By now, all of you know that the president has been diagnosed with COVID-19. Reports are that his symptoms were moderate to severe on Friday but have since improved. His symptoms have included cough, fever and low oxygen saturation levels (less than 94% on room air).
His treatment plan includes administering a course of treatment of remdesivir, a drug that slows the replication of of the virus. This medication has been shown to improve outcomes in some patients when administered early. A clinical trial found that the drug accelerated recovery among patients that had advanced disease. It was a randomized, controlled trial involving 1063 patients.
The study found that patients who got remdesivir recovered 31% faster than the people that got the placebo (p<0.001). The median time to recovery was 11 days for patients treated with remdesivir compared with 15 days for those who got the placebo. Results also suggested a survival benefit, with a mortality rate of 8.0% for the group receiving remdesivir versus 11.6% for the placebo group (p=0.059).
A few months ago the FDA issued an Emergency Use Authorization for remdesivir to treat COVID. That means doc’s can now prescribe for patients without enrolling them in a clinical trial or getting compassionate use approval.
The patient is also being treated with dexamethazone, a steroid. This medication is used in COVID patients that have low oxygen saturation on room air. It tamps down inflammation and has been shown to improve clinical outcomes in patients that have lowered blood oxygen levels. He received supplemental oxygen on Friday (2/L per minute).
The patient’s treatment team also administered monoclonal antibodies produced by Regeneron. This experimental monoclonal antibody treatment is still in clinical trials (it is an investigational new drug) and is available “for compassionate use” outside of clinical trials if approved by the FDA. The FDA issued such an approval Friday.
The Regeneron CEO has made statements suggesting that the drug is quite effective, but no data (that I could find) establishes this as the case. Here’s more about the investigational new drug process from a previous blog.
The patient’s treatment plan also includes zinc, vitamin D, an antacid called famotidine, melatonin and aspirin. None of these require a prescription and none have been proven to be effective against COVID-19.
Statistically, a 74 year-old male in reasonably good health has a 3% chance of dying from COVID19. Patients in that range have symptoms bad enough to be hospitalized in about 10-15% of cases.
Persons with other underlying medical conditions (like obesity) are more likely to have a worse outcome.
On the other hand, these statistics include patients that were infected in the Spring and Summer of 2020 when less was known about effective treatment for the infection. Treatment for this illness has improved significantly in recent weeks and I expect outcomes to continue to improve as more is learned about effective therapies.
