Coronavirus

[bkp_duke]

Those numbers are way off. They're based on cases, which were way under counted early on due to limited testing and are still significantly under counted. Also treatment has improved.

BINGO. Not remotely close to the population statistics.

. . .and they've put him on a polyclonal antibody cocktail from Regeneron.

Called it. Glad to see my clinical skills have not gotten rusty.

 

[AlanSubie4Life]

However, Trump is a symptomatic case now. Do you have any stats on more recent, symptomatic cases? I assume that most of the uncounted cases were asymptomatic. I would imagine that people with symptoms would be more likely than not to seek out a test. Around here you can get a free test at CVS, Walgreens, etc. if you have symptoms.

There are some posts earlier here. It's really hard to figure out specifically for Trump what the risk of death is, but given that he is symptomatic with a fever, I think he's probably at about a 5-6% chance of death. Overall IFR at his age (including asymptomatics, including male/female, including individuals who are healthy and not healthy prior to infection) is estimated by multiple sources to be around 3%.

That 6% COULD be a lot lower if some of the experimental treatment he is taking ends up being effective. We won't know.

He's also on Vitamin D, Zinc, Pepcid, melatonin, and aspirin (why I do not know, but I guess this stuff can't hurt - the Pepcid stuff was shown (perhaps) to improve outcomes to do some interfering in inflammatory pathways), in addition to the Regeneron polyclonal antibody cocktail.


Guess he is headed to Walter Reed now. I'm sure all is well. Just a nice day for a little drive.

 

[favo]

Those numbers are way off. They're based on cases, which were way under counted early on due to limited testing and are still significantly under counted. Also treatment has improved.

Trump is on his way to Walter Reed to be kept there for a few days, "out of an abundance of caution." They say his symptoms are still mild.

[ETA: Not "on his way" just yet, but Marine-1 is landing right now on the South Lawn.]

 

[SMAlset]

Article on the Walter Reed move posted on CNBC: President Trump being taken to Walter Reed Military Medical Center as a 'precautionary measure'

 

[AlanSubie4Life]

Called it. Glad to see my clinical skills have not gotten rusty.

What are your thoughts on actually giving him experimental drugs like this? My thought is that you would not do this unless there were evidence that his disease may have the potential to take a more serious turn, or at least there is some hint of that.

But I'm no doctor! I have no idea what the risk/benefit is here.

For example, I can't imagine they would do this for an asymptomatic patient. So where's the line?

 

[bkp_duke]

What are your thoughts on actually giving him experimental drugs like this? My thought is that you would not do this unless there were evidence that his disease may have the potential to take a more serious turn, or at least there is some hint of that.

But I'm no doctor! I have no idea what the risk/benefit is here.

For example, I can't imagine they would do this for an asymptomatic patient. So where's the line?

Meh, IIRC Phase 3 of that drug has already completed.

Regeneron's monocolonal antibody should be thought of as "Convalescent Plasma 2.0". You take the best part of that (antibody) and none of the bad stuff.

It's too expensive, and has not shown to prevent asymptomatic patients from becoming symptomatic, but fever is a primary symptom for COVID-19, so by all objective criteria (positive test, fever), Trump qualifies for treatment.



If it were me, from my armchair quarterback office, I would do the following:
1) Regeneron mAb therapy
2) replenish any Vitamin D or Vitamin C deficiencies (NOT the same as mega doses, which have not been shown to help)
3) if he starts with respiratory symptoms, start dexamethasone (NOT before, as you don't want to blunt the natural immune response)
4) consider anti-TNFalpha therapy if symptoms progress (i.e. the Bradykinin pathway looks to be getting over-stimulated)

EDIT - forgot - add Remdesivir. It would work synergistically with the mAb therapy.

 

[AlanSubie4Life]

Regeneron's monocolonal antibody

It's a polyclonal antibody cocktail. I assume that just means it's a mix of various monoclonal antibodies, just for a scatter gun sort of approach?

Seems odd that he's going to the hospital, but I guess it allows no limitations on treatment options should anything take a turn for the worse?

I guess Regeneron is a drip, but that could still be done at the residence.

EDIT: My quick search seemed to imply it was still in clinical trials, but no idea.

 

[favo]

What are your thoughts on actually giving him experimental drugs like this? My thought is that you would not do this unless there were evidence that his disease may have the potential to take a more serious turn, or at least there is some hint of that.

But I'm no doctor! I have no idea what the risk/benefit is here.

For example, I can't imagine they would do this for an asymptomatic patient. So where's the line?

I'm no doctor either!

My fear is that he's not all that healthy. He is clearly obese. He is being treated for high cholesterol and (maybe?) high blood pressure. There is every indication he has some level of atherosclerosis. There was the surprise visit to Walter Reed a few (?) months ago. There is his constant projection about how "weak" Biden is (probably the best indicator). There is having trouble walking down ramps and drinking from a glass. The latter may be aberrations, but who knows? They have certainly not been fully forthcoming about his medical history and health status.

Remember Boris Johnson's case? He was fine and working from home for about a week, then suddenly had to go into the hospital and was in the ICU for 3 days, and nearly died by his own admission. Johnson is about 20 years younger than Trump, and not as obese. Maybe he has some other comorbidity, or just had bad luck. Ultimately, he was largely out of commission for almost a month. That could be among Trump's better scenarios right now.

I think obesity is a significant and underappreciated comorbidity. If you notice all the cases of younger people (under 65) who died and are reported as having no contributing factors, most appear to be overweight. (Anecdotal, I know.) It may be second only to hypertension as a risk factor. Here's a paper I haven't read, but might be worthwhile: Obesity, the most common comorbidity in SARS-CoV-2: is leptin the link? | International Journal of Obesity

 

[bkp_duke]

It's a polyclonal antibody cocktail. I assume that just means it's a mix of various monoclonal antibodies, just for a scatter gun sort of approach?

Seems odd that he's going to the hospital, but I guess it allows no limitations on treatment options should anything take a turn for the worse?

I guess Regeneron is a drip, but that could still be done at the residence.

Polyclonal probably has a better chance of success. Regardless, last I checked it was past Phase 3 trials with no outstanding side effects.

Antibody treatments are almost always IV infusions, usually over several hours of time. Most likely, doses every 8 hours. That is infinitely easier to perform at a hospital than . . . pretty much anywhere else.

 

[Norbert]

For example, I can't imagine they would do this for an asymptomatic patient. So where's the line?

In terms of public perception, I guess his chances to go through this as an asymptomatic superman are already pretty much gone.

 

[bkp_duke]

I'm no doctor either!

My fear is that he's not all that healthy. He is clearly obese. He is being treated for high cholesterol and (maybe?) high blood pressure. There is every indication he has some level of atherosclerosis. There was the surprise visit to Walter Reed a few (?) months ago. There is his constant projection about how "weak" Biden is (probably the best indicator). There is having trouble walking down ramps and drinking from a glass. The latter may be aberrations, but who knows? They have certainly not been fully forthcoming about his medical history and health status.

Remember Boris Johnson's case? He was fine and working from home for about a week, then suddenly had to go into the hospital and was in the ICU for 3 days, and nearly died by his own admission. Johnson is about 20 years younger than Trump, and not as obese. Maybe he has some other comorbidity, or just had bad luck. Ultimately, he was largely out of commission for almost a month. That could be among Trump's better scenarios right now.

I think obesity is a significant and underappreciated comorbidity. If you notice all the cases of younger people (under 65) who died and are reported as having no contributing factors, most appear to be overweight. (Anecdotal, I know.) It may be second only to hypertension as a risk factor. Here's a paper I haven't read, but might be worthwhile: Obesity, the most common comorbidity in SARS-CoV-2: is leptin the link? | International Journal of Obesity

I am a doctor, and nothing I have heard so far has set off my spidy sense of "oh, that's not good".

Sure, he has co-morbidities, but literally 50+% of the US population does.

He will get the best care in the world, his odds of an event-free survival are higher than anyone with the same co-morbidity profile.

 

[favo]

Meh, IIRC Phase 3 of that drug has already completed.

Regeneron's monocolonal antibody should be thought of as "Convalescent Plasma 2.0". You take the best part of that (antibody) and none of the bad stuff.

It's too expensive, and has not shown to prevent asymptomatic patients from becoming symptomatic, but fever is a primary symptom for COVID-19, so by all objective criteria (positive test, fever), Trump qualifies for treatment.



If it were me, from my armchair quarterback office, I would do the following:
1) Regeneron mAb therapy
2) replenish any Vitamin D or Vitamin C deficiencies (NOT the same as mega doses, which have not been shown to help)
3) if he starts with respiratory symptoms, start dexamethasone (NOT before, as you don't want to blunt the natural immune response)
4) consider anti-TNFalpha therapy if symptoms progress (i.e. the Bradykinin pathway looks to be getting over-stimulated)

EDIT - forgot - add Remdesivir. It would work synergistically with the mAb therapy.

If we hear they have him on dexamethasone or Remdesivir, wouldn't that indicate that his case is substantially worse than "mild"? Not that he still couldn't come out the other side fine, but that would seem to be a bad sign if it happens and would at the very least indicate an extended hospital stay, no?

 

[bkp_duke]

In terms of public perception, I guess his chances to go through this as an asymptomatic superman are already pretty much gone.

One can hope he has a bit more objectivity after the experience and makes better decisions.

 

[SMAlset]

Reports from his physician also listed him as "fatigued but in good spirits". Fatigue also seems to be one of those symptom indicators.

 

[bkp_duke]

If we hear they have him on dexamethasone or Remdesivir, wouldn't that indicate that his case is substantially worse than "mild"? Not that he still couldn't come out the other side fine, but that would seem to be a bad sign if it happens and would at the very least indicate an extended hospital stay, no?

Remdesivir should be given, immediately. It's most effective when viral loads are lower.

Dexamethasone should be reserved until there are respiratory findings (X-Ray findings, low O2 sats, or difficulty breathing). You give Dex early, and you suppress the immune system and give the virus a chance to run rampant.

 

[favo]

Remdesivir should be given, immediately. It's most effective when viral loads are lower.

Dexamethasone should be reserved until there are respiratory findings (X-Ray findings, low O2 sats, or difficulty breathing). You give Dex early, and you suppress the immune system and give the virus a chance to run rampant.

I wonder if they will try to "prone" him. It seemed like that was a low-tech treatment that was reasonably effective at lessening the severity of the lung damage. I also wonder if he would be compliant for such a treatment.

 

[bkp_duke]

I wonder if they will try to "prone" him. It seemed like that was a low-tech treatment that was reasonably effective at lessening the severity of the lung damage. I also wonder if he would be compliant for such a treatment.

There is no indication he has respiratory symptoms. That would be something to try only if there are significant (not mild) respiratory symptoms with the goal of preventing intubation.

 

[favo]

He will get the best care in the world, his odds of an event-free survival are higher than anyone with the same co-morbidity profile.

Then again, he surrounds himself with yes-men like Scott Atlas and his previous doctors who claimed him to be the healthiest President ever. Maybe he'll demand Hydroxychloroquine or that herbal snake oil from the pillow guy. Kinda makes you wonder. One hopes his self-preservation instincts will kick in, and he'll actually listen.

 

[JRP3]

One can hope he has a bit more objectivity after the experience and makes better decisions.

Is a brain transplant standard treatment now?

 

[Daniel in SD]

OK, fair enough. Those stats only ran through the end of May, which was a while ago.

However, Trump is a symptomatic case now. Do you have any stats on more recent, symptomatic cases? I assume that most of the uncounted cases were asymptomatic. I would imagine that people with symptoms would be more likely than not to seek out a test. Around here you can get a free test at CVS, Walgreens, etc. if you have symptoms.

CFR in Florida for 70-80 year olds is 7% now. Maybe the majority of cases of symptomatic 70-80 year olds are being caught so half that? Trump may be healthier than the average 70-80 year old (only through good luck as far as I can tell!). Hard to say, men have it worse and he's certainly obese!
Obviously he'll receive very good treatment though I'm a wondering if they're going to try to pump him full of every experimental drug, I'm skeptical of that strategy.

CFR data: mbevand/florida-covid19-line-list-data