Trump is taking the latest in COVID-19 treatments – here's what doctors know works against the virus

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What are the best-proven treatments for her and other patients when 74-year-old President Trump and 50-year-old first lady Melania Trump test positive for the coronavirus?

We are both doctors and scientists at the University of Virginia. We care for COVID-19 patients and conduct research to find better ways to diagnose and treat COVID-19.

Here we share what doctors have learned over the past eight months treating different stages of this disease. As of the beginning of the year, few treatments were known for people who showed severe COVID-19 symptoms other than being maintained on ventilators. Now, a few months later, there are a handful of treatments, including drugs, that offer doctors far better tools for healing patients, especially the very sick.

Who is Most at Risk for Severe COVID-19?

Men are one and a half times more likely to die, and an 80-year-old is 20 times more likely to die than a 50-year-old. In addition to age and male gender, obesity; Diabetes; current cancer diagnosis; chronic heart, lung and liver diseases; Stroke; and dementia are all linked to an increased risk of dying from COVID-19. Based on these criteria, the president falls into a higher risk category based on the gender and age of the men.

Does the treatment differ depending on how sick you are?

The therapeutic approach is different depending on the stage of the disease.

It is therefore important not only to diagnose COVID-19, but also to define whether the infection is asymptomatic or pre-symptomatic. How ill a person is – whether the case is mild, moderate, severe, or critical – also changes the way a patient is treated.

What treatment is there for an asymptomatic or pre-symptomatic infection?

Asymptomatic or pre-symptomatic infection is defined as a positive diagnostic test for COVID-19 (a PCR or antigen detection test) with no symptoms of infection.

There is currently no known effective treatment for this stage. Someone with asymptomatic or pre-symptomatic infection should isolate themselves at home for 10 days to avoid exposure to others.

What are the symptoms of a mild illness and what treatments work?

Symptoms of mild COVID-19 infection can include fever, cough, loss of taste or smell, muscle pain, headache, nausea, vomiting, diarrhea, constipation, and runny nose.

Someone with mild COVID-19 will not experience breathlessness, chest pain, or signs of pneumonia during a chest x-ray. The exception is children with mild medical conditions who may still have an abnormal x-ray.

There are no treatments that have been shown to benefit people with mild illnesses. However, such patients should be familiar with the symptoms of moderate illness so that they and others can identify if they are progressing to moderate illness. This is important because the progression to a more severe condition can be rapid – usually five to 10 days after the first symptoms.

Moderate illness

Moderate illness is defined as shortness of breath, chest pain or chest x-rays, signs of pneumonia but without hypoxia (low blood oxygen levels).

There is currently no known effective therapy for moderate illnesses.

Major illness

Serious illness is identified by a fast breathing rate (more than 30 breaths per minute) or low levels of oxygen in the blood, which is known as hypoxia. Signs of pneumonia that affects more than half the lungs, as diagnosed on a chest x-ray, are also signs of a severe case.

Controlled clinical studies have shown that the antiviral drug Remdesivir speeds recovery in patients with severe but not critical illness.

In addition, the anti-inflammatory steroid dexamethasone (a drug similar to prednisone) lowers mortality.

Critical Illness

Critical illness occurs when the patient becomes so ill that vital organs begin to fail and require medication or other therapy to support these vital functions.

If the lung failure is severe enough, doctors can put the patient on a mechanical ventilator or on large amounts of oxygen. There is no evidence to suggest that remdesivir treatment is beneficial in this critical phase. Dexamethasone is still recommended for treatment because it has been shown to reduce mortality.

Which therapies don’t work or are still being tested?

Some treatments that have been found to be ineffective include chloroquine and hydroxychloroquine.

Other potential treatments are still in the midst of clinical trials to test whether they are effective. This includes human convalescent plasma, which contains antibodies that are designed to bind to the virus and prevent it from entering cells.

There are also drugs that modulate the immune response, such as interferons and inhibitors of IL-6, which in some cases can prevent the harmful overreaction of the immune system, commonly called a cytokine storm.

Newer treatments, including a President Trump, have been given

There is currently no approved treatment for outpatients with asymptomatic or mild to moderate COVID-19. That seems to be changing, however, as Eli Lilly and Regeneron have released clinical trial data on the use of laboratory-made antibodies to the spike glycoprotein of the new coronavirus.

In this approach, like convalescent plasma, the antibodies work by attaching to the virus and preventing it from entering cells and multiplying. This could be effective especially early in the infection, before the disease becomes severe.

In an early preview of data from an ongoing Phase 3 clinical trial, subjects with COVID-19 injected with a cocktail of monoclonal antibodies to the SARS-CoV-2 spike glycoprotein had symptoms that lasted just seven days instead of 13 The amount of virus remaining in the nasopharynx – the upper part of the throat behind the nose – was also reduced.

An update from the president’s doctor on the afternoon of October 2 revealed that the president had received an infusion of Regeneron’s antibody cocktail as a precaution. This and similar approaches are currently being tested as a high priority by the National Institutes of Health to determine if they are safe and effective.

Trump Receives Experimental Serious Disease Control Drug (Update) from The Conversation

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