With input from Dr Monica Vasudev

1102: Trump Started on Dexamethasone; will he be started on newer oral anticoagulants or LMW heparin?

The only surprising thing is no one mentions about low molecular weight heparin on him

1. President Trump was administered dexamethasone for COVID-19 treatment and had two episodes of low oxygen saturation levels requiring supplemental oxygen, stated doctors at Walter Reed Medical Center at a press conference on Sunday.
2. As per the U.K.s RECOVERY trial, incidence of mortality was found to be significantly lower for patients receiving mechanical ventilation, and those receiving supplemental oxygen without mechanical ventilation; however, there appeared to be no significant benefit for those not receiving respiratory support. The NIH currently recommends dexamethasone for hospitalized patients with severe COVID-19.
3. Signs of pneumonia, lung involvement or damage to the lungs: expected findings, but nothing of any clinical concern.
4. President Trumps oxygen levels declined to 93%; he received supplemental oxygen 2 L per minute on Friday for about an hour, though it wasnt in the low 80s.
5. President Trumps current oxygen levels are at 98%.
6. He had a momentary episode of high fever and temporary fall in oxygen saturation on Friday, after which he was moved to Walter Reed.
7. Presidents liver and kidney function remain normal.
8. Lung spirometry was performed on President Trump and it was over 2,500 ml each time.
9. When asked if the President is being treated in a negative pressure room, White House physician Sean Conley maintained he was not going to get into the specifics of care.
10. Earlier he received monoclonal antibodies, an experimental drug.

Risk

1. President Trump has a much higher risk of dying and being hospitalized than young, healthy people.
2. However, despite being male, over 70, and obese, the president is at a good high risk [greater than 90%, 95% chance that he will get through this].
3. Trump announced early Friday morning that he and First Lady Melania Trump had tested positive.
4. As per CDC, a 74-year-old man has a 5 times higher risk of being hospitalized with COVID-19 compared to 18- to 29-year-olds, and is 90 times more likely to die.
5. In July, the National Bureau of Economic Research put the risk for an infected 70- to 79-year-old without major comorbidities at 4.6%, without differentiating by sex.
6. The potential for needing hospitalization increases after the age of 50 years.
7. Being male is also associated with higher risk of becoming very ill or dying due to COVID-19. According to CDC statistics, older men are almost twice as likely as women to die.
8. At a 2019 exam, President Trump’s height and weight (244 pounds and 6 feet 3 inches tall) put him in the obese category with a body mass index of 30.49. Obesity triples his risk of requiring hospitalization.
9. He has no diabetes, hypertension, other chronic heart and lung disease.
10. He takes a statin drug, which the White House physician reported last year had reduced his total cholesterol level to 167 from 196.
11. In early 2018, Trump underwent a coronary calcium CT scan which yielded a score of 133, indicating a degree of arterial plaque.
12. He is also on zinc, vitamin D, famotidine, aspirin, melatonin.
13. The initial treatment includes a single infusion of an experimental polyclonal antibody cocktail from Regeneron.  The investigational REGN-COV2 antibody cocktail in Phase I/II/III trial has shown the drug reduced viral load and the time to relieve symptoms in non-hospitalized patients with COVID-19, and showed positive trends towards reducing medical visits. The product has not received FDA approval emergency use authorization yet.

[Medpage Today]

All those who have come into contact with President Trump recently are being tested for coronavirus infection

Here is a list of members of his family, his administration, and other senior officials (including Trumps November election opponents) who have announced test results. The list will be updated as more results are announced.

Those with positive tests:

• Donald Trump, President, age 74; symptoms and treatment
• Melania Trump, First Lady, age 50; mild symptoms
• Bill Stepien, campaign manager for Trump, age 42; no symptom information
• Kellyanne Conway, ex-counselor to the president, age 53; mild symptoms
• Ronna McDaniel, Republican National Committee chair, age 47; no symptom information
• Mike Lee, U.S. senator, age 47; mild symptoms
• Thom Tillis, U.S. senator, age 60; no symptom information
• Ron Johnson, U.S. senator, age 65; asymptomatic
• Hope Hicks, senior aide to Trump, age 31; no symptom information
• Rev. John Jenkins, President of Notre Dame University, age 66; no symptom information

Those who have declared a negative test:

• Mike Pence, Vice President, age 61
• Karen Pence, Second Lady, age 63
• Joe Biden, former vice president, age 78
• Ivanka Trump, daughter and advisor, age 38
• Jared Kushner, son-in-law and senior advisor, age 39
• Barron Trump, son, age 14
• Kamala Harris, Democratic vice presidential nominee, age 55
• Steven Mnuchin, Secretary of the Treasury, age 57
• Mike Pompeo, Secretary of State, age 56
• William Barr, Attorney General, age 70
• Alex Azar, Secretary of Health and Human Services, age 53
• Amy Coney Barrett, Supreme Court nominee, age 48

[Medpage Today]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA