Donald Trump is being treated with an experimental antibody drug that has shown promising initial early results but has yet to be peer-reviewed. According to statement from his doctor, the president has received a single eight-gram dose of an antibody cocktail called REGN-COV2 – a combination of two human neutralising antibodies against the virus.
The treatment was developed by Regeneron Pharmaceuticals, which previously developed a similar antibody drug against Ebola. He is also taking zinc, vitamin D, melatonin, aspirin and the heartburn drug famotidine – often sold in the US under the brand name Pepcid. Although the drug has not been shown to work against coronavirus, researchers are studying it as a possible treatment.
REGN-COV2 is part of a class of experimental Covid-19 drugs known as monoclonal antibodies: manufactured copies of human antibodies to the virus that are being studied for use in patients with early illness.
Data so far is limited, but the White House coronavirus adviser Anthony Fauci is among those saying it has shown promise.
In a press release earlier this week, Regeneron said the early trial results showed that treatment reduced viral levels and improved symptoms in non-hospitalised Covid-19 patients.
But doctors have said that the president has numerous health factors placing him at risk of complications from Covid-19, including his age and weight.
The White House announced on Friday that the 74-year-old president would be moved to the Walter Reed hospital in Washington DC “out of an abundance of caution, and at the recommendation of his physician and medical experts”.
Both Trump and his wife Melania were earlier described as displaying “mild symptoms” after testing positive.
While doctors expect symptoms such as headache, fever and loss of taste to emerge in the first week of infection, it is in the second week when patients can go dangerously downhill as the virus spreads to the lungs and causes problems with breathing.
As an older man, Trump is already in a high-risk group and being borderline obese raises the risk further.
Figures from around the world suggest the so-called infection fatality rate for someone in their mid-70s is about 4%, but men are nearly twice as likely to die as women and being obese triples the risk of hospital admission.
Trump’s positive test adds to a wealth of evidence that hydroxychloroquine, a drug he said he was taking earlier in the year, does not prevent Covid-19, but over the past nine months clinical trials have found beneficial treatments.
Fever and headache can be helped with paracetamol. Throughout the course of the infection doctors will monitor Trump’s vital signs and blood oxygen saturation, which reveals how the lungs are functioning.
Other treatments are normally reserved for patients in hospital, but remdesivir, an antiviral drug, is thought to be most effective when given early, while the virus is still replicating.
US doctors have raised fresh concerns over Trump’s high levels of “bad cholesterol”, which they claimed put him at risk of a stroke or heart attack.
Given the potential underlying health issues, doctors may be poised to administer antiplatelet or anticoagulant drugs if they fear he is at risk of blood clots.
Dr Barry Dixon, an intensive care doctor at St Vincent’s hospital in Melbourne, said Trump’s risk would increase if he developed pneumonia, which is associated with a high mortality rate, especially in patients over 65 and those with cardiovascular disease or conditions affecting blood vessels of the brain.
“He’s at a much higher risk of dying if he does develop that bad pneumonia,” Dixon said. “There are other risk factors and comorbidities, such as whether you are a heavy smoker, have diabetes, or have heart disease.
Dixon said mild symptoms at the onset did not indicate someone would avoid more severe disease. He said around the one-week mark people either seemed to improve or decline rapidly.
“We tend to see people with very mild symptoms for the first week, that is typical, and in the second week typically people either develop pneumonia or not,” he said.
“If you see someone who just got it, they’ve just tested positive, typically they look well. But we would tell those patients to isolate at home and to come to hospital if they feel short of breath. Because in that second week of the virus, people can go from looking very good to pretty rotten even over just 24 to 48 hours. It’s a quick deterioration, and that’s what we saw with Boris Johnson.”
Prof Peter Collignon, an infectious diseases doctor in Canberra, said: “If he’s well enough to walk and breathe OK, then he’d be fine to go home for a while. But a proportion will deteriorate between five to seven days later, so you’d need to monitor how he is breathing and how he looks.”
Prof Christine Jenkins, head of the respiratory group at the George Institute for Global Health, said while “Trump’s ideas about prophylactic hydroxychloroquine treatment and disinfectants were fake news”, he would probably benefit from the many evidence-based scientific advances made.
It was difficult to estimate his chances of being admitted to intensive care or dying, she said, because these statistics changed frequently as treatment improved.
“Early on we thought if you had Covid, were admitted to intensive care and over 70, you had only a 40-to-50% chance of survival,” Jenkins said.
“Today, those figures are not that bad, and we have had study results come out with promising findings about treatments for people who do become severely unwell, such as the drug dexamethasone.”
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