U.S. President Donald Trump wears a face mask while leaving the White House for Walter Reed National ... [+]
One thing’s for sure about President Donald Trump’s recent Covid-19 coronavirus infection diagnosis. Every bit of news that emerges about his condition is going to get analyzed and re-analyzed more than Kim Kardashian’s clothes. And the latest news is that he has received remdesivir, an antiviral treatment. This is what Sean Conley, DO, the Physician to the President, said in a statement shared last night by White House Press Secretary Kayleigh McEnany via a tweet:
The statement is a bit like that “Blue (Da Ba Dee)" song from Eiffel 65. It didn’t say a whole lot. Trump is now at Walter Reed National Military Medical Center, which is in line with the fact that a Covid-19 coronavirus infection is not just like a cold, a case of sniffles, or even a routine case of the seasonal flu. It’s not as if Walter Reed necessarily has more tissues or toilet paper than the White House. The trip there reflects heightened concern and access to more medical equipment and treatments than the White House can offer.
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“Doing very well” is not an official medical term and can be quite relative and subjective. Certainly the phrase sounds better than “doing very badly.” Nevertheless, “doing very well” is about as specific as the phrase “it me.” The only real substantive statements are that Trump is “not requiring any supplemental oxygen” and that the doctors “have elected to initiate Remdesivir therapy.”
“Not requiring supplemental oxygen” suggests that Trump doesn’t have significant lung problems from the infection. Assuming that you are not a block of cheese, you need oxygen to survive. You breathe in oxygen through your respiratory tract and lungs. Your lungs then swap the oxygen into your bloodstream where it is carried by the hemoglobin in your blood cells to different parts of your body. Oxygen to your cells is like chocolate. They can’t survive without it.
Typically, between 95 to 100 percent of your hemoglobin should be carrying oxygen. Levels may fall below this range when your lungs can’t breathe in enough oxygen or lung damage prevents your lungs from transferring this oxygen to your bloodstream. If any of this occurs, doctors may choose to put you on supplemental oxygen, that is oxygen beyond what is in the air. This may be via a nasal canula or a mask.
Getting remdesivir certainly isn’t like getting Tylenol. You typically won’t say, “I am not feeling that great. I could use some avocado on a tray-shaped piece of carbohydrate infused with walnuts and cheese with early girl tomatoes, salt, and some remdesivir.” Remdesivir is an intravenous medication. It costs about $520 per vial, based on the price announced by Gilead Sciences in June. This would mean five days of the stuff could set you back about $3,120. That’s about how much 520 pounds of cole slaw would cost to give those hoarding cole slaw some perspective. Not everyone in America happens to have that kind of cash laying around or the BTS-autographed shirts to sell to raise that amount. That being said, if you are on certain U.S. government programs, you could get it for cheaper. And Trump is on a government program.
Gilead Sciences Inc. developed and manufactures remdesivir. (Photo by Liu Guanguan/China News ... [+]
Gilead Sciences originally developed remdesivir in 2009 as an antiviral treatment against hepatitis C infections. That didn’t work out so well. Since then, doctors have tried using remdesivir versus other viruses such as the Ebola virus disease, the Marburg virus, and now the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2).
Remdesivir is still considered an investigational treatment for SARS-CoV2. “Investigational” does not mean that it should be widely used. If someone says that they cooked an “investigational dish” for you, be wary. An “investigational treatment” means that there isn’t yet enough data to justify its broader use beyond clinical trial settings and special cases. Trump, however, in many ways, is a special case.
The treatment is supposed to act by binding to the RNA-dependent RNA polymerase of the SARS-CoV2. This is an enzyme that the virus uses to reproduce itself. Lab experiments have shown that binding to the enzyme can blocks the ability of the virus to reproduce itself. In short, the medication is supposed to prevent the virus from replicating, doing the nasty, knocking spikes, or whatever term you want to use for making new copies of itself. Keep in mind that what works in the lab doesn’t necessarily work in the “real world” in humans.
Scientists have found that rhesus macaque monkeys who received remdesivir soon after being infected with SARS-CoV2 ended up having less virus in their lungs and less lung damage. A publication in the scientific journal Nature described these findings. Of course, Trump is not a rhesus macaque monkey.
So what’s the evidence that remdesivir can work in humans against SARS-CoV2? Well, most of the evidence so far comes from the Adaptive COVID-19 Treatment Trial (ACTT-1), a multinational, randomized, placebo-controlled trial that included 1,063 patients hospitalized with COVID-19 and evidence of lower respiratory tract infection. According to a publication in the New England Journal of Medicine, those treated with IV remdesivir for 10 days (or until they were discharged from the hospital) had a shorter time to recovering from the infection (a median of 11 days) than those who had received placebo (15 days). There were also differences in mortality by 14 days: 7.1% of those remdesivir did not survive by 14 days compared to 11.9% of those who had received placebo. That meant that those receiving remdesivir were 70% as likely to have died. Typically, patients will receive remdesivir for five days straight. In some cases, as in ACTT-1, this can be extended to up to 10 days. All of this is “encouraging” but doesn’t mean definitely that remdesivir will help everyone with Covid-19. It also doesn’t mean that it is a cure for Covid-19.
If you want the most reliable information in the U.S. on possible Covid-19 treatments, go to the National Institutes of Health (NIH) COVID-19 Treatment Guidelines. Yes, these are more reliable and accurate sources than that dude on Facebook or an economics adviser who has suddenly turned into a supposed infectious disease expert. According to these guidelines, “There are insufficient data for the Panel to recommend either for or against the use of remdesivir in patients with mild or moderate COVID-19.” The guidelines also state, as of October 3, “because remdesivir supplies are limited, the Panel recommends prioritizing remdesivir for use in hospitalized patients with COVID-19 who require supplemental oxygen but who do not require oxygen delivery through a high-flow device, noninvasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).”
So can you divine much about President Trump’s condition from this information alone? Not really. Trump is not an everyday American. That’;s for sure. He will have access to treatments, resources, and expertise that most people wouldn’t. Hearing that Trump is getting remdesivir may not be the same as hearing that your friend is getting the same treatment, unless your friend somehow has access to the nuclear codes. Doctors may give Trump medications as precautionary measures in ways that don’t quite follow guidelines for everyone else.
Plus, everything that you hear in a statement from Trump’s physician will probably have been thoroughly vetted by others in the Trump administration, more thoroughly than an outfit on the TV show Project Runway. In effect, these announcements are on a “tape delay.” The information that you get may already be old news.
Over the ensuing week, don’t expect real-time information about the President’s condition. There aren’t play-by-play announcers providing updates on the President’s breathing and bowel movements. Only Trump’s doctors, whoever they may all be, will know for sure what’s happening. One thing’s clear. The White House seems to be treating Trump’s Covid-19 coronavirus diagnosis quite seriously. This virus is not going to just go away.
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