With input from Dr Monica Vasudev

1105: Lessons learnt from Trump’s illness

VIP gets a cocktail of drugs 

1. Hes taking vitamin D, zinc and famotidine.
2. He was also given a pooled antibody from Regeneron, a product under clinical trials as compassionate use. The President is among that group.
3. He was given remdesivir, a drug that yields a very modest improvement in patients who have mild or moderate COVID-19.
4. He received dexamethasone, a drug with a considerable benefit for people who are mechanically ventilated, and a smaller but real benefit for those who are oxygen-dependent and hospitalized. There appear to be two clear phases of COVID-19. There is the viral proliferative phase, and there is the immune phase. And its believed that dexamethasone works in the immune phase.
5. Eli Lilly has asked the US government to allow emergency use of an experimental antibody therapy on the basis of early results from a study suggesting that the drug reduced symptoms, the amount of virus, hospitalizations, and ER visits for patients with mild or moderate COVID-19. The drug is similar to one that the President received. These medicines provide concentrated versions of specific antibodies to assist the immune system and are given as a one-time treatment through IV. The results yield an interim look at a mid-stage study wherein 112 people were given the antibodies and 156 received a placebo. The amount of virus was found to be significantly lower 11 days later in those given the drug. Virus was lower at earlier time points as well. Symptom scores were shown to be better at 3 days. Nearly 5.8% of patients receiving placebo required hospitalization or an ER visit compared to 0.9% of those given the antibodies. No serious drug-related side effects were reported.

VIPs have different isolation rules?

1. Vice President Mike Pence did not self-quarantine but attended debate
2. He was sitting for longer than 15 minutes within 6 feet of people who subsequently tested positive for COVID-19 and met the CDC definition of close contact. Quarantine means hed be at home and not out or about for 14 days after that event
3. Questions remains: Who will drive his car, who will fly his plane, who work in hotels — all those people will be exposed
4. However, the CDC after consultation with White House physician decided that the Vice President was not a close contact of any known person with COVID-19, including the President, and cleared him of quarantine.
5. 14-15 people connected to the White House became positive. All of these people should remain in isolation for at least 10 days, and anybody who came in contact with them must be quarantined for 14 days.

VIPs have different masking rules?

1. President Donald Trump came back to the White House after a 3-day hospital stay for COVID-19, removed his mask, and entered a room full of unmasked staff.
2. White House did not carry out the recommended levels of contact tracing.  The White House, with over two dozen infections and at least two hospitalizations, is a superspreader event.  It also resulted in a temporary shutdown of U.S. Senate floor activity after several members tested positive.
3. The September 26 White House event to introduce Trumps Supreme Court nominee, Amy Coney Barrett, acted as the catalyst for the cases. Images of the outside ceremony in the White House Rose Garden showed guests seated close together, often without masks, and many were seen hugging afterward. The inside shot was far scarier, showing a meeting of the nominee and family inside the White House, in terms of aerosol transmission. Anyone who attended the Barrett event should quarantine for 14 days.

[Medscape, DG Alert, Medpage Today excerpts}

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA