“Feeling really good!” the President of the United States of America, Donald Trump, tweeted on Monday, 8 October, just three nights after he was first diagnosed with COVID-19.
Upon discharge from Walter Reed Hospital, he told Americans, “Don’t be afraid of COVID. Don’t let it dominate your life. We have developed, under the Trump Administration, some really great drugs & knowledge. I feel better than I did 20 years ago!” Throughout the address, he did not have a face mask on.
As Trump downplays the threat from COVID-19, a disease that has killed more than a million people globally and more than 212000 in the US alone, experts have warned that he is not ‘out of the woods’ yet and could still face serious health risks.
FIT speaks to Dr Sumit Ray, Head of Department, Critical Care Medicine at Holy Family Hospital, Delhi, who breaks down the treatment offered to Donald Trump during his hospital stay, what it indicates about his condition, and why it is premature to assume he is already out of danger.
Could you take us through the medicines offered to him and explain when these are typically used for COVID-19 patients?
Dr Sumit Ray: He’s in the ‘viremia’ stage, which is the early phase of the disease when the virus is still in the body. In this phase, probably there is a role of remdesivir - an antiviral. Though it doesn’t have very strong evidence behind it, there is still some proof to suggest that remdesivir reduces the length of stay in the hospital.
Second, he has been given monoclonal antibodies - a cocktail of drugs that boosts immunity by injecting semi-synthetic antibodies into your body. This is still in the experimental phase, and hasn’t been found very effective in acute viral infections like dengue and influenza as well. This is because these would theoretically work best even before the symptoms appear and as soon as the virus attaches to the cells in the body. So, you have to almost preemptively know that the virus is entering the body and give the antibodies for it to be most efficient. These monoclonal antibodies, therefore, have been useful more in chronic slower diseases in rheumatology and immunology, so they are pushed and promoted more by those specialties. But in acute infections, these have not yet been successful.
Another medication he has received is dexamethasone, which is a steroid. Dexamethasone has shown benefit in those COVID patients who required oxygen or mechanical ventilation. We are not yet sure if Trump required oxygen because his team of doctors say different things at different points of time. The second worry with the use of this drug is that if he is requiring a steroid and oxygen support so early in the disease, that’s a worrying sign about significant lung damage. Usually, the severe lung damage happens, if at all it happens, is seen in the slightly later stage of the disease as the imbalanced immune response in some patents causes the worsening damage to the lungs. This is when we would want to modulate the immune system using these steroids. Therefore, putting him so early on steroids could be a worrying sign.
He was discharged in just four days. What does that indicate?
As I said earlier, the phase of viremia is sometimes the least dangerous stage. What we are actually finding in COVID, and there is data to suggest this as well, that the real worsening happens after 7-10 days of the infection or the symptoms beginning, which is related to our own imbalanced immune response.
Most of us have a very balanced immune response and we get a very mild illness and may not even realize at times. But even among those who have a moderate or severe disease and require oxygen because of an inappropriate response of the immune system, this usually happens in the second stage. This stage is going to come later for Trump.
So, it is not time to say yet that he is out of danger and everything is going to be fine. He could himself be infected, and he should be isolated and quarantined and not be moving around publicly.
How dangerous is the messaging he is giving to all? Can the threat from COVID-19 be downplayed?
Dr Sumit Ray: Most people who get the infection do not get a severe illness. But those who are at high risk because of multiple reasons and co-morbidities, for example, in the Indian context, diabetics, obesity or chronic kidney disease, they have a higher risk of getting a severe form of the illness which could be very dangerous.
The problem with Trump is that he kind of tom-toms things even before they have actually settled down. He made it into a political gesture saying that he has almost beaten COVID and we shouldn’t be worried about the disease. For most of us, as I said, it won’t be a very serious illness, but he needs to be more careful for himself as well as the people he is talking to. It’s not time to celebrate yet that he is out of danger.
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