Trump placed on steroid beneficial for extreme Covid-19 instances, whilst docs share upbeat outlook
President Donald Trump’s doctors said Sunday that they had begun treating him with dexamethasone, a steroid that has shown promise for critically ill patients but may cause harm to those with less severe cases of Covid-19.
The revelation, which came as part of an upbeat briefing on the president’s condition, raised further questions about Trump’s health as the 74-year-old wrestles with the virus that has killed more than 200,000 Americans.
Dr. Nahid Bhadelia, an infectious diseases physician at the Boston University School of Medicine, said the steroid treatment suggests that Trump has a level of inflammation that warrants the use of steroids despite the fact that the drug also suppresses the immune system.
“That they made a conscious decision that the benefit of giving steroids outweighs the risk implies a higher degree of severity than what we knew on Friday and Saturday,” Bhadelia said in an email.
Another expert, Dr. Vin Gupta, said the doctors’ disclosures may indicate that Trump could be suffering from pneumonia.
“The treatment the doctors report they administered suggest the president has COVID pneumonia of at least mild severity,” said Gupta, a member of the faculty at the University of Washington’s Institute for Health Metrics and Evaluation.
The briefing took place outside the Walter Reed military hospital in Bethesda, Md., where the president has been treated since Friday.
White House physician Sean Conley said the president’s medical team had begun treating the president with dexamethasone. The course of treatment came in response to two incidents in which Trump’s blood oxygen levels dipped below normal levels in recent days.
Conley also said that Trump could be discharged as soon as Monday and said his health was improving.
Bhadelia said she generally would not discharge someone who was just put on steroids.
The Trump medical team’s announcement complicated assessments of how dire the president’s case is, particularly in light of the caginess that has surrounded details about the president’s health.
According to the World Health Organization, dexamethasone has been shown to reduce 28-day mortality in patients with severe and critical cases of Covid-19. In contrast, the organization found, it “may increase the risk of death when administered to patients with non-severe” cases of the disease.
The WHO defined severe cases of Covid-19 as causing blood oxygen levels to fall below 90%. Healthy adults generally have blood oxygen levels of 95% or higher. Rapid breathing or other signs of respiratory distress could also cause a case to be considered severe.
One study cited by the WHO showed that dexamethasone reduced mortality to about 22.9% compared to 25.7% for those given usual treatments.
Trump’s doctors declined to say how low the president’s blood oxygen level has fallen, beyond saying that it has not been recorded in the low 80s. Conley said that Trump’s blood oxygen level was 98% on Sunday.
Dr. Scott Gottlieb, who led the FDA from 2017 to 2019, said that the president’s two drops in his blood oxygen level did not suggest a strong recovery.
“I am concerned about the O2 because that means his lungs are affected (COVID-19 is the disease part and now he has that),” Gottlieb said in an email. He added, “If they are going to discharge him tomorrow, that would mean he is virus negative. I don’t think that’s possible.”
Gottlieb added: “The low oxygen and the statement that his ‘chest imaging had findings that were consistent with his condition’ suggest he could have a pneumonia of his lungs.”
On Saturday, Conley dodged questions about whether the president had received any supplemental oxygen. Then, on Sunday, Conley said the president’s oxygen levels fell Friday and Saturday, and he revealed that the president received supplemental oxygen Friday.
It was not clear, however, whether Trump received oxygen Saturday. When asked about it Sunday, Conley deferred to the nursing staff.
“I’d have to, I’d have to check with the nursing staff. I don’t think that — if he did it was very, very limited. But he’s not on oxygen,” Conley said. “The only oxygen that I ordered that we provided was that Friday morning, initially.”
The president’s medical team has not been forthcoming about his condition, forcing the public to read between the lines.
“I didn’t want to give any information that might steer the course of illness in another direction, and in doing so, you know, it came off that we were trying to hide something, which wasn’t necessarily true,” Conley explained on Sunday.
Still, the fact that the president has only needed supplemental oxygen one or two times seemed curious to physicians, in light of the dexamethasone treatment. The National Institutes of Health Covid-19 treatment guidelines note that dexamethasone has only been shown to have positive effects in patients who require supplemental oxygen.
“Dexamethasone is an incredibly common steroid. But not at the high doses used in COVID-19 which is why the NIH recommends AGAINST using it unless the (patient) requires supplemental oxygen,” wrote Dr. Kavita Patel, a former managing director of clinical transformation at the Center for Health Policy at Brookings, in a post on Twitter on Sunday.
“Not on oxygen for a second here or there,” she wrote.
— CNBC’s Shepard Smith contributed to this report
Disclosure: Scott Gottlieb is a CNBC contributor and is a member of the boards of Pfizer, genetic testing start-up Tempus and biotech company Illumina. Pfizer has a manufacturing agreement with Gilead for remdesivir. Gottlieb also serves as co-chair of Norwegian Cruise Line Holdings′ and Royal Caribbean’s “Healthy Sail Panel.”
Correction: This story was updated to reflect that Sean Conley, the president’s physician, did not say whether the president received supplemental oxygen Saturday.