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Doctors Question Trump’s Experimental Covid Treatment and Dosage

Summary:
Casual_Observer7 hrsTrump's doctors try to downplay his condition, but blow up the timeline of Trump's illness Donald Trump was flown to Walter Reed National Military Medical Center on Friday evening. At the time, he was apparently suffering from coughing, fever, lethargy, and some difficulty in breathing. The decision to send him to the hospital at that point appears to have been made not just out of an abundance of caution, but because, as The Washington Post reports, with Trump’s condition worsening, they wanted to move while Trump was “still able to walk to Marine One on his own.” Even at that point, they were concerned about the “political optics.” On Saturday morning, Trump’s physician Dr. Sean Conley provided an update on his condition. Appearing 40 minutes late for a scheduled

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Casual_Observer

Trump's doctors try to downplay his condition, but blow up the timeline of Trump's illness

Donald Trump was flown to Walter Reed National Military Medical Center on Friday evening. At the time, he was apparently suffering from coughing, fever, lethargy, and some difficulty in breathing. The decision to send him to the hospital at that point appears to have been made not just out of an abundance of caution, but because, as The Washington Post reports, with Trump’s condition worsening, they wanted to move while Trump was “still able to walk to Marine One on his own.” Even at that point, they were concerned about the “political optics.”

On Saturday morning, Trump’s physician Dr. Sean Conley provided an update on his condition. Appearing 40 minutes late for a scheduled report, Conley said that Trump was “doing very well,” before introducing an entire team of specialists on respiratory and pulmonary care, along with infectious disease experts. Conley reported that Trump’s cough and nasal congestion were “resolving and improving.” Additional physicians reported that Trump was receiving “outstanding” and “state of the art” care—all of which is a world away from the crowded emergency rooms and hastily expanded ICUs faced by many COVID-19 patients. Conley indicated that Trump is receiving “the state of the art and beyond.”

One thing that immediately stood out—Conley said that it had been 72 hours since Trump’s diagnosis, which put that diagnosis well over a day earlier than anything revealed to the public. If Conley’s timeline is correct, Trump was already aware he was positive during a rally on Wednesday and a face-to-face fundraiser on Thursday.

Trump was said to no longer be running a fever. Conley refused to say how high Trump’s fever had been. Conley denied earlier statements that Trump had experienced breathing difficulty, saying that he had never had an issue with breathing. Asked about comorbidities, Conley described Trump as “slightly overweight” while insisting that his health was good.

The team confirmed that Trump had received both remdesivir and an experimental antibody treatment. Multiple attempts to get the doctors to respond to whether or not Trump had received oxygen were met with the answer “he’s not on oxygen right now” which is a pretty good indicator that Trump was given oxygen earlier. The longer reporters tried to get a straight answer, the more that Conley squirmed away from providing the information, but it seemed clear that Trump had received oxygen on Friday at the White House. Similarly, questions about Trump’s heart and lungs were met with answers that were more about the tests that Trump had received, than any results on those tests.

Conley refused to provide a date on which Trump last had a negative test, continuing to obscure the point at which he became infected and his status over the last week. The rapid decline of Trump’s condition is a strong indicator that he has actually been sick for several days. Considering that Trump is supposedly tested each day, this also suggests that the results of those tests may have indicated he was positive well before that information was released to the public—and at a point where Trump was still engaged in rallies and fundraising.

Previous reports indicated that Trump has received two treatments: antiviral drug remdesivir from pharmaceutical company Gilead Sciences, and monoclonal antibodies “cocktail” developed by Regeneron Pharmaceuticals.

Remdesivir emerged in May as a treatment which showed “a clear-cut, significant, positive effect in diminishing the time to recovery.” It’s been subject to an FDA Emergency Use Authorization for months, and has become widely used. There have been numerous studies about the use of the antiviral drug, and the best time in the infection for it to be administered. The drug remains expensive—over $3,000 for a single course of treatment—but it does seem to be effective for a significant percentage of COVID-19 patients and has been widely administered.

The monoclonal antibody treatment from Regeneron is something entirely different. It is not the subject of an EUA, and is supposed to be used only as part of restricted studies. At this point, there are only preliminary results from limited human trials. That preliminary data indicated that the treatment could reduce the viral load if administered early, before people develop their own antibody response to the virus. Generally, that means within the first week following exposure.

For Trump to receive this treatment involves invoking “compassionate use,” a decision that’s usually limited to patients in extremis. But since the treatment is best used soon after exposure, it’s unclear how compassionate use applies in this situation. Another unusual factor: Trump appears to have been given an injection an 8 gram infusion of the treatment, but the initial report from Regeneron specifically notes that a dose of 2.4 grams was just as effective. So why Trump was given such a large dose is unclear.

What’s not mentioned in discussion of Trump’s treatment is any sign that he’s been given hydroxychloroquine, much less been injected with either disinfectant or UV light. Trump’s treatment seems to reflect the best available medical advice at this point — including providing him with an experimental treatment that is decidedly not available to more than a handful of patients.

Mike Shedlock
Mike Shedlock (Mish) is a registered investment advisor representative for SitkaPacific Capital Management (http://www.sitkapacific.com/). Sitka Pacific is an asset management firm whose goal is strong performance and low volatility, regardless of market direction.

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