Coronavirus

[SMAlset]

As I said earlier, the trump oxygen treatment story is mired in White house spin and/or lies. I get the impression that trump was O2 dependent for a time which of course puts a big fat LIE label on the line that trump was hospitalized 'out of an abundance of caution' BS.

His apparent improvement could be viewed with cautious optimism by those who want him to survive but given the context of his improvement after receipt of an experimental drug I have no idea what his course will follow. I also presume that treatment details are incomplete.

Bloomberg’s article on the timeline and events:

Trump’s First Hospital Day Marked by Split Account of Health
Trump’s First Hospital Day Marked by Split Account of Health

So WH would have the public believe that Walter Reed isn’t a hospital. Hmmm. The spin and fake news.

Article includes Chris Christies’ diagnosis and why he went to a medical center for treatment. Is a medical center a hospital? Asthma isn’t his only comobidity factor.

You have to believe that Mark Meadows didn’t make up what was relayed to the press today. No way.

 

[SageBrush]

And now Pence (and others) is refusing to quarantine, Sen Johnson went to a festival after testing positive and Christie went massless in the debate prep and then went to the ABC post debate panel.

There are definite silver linings to their stupidity

 

[PACEMD]

Corticosteroids

Ok.......decadron.......dexamethasone........we are using that one but the jury is still out. Probably ok, not causing harm. We are also using remdesivir..........same thing.........best information we've got just now.........doesn't tell us much about the long term or true effectiveness. Not the first time we have been down this road. You do the best you can but you don't really know until you know. Knowing takes time, experience, work.

 

[bkp_duke]

Corticosteroids

Or that. LoL. Abbreviations, never liked em.

 

[PACEMD]

Convalescent Serum. I.e. serum harvested from donors that have fought off the infection. Time tested (over 100 years) therapy, but not without side effects.
The true historical origin of convalescent plasma therapy

Regeneron's Antibody treatment is basically a synthetic version of CS, with probably about the same effectiveness, but the goal of a lower side-effect profile:
Regeneron's REGN-COV2 Antibody Cocktail Reduced Viral Levels and Improved Symptoms in Non-Hospitalized COVID-19 Patients | Regeneron Pharmaceuticals Inc.

I ask because you will not find universal agreement about what CS means. Meaning you are better off to just say what you mean.

 

[bkp_duke]

I ask because you will not find universal agreement about what CS means. Meaning you are better off to just say what you mean.

Agreed. See my post right above yours.

I'm an endocrinologist, and even we never use the abbreviation CS.

 

[SageBrush]

Sure, there are medications potentially more promising than others.

Many, but my short list was of those that have passed reasonable randomized controlled trials and would be FDA approved by reasonable protocols without trump interference.

You can always invoke some drug that was given FDA clearance, only to be revoked later as your argument. But then you probably have to refrain from treating acute MI with ASA to be consistent, let alone use any new fangled antibiotic, or heaven forbid any immuno-modulator in transplant patients or those with auto-immune disease.

May I politely suggest that therapeutics is not your area of expertise ?

 

[PACEMD]

Many, but my short list was of those that have passed reasonable randomized controlled trials and would be FDA approved by reasonable protocols without trump interference.

You can always invoke some drug that was given FDA clearance, only to be revoked later as your argument. But then you probably have to refrain from treating acute MI with ASA to be consistent, let alone use any new fangled antibiotic.

Not that simple, aspirin is the one thing we know for sure is helpful with acute coronary obstruction. And trust me, most of us don't use new-fangled antibiotics, for good reasons, as I have described. There are countless examples of FDA approvals of medications that are either not effective or are dangerous. We discuss this every day. The list goes on and on, and it's worse as time goes by. The FDA is owned by industry now. Rapid studies and expedited approvals are especially fraught with dangers.

 

[SarahsDad]

Trump did look better just now in his new video statement from Walter Reed. But I'm betting it's temporary. He wouldn't have received the Regeneron antibody unless he was considered high risk (low native antibodies, high viral load). The antibody essentially didn't work at all in those who already had circulating antibodies, and therefore lower virus loads. So I bet they tested both his native antibody levels as well as viral load before determining that he was in that high risk group.

Regeneron's REGN-COV2 Antibody Cocktail Reduced Viral Levels and Improved Symptoms in Non-Hospitalized COVID-19 Patients | Regeneron Pharmaceuticals Inc.

No MD would've recommended an experimental treatment with no proven safety profile if he was in the low risk group and therefore unlikely to benefit from the treatment.

I think he looks better now because he would've received Decadron, and as any medical person knows, patients feel "great" (almost manic) for a while after getting this. We call it steroid psychosis. So this may very well be a temporary improvement before he gets worse again.

Mortality rates (depending on the data source) are 5-12% for those 70-79 years old. Add male gender, obesity, and now low native antibodies/high viral load (my suspicion), that could double the risk.

 

[KG M3]

And what is CS, by the way?

In Trump's case, we can hope they use o-chlorobenzylidene malononitrile

CS gas - Wikipedia

 

[PACEMD]

We can discuss the pharmaceutical cartel till the cows come home but that's really another subject. We take the best information we currently have and do what we must do, but always with a sceptical eye...........and a view to the future.......

 

[bkp_duke]

Trump did look better just now in his new video statement from Walter Reed. But I'm betting it's temporary. He wouldn't have received the Regeneron antibody unless he was considered high risk (low native antibodies, high viral load). The antibody essentially didn't work at all in those who already had circulating antibodies, and therefore lower virus loads. So I bet they tested both his native antibody levels as well as viral load before determining that he was in that high risk group.

Regeneron's REGN-COV2 Antibody Cocktail Reduced Viral Levels and Improved Symptoms in Non-Hospitalized COVID-19 Patients | Regeneron Pharmaceuticals Inc.

No MD would've recommended an experimental treatment with no proven safety profile if he was in the low risk group and therefore unlikely to benefit from the treatment.

I think he looks better now because he would've received Decadron, and as any medical person knows, patients feel "great" (almost manic) for a while after getting this. We call it steroid psychosis. So this may very well be a temporary improvement before he gets worse again.

Mortality rates (depending on the data source) are 5-12% for those 70-79 years old. Add male gender, obesity, and now low native antibodies/high viral load (my suspicion), that could double the risk.

It's too early in his course for him to any "native antibodies".

Agreed that he is high risk (age, obesity).

Additionally, you guys are making WAY too much of the Regeneron antibody cocktail being "experimental". It started Phase 3 in early July, which means it is probably done, and the safety data are fine (non-safe drugs are pulled before a phase ends). It's a polyclonal antibody treatment, not exactly something new-fangled and earth-shattering (like the Moderna RNA vaccine).
Regeneron Announces Start of REGN-COV2 Phase 3 COVID-19 Prevention Trial in Collaboration with National Institute of Allergy and Infectious Diseases (NIAID) | Regeneron Pharmaceuticals Inc.


Although (and this is a joke for the non-MDs out there) - anecdotally, he has the "asshole gene". The MDs here understand this. For unknown reasons, we see the "nice" people succumb to disease in the hospital every day. It's the ornery, old, usually veterans, that come out on the other side unscathed. Probably just to keep annoying the rest of us. Trump got a double-dose of that genetic polymorphism.

 

[PACEMD]

Agreed. See my post right above yours.

I'm an endocrinologist, and even we never use the abbreviation CS.

Yes, thanks for your input........

 

[AlanSubie4Life]

Ok.......decadron.......dexamethasone........we are using that one but the jury is still out. Probably ok, not causing harm.

I thought steroids were damaging if given too early because they can blunt the immune response? I assume that is why they have not yet administered dexamethasone.

I’m not a doctor though!

So I bet they tested both his native antibody levels as well as viral load before determining that he was in that high risk group.

I hope he does not end up with high antibody titers in a few weeks, that way he will be encouraged by doctors to wear a mask going forward to avoid (the small chance of) reinfection. That would be best for everyone involved.

I think he looks better now because he would've received Decadron, and as any medical person knows, patients feel "great" (almost manic) for a while after getting this. We call it steroid psychosis.

My understanding is they hold off on steroids until later, the inflammatory phase. I am not a doctor though!

 

[PACEMD]

Although (and this is a joke for the non-MDs out there) - anecdotally, he has the "asshole gene". The MDs here understand this. For unknown reasons, we see the "nice" people succumb to disease in the hospital every day. It's the ornery, old, usually veterans, that come out on the other side unscathed. Probably just to keep annoying the rest of us. Trump got a double-dose of that genetic polymorphism.

That's exactly why I don't go to the church anymore............

 

[PACEMD]

I thought steroids were damaging if given too early because they can blunt the immune response? I assume that is why they have not yet administered dexamethasone.

I’m not a doctor though!



I hope he does not end up with high antibody titers in a few weeks, that way he will be encouraged by doctors to wear a mask going forward to avoid (the small chance of) reinfection. That would be best for everyone involved.



My understanding is they hold off on steroids until later, the inflammatory phase.

Right, well most are using decadron when folks get sicker. More a what else do we have than a completely proven strategy. We are not using steroids in non-hospitalized patients. Why? We don't really know the safety or efficacy.

 

[bkp_duke]

I thought steroids were damaging if given too early because they can blunt the immune response? I assume that is why they have not yet administered dexamethasone.

The gold standard trial here was the RECOVERY trial, and it was focused on critically ill patients:
Coronavirus breakthrough: dexamethasone is first drug shown to save lives

In those patients, there is a marked survival benefit by treating with dexamethasone.

The same study showed a NOT statistically-significant chance of increased death in people that had just mild cases (i.e. not intubated). The problem is the study was not designed to study that group in detail and the results were only indicative, not with P values < 0.05 (i.e. more research is needed).
The cheap steroid touted as a 'breakthrough' coronavirus drug may carry a small risk for people who don't need respiratory support

Based upon that, the consensus is to not give steroids unless there are signs of lung disease (decreased O2 sats, increased work of breathing, significant X-Ray findings, etc.).


So yes, you are correct that "standard of care" is to not give steroids too early, for concern that they may blunt a potentially beneficial immune response.


EDIT - PACEMD beat me to it, and in a more succinct fashion.

 

[SMAlset]

This was from CNN about the Tuesday debate preparations: Chris Christie tests positive. Former governor checks himself into hospital as a precaution - CNNPolitics

“Christie and a team of advisers held debate preparation sessions with Trump on Sunday and Monday at the White House. He told ABC News on Friday that no one was wearing masks in the room as they prepped the President....
Other members of the President's debate prep team and inner circle have since announced they have tested positive for the virus.”

Read elsewhere that Haley, first to test positive we know about, was there, and likely the prep meetings went on for some period of time increasing viral load among all in the vicinity. Would be curious who else was there that we might be hearing about.

Subsequently to the Tuesday debate was the Rose Garden event where a number of those in attendance tested positive and I know someone who road on Air Force One had been diagnosed as well. News from Bedminister will start coming out in a few days.

With all the testing that was going on among staff and others near and around him helps illustrate with no masks on how easily it can spread.

 

[SarahsDad]

It's too early in his course for him to any "native antibodies".

If you read the linked article, you would have seen that "All patients entering the trial had laboratory-confirmed COVID-19 that was being treated in the outpatient setting." Yet 45% were already seropositive (had native antibodies). And since the Walter Reed MDs failed to answer the question as to when Trump's last negative test was, he could have been infected for many days.

 

[PACEMD]

The gold standard trial here was the RECOVERY trial, and it was focused on critically ill patients:
Coronavirus breakthrough: dexamethasone is first drug shown to save lives

In those patients, there is a marked survival benefit by treating with dexamethasone.

The same study showed a NOT statistically-significant chance of increased death in people that had just mild cases (i.e. not intubated). The problem is the study was not designed to study that group in detail and the results were only indicative, not with P values < 0.05 (i.e. more research is needed).
The cheap steroid touted as a 'breakthrough' coronavirus drug may carry a small risk for people who don't need respiratory support

Based upon that, the consensus is to not give steroids unless there are signs of lung disease (decreased O2 sats, increased work of breathing, significant X-Ray findings, etc.).


So yes, you are correct that "standard of care" is to not give steroids too early, for concern that they may blunt a potentially beneficial immune response.


EDIT - PACEMD beat me to it, and in a more succinct fashion.

But you said it so much better, well done.