UAB doctor who had COVID-19 would advise Trump to ‘go slow’

The treatment President Donald Trump is receiving for COVID-19 is probably the first of its kind and could help him improve quickly. But Dr. Michael Saag, an infectious disease expert at UAB who came down with COVID-19 back in March, would advise the president to “go slow.”

“The symptoms wax and wane, so there will be moments where he will feel pretty good, and he’ll think he’s through it, and then it will come back in a very haunting way 12 hours later,” Saag said. “The people who I see who suffer the most from fatigue are the ones who tried to do too much too quickly. So I would say definitely take it easy for at least the next week. The more he tries to do, the slower his recovery will be from the fatigue.”

Saag, a professor of medicine and infectious diseases at UAB, said much of Trump’s treatment, as gleaned from medical briefings, shows the strides physicians have made in the past six months in fighting coronavirus.

Trump entered Walter Reed Medical Center Friday, with reports emerging later of a spike in fever and fatigue. Doctors revealed that Trump experienced two incidents, on Friday and Saturday, where his oxygen levels dropped.

According to medical briefings, the president has been given the steroid dexamethasone on Saturday, in addition to remdesivir, an antiviral drug. He has also received an experimental antibody cocktail that is being tested by the drug maker Regeneron.

Remdesivir and dexamethasone are drugs that already have a track record of being used with COVID-19 patients, Saag said. The Regneron therapy, however, is new, and Saag said he didn’t know of any other patients who have used it in conjunction with remdesivir and dexamethasone.

To understand how the drugs work, Saag said its important to know how the virus attacks the body. SARS-CoV-2, which causes coronavirus, attacks the body, reproducing “like crazy” within the body and triggering a response from the patient’s immune system. The problem is that the virus complicates the immune system’s ability to “cool down,” causing many of the well-known symptoms – shortness of breath, coughing, fever.

Remdesivir is usually given intravenously for five days, twice-a-day, he said. The Regneron therapy attacks the spike protein of the virus, blocking the ability of the virus to enter cells in the body. Together, the two drugs are meant to keep the virus from replicating.

“To my knowledge, (Trump) is the first person in the world to receive the drugs together,” he said. “That said, it makes perfect sense to choose that approach, even though there is no data to support it.”

Dexamethasone takes on the other problem – that of an overactive immune system.

“After the immune system attacks a virus, it has a way of tapping the brakes and slowing down,” Saag said. “The COVID virus has an almost unique ability to interfere with the immune system’s shutting down. What you end up with, especially in people who get older, there’s an out-of-control immune system response that makes people sicker and sicker. Dexamethasone cools that immune system response down.”

Saag said when he was ill in March, the thinking on COVID-19 was different. The conventional wisdom was not to prescribe steroids, with the belief it would worsen the condition. Remdesivir was only beginning trials, and the Regneron therapy wasn’t available.

“The progress we’ve made in the last six months in treatment has been spectacular,” he said.

Earlier today, Trump recorded a short video for supporters, saying he has a new perspective on the virus.

“It’s been a very interesting journey. I learned a lot about Covid,” Trump said in the video. “I learned it by really going to school. This is the real school, this isn’t the let’s-read-the-book school. And I get it and I understand it, and it’s a very interesting thing and I’m going to be letting you know about it.”

Shortly after, he rode past supporters outside the hospital in a sport utility vehicle, waving to the crowd while wearing a mask.

Still, Saag said, despite the demands of the office and the Nov. 3 presidential election, the president is going to need rest. Because of the unique nature of his therapy, there isn’t a clear track record on the long-term effects. And while COVID-19 affects each patient differently, long-term fatigue is an almost universal symptom. Saag said that even after he had recovered from the acute symptoms, he was still feeling fatigue three weeks later. In some people, it lingers for months.

“My sense is that he will have that,” he said. “If I were to guess, I would suspect that fatigue will be plaguing him until the election…The more he tries to do, the slower his recovery will be from the fatigue, I think it’s pretty fair to say that. To disengage is in some ways impossible for a president, but just to do the essential things and rest the rest of the time.”

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