U.S. President Trump waves from the back of a car in a motorcade outside of Walter Reed Medical Center in Bethesda, Maryland on October 4, 2020. Credit – Alex Edelman—AFP/Getty Images
With each day since U.S. President Donald Trump reported that he tested positive for COVID-19, his doctors have added a new major therapy to treat the disease, for a total of three at this point.
On Friday—the same day that Trump said he tested positive—the President received an experimental combination of two monoclonal antibodies to help his immune system fight the coronavirus infection, according to his physician, Sean Conley. The next day—after he was hospitalized at Walter Reed National Military Medical Center—he received the drug remdesivir, which blocks the coronavirus’s ability to make more copies of itself. Remdesivir is not approved by the U.S. Food and Drug Administration, but has received emergency use authorization for treating COVID-19. On Sunday—day three—Trump’s doctors revealed he’s also taking dexamethasone, a corticosteroid typically administered to control the inflammatory response common in more advanced stages of the disease.
While the monoclonal antibodies are designed to be used in non-hospitalized patients early in their infection—as the President apparently was when he received them—remdesivir was originally only authorized for hospitalized patients who are moderately to severely ill and in intensive care. That authorization has only recently been expanded, on Aug. 28, to include any hospitalized patient. Still, even hospitalized patients who may not need intensive care and receive remdesivir are generally further along in their disease than the President appears to be. Furthermore, patients who receive the drug are generally enrolled in trials, so researchers can learn more about its safety and effectiveness. In rare exceptions, doctors can apply for compassionate use outside of these studies, which is presumably what Trump received. (In the early months of the pandemic, many doctors applied for this special dispensation until larger studies were established to increase access to the medication after it showed encouraging results.)
“The thing that is odd is that in most trials people usually have symptoms eight, nine or 10 days before they are enrolled in the trial,” says Dr. Walid Gellad, director of the center for pharmaceutical policy and prescribing at the University of Pittsburgh, about remdesivir. “From that standpoint, it’s a little unprecedented that anyone so early [in their disease] would be receiving it.”
Similarly, dexamethasone, a steroid approved to reduce inflammation and suppress overactive immune reactions triggered by autoimmune diseases, is also recommended for patients long into their battle with COVID-19 and who are showing more severe symptoms. The steroid seems to reduce the inflammation that can compromise respiratory tissues and ultimately make it difficult for patients to breathe. But both the U.S. National Institutes of Health and the World Health Organization recommend dexamethasone only for hospitalized patients who need supplemental oxygen or are on a ventilator. The NIH guidance specifically advises