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How could President Donald Trump get away with COVID-19? | Science

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President Donald Trump has tested positive for the pandemic coronavirus.

Evan Vucci / AP

The COVID-19 Science reports are supported by the Pulitzer Center and the Heising-Simons Foundation.

* Update 4:40 p.m .: The White House issued a statement regarding the treatment the president received: “Following PCR confirmation of the president’s diagnosis, as a precautionary measure, he received a single dose of 8 grams of Regeneron’s polyclonal antibody cocktail. He completed the infusion without incident. In addition to the polyclonal antibodies, the president took zinc, vitamin D, famotidine [Pepcid], melatonin and a daily aspirin. “

The nighttime bomb that President Donald Trump tested positive for the pandemic coronavirus sparked a flood of questions. Among them: What is his risk of serious illness? And how could it be treated? To find out more, ScienceInsider spoke with Neil Schluger, a pulmonologist who heads the Department of Medicine at New York Medical College. He was among many doctors who rushed to treat patients when New York City suffered a massive spike in COVID-19 cases in the spring.

Schluger emphasizes that he has no direct knowledge of the details of Trumps’ disease and is in no way related to his care. He generally commented on what we learned about risk factors and the treatment of mild and severe cases of COVID-19, as well as whether former Vice President Joe Biden, Democratic candidate for the presidency, could be in danger after the presidential debate on Tuesday.

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This interview has been edited for clarity and length.

Q: Let’s start with comorbidities, which we now know play an important role in the course of COVID-19. 74-year-old’s strengths along with her weight and being a man have been shown to increase the risk of more serious illness from this virus. He is also believed to have high cholesterol. What additional risk could these conditions pose, and can we separate them?

A: There is no doubt that the most important risk factor for severe illness and poor outcome is age. This, I think, has resisted all over the world. It almost overwhelms the other risk factors.

Men seem to have more difficult times. When you look at serious illnesses and mortality, men seem to be more affected than women. And [being] overweight and obesity are very interesting. They have consistently appeared in many studies to be a common feature in hospitalized people. A study published in July in the Annals of Internal Medicine indicated that [being] overweight and obesity were poor prognostic factors, especially among younger people, who they defined as anyone under 65.

Q: How much does the risk of being over 70 increase?

A: It’s important to remember that at 74, the age of the president, most people recover. But when you look at the age-related mortality curves, it really starts to go up. Compared to 18 to 29 year olds, people aged 65 to 74 have a five times higher hospitalization rate and a 90 times higher risk of death.

Q: If Trump is at the onset of illness, how could you treat someone like him? Are the antiviral drugs remdesivir or interferon indicated? Would it depend on the patient’s symptoms, if applicable?

A: I mean pretty generally. I don’t think it’s fair to comment over the shoulder of whoever might be dealing with the president.

With this warning, the best evidence of therapeutic efficacy is dexamethasone, but it is only used and needed in people with severe illness. In the next category, there would be remdesivir. The general feeling about remdesivir is that it has modest benefit in people with moderate illness. This seems to shorten the duration of the symptoms a bit, they feel better faster. We kind of compare it to the effectiveness of oseltamivir (Tamiflu) for the flu which isn’t a huge lifeline, but it seems to reduce symptoms.

Should you take remdesivir as soon as you know you have COVID? This is obviously not a crazy idea. There hasn’t really been any data on this, because at the moment the drug is administered intravenously. Studies have not been done in people with mild illness. But obviously the President of the United States has access to everything.

The next therapy that has been given to many people, and for which we don’t have good answers, would be convalescent plasma. Last week, the NIH [National Institutes of Health] An expert group on COVID treatment has said it will not make any recommendations for or against the use of convalescent plasma in anyone with COVID.

Q: What about treatments that stimulate interferons, proteins that defend against viral invasions?

A: There have been a few small studies that look promising, but I’m not sure I would give it.

Q: Another treatment that has received attention is monoclonal antibodies. Would they be valuable?

A: The trials are really interesting and important. There has been some effectiveness of these drugs in Ebola. But I haven’t seen any definitive data for COVID. Personally, unless someone has access to data that hasn’t been released yet that looks really promising, I’d say it’s not ready for prime time. In theory, they could be made available to some people, but it makes more sense in sicker or high-risk patients.

Q: Let’s talk about the course of the disease in a person with an Asset health and age profile. He is currently suffering from mild symptoms. In what ways could this happen?

A: As the tests became more widespread, we have learned that most people like him will have mild illness and will recover without specific treatment. The natural history of the disease is such that most people who become seriously ill will usually become very ill within the first 7-10 days. There are always exceptions, but I think next week or so there will be huge concern.

Q: Why does the virus make some people with mild symptoms worse, while others recover quickly? What determines if a person becomes seriously ill?

A: There are host factors and bug factors. Some bug factors might have to do with the initial exposure: Have you really received a coronavirus blast from a highly contagious person? Or have you just been infected with a small number of virus particles that your immune system can take care of? On the host side, it really has to do with the nature of their immune response, their age, and other conditions.

Q: When would hospitalization be recommended?

A: The reasons for hospitalizing someone with COVID are the reasons you are hospitalizing someone: your vital signs are unstable and need to be monitored because you feared something serious might happen, or because you have need therapy that cannot be given on an outpatient basis. Certainly, if someone develops respiratory complications and needs extra oxygen, there is a reason to be in the hospital. But the vast majority of people won’t need to be in the hospital.

One of the things that I think everyone noticed was a feeling that was better in dealing with this than in March and April. We have improved in the treatment of severe cases.

Q: There has been some discussion about whether Biden is in danger after Tuesday’s debate. The candidates were at some distance from each other, but of course without a mask and speaking forcefully for about 90 minutes. Would you be worried about Biden? When would you stop worrying?

A: The incubation period appears to be 2-12 days, more or less. They seemed relatively distant from each other, so the risk should be relatively low. I’m sure the Biden campaign will be very careful given the circumstances. [Biden reported testing negative after this interview took place.]

Q: What comes next?

A: I think we have to wait and see. I am sure he will receive very close medical attention. There are concerns for anyone in this age group, although President Trump still has a very good chance of having a mild illness. But there is no way to really know.

Q: Do you have any farewell words?

A: I think people should wear masks. They really do work.

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