When President Donald Trump first revealed he and First Lady Melania Trump were diagnosed with COVID-19 early in the morning on Friday, October 2 it was unclear just how bad his illness was. Now, four days into his diagnosis—three of which were spent at Walter Reed National Military Medical Center—we're learning more about the measures that have been taken to treat the 45th president.
On Friday afternoon, the president's physician, Sean Conley, DO, sent a memo to White House Press Secretary Kayleigh McEnany revealing that the president received a dose of drugmaker Regeneron's "polyclonal antibody cocktail" (in reality, the Regeneron treatment was two monoclonal antibodies, but more on that later). In the same statement, Dr. Conley added that the president was also taking zinc, vitamin D, famotidine, melatonin, and a daily aspirin.
Shortly after that memo, on Friday evening, Dr. Conley noted that the president had been admitted to Walter Reed, where he began remdesivir therapy. On Sunday, President Trump's doctors informed the public once again that he started yet another treatment: dexamethasone.
As far as we know, that brings the total count of medications and supplements President Trump is currently taking or has taken to treat COVID-19 to 8: Regeneron's antibody cocktail, famotidine, remdesivir, dexamethasone, zinc, vitamin D, melatonin, and a daily aspirin.
It seems like a lot—enough to make physicians not directly caring for Trump worried about his health status. "Suddenly, they’re throwing the kitchen sink at him,” Thomas McGinn, MD, physician-in-chief at Northwell Health, recently told The New York Times. “It raises the question: Is he sicker than we’re hearing, or are they being overly aggressive because he is the president, in a way that could be potentially harmful?”
Some physicians, according to the NYT, have even suggested that Trump himself is dictating his own care and demanding these intense treatments—a pattern known as VIP syndrome, which describes situations in which prominent figures (like the President of the United States) actually receive poor medical care because doctors are either "too zealous in treating them—or defer too readily to their instructions."
Here's what we know about the treatments being used in his recovery, so far.
Regeneron’s antibody cocktail
Pharmaceutical company Regeneron's antibody cocktail—technically known as REGN-COV2—is a pair of two monoclonal antibodies used to help generate an immune response to COVID-19.
Monoclonal antibodies are essential man-made antibodies that act like human antibodies in the immune system, and they've been used to treat many different diseases, including certain types of cancer, according to the American Cancer Society.
Regarding Regeneron's antibody cocktail specifically, a "phase 1/2/3 trial" found that the drug "reduced viral load and the time to alleviate symptoms in non-hospitalized patients with COVID-19," according to a press release by Regeneron.
Most notably, according to the press release, was REGN-COV2's impact on those who were unable to generate an effective enough immune response on their own. "The greatest treatment benefit was in patients who had not mounted their own effective immune response, suggesting that REGN-COV2 could provide a therapeutic substitute for the naturally-occurring immune response," George D. Yancopoulos, MD, PhD, President and Chief Scientific Officer of Regeneron, said in the press release.
It was reported that the president received a one-time, 8-gram dose of REGN-COV2—the only dose shown to have significant effects against COVID-19—under a compassionate use request, according to CBS News. Under that request, the US Food and Drug Administration (FDA) allows a patient with an "immediately life-threatening condition or serious disease or condition" to receive an investigational medical product "for treatment outside of clinical trials when no comparable or satisfactory alternative therapy options are available."
A few things should be noted: The data surrounding Regeneron's REGN-COV2 antibody cocktail is still preliminary with further results to be published at a later date. The single study showing the efficacy in non-hospitalized COVID-19-positive patients is also part of a larger group of studies analyzing REGN-COV2 for the treatment of hospitalized patients, and for prevention of infection in people who have been exposed to COVID-19 patients. But according to Regeneron's press release, their researchers are "highly encouraged" by the ongoing trials for the experimental therapy.
Famotidine—available in prescription and over-the-counter variations—is the active ingredient in Pepcid, the popular heartburn medication. The US National Library of Medicine adds that the drug is mainly used to treat ulcers, gastroesophageal reflux disease, and other conditions in which the stomach produces too much acid.
It's unclear why exactly the president is taking famotidine—it was only briefly noted in Dr. Conley's first memo. It's entirely possibly that he is taking the drug purely for heartburn purposes, but it's worth noting that, in addition to decreasing the amount of acid in the stomach, the drug has also been researched as a potential treatment for COVID-19.
Back in April, Northwell Health in New York City began "quietly" testing the heartburn drug's effects on coronavirus. Kevin Tracey, MD, president of Feinstein Institutes for Medical Research at Northwell Health, who's in charge of the hospital's research, told Science that early data out of China suggested those over the age of 80 who survived COVID-19 were found to have taken the heartburn meds. This prompted the US to look into famotidine's potential as a COVID-19 treatment.
The thinking here, Dr. Tracey said, was that famotidine, as a histamine receptor blocker, is structured in a way that could prevent the coronavirus from replicating. "It is not intuitive to think that famotidine would be a successful treatment for COVID-19 patients,” Abraham Khan, MD, director of the Center for Esophageal Diseases at NYU Langone Health, previously told Health. It's also thought that famotidine's antagonism of the histamine-2 receptor—limiting the body's histamine response—could lessen more serious outcomes.
Since April, more research has been published about famotidine's potential effect on COVID-19, including an August report in the American Journal of Gastroenterology that found famotidine was "significantly associated with a reduction in death and either death or intubation" among those treated with famotidine versus those without. Another study out of Hartford Hospital also found that patients with COVID-19 taking Pepcid were 45% less likely to die in the hospital, 48% less likely to need help breathing from a ventilator, and also less likely to have combined adverse outcomes leading to death.
McNeil Consumer Pharmaceuticals Co., the makers of Pepcid, however, maintain that Pepcid is not indicated for treatment or prevention of COVID-19, and that any clinical studies looking at famotidine have been looking at the generic drug in an IV-administered form—not over-the-counter medications.
Remdesivir, sold under the brand name Veklury, is an antiviral medication—given via injection—developed by Gilead Sciences, a biopharmaceutical company. The drug was initially failed in trials against the Ebola virus, but has since been repurposed as a treatment for COVID-19.
In May, the FDA issued an emergency use authorization (EUA) for remdesivir in hospitalized adult and pediatric patients with severe COVID-19—but in August, the FDA eased up and allowed the drug to be used for all hospitalized adult and pediatric patients with suspected or confirmed COVID-19, regardless of the severity of their disease.
In April, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), told NBC News that the drug “has a clear-cut, significant, positive effect in diminishing the time to recovery,” adding that the drug essentially works by "blocking" the virus. He revealed that in a large international study, patients who took remdesivir needed an average of 11 days to recover from COVID-19, compared to 15 days for those in the study who received a placebo.
The FDA's recent decision to lessen the restrictions on remdesivir came after their analysis of additional data on the drug from two randomized, controlled clinical trials. The first, conducted by the National Institute of Allergy and Infectious Diseases (NIAID), found that, of 1,062 hospitalized subjects with mild, moderate and, severe COVID-19—about half who received remdesivir and half who received placebo—patients who received remdesivir recovered in about 10 days, versus about 15 days for those who got the placebo.
The other study that helped the FDA come to their conclusion was a separate Gilead Sciences study looking at adults hospitalized with moderate COVID-19, who received either a five-day course of remdesivir, a 10-day course of remdesivir, or a typical course of standard care. On day 11, the study found that those treated with a five-day course of remdesivir had much better odds of their symptoms improving versus those who had only standard care. Those who had a 10-day course of remdesivir also had a better chance of symptom resolve, but it wasn't statically significant to those who received standard care.
In an October 3 memo from Dr. Conely, the president's physician said he completed his second dose of Remdesivir without complication." According to NPR, the president is expected to be on a five-day course of the drug.
Dexamethasone is a corticosteroid used primarily to relieve inflammation, the US National Library of Medicine says. It's also used to treat arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders; severe allergies; asthma; and certain types of cancer. The drug is similar to other steroids, like prednisone and cortisone, Robert Weber, PharmD, pharmacy administrator at The Ohio State University Wexner Medical Center, previously told Health. “It works by blocking the inflammation response in the body,” he said. “Steroids [in general] suppress the immune system to counteract the body’s response to inflammation.”
Researchers from the University of Oxford released a statement in June regarding dexamethason's effectiveness in reducing COVID-19 deaths in hospitalized patients. The study, part of a larger randomized clinical trial called the Randomised Evaluation of COVid-19 thERapY (RECOVERY) trial, set out to test potential treatments for COVID-19 on 11,500 patients from 174 hospitals in the UK.
In the dexamethasone portion of the study, researchers found that the drug reduced the 28-day mortality rate by 17%, showing the greatest benefits for patients who required ventilation. Because of these findings, study co-author Peter Horby, MD, a professor of emerging infectious diseases at the University of Oxford, said in a statement that "the survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients."
The theory here is that dexamethasone may help reduce inflammation caused by the virus. "The virus is known for inducing a cytokine storm, which causes massive inflammation," Jamie K. Alan, PharmD, PhD, an assistant professor in the Department of Pharmacology and Toxicology at Michigan State University, previously told Health.
However, dexamethasone didn't have an impact on everyone: the RECOVERY study authors pointed out that dexamethasone was found to have no evidence of patients who didn't require oxygen. Going off of that information, in the COVID-19 treatment guidelines by the National Institutes of Health, the health agency "recommends against using dexamethasone for the treatment of COVID-19 in patients who do not require supplemental oxygen."
The president's oxygen levels throughout the course of his disease—and thus his need for dexamethasone—is still unclear. In a press briefing on Sunday, Dr. Conley reveled that he had administered supplemental oxygen to the president before his hospitalization on Friday morning, after his oxygen saturation levels were "transiently dipping below 94%," according to Politico (a normal blood-oxygen saturation level is 95% or above). Past that, Dr. Conley noted a few more dips in his oxygen levels, but did not report any other use of supplemental oxygen.
Other supplements and medications
The president is also reportedly taking four over-the-counter supplements and medications currently—and it's unknown whether they're connected to his COVID-19 diagnosis or not: zinc, vitamin D, melatonin, and a daily aspirin.
For starters, vitamin D has actually been recommended by Dr. Fauci himself. "If you're deficient in vitamin D, that does have an impact on your susceptibility to infection,” he said in a recent Instagram Live session with Jennifer Garner. “I would not mind recommending, and I do it myself, taking vitamin D supplements." And there's some evidence to back his recommendation up: The NIH says vitamin D—a fat-soluble vitamin known as calciferol and produced naturally by your body—can help strengthen bones, reduce inflammation, and help with immune function. The supplementation is beneficial because some people may be deficient in it, Amesh A. Adalja, senior scholar at the Johns Hopkins Center for Health Security, previously told Health. He adds that “there is clear evidence that vitamin D does help fight off respiratory infections," citing studies published in both the BMJ and PLOS One.
The research surrounding zinc's potential effects on COVID-19 is much more scant. Zinc is generally known for its antiviral properties, but there's no real evidence as of yet that the nutrient can provide any protection against COVID-19. Instead, preliminary research recently released at the European Society of Clinical Microbiology and Infectious Diseases’ online coronavirus disease conference suggested a possible link between lower blood levels of zinc and poorer health outcomes in people with COVID-19. It's important to note, however, that these findings don't prove that lower zinc levels cause worse COVID-19 outcomes—rather, it's merely an association that needs more research, not only to detect a stronger link but to find any possible therapeutic effects of zinc.
There's even less information available about any potential benefits of aspirin and melatonin on COVID-19—though those two treatments may be more for general symptoms management, or they were already part of the president's daily treatment plan pre-COVID.
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