When Donald Trump returned to the White House and immediately removed his mask in a fresh act of pandemic denialist theater late Monday, he did so after being administered an unusual and potentially dangerous mix of drugs to treat his novel coronavirus infection.
It’s not clear yet how effective the drug cocktail might be in reducing the severity of Trump’s COVID-19 case and attendant symptoms; medical experts are increasingly skeptical of any information coming out of the White House. It’s also not clear whether the 74-year-old president is enduring side-effects that could weigh on his stability, mental clarity, and judgment in the coming days. But major side-effects are certainly possible from the mix of drugs he’s taken, experts said.
Welcome to Rabbit Hole, where we dive deep on the biggest story. It’s for Beast Inside members only. Join up today.
ADVERTISEMENT
Trump announced he was positive for SARS-CoV-2 early Friday, after reportedly showing symptoms by Thursday afternoon.
His physician, Sean Conley, began treating the president—who received supplemental oxygen at the White House—before Trump checked into Walter Reed National Medical Center on Friday. The first major COVID-19-targeted treatment he received, according to Conley, was an experimental monoclonal antibody cocktail from New York-based pharma Regeneron.
The drug, which has not received approval for widespread use by the FDA, includes at least two lab-grown antibodies that attach to the spike protein on the surface of the novel coronavirus, potentially preventing the proteins from attaching to healthy cells and causing a new infection—or worsening an existing one.
Later, at Walter Reed, Trump was also said to get doses of the antiviral drug Remdesivir, and the anti-inflammatory steroid dexamethasone. Remdesivir and dexamethasone are well-established drugs and have FDA approval for routine treatment of other diseases, but they haven’t been fully tested for treating COVID. The FDA allows clinicians to administer drugs like Remdesivir to coronavirus patients on a limited basis under separate emergency-use authorizations.
“We simply do not know what the ramifications are of using such a trio of interventions, all involving investigational drugs,” Lawrence Gostin, a Georgetown University global-health expert, told The Daily Beast.
The U.S. Food and Drug Administration and the White House did not immediately respond to requests for comment. The Trump campaign declined to comment on the record.
The combination of monoclonal antibodies, Remdesivir and dexamethasone was a puzzling one, experts said, even if throwing the kitchen sink at treating the most powerful person on the planet wasn’t exactly shocking.
Among other wrinkles, each drug works best at a different stage of an infection or potential infection, but Trump got them nearly simultaneously. “Very few people in the real world get those three drugs,” Irwin Redlener, the founding director of Columbia University’s National Center for Disaster Preparedness, told The Daily Beast.
Monoclonal antibodies are most effective at preventing an infection, not treating it. But Trump apparently received the antibody cocktail after testing positive for the virus. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, was blunt about the drug’s potential to help Trump. “Regeneron is not going to work,” Offit told The Daily Beast. “It’s been given too late.”
A Regeneron spokesperson told The Daily Beast that, so far, trials have not indicated any risk from mixing the antibody cocktail with Remdesivir or dexamethasone. But they stressed that the company has only analyzed data from 275 test subjects. “No one was taking these other drugs in that group,” the spokesperson added.
Remdesivir by itself “makes sense,” Offit said. But that drug works best at reducing milder infections. California-based pharma Gilead, which makes Remdesivir, did not immediately respond to a request for comment.
Dexamethasone, by contrast, is usually reserved for patients who are suffering a self-destructive hyperactive immune response—a common effect of serious COVID. The generic steroid can save the lives of very sick people, but it also can have serious side effects. “It blunts the immune system across the board,” Offit said. “But it also increases the risk of other infections.”
Taken together at roughly the same time, the three drugs amount to “a very confusing cocktail that’s uncharted territory for someone with COVID,” Redlener argued.
It’s possible Trump’s doctors felt compelled to treat the president with all the most powerful drugs all at the same time because, well, he’s the president and he shouldn’t be mouldering in a hospital. “If it weren't the president, I would doubt very much that any other patient would receive that combination of unproven treatments simultaneously,” Gostin said.
Of course, there’s an alternative explanation. Maybe Trump has been much sicker than he or anyone around him is letting on and his doctors panicked, as has been widely speculated. “My scientific but not clinical perspective suggests to me that he may be sicker than has been disclosed… and they decided to try everything,” Pierre Mourad, a University of Washington bio-engineer, told The Daily Beast.
Trump has certainly been eager to project an image of strength—however dubious—even as he convalesces. He briefly left Walter Reed on Sunday in order to drive past some supporters who had gathered nearby. The car trip drew criticism, as the president’s special vehicles are hermetically sealed against chemical attack, potentially boosting the chance that Trump might infect the Secret Service or other personnel inside with him.
The recovery tour continued when the president returned to the White House on Monday evening after tweeting, “I feel better than I did 20 years ago!” But a three-night stay at a hospital might not be long enough for an elderly, obese patient with a potentially serious case of COVID-19.
The coming days could be critical for the president’s health. According to the U.S. Centers for Disease Control and Prevention, serious COVID cases can reach their most dangerous stage a week or more after infection. “Clinicians should be aware of the potential for some patients to rapidly deteriorate one week after illness onset,” the agency has warned.
Even if Trump’s drug cocktail works and he doesn’t suffer the worst effects of COVID, there could be serious side-effects. Dexamethasone in particular is known to cause confusion, disorientation, and severe headaches in addition to suppressing a recipient’s immune system and making them more vulnerable to other diseases.
Considering Trump could be very sick and he’s been on dexamethasone, it will be critically important to observe the president for signs of impaired cognition.
“Is the president experiencing consequences of both COVID and any therapies used that may undermine his executive functioning?” Redlener asked. “If so and that’s reflective of any judgment issues that are more acute than his usual state, then we need the vice president to be in charge now.”
