“We decided that in this case, the potential benefits at the beginning of the course likely outweighed the risks at that point,” said White House Doctor Dr. Sean Conley told reporters outside the Walter Reed National Military Medical Center on Sunday.
At least one large, randomized study has shown that coronavirus patients do better when given dexamethasone, a cheap and widely used corticosteroid drug that suppresses dangerous inflammation.
“The panel recommends not using dexamethasone to treat Covid-19 in patients who do not need supplemental oxygen,” the NIH guidelines read.
In the UK study of dexamethasone, about 23% of patients who received dexamethasone died compared to about 26% of those who did not.
“No survival benefit was seen in participants who did not require oxygen therapy at enrollment,” the NIH said.
There’s a reason for this – the drug reduces inflammation, but it can affect the body’s ability to fight off infection.
“In severe influenza virus pneumonia, corticosteroid therapy appears to lead to poorer clinical outcomes, including secondary bacterial infections and death,” the panel notes. Therefore, patients must be carefully monitored while taking the medication, and the benefits of 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.
On Thursday evening and into early Friday morning, Conley said the president was “fine with only mild symptoms” and his oxygen level was in the high 90s – but then by late Friday morning “the president had a high fever and his oxygen saturation temporarily dropped below 94%, “said Conley.
The president was given oxygen.
“And after about a minute with just two liters, his saturation level was back above 95%. It stayed there for maybe an hour and was gone and gone,” said Conley.
On Saturday, Trump’s oxygen levels fell below 93% again. “We saw it and it went up again,” said Conley.
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 of it yesterday,” Garibaldi said during the briefing on Sunday.
“Our plan is to continue this for the time being.”
“Generally, you start on dexamethasone when you are concerned that it is going the wrong way,” Walenksy said. “So what happened today? Either he made progress or people say we just throw the sink at him.
“I don’t know why they would have given this to him if he hadn’t needed extra 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.
“He developed oxygen saturation below 94%,” noted del Rio.