President Trump’s team of physicians revealed Sunday that he was being treated with dexamethasone, and health experts immediately voiced concern. The powerful steroid has shown promise for treating patients with severe covid-19 who are getting supplemental oxygen, as Trump was, but may cause harm for those with minor infections.
Trump’s doctors at Walter Reed National Military Medical Center in Bethesda, Md., cited the positive research when they disclosed that they prescribed the steroid after Trump’s oxygen levels concerningly dropped to 93 percent. Healthy blood oxygen levels range from 95 to 100 percent.
For covid-19 patients on ventilators or receiving oxygen, taking dexamethasone increased their chance of survival, according to the research published in July. Patients receiving dexamethasone who didn’t require ventilation or oxygen fared no better than patients on the normal course of treatment.
In fact, giving dexamethasone to coronavirus patients who are not at risk of severe illness could further endanger their health, according to research published in the August issue of the Journal of Hospital Medicine.
In its guidelines, the National Institutes of Health recommends against using dexamethasone for covid-19 patients who do not require supplemental oxygen.
Dexamethasone is not often prescribed toward the start of a patient’s infection, experts say, because it can suppress the immune system’s ability to ward off the virus. But Trump’s doctors opted to administer the steroid less than two days after Trump publicly disclosed that he had tested positive.
“We decided that in this case the potential benefits early on in the course probably outweighed the risks,” Conley said Sunday.
Dexamethasone can also have concerning side effects, ranging from blood clots, blurred vision, and headaches to “psychic derangements,” such as insomnia, mood swings and “frank psychotic manifestations,” according to the drug label.
Doctors know what to expect with dexamethasone because the drug itself is not new. The steroid, which is used to treat asthma, Crohn’s disease, IBS and some cancers, is 60 years old and ubiquitous.
“It’s cheap as borscht, as my grandparents would say,” Isaac Bogoch, an infectious-disease specialist at Toronto General Hospital, previously told The Washington Post. “It’s widely available. Every single physician on the planet that practices hospital-based medicine is comfortable using this drug.”
Another well-known, therapeutic effect of the drug is a sensation of euphoria. But the relief a patient may feel should not be confused with physical improvement, said Peter B. Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center.
Before departing Walter Reed on Monday, Trump boasted on Twitter that he felt better than he did two decades ago.
“Feeling really good! Don’t be afraid of Covid. Don’t let it dominate your life,” he wrote after his brief hospitalization for the disease that has killed more than 210,000 Americans.
Patients who are prescribed a steroid like dexamethasone can over-exaggerate how well they feel, Bach told The Post. But he advises patients who take the steroid not to be deceived by the reprieve and overexert themselves.
“Having taken this myself, for a herniated disc, I felt like a million bucks,” Bach said, “but actually I was barely able to move.”
Trump was prescribed the drug in concert with other medicine — supplemental oxygen, a monoclonal antibody cocktail and a five-day course of the intravenous antiviral remdesivir.
It’s not fully known how dexamethasone interacts with the two experimental therapeutics — or even how Trump has responded.
The president’s condition, including when he first tested positive, has been clouded by secrecy. His doctors have dodged questions from reporters, which has complicated efforts of physicians and experts on the outside to weigh in about his care, including how effective dexamethasone is.
Céline Gounder, an infectious-disease professor at New York University and Bellevue Hospital Center, said she was unable to assess whether dexamethasone was the best treatment for Trump, given how little is known about his bout with the disease.
It is recommended that dexamethasone be administered a week into illness for patients with severe covid-19, but that depends on the patient’s lab results, which in Trump’s case have not been shared publicly.
“If they would release full details, it would be much easier to say, ‘Okay, this makes sense’ or not,” Gounder said.
Given what is known about dexamethasone, she warned that the steroid could obscure the symptoms of the disease caused by the virus. For instance, the steroid can suppress a fever.
“Treating with dexamethasone can confound the picture,” Gounder said.
President Trump tests positive for coronavirus
Reconstruction: Trump’s movements, contacts before he tested positive