Trump put on dexamethasone, a steroid recommended for severe cases of Covid-19

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Doctors for President Donald Trump said on Sunday that they had started treating him with dexamethasone, a steroid that has shown promise for critically ill patients but could harm those with less severe cases of Covid- 19.The revelation, which is part of an optimistic briefing on the president’s condition, raised further questions about Trump’s health as the 74-year-old battles the virus that has killed more than 200,000 Americans.

Dr Nahid Bhadelia, an infectious disease physician at the Boston University School of Medicine, said steroid treatment suggests that Trump has a level of inflammation that justifies steroid use despite the drug also suppressing the immune system.

“That they made the conscious decision that the benefit of giving steroids outweighs the risk implies a higher degree of severity than we knew on Friday and Saturday,” Bhadelia said in an email.

Another expert, Dr Vin Gupta, said the revelations from doctors could indicate Trump may be suffering from pneumonia.

“The treatment doctors report they have given suggests the president has COVID pneumonia of at least mild severity,” said Gupta, a faculty member at the Institute for Measurement and Evaluation of University of Washington Health.

The briefing took place outside the Walter Reed National Military Medical Center in Bethesda, Maryland, where the president has been treated since Friday.

White House doctor Dr Sean Conley said the president’s medical team had started treating the president with dexamethasone. The treatment came in response to two incidents in which Trump’s blood oxygen levels fell below normal in recent days.

Conley also said Trump could be released as early as Monday and said his health was improving.

Bhadelia said she generally wouldn’t reject someone who had just been on steroids.

The announcement by Trump’s medical team complicated assessments of the seriousness of the president’s case, especially in light of the shyness surrounding 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 that it “may increase the risk of death when given to patients with non-severe cases” of the disease.

The WHO has defined severe cases of Covid-19 as causing blood oxygen levels to drop below 90%. Healthy adults typically have blood oxygen levels of 95% or more. Rapid breathing or other signs of respiratory distress can also cause a case to be considered serious.

A study cited by the WHO showed that dexamethasone reduced mortality to around 22.9% compared to 25.7% for people receiving usual treatments.

Trump’s medics declined to say how much the president’s blood oxygen level has dropped, beyond saying it was not recorded in the 1980s. Conley said the rate of d Trump’s blood oxygen was 98% on Sunday.

Dr Scott Gottlieb, who led the FDA from 2017 to 2019, said the president’s two drops in blood oxygen levels did not suggest a strong recovery.

“I’m concerned about O2 because it means his lungs are affected (COVID-19 is the disease and now he has it),” Gottlieb said in an email. He added, “If they’re going to fire him tomorrow, that would mean he’s HIV negative. I do not think it is possible. ”

Gottlieb added: “The low oxygen levels and the claim that ‘chest imaging was showing results consistent with his condition’ suggest he may have lung pneumonia. ”

On Saturday, Conley dodged questions of whether the President had received supplemental oxygen. Then, on Sunday, Conley said the president’s oxygen levels dropped on Friday and Saturday, and he revealed the president received supplemental oxygen on Friday.

However, it was not clear if Trump received oxygen on Saturday. When asked about it on Sunday, Conley deferred to the nursing staff.

“I should, I should check with the nurses. I don’t think – if he did, it was very, very limited. But he’s not on oxygen, ”Conley said. “The only oxygen I ordered that we provided was this Friday morning, initially. ”

The president’s medical team did not disclose his state of health, forcing the public to read between the lines.

“I didn’t want to give out any information that might point the course of the disease in another direction, and in doing so, you know, it turned out that we were trying to hide something, which was not necessarily true,” explained Conley. on Sunday.

Still, it seemed curious to doctors that the president would only need supplemental oxygen once or twice, in light of the dexamethasone treatment. The National Institutes of Health Covid-19 treatment guidelines note that dexamethasone has only shown positive effects in patients requiring supplemental oxygen.

“Dexamethasone is an incredibly common steroid. But not at the high doses used in COVID-19, which is why the NIH recommends NOT using it unless the [patient] requires supplemental oxygen, ”wrote Dr. Kavita Patel, former executive director of clinical transformation at the Brookings Institution’s Center for Health Policy, in a Twitter post Sunday.

“No 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 board of directors of Pfizer, a Tempus genetic testing start-up and biotech company Illumina. Pfizer has a manufacturing agreement with Gilead for remdesivir. Gottlieb is also co-chair of Norwegian Cruise Line Holdings‘and Royal Caribbean«Healthy Sail Panel».

Correction: This story has been updated to reflect that Sean Conley, the President’s doctor, did not say if the President received supplemental oxygen on Saturday.

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