How Trump's Covid-19 treatment is far different from what most American patients get

Source: CNN:::

October 5, 2020 at 19:29

How Trump's Covid-19 treatment is far different from what most American patients get

While many Americans have struggled to get Covid-19 tests or test results without massive delays, Trump has been "the most tested man in America," White House press secretary Kayleigh McEnany said.

(CNN) - If you get sick with Covid-19, don't expect to get the same treatment as President Donald Trump.

It may seem obvious the country's leader would receive extra attention and the best care possible. But some of the treatment he's getting isn't even available to the general public.

That fact may have been lost on Trump when he told millions of followers "Don't be afraid of Covid."
"I feel better than I did 20 years ago!" he tweeted Monday -- not mentioning that other Americans with the deadly disease don't have access to the drugs and treatment he received.

Before he was hospitalized Friday, Trump received Regeneron's experimental antibody therapy -- which may reduce levels of coronavirus and has shown promising results in a trial involving 275 patients.

But the treatment has not yet received emergency use authorization from the Food and Drug Administration. Biotech company Regeneron said it provided the drug after receiving a "compassionate use" request from Trump's doctors.

For most people, "getting access to not-yet-approved drugs through a compassionate use request can be a long and challenging process," the Mayo Clinic said, listing a series of requirements that most patients would need to meet.

But Trump received the therapeutic Friday, just one day after he tested positive for Covid-19, according to the White House press secretary and Trump's doctor.
"Of course, this is the President of the USA. He is going to get the kitchen sink thrown at him medically, offered all there is -- whether it's authorized under emergency use or not, in the case of the antibody treatment," epidemiologist Dr. Seema Yasmin said.

"But then there are (almost) 210,000 Americans who have died over the past few months because the pandemic response has been so bad. And they certainly didn't get access to this kind of treatment."

That's not the only advantage Trump has compared to the hundreds of thousands of other Americans who have been hospitalized with coronavirus.

Trump may be 'the only patient on the planet' to get these 3 drugs

In addition to the experimental antibody therapy, Trump was also given remdesivir and dexamethasone.
"The President might be the only patient on the planet ever to receive this particular combination of medicines," said Dr. Jonathan Reiner, a professor of medicine at George Washington University.

Remdesivir has not received FDA approval for the treatment of Covid-19, but it's gotten an emergency use authorization from the agency.
Clinical trials have shown that a five-day course of remdesivir can speed recovery times in some patients. But the antiviral can also cause side effects such as anemia, liver toxicity and kidney toxicity.

Remdesivir is administered by IV, so patients are typically hospitalized when getting the five-day course.

But Trump's doctors let him go home early Monday evening to finish the treatment. Unlike other Americans' homes, Trump has an in-house White House Medical Unit, "where he'll be surrounded by world-class medical care," his physician Dr. Sean Conley said.

Trump has also received dexamethasone, a cheap and widely available corticosteroid that can reduce inflammation. But it also suppresses the immune system, so it's generally not recommended for Covid-19 patients unless the situation is severe.

Some patients who have benefited from dexamethasone still die less than a month later, Reiner said.

"We know that dexamethasone does reduce the risk of mortality. That comes from data from a trial called the Recovery trial," Reiner said.
"But to show you what the stakes are, the patients in that trial who received dexamethasone and derived a benefit still had a 23% 28-day mortality rate. So almost a quarter of the patients treated with dexamethasone were dead by a month out," Reiner said.

"So the only conclusion one can make from this triple therapy is that the President's physicians feel that he's in grave danger."
Conley said his patient seemed well enough to leave Walter Reed National Military Medical Center on Monday evening. But he acknowledged he's concerned about a possible reversal in Trump's condition.

"That's why we all remain cautiously optimistic and on guard, because we're in a bit of uncharted territory when it comes to a patient that received the therapies he has so early in the course," Conley said.

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