What Is The Status Of President Trump’s COVID-19 Case?

IRA FLATOW: This is Science Friday. I’m Ira Flatow. A bit later in the hour, the SciFri Book Club returns with a book about Afrofuturism.

But first, last week President Trump announced that he had tested positive for COVID-19 and was admitted to Walter Reed National Military Medical Center. This Tuesday he left the hospital, returned to the White House. There are still many questions about the status of his health, the experimental treatments he received, and who else in the White House and in Congress may have been infected.

Umair Irfan is here to fill us in on the latest updates. He’s a staff writer at Vox and based out of Washington, DC. Welcome back.

UMAIR IRFAN: Thanks, Ira

IRA FLATOW: OK, let’s see if we can parse a lot of this stuff. Throughout the week there have been mixed messages about Trump’s health status. Do we know how severe his case might be? Do we know what his actual condition is?

UMAIR IRFAN: Well, we got an update on Thursday evening from White House physician Sean Conley. And he reported that the president’s vitals– his heart rate, blood oxygen, blood pressure, and breathing rate– were all normal, and that there was no indication that the illness was progressing, nor any side effects of the drugs.

But he also said that this Saturday would mark 10 days since Trump’s initial diagnosis. And this sort of confirms the timeline that had been a little bit vague, which indicates that the president likely was diagnosed on October 1. And according to the CDC guidelines, the isolation precautions can start being relaxed 10 days after the onset of symptoms. So the latest update does clarify some of these things, but there’s still a lot that’s up in the air.

IRA FLATOW: For example, we still don’t know the date of his last negative test, correct?

UMAIR IRFAN: Yes. The White House has been a little bit hesitant to release that information. Similarly, when Sean Conley was questioned about the president’s lung scans, any anomalies that were there, he cited patient privacy laws. And that’s kind of concerning because we know for a fact that past COVID patients have seen lesions in their lungs develop as a result of this infection, even patients who had a mild course of the illness.

So that remains a possibility, and also there are people that have had long term complications even after they’ve supposedly gotten better from this illness. So the president may not be out of the woods yet. There may still be some issues with breathing or even, potentially, blood clotting.

IRA FLATOW: So he’s currently back in the White House, claims he’s feeling fine, ready to hold large rallies. Do we know what kind of guidelines, then, he is following? For example, about quarantining?

UMAIR IRFAN: Well, we know that White House staff have been encouraged to wear personal protective equipment, things like face masks. But that’s not been historically enforced very well at the White House, and that’s part of the reason they were in this situation to begin with.

And the president said that he wants to return to in-person rallies. And the White House physician said that he can return to public events. And so very likely a lot of these restrictions that may have been in place this past week will start being relaxed.

IRA FLATOW: Let’s talk about the experimental treatment he received, especially a drug produced by the company Regeneron. What type of treatment is this?

UMAIR IRFAN: Well, this drug is a combination of two different monoclonal antibodies, and that’s why it’s called an antibody cocktail. Basically, these are the proteins that the immune system generates to attack the virus and prevent it from causing an infection. And what this company did was, they used an engineered version that was produced from genetically engineered animals, as well as one that was produced from a human that had recovered from COVID-19. And the idea is the mix of these two separate antibodies would create a situation where it would be very hard for the virus to slip by them.

And this is a drug that’s still under testing. This is still in Phase 1, 2, and 3 clinical trials. There were some good results that were posted by the company later in September, but right now to my knowledge, there is no published data. And there hasn’t really been any clinical trials that have run to full completion nor any peer reviewed papers on this. And so we really have the company’s word to go on about its effectiveness, and now the president’s word because he has been promoting this drug pretty aggressively now.

IRA FLATOW: And he’s called it a cure, right? I mean, this is a treatment. This has not been classified as a cure.

UMAIR IRFAN: That’s right. The president received this very early on in his course of treatment, and he still had to be hospitalized, and still had to have these pretty severe medical interventions. So it may have helped him recover a little bit faster, but the fact is that this still meant that the disease was quite dangerous to him.

IRA FLATOW: He’s had a test showing that he’s had antibodies to the virus. What do these antibodies tell us?

UMAIR IRFAN: At this point, probably not all that much. I mean, he received a very high dose of this Regeneron treatment, the highest dose that’s available. And so some physicians looking at those results have said that it’s very likely that the antibody tests that he had this week was likely residual antibodies from that initial dose of the medication, and not antibodies that were produced by his own body. That can take up to two weeks to produce.

IRA FLATOW: And Regeneron is asking for emergency approval by the FDA. What are the implications of this? What does emergency approval mean?

UMAIR IRFAN: Right, emergency approval means that more doctors will have access to this drug, and they can use their own discretion to administer it to patients. Previously, this was– even though it was an experimental drug, it was available under a compassionate use guidelines, which means that it’s only available on a case by case basis. And there’s a lot more back and forth. But with emergency use, the standard is that it has a likely benefit, whereas full FDA approval means that the drug has a demonstrated benefit.

So this is a slightly lower bar than what we would get with typical approval. But again this is also still an acknowledgment this is a stopgap, that we don’t fully know the full benefits and potentially the harmful effects of this drug as well. There’s still a risk here.

IRA FLATOW: And of course Trump is saying that he wants this treatment for everyone. But this is a really costly drug, is it not?

UMAIR IRFAN: Yeah, this is an intravenous drug. It can cost thousands of dollars for a course of treatment. And this is a highly specialized drug. It’s produced using genetic engineering, and it’s also harvested from people who’ve recovered from the illness. So it’s very complicated to manufacture. And it’s also something that’s going to be kind of difficult to scale up, and yes, it’s also very expensive.

IRA FLATOW: And the president has been given sort of a cocktail of different treatments. I think it’s been described as “throwing in the kitchen sink” approach. No one has ever been given this combination of drugs. Do we have any idea what all of these do in the body together, or how they might interact?

UMAIR IRFAN: Not really, and that’s kind of the concern here. Doctors often express concern about this VIP syndrome, where if you have a very high profile patient they tend to give them everything that they have in their disposal. But really it may make more sense to have just one targeted approach, where you either try to tamp down the immune system’s overreactions or boost the immune system if it’s having a hard time fighting off the infection.

So for example, in addition to this Regeneron antibody cocktail, the president also received dexamethasone. This is an corticosteroid. And it has the effect of actually tamping down on the immune system.

Now this is one of the few drugs that actually has a demonstrated benefit on mortality. This is– according to studies, it can actually save the lives of patients who had COVID-19, but only in severely ill patients, patients who have needed oxygen support or needed to be intubated. And that’s because it can tamp down on some of these conditions of the immune system overreacting, like the cytokine storm, which you may have heard about. And that’s where that benefit comes in.

And then there is an antiviral drug that the president also received called remdesivir. And this is a drug that also has had some indication that it can be effective. There was just a clinical trial that was published this week that showed that for patients who receive the drug, they were released from the hospital within 10 days, whereas the patients who received the placebo recovered within 15 days.

And so it had a benefit in reducing the course of the illness. All of these things taken together, it makes it harder to tease out which drug was doing the heavy lifting here. And we don’t still know how they all interact, as you noted.

IRA FLATOW: So we don’t know which one has been most effective for the president.

UMAIR IRFAN: Yeah, and that’s important to figure out because it’s not likely that anybody else will be able to get all of these drugs at the same time. Very likely, doctors will have to make careful decisions about what individual drugs they prescribe to patients and sometimes that requires figuring out what these drugs actually do.

IRA FLATOW: Well, we now know that there have been dozens of people around the president, in the White House and the staff in the Pentagon, who have tested positive. We’re told there is frequent testing at the White House. Do we know what type of testing the White House has been using?

UMAIR IRFAN: Well, the White House said that it’s been using a system from Abbott Labs. This is a genetic test called ID NOW. And this was a rapid testing system that was released over the summer, but this is a test that also had some issues with accuracy. That was generally the trade-off, that because it’s a faster test there is a little bit of a reduction in some of the accuracy of the results. But White House staff have had access to these tests at their own discretion over the summer, but then in August, that’s when the White House implemented a policy of randomized mandatory testing.

So it was pretty late in the game where the White House enforced a testing regime. But to this point, we still don’t know how regular that was, how systematically staffers were being tested, and we don’t know how often the president himself was being tested. And that’s part of the reason why we have such a hard time keeping track of his illness. We don’t know when he was last negative and when he was first positive.

IRA FLATOW: So there has been a reliance on testing, but not on wearing masks.

UMAIR IRFAN: Right, and the White House hasn’t enforced mask mandates. And we saw that in some of the recent events that were held at the White House where very few people were wearing masks or even keeping distant from each other. And so that’s created a situation where the risk is much higher.

Individually, many of these measures have a marginal benefit, but taken together– wearing masks, maintaining social distance, staying in well ventilated places outdoors– together that provides a robust barrier against infection. But on the other hand, if you do none of those things– if you are very close to people not wearing masks in close proximity indoors for long periods of time, as the White House has been doing– that can dramatically boost the risk.

IRA FLATOW: With all the people who have been testing positive– the White House staff, Congress, as I say, the Pentagon– is the White House now considered a hotspot?

UMAIR IRFAN: Yes, in Washington, DC, transmission of COVID-19 has been fairly low. And now this is one of the epicenters in the city. And city officials are now concerned that the White House isn’t handling this quite properly. City officials reached out to the White House this week saying that they want them to start implementing a contact tracing regimen where they try to figure out where all these White House officials were and who they’ve come into contact with.

And it’s kind of surprising that they haven’t implemented this already, that the White House has been kind of dragging its feet on figuring out who else may have been exposed. And we keep finding out more and more people connected to this one White House event, the nomination ceremony for Supreme Court Justice Amy Coney Barrett, have been exposed to this. And so we may still yet learn that more people were connected to this cluster.

IRA FLATOW: One of the most visible Trump confidants is Governor Chris Christie, who also tested positive and admitted himself to the hospital in New Jersey last Saturday. So it’s been about a week. He’s still in the hospital after six days. Do we know anything about his status? It’s been pretty quiet.

UMAIR IRFAN: Yeah, it’s been pretty quiet about him and a number of other officials that have also been exposed and tested positive. The same story is true for just about everybody else connected to this cluster, that we don’t quite know who has been infected, how severely, and what their current status is.

IRA FLATOW: And Trump’s physician has cleared him, though, to start attending rallies this weekend.

UMAIR IRFAN: The president’s physician has said that the president would be cleared to start attending public events starting Saturday.

IRA FLATOW: Wow, so we’ll see what happens this weekend. Thanks, Umair.

UMAIR IRFAN: You bet.

IRA FLATOW: Umair Irfan, a staff writer at Vox and based out of Washington, DC.

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