President Donald Trump’s physician, Navy Cmdr. Dr. Sean Conley, announced during a medical briefing Sunday that the president’s blood oxygen levels have dipped twice since receiving a COVID-19 diagnosis, requiring him to receive supplemental oxygen.
The news came less than 48 hours after Trump was moved to Walter Reed Medical Center for further care.
Trump’s medical team also announced Sunday that the president is receiving dexamethasone, a common corticosteroid used to reduce the inflammation the infection is known to cause.
Dexamethasone is typically administered to those who are experiencing severe symptoms of COVID-19, which has sparked concern about Trump’s current condition.
Trump previously received two other experimental drugs, an antibody cocktail and the antiviral remdesivir, used to treat moderate to severe cases of COVI9-19.
“The treatments they’ve chosen to give him, from the monoclonal antibody, the remdesivir, and dexamethasone today suggest that he’s having some symptomatic and inflammatory changes that are concerning,” Dr. Maria Torroella Carney, the chief of geriatric and palliative medicine at Northwell Health in New Hyde Park, New York, told Healthline.
This weekend, Trump received Regeneron’s antibody cocktail REGN-COV2 — currently under ongoing clinical trials — which supplies neutralizing antibodies, along with two doses of remdesivir, which prevents viral replication and can shorten the duration of the illness when given early in the course of the disease.
Trump has also received supplemental oxygen, according to his medical team, and his blood oxygen levels are now stable.
Dr. Sunil Sood, an infectious disease specialist at South Shore University Hospital in New York, says we don’t have a clear picture of Trump’s blood oxygen trajectory, making it difficult to determine how he is doing.
“If it really did drop twice, that’s an indication he has pulmonary involvement (COVID pneumonia), which can be mild initially but could still worsen over the next few days,” Sood said.
On Sunday, Trump’s medical team announced he is now on dexamethasone, a steroid that has a powerful anti-inflammatory effect that helps fight the hyperactive inflammatory immune response experienced by some with COVID-19.
A chest scan is typically administered prior to giving the steroid, to see if there’s evidence of viral pneumonia, inflammatory changes, or microclots in the lungs, says Carney.
Dexamethasone is usually given to those experiencing moderate to severe symptoms of COVID-19, like widespread inflammation and viral pneumonia, according to Sood.
This would suggest Trump may have some signs of inflammation or viral pneumonia.
“That is suggestive that the virus has created inflammation levels. [Dexamethasone] has shown good response, but is usually [used] when there is inflammation present, and that worries me,” Carney said.
These three drugs have never been given together in any other COVID-19 patient, says Carney.
Most patients receive the drugs further into the course of their illness, though it’s unclear exactly when Trump was diagnosed and began experiencing symptoms.
“His course has been very different from our usual patients with COVID-19 because he’s getting such specialized treatment, very aggressive treatment,” Dr. Aruna Subramanian, infectious disease physician at Stanford Health Care, said.
Trump’s medical team said Sunday that the president could be released from the hospital as early as Monday, but health experts suspect that’s too soon.
It’s hard to predict Trump’s path to recovery since there are so many unknowns, but the president will need to be monitored closely over the next several days, says Subramanian.
“Usually, between 7 to 10 days into the illness is where you see things worsen, so it is a bit worrisome. We normally would keep somebody in the hospital if they’re on and off oxygen and having fevers and high risk like him,” Subramanian said.
It’s suspected Trump may also require anticoagulation agents, considering the impact COVID-19 can have on the heart and blood vessels.
It’s unclear how Trump’s path to recovery will play out.
Some with mild to moderate symptoms gradually improve. Others are long-haulers and carry their symptoms like fatigue and shortness of breath for months.
Some people’s symptoms worsen the further into the disease they get, and a smaller percentage of patients’ symptoms improve only to decline a week to 10 days after first experiencing symptoms.
Trump has multiple risk factors — his age (74 years), he’s male, and medically falls within the obese categories, explains Carney.
It’s thought he is only 4 days into the infection and he’s already required three medications, which have not yet been given simultaneously in other patients.
“They definitely need to keep an eye on him,” Subramanian said.
President Trump’s medical team announced Sunday that the president has required supplemental oxygen and is receiving dexamethasone, a common corticosteroid used to reduce the inflammation the infection is known to cause.
Looking at typical treatments for COVID-19, this suggests the president is experiencing some signs of inflammation or viral pneumonia in his lungs.
It’s unclear when Trump was first diagnosed and how long he’s had symptoms, but health experts agree he will need to be monitored closely in the days to come.