touts the drug that studies have found does not show a benefit, tweeted Friday that she thought the person who told Trump to “stop taking HCQ should be punched in the face.”
The best results for COVID-19 have come fromdexamethasone, an approved steroid used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects. But if it were used to treat Trump, it would be a sign his disease had become severe. The drug tamps down an out-ofcontrol immune response, a problem in severe cases. In less severe cases, a strong immune response is needed to clear the virus.
In severe cases, dexamethasone has been shown to reduce death by about a third.
“The bottom line is we don’t have enough data to know the severity of Trump’s case,” said Dr. Bela Patel, a critical care medicine specialist at UTHealth and Memorial Hermann Hospital. “People his age do recover, but his age and weight definitely put him at higher risk.”