What we know about dexamethasone against covid-19 1:35
(CNN) -
One of the doctors treating President Donald Trump, Dr. Brian Garibaldi, said Sunday that the president is being administered the steroid dexamethasone as part of his COVID-19 treatment.
It is an indication that Trump's condition is concerning, as the drug should not be given to anyone who is not sick enough to justify the downsides of taking steroids, including the fact that it suppresses the immune system.
"We decided that, in this case, the potential benefits, early in the course, probably outweighed the risks at this point," White House physician Dr. Sean Conley told reporters outside the Military Medical Center on Sunday. National Walter Reed.
Trump is taking remdesivir, dexamethasone, and more to treat covid-19
Why does dexamethasone break a paradigm of medicine in the treatment of covid-19?
1:24
At least one large randomized study has shown that coronavirus patients do better given dexamethasone, a cheap and widely available corticosteroid drug that reduces dangerous inflammation.
The National Institutes of Health (NIH) say in its guidelines on the treatment of coronavirus infections that "patients with severe COVID-19 can develop a systemic (whole body) inflammatory response that can lead to lung damage and multisystemic organ dysfunction. ».
Based on the results of one trial, the NIH expert panel recommended administering dexamethasone to COVID-19 patients who need oxygen.
"The Panel recommends not using dexamethasone for the treatment of COVID-19 in patients who do not require supplemental oxygen," the NIH guidelines say.
The use of dexamethasone
In the dexamethasone study, which was conducted in Great Britain, about 23% of the patients who received dexamethasone died, compared with about 26% of those who did not.
"No survival benefit was seen among participants who did not require oxygen therapy at enrollment," the NIH said.
There's a reason for this: the drug reduces inflammation, but by doing so, it can affect the body's ability to fight infection.
"In severe pneumonia caused by influenza viruses, corticosteroid therapy appears to produce worse clinical outcomes, including secondary bacterial infection and death," the panel notes.
Therefore, patients must be carefully monitored while taking medications, and the benefits of any treatment must outweigh the risks.
Why did Trump's doctors start taking dexamethasone?
Trump's doctors said they decided to give him dexamethasone after his oxygen levels dropped twice.
Thursday night and into the early hours of Friday, Conley said, the president "was fine with mild symptoms."
His oxygen level was in the 90s, but then Friday morning "the president had a high fever and his oxygen saturation transiently dropped below 94%," Conley said.
The president received oxygen.
'And after about a minute with just two liters, their saturation levels were back above 95%.
He stayed at it for about an hour, coming and going, ”Conley said.
On Saturday, Trump's oxygen levels fell back below 93%.
"We saw him and he came back up," Conley said.
But the decision was made to administer dexamethasone to Trump.
"In response to transient low oxygen levels, as Dr. Conley has commented, we started dexamethasone therapy, and he received his first dose yesterday," Garibaldi said during Sunday's briefing.
"Our plan is to continue that for now."
Trump's oxygen levels
Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital, said the use of dexamethasone raises questions because it is suggested for people with serious illnesses.
She noted that video posted Saturday of Trump at Walter Reed Medical Center did not appear to show shortness of breath or cough.
"Usually you start on dexamethasone when you start to worry that you are going the wrong way," Walenksy said.
So what happened today?
Either it progressed or, people say, well, let's try whatever it takes to figure this out.
I'm not sure why they would have given him that if he didn't need supplemental oxygen. "
Dr. Carlos del Rio, an infectious disease specialist at Emory School of Medicine, said dexamethasone should only be given to seriously ill patients.
But based on what the president's doctors said, Trump could be seriously ill.
"It continued to develop oxygen saturation below 94%," Del Rio noted.
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