Wednesday, October 28, 2020

Hesham A Hassaballa's COLUMN

A Closer Look into the Treatments Trump Received for COVID-19

They are hardly a “cure”

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President Trump stated in a video that contracting Covid-19 was a “blessing from God.

He called it a blessing from God because he was able to get multiple treatments for COVID-19. He then went on to tout those treatments as a “cure” for the disease. The reality, however, is quite different. The treatments he received can hardly be characterized as “cures,” and here is the data behind each one.

Monoclonal Antibodies

The most high profile treatment President Trump received — under a “compassionate use” application — was monoclonal antibodies. These are proteins that are highly specific against SARS CoV-2, and they have the ability to latch on to the virus to prevent it from entering the cells.

The data behind using them is from a study of ambulatory patients, which means patients in a doctor’s office or clinic setting, not the hospital. Right off the bat, this tells me that those patients were not very sick, to begin with. If they were, they would have been hospitalized. The drug has not been studied in that patient population, as far as I know.

In that ambulatory setting, the greatest benefit was for those patients who did not have their own antibodies against the disease, so-called seronegative patients. Those who had antibodies already did not benefit as much. Furthermore, there is absolutely no evidence that this treatment will work in patients with severe disease requiring hospitalization or ICU care (such as patients whom I see).

What’s more, it seems that the highest dose of the antibodies — the same dose the President received — was not as effective as the lower dose. More of the patients receiving the highest dose had to seek medical attention, and it took them longer to achieve symptom alleviation. These findings, however, were not statistically significant.

So, really, this treatment is hardly a “cure” as the President claims. It is definitely promising, but we need to wait for more data to come out.

Remdesivir

President Trump also received remdesivir, an anti-viral drug that was originally developed for Ebola. Remdesivir may also be helpful in treating Covid-19. The final results were recently published in the New England Journal of Medicine.

All that remdesivir does is shorten the time to recovery from 15 days to 10 days compared to placebo. That’s it. I am not saying that this is not significant, but it is not a “cure.”

Now, there was a trend toward lower mortality in the patients who received the drug, but technically, it was not statistically significant. Thus, you can’t make this claim about Remdesivir, and the study authors did not make this claim in their study conclusions.

Dexamethasone

By far, the best data is for dexamethasone. In this randomized clinical trial, the number of days alive and free from mechanical ventilation during the first 28 days was significantly higher among patients treated with dexamethasone plus standard care when compared with standard care alone (6.6 days vs 4.0 days).

When they pooled all the data for steroids in a meta-analysis, the 28-day all-cause mortality was lower among patients who received corticosteroids compared with those who received usual care or placebo (summary odds ratio, 0.66). This odds ratio means that the group who got steroids had a 34% decreased risk of death.

Now, the President received other treatments such aspirin, famotidine, zinc, and vitamin D. The data for these treatments is even more sparse. That’s what makes it so frustrating with this disease: it such a horrific condition with few truly effective treatment options.

The treatments for seasonal influenza are also not blockbusters, but seasonal influenza is not nearly as deadly as COVID-19. So, at the end of the day, the studies behind the treatments that the president received were not blockbusters, and they showed some benefit. But, I would hardly characterize them as “cures.”

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Dr. Hesham A. Hassaballahttp://drhassaballa.com
Dr. Hesham A. Hassaballa is a NY Times featured Pulmonary and Critical Care Medicine specialist in clinical practice for over 20 years. He is Board Certified in Internal Medicine, Pulmonary Medicine, Critical Care Medicine, and Sleep Medicine. He is a prolific writer, with dozens of peer-reviewed scientific articles and medical blog posts. He is a Physician Leader and published author. His latest book is "Code Blue," a medical thriller.

DR HESHAM A HASSABLLA

Medika Editor: Cardio and Pulmonary

Dr. Hesham A. Hassaballa is a NY Times featured Pulmonary and Critical Care Medicine specialist in clinical practice for over 20 years. He is Board Certified in Internal Medicine, Pulmonary Medicine, Critical Care Medicine, and Sleep Medicine.

He is a prolific writer, with dozens of peer-reviewed scientific articles and medical blog posts. He is a Physician Leader and published author. His latest book is "Code Blue," a medical thriller.

Medika are also thrilled to announce Hesham has recently joined our team as an Editor for BeingWell, Medika's publication on Medium

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