“We decided that in this case the potential benefits at the start of the course probably outweighed the risks at this time,” Dr. Sean Conley told reporters outside the Walter Reed National Military Medical Center on Sunday.
At least one large randomized trial has shown that coronavirus patients perform better if they are given dexamethasone, a cheap and widely available corticosteroid drug that suppresses dangerous inflammation.
“The Panel recommends that dexamethasone not be used for the treatment of Covid-19 in patients who do not require supplemental oxygen,” read the NIH guidelines.
In the dexamethasone study, conducted in the UK, around 23% of patients who received dexamethasone died, compared with around 26% of those who did not.
“No survival benefit was found among participants who did not require oxygen therapy at enrollment,” the NIH said.
There is a reason for this: The drug reduces inflammation, but doing so can impair the body’s ability to fight infections.
“In severe pneumonia caused by influenza viruses, corticosteroid therapy appears to cause worse clinical outcomes, including secondary bacterial infection and death,” notes the panel. Therefore patients must be monitored closely while taking medications and the benefits of any treatment should outweigh the risks.
Why Trump’s doctors started dexamethasone
Trump’s doctors said they decided to give him dexamethasone after his oxygen levels dropped twice.
Thursday night and through early Friday morning, Conley said, the president “was fine with only mild symptoms” and his oxygen level was in the 90s – but then late Friday morning, “the president had a high fever. and his oxygen saturation transiently dropped below 94 percent, ”Conley said.
The president received oxygen.
“And after about a minute with only two liters, his saturation levels were back over 95 percent. He stayed on that for about an hour maybe, and it was off and gone,” Conley said.
On Saturday, Trump’s oxygen levels dropped back below 93%. “We looked at it and it came back up,” Conley said.
But the decision was made to give Trump dexamethasone.
“In response to transient low oxygen levels, as Dr. Conley discussed, we started dexamethasone therapy, and he received his first dose yesterday,” Garibaldi said during Sunday’s briefing.
“Our plan is to continue like this for the time being.”
“Dexamethasone generally starts when you start worrying that they’re going the wrong way,” Walenksy said. “So what happened today? Either he’s progressed or people say, well, let’s throw the kitchen sink on him.
“It’s not clear to me why they would have given it to him if he didn’t need supplemental oxygen.”
Dr. Carlos del Rio, an infectious disease specialist at the Emory School of Medicine, said dexamethasone should only be given to seriously ill patients. But based on what the president’s doctors have said, Trump could be seriously ill.
“It continued to develop oxygen saturation below 94 percent,” del Rio noted.