President Trump Hospitalized for COVID-19 (Lung Doctor Gives Medical Analysis)
Hi guys, for those of you who don’t me, I’m Mike Hansen, board-certified in internal medicine, pulmonary disease, and critical care medicine. As a critical care doctor, and lung doctor, I want to give my take President Donald Trump’s COVID-19 diagnosis and prognosis, and how I think his doctors at Walter Reed Medical Center will medically manage him.
He was said to have fatigue, fever, hoarse voice, and cough, and no shortness of breath. While at the white house, he gets zinc, vitamin D, melatonin, famotidine, and this new polyclonal antibody treatment, which is a totally new therapy that we don’t even know if it works or night, as there are no RCT published about this. It’s an experimental therapy.
We see him walking to the helicopter. Which is significant. He wasn’t in resp distress, he wasn’t requiring extra oxygen. So based on the fact that he is walking without becoming short of breath or hypoxic, this is mild COVID-19. The concern is that this process, and with COVID-19, can progress slowly and gradually, or it can progress slowly and gradually and all of a sudden there can be clinical deterioration. So why hospitalization? According to the press secretary, he will be hospitalized for several days. That is of course assuming his disease does not progress. The decision to hospitalize someone with COVID is really based on breathing. Are they short of breath? Do they have hypoxia, meaning lower oxygen levels? He does have risk factors, age 74, male, obese, hypertension, cardiovascular disease. Overall, the numbers say he is likely to come out of this ok, but who knows. There is no way to predict what happens. It’s a mysterious illness. So when he is admitted to the hospital, here are things that I want to know, and things that I would do.
What about treatment? Most patients with mild disease are not hospitalized. But the president is not most patients, and that is why he is hospitalized despite only having a mild illness, based on the information that I can glean so far. Dexamethasone is a glucocorticoid, a type of steroid has been shown to have improved mortality in hospitalized patients with moderate or severe disease. Remdesivir might be somewhat helpful in hospitalized patients. But both of these might improve clinical outcomes but are far from any cure. What about convalescent plasma? Well, he already received antibodies so giving him additional antibodies is unlikely to have any benefit. Even if he did not receive those antibodies, CP hasn’t been proven to be beneficial in any RCT. I made an entire video about CP if you want to learn more about that. Anticoagulation, meaning a blood thinner, is always given to hospitalized patients, even before COVID, unless there is a contraindication like they have bleeding. But COVID does raise the risk of people developing blood clots, especially those who have cardiovascular risk factors, like obesity, HTN, and high cholesterol. This is because of COVID-19 latches on to the ACE2 receptors not just in the alveoli of the lungs, but also the ACE2 receptors that line our capillaries, the tiniest blood vessels in our body. So the potential for blood clots is a big concern.
The other big concern is how extensive is his COVID-19 pneumonia? Meaning how much inflammation is there in the lungs? My guess is he is getting a CT scan of the lungs, and probably a CTa of the lungs to look for blood clots. Another potential treatment, which is reserved for critically ill patients, which Trump is not, is Tocilizumab, which is an IL-6 monoclonal antibody. IL-6 is a central player in the cytokine storm that develops in COVID -19 patients with severe disease. When patients have very elevated inflammatory markers (D-dimer, ferritin) and elevated pro-inflammatory cytokines (including IL-6) are associated with critical and fatal COVID-19, and blocking the inflammatory pathway has been hypothesized to prevent disease progression. Several drugs that target the IL-6 pathway have been evaluated in randomized trials for the treatment of COVID-19; these include the IL-6 receptor blockers tocilizumab and sarilumab and the direct IL-6 inhibitor siltuximab. In one study of over 500 patients with severe COVID-19, treatment with tocilizumab was associated with a decreased risk of invasive mechanical ventilation or death.
