President Trump’s Dexamethasone

Dexamethasone is not like Hydroxychloroquine that caused such a freak-out when the President seemed to promote its use as a treatment or preventive against  Covid-19.

Hydroxychloroquine is used to prevent and treat acute attacks of malaria. It’s use in Covid-19 is based on immunosuppressive  and antiautophagy properties that theoretically could benefit people with Covid-19. That’s why doctors tried it with varying success.  As with many drugs, timing is a critical factor in whether it is useful of not.

Dexamethasone is a long acting corticosteroid used to slow the body’s natural and often inappropriate response to things that cause inflammation. There are shorter acting steroids such as prednisilone that have a similar action. None is a cure or preventive for Covid-19, only a treatment when appropriate. There is no substance or drug that will prevent Covid-19.  Once infected, a person’s immune system is the only cure.  A vaccine, when available, will cause the body’s immune system to produce substances to recognize and destroy the SARS-CoV-2 virus that causes Covid-19.

Press Coverage of President Trump’s Infection

After it became known that the President was administered dexamethasone as part of his treatment for Covid-19, the legacy press exploded with uninformed comments about the severity of his infection.

Networks make an appeal to authority by having medical correspondents on the air to explain what different treatment options may mean.  One such correspondent is Dr. John Torres who appeared in numerous reports on  NBC following the announcement that President Trump contracted the virus. In one report, Dr. Torres cited NIH guidelines for using dexamethasone.  He said. “The fact that he got dexamethasone throws up a red flag,”

The press loves red flags.

Some people seized on his explanation of the guidelines as proof that the President was in worse shape than he claimed. That’s not what the doctor really said. A red flag means “ask more questions.” But he did mention the NIH guidelines, and failed to clarify that the panel “may modify these recommendations.”  You be the judge.

“Based on the preliminary, unpublished results of the RECOVERY trial, the Panel recommends dexamethasone 6 mg daily for up to 10 days in patients with COVID-19 who are on mechanical ventilation (AI) or those who require supplemental oxygen but who are not on mechanical ventilation (BI). The Panel recommends against using dexamethasone to treat patients with COVID-19 who do not require supplemental oxygen (AI). The Panel may modify these recommendations based on the final published results of this study and the results of other ongoing studies.”

When guidelines are cited by an authority, many uninformed people, as most voters are, assume that the use of a drug outside the guidelines constitutes some kind of transgression. Conversely, if the guidelines are followed, then the condition of the patient must be as severe as the guidelines would suggest. Both are wrong. The guidelines are wrong. Every patient’s immune status is different.

Dr. John Torres Explains the President’s Treatment

Guidelines are Subject to Revision

Doctors are still learning how to treat Covid-19.  A lot of mistakes were made in the beginning, particularly waiting too long to start patients on steroids until they required ventilation. Remember the panic about not having enough ventilators?

Medical science will certainly rewrite the guidelines for the use of dexamethasone in treating the sequelae of Covid-19. Other steroid drugs may be more appropriate in specific cases.  Or none at all.

Doctor Paul Marik, Chief of Pulmonary and Critical Care Medicine at Eastern Virginia Medical School, in Norfolk, VA has published a protocol for treating Covid-19 that deserves attention. In it, he correctly observes that Covid-19 is a steroid responsive disease, but timing is critical.  Again he is correct.

You can download a copy of the protocol HERE

Be aware that the protocol is a suggestion based on available research. It will change as more information becomes available. Certainly the NIH will be slow to publicize current observational results.

For the time being, we are confident that the President’s physicians are aware of everything in the protocol and are weighing whether any of it or none of it applies to President Trump’s unique circumstances. We think he got the steroid at an appropriate time. Doctors can argue about which corticosteroid should be given at what time and in what dose. After all, they are practicing.