COVID-19: How Trump’s Physicians Use Dexamethasone to Improve His Condition

President Donald Trump’s condition has continued to improve since being taken to the hospital Friday due to symptoms from a COVID-19 infection, White House physician Sean Conley told reporters on Sunday.

Conley had previously said he was using a “multi-prong” approach to treat Trump. He said Sunday that included the steroid dexamethasone in response to Trump’s blood oxygen level dropping twice.

An affordable, widely available steroid, dexamethasone has shown promise in improving survival outcomes in COVID-19 patients.

Although the British government has authorized its use among some patients, it remains unclear how beneficial the treatment may be for less severe COVID-19 cases. Further, it has not been peer-reviewed or replicated in other studies.

“This is a significant improvement in the available therapeutic options that we have,” said Dr. Anthony Fauci, the United States’ top infectious disease expert.

What we know about the potentially lifesaving treatment:

What is dexamethasone?

Usually prescribed as an oral or intravenous steroid, dexamethasone is a general-purpose anti-inflammatory and anti-swelling drug used for a variety of conditions, said Dr. Onyema Ogbuagu, an infectious disease doctor and associate professor of medicine at Yale, in June.

Like other steroids, however, “it is a non-specific treatment not necessarily targeting a single, specific pathway of inflammation or swelling,” Ogbuagu says. That has its drawbacks.

How is it used to treat COVID-19 patients?

Generally, COVID-19 comes in two phases, explained Ogbuagu.

“People get the virus, it replicates, and that’s the first phase of the illness,” he said. “Afterward, around 10 days into the infection, people start to produce antibodies and inflammatory reactions to the virus.”

These inflammatory chemicals can sometimes create severe COVID-19 complications, such as acute respiratory distress syndrome, which makes it difficult for oxygen to enter the bloodstream and reach organs.

Patients with severe COVID-19 complications saw significant benefits with dexamethasone in the United Kingdom study. These patients took it for 10 days, either orally or via IV.

As of June, it had reduced deaths by 35% in patients who needed treatment with breathing machines and by 20% in those needing supplemental oxygen. It did not appear to help less ill patients.

Trump is receiving lots of medical care. Some doctors wonder if it’s too much.

Are there complications?

Ogbuagu notes that timing and selectiveness among patients is critical to ensure dexamethasone is properly used as a treatment for COVID-19.

Early findings suggest COVID-19 patients who do not have severe symptoms, such as requiring a respirator, should not take dexamethasone.

“The downside of steroids is that it’s not selective,” Ogbuagu said. “It’s a double-edged sword that may hinder your body’s ability to fight the virus.”

He noted that some studies have found higher mortality rates in people who used steroids, since they inhibit the body’s immune response to the virus.

The World Health Organization and other organizations advise against using steroids earlier in the course of illness because they can impede clearing the virus.

Ogbuagu also says that steroids, in general, may cause some severe side effects, such as new or worsening diabetes, as well as psychosis or emotional disturbance.

What does it mean for the president?

“It is common for people who hold positions of stature to get more aggressive care because there’s pressure to give someone everything imaginable. I would hope his physicians are being very deliberate in the treatment,” said Dr. Russell Buhr, a professor of pulmonary and critical care medicine at the University of California, Los Angeles.

That could explain why the president is receiving relatively aggressive treatment for someone whose physician described him as “doing very well” on both Saturday and Sunday.

But Buhr said that he doesn’t “think we can speculate on the reasons behind the care.”

Yahoo