Early in the coronavirus outbreak, hospitals across the U.S. told patients to avoid going to the emergency room or even the doctor’s office unless they were seriously sick or perhaps having trouble breathing.
Since then, not much has changed.
Most people recover uneventfully at home. A large number may never even know that they had been infected, since the virus causes no symptoms in up to 40% of patients.
However, President Donald Trump, who revealed he had tested positive for the coronavirus early Friday morning, is likely screened more often than almost anyone else in the world. His family, top aides and staff, and journalists who enter the White House, are also tested often.
That means it is likely the president was diagnosed early in his bout with the virus, allowing doctors to closely monitor the infection as it sweeps through his body and attempts to hijack healthy cells to create more virus. And a trip to the hospital on Friday evening will allow him ready access to two treatments now used on patients who fall very ill.
Trump was taken by helicopter from the White House to the nearby Walter Reed National Military Medical Center in Bethesda, Maryland. He walked from the White House to Marine One, wearing a mask, for the brief flight. In a video he tweeted after his departure, the president said, “I think I’m doing very well.”
While the White House has said Trump’s symptoms are mild, the hospital stay raised questions about his condition.
The vast majority of people with Covid-19 don’t need to be hospitalised, and those who do go to the hospital have a reason to be there, said Michael Ben-Aderet, an infectious disease specialist and associate medical director of hospital epidemiology at Cedars-Sinai Medical Center in Los Angeles.
“In my opinion, being hospitalised is a marker of the severity of the disease. I don’t have any details of the severity of the president’s condition, but when I hear that someone is hospitalised with Covid-19, that’s an indication that they have a more severe case,” said Ben-Aderet. “There is no benefit to being in the hospital otherwise.”
The three treatments that are available under emergency-use authorisation by the U.S. Food and Drug Administration for Covid-19 are only available in the hospital.
The president’s physician, Sean Conley, said late Friday night that Trump was being treated with Gilead Sciences Inc.’s remdesivir, which has been shown to help patients recover and allow them to be released more quickly.
“This evening, I am happy to report that the president is doing very well,” Conley said in a White House statement. “He is not requiring any supplemental oxygen, but in consultation with specialists we have elected to initiate Remdesivir therapy. He completed his first dose and is resting comfortably.”
The steroid dexamethasone is typically given to patients in intensive care whose immune systems are overly active. Another option is convalescent plasma, which has antibodies from the blood of patients who have recovered.
“The fact that the President is going to Walter Reed may mean his symptoms are now concerning enough to his physician team for him to be hospitalised or that he is going to get a specific treatment, or that they just want him there to be closely monitored as a precaution,” Tom Inglesby, director of the Center for Health Security at Johns Hopkins School of Public Health, said in a tweet.
Patients who are getting drug therapy in the hospital undergo frequent blood tests to monitor their organ function, to ensure they aren’t suffering any side effects from the treatment and to make sure the disease isn’t worsening, Ben-Aderet said. Those tests are done so frequently that it would be much easier to be in the hospital, he said.
There is little doctors can offer to relatively healthy patients, as efforts to find therapies to hasten recovery from SARS-CoV-2 have largely fallen flat. Among the medications that have been tried are HIV treatments and hydroxychloroquine, a malaria drug Trump took earlier in the outbreak when he was afraid he may have contracted the virus from aides. He never tested positive, and clinical trials have since shown the drug offers no substantial benefit.
Trump already received another medication on Friday that has shown early signs of promise in the lab.
Regeneron Pharmaceuticals Inc.’s experimental antibody cocktail was given to Trump before he flew to Walter Reed. The infusion is a combination of man-made antibodies that the human immune system normally produces to fight off infection.
In the first detailed study of the compound, disclosed by Regeneron Tuesday, patients who produced high levels of their own antibodies had their symptoms ease within a week, while those who didn’t make their own had symptoms for an average of almost two weeks. The drug yielded the most improvement in people who didn’t produce their own vigorous antibody response.
The compound is still experimental, however, and some doctors speculated that its use by Trump may indicate his condition is worse than disclosed. Unapproved drugs are given on a compassionate-use basis when the potential benefits are significant and the patient is willing to accept the unknown risks.
“I’m very concerned about the president’s team giving him an unvetted, untested treatment,” said Jeremy Faust, an emergency medicine doctor at Brigham & Women’s Hospital in Boston and editor of Brief19, a daily roundup of news on SARS-CoV-2 and Covid-19 research. “This has not been shown to work in clinical trials.”
Faust said he was concerned that the move to give Trump the Regeneron drug reflected desperation.
Trump has previously demonstrated a willingness to take risks. He used hydroxychloroquine before it was fully vetted. He has also been reluctant to wear masks that may have reduced his risk of infection, and has been critical of others who have advocated their wide adoption.