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Trump’s covid-19 medical treatment makes no sense

The medical obscurity began Friday, when we learned of the president’s diagnosis but got no information regarding prior tests and their results — important facts when trying to provide contact tracing and inform people if they might be at risk for a potentially deadly illness. Besides the positive test Thursday night, we then learned, Trump might have had symptoms earlier that day at a fundraiser in Bedminster, N.J., along with “low grade fevers and a cough” early Friday, which indicated that he had covid-19, the disease caused by the SARS-CoV-2 virus.

Behind the scenes, White House physicians, who can consult directly with any expert in the world they might want to reach, discussed potential treatments and opted for an experimental medication, an antibody cocktail made of artificial molecules that fight the spread of the virus in the body. Regeneron’s monoclonal antibody cocktail is not yet approved by the Food and Drug Administration; the treatment is not available to anyone outside of clinical trials. The drug was procured swiftly and directly from the company through the FDA’s compassionate use program, which is usually reserved for immediately life-threatening conditions or serious disease when no comparable or satisfactory alternative therapy options are available. That his doctors would risk using a drug that has not yet demonstrated its efficacy was a signal that either the president’s condition was much more serious than the White House was admitting or that his course of treatment was taking unusual turns.

Once Trump was admitted to Walter Reed National Military Medical Center on Friday night — ostensibly out of an abundance of caution — the president also received remdesivir, an expensive antiviral drug that’s in short supply for the nation’s 30,000 other hospitalized covid-19 patients, with an emergency use authorization (not full approval) from the FDA for patients who are critically ill with the disease.

His medical team never explained why they chose to start that treatment, either. On Saturday, White House physician Sean Conley assured the nation that Trump was not “presently on supplemental oxygen,” without answering questions about whether he ever had been; we later learned that the president had at least two episodes of lower oxygen saturation. Those incidents prompted the addition of a high-dose steroid, dexamethasone, which is also approved by the FDA under an emergency use authorization but is also reserved for patients with severe covid-19 who require supplemental oxygen. Dexamethasone also has a significant number of side effects, particularly for older patients, who can often experience delirium or psychoses as a direct result of the steroids.

As a doctor who’s treated covid-19, the decision to use those three major agents — an antibody cocktail, an antiviral drug and a high dose of steroids — indicated one thing clearly to me: Trump must have been getting sicker in the hospital. Each of the three major drugs used attack a different aspect of the disease; they attack the virus itself as well as the body’s response to the virus. But all the treatments have