COMMENTARY

'No One Is Protected' From COVID-19, Not Even the President

Paul G. Auwaerter, MD

Disclosures

October 05, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

This transcript has been edited for clarity.

Hello. This is Paul Auwaerter for Medscape Infectious Diseases, from the Johns Hopkins University School of Medicine in Baltimore, Maryland.

President Trump is in the news most prominently because he unfortunately has contracted the novel coronavirus, and based on mild respiratory symptoms, he appears to have the clinical illness COVID-19. As I'm speaking now, on the evening of October 2, there are reports that he is being moved to Walter Reed Medical Center as a precautionary measure. There's no word that he requires oxygen, but he has perhaps been symptomatic now for two days or so. [Editor's note: Since the time of this recording, the White House physician has reported that President Trump received supplemental oxygen.]

What we know is that the president is in an age group at risk for severe coronavirus disease. He also may have some other comorbidities, such as obesity. This could mean that he'll have a rougher time than [other] men his age.

What is available for the president in terms of trying to staunch the infection from becoming severe? We know that on average, 5-10 days after [disease] onset is the typical timeframe within which people might develop severe symptoms — the hyperinflammatory responses of COVID-19. There are no FDA-approved outpatient treatments.

There are reports that the president has received a monoclonal antibody cocktail made by Regeneron, which has received funding from the federal government. Their press release from the last week of September suggests that outpatients who received this had alleviation of symptoms sooner, and therefore less severe illness. Patients who seemed to benefit most were those who had a high viral titer or who lacked any antibody responses at the time of receiving this monoclonal antibody cocktail, which may serve to neutralize viruses and therefore prevent additional cellular infections and/or tissue damage. If he has indeed received this, it may be the state of the art, at least based on information that has not been fully disclosed. But it at least looks promising.

There are many other experimental therapies, such as convalescent plasma and antivirals, but no studies have yet progressed enough to meet FDA approval. Convalescent plasma is authorized under emergency use for people who are hospitalized and require oxygen therapy. There's also the antiviral remdesivir, again approved for emergency use as an investigational agent for people who are hospitalized, although the best data suggest that people who seem to benefit are those who require oxygen or have more severe disease.

So, there are a number of treatment modalities. I'm certain that the president's physicians are exploring many of these potentials, especially if his condition were to worsen.

No One Is Protected; Prevention Is Key

The take-home message about the president's illness is that we know the president has not been a fan of always wearing masks or social distancing, even though he is in an extremely important role. Other world leaders have suffered from COVID-19, including Boris Johnson, who had a severe illness, although it was earlier in the pandemic. We know much more now, but hands down, prevention is key.

We don't yet have vaccines available here in the United States, so wearing masks and social distancing are very important not only to prevent infection for yourself but also to help prevent spread to others. This situation highlights the fact that no one and no situation is protected, even with frequent testing or other maneuvers. These [precautions] should be carried out even in your own homes if someone is especially at risk of contracting the disease and having severe illness, such as people over 65.

I wish the president, his family, and everyone involved in the White House well and that their illnesses may be mild [so they can quickly] recuperate, especially during this important time in our election cycle, such that there can be full participation. This will certainly be watched on a daily basis, and there may even be additional information coming out soon about new medications, as always seems to be the case.

I've included a link to the press release from Regeneron on their monoclonal antibody cocktail that gives the key findings from their study so far. Thanks very much for listening. The pandemic remains with us, and I hope you all stay well and that we communicate to our patients the importance of wearing masks and social distancing to keep us safe and sound.

Paul G. Auwaerter, MD, is a professor of medicine at the Johns Hopkins University School of Medicine and clinical director of the Division of Infectious Diseases. His areas of clinical expertise include Lyme disease, Epstein-Barr virus, and fever of unknown origin. He has been a Medscape contributor since 2008.

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