President Trump has reportedly been symptom-free for about two days and is “feeling great” after being released from the hospital for COVID-19 treatment Monday. This is according to his physician Dr. Sean Conley.
According to his doctors, the president received the steroid dexamethasone, a course of the anti-viral treatment remdesivir and an experimental monoclonal antibody cocktail.
“We’re told now that he is off treatment,” said Dr. David Agus, professor of medicine and engineering at the University of Southern California Keck School of Medicine. “So we assume that dexamethasone, the steroids, have been stopped. He’s already completed his course of remdesivir and the antibodies are a one shot that lasts for 22 days.”
Dr. Agus says that because the antibody cocktail the president received is still undergoing clinical trials, few others may have received the same combination of medications as Mr. Trump.
Remdesivir is an anti-viral treatment that has been demonstrated to be an effective treatment for hospitalized patients. A recent study from its manufacturer Gilead found that it can speed up recovery times by as much as five days.
Dexamethasone, also known by the brand name Decadron, is a steroid that has been used to treat inflammation from a number of illnesses besides COVID-19 and its side effects are well understood.
“(Trump) is claiming that he’s feeling well but until now he’s been on dexamethasone – or steroids – which really give you a lot of energy and make you, many times, feel better than you are,” said Dr. Agus. “I think the real telling is going to be over the next few days.”
Many experts have said that dexamethasone can impair judgment and cause a sense of elation.
Dr. Agus says he had one patient who felt so euphoric that he contacted a contractor to build a bowling alley in his home, even though he hates bowling and could not afford the project.
“But the decadron just gave him this overwhelming sense of aggressive, almost mania; manic behavior.”
The drug can also adversely affect a patient’s blood sugar, possibly inducing diabetes, and cause difficulty sleeping and an increased appetite.
“You’d normally stop as soon as you can because of the side effects, when the lungs get better,” said Dr. Agus.
Researchers and doctors are optimistic about the potential for the experimental monoclonal antibody cocktail that the president received from Regeneron Pharmaceuticals. Samples are taken from patients who have recovered from COVID-19 and have antibodies. Those samples are then turned into a treatment that can be infused into someone else.
“Monoclonal antibodies are really our hope because they bind to the spike protein,” explained Dr. Agus. “It can either be protective or it can be treatment.”
Theoretically, the cocktail could be administered in a high-risk scenario such as a nursing home before infection occurs. It can also be used after infection to prevent the virus from replicating further in the body.
And because the cocktail is based on antibodies produced by the body and targets the coronavirus’ spike protein, which is not similar to anything naturally occurring in the human body, so far there do not seem to be any significant side effects and researchers do not anticipate any.
While the treatment shows a lot of promise, there are limits.
“The problem is it’s really hard to scale and make a lot of it, and it’s a relatively expensive medicine,” explained Dr. Agus. “Remdesivir costs pennies to make. This costs hundreds and hundreds of dollars to make one dose. And so it’s difficult to make very large numbers or else we’d obviously be giving it to everyone in the country.”
And while President Trump recently hailed the cocktail as a cure, clinical trials are still ongoing and early data suggests it is effective early in the course of the disease but not later on.