As reported by the White House medical team, the drugs given to President Trump to treat COVID-19 included Regeneron’s antibody cocktail (monoclonal antibodies), Gilead Sciences’ remdesivir (brand name Veklury), and dexamethasone.
• Monoclonal antibodies (REGN-COV2 Antibody Cocktail, Regeneron): When you have an infection, your immune system is supposed to produce large amounts of antibodies — proteins that attach to and kill the invading germs. Most people who have recovered from COVID-19 have large amounts of antibodies against that infection in their bloodstreams. Instead of using blood drawn from recovered patients, Regeneron manufactured two special antibodies in their laboratory that copied antibodies from humans and a mouse with a human-like immune system. We know that the virus that causes COVID-19 enters humans cells by using a special spike protein key. Regeneron created special antibodies that attach to and destroy the key for COVID-19 to enter cells. Since viruses are not living creatures, they have to enter human cells to survive. If they can’t enter human cells, they die very quickly. Monoclonal antibodies have not yet been approved by the U.S. Food and Drug Administration (FDA) to treat people infected by the coronavirus, but studies show that these antibodies rapidly reduce viral load substantially. The drug was found to be effective and safe when tested in 275 patients (Science, pre-published online, September 30, 2020). Monoclonal antibodies must be given early in an infection, before it has entered and damaged human organs.
• Remdesivir (Gilead Sciences) is a drug that was developed to treat HIV. It attacks viruses that have already entered human cells by blocking certain viral genes. In May 2020, the FDA granted emergency clearance for treating very sick COVID-19 patients, after research showed that remdesivir shortened hospital stays in these patients (NEJM, October 8, 2020).
• Dexamethasone (many brands) is a corticosteroid that helps to treat patients in the late stages of COVID-19 by dampening down the immune system. When you are infected by certain viruses, your immune system produces large amounts of cells and proteins called cytokines that attach to and try to kill the invading virus. COVID-19 can kill you by causing a “cytokine storm,” such a massive response of your immune system that these cells and cytokines attack and destroy your own cells. The major cause of death in COVID-19 appears to be destruction of, and clotting in, the lungs, liver, heart, kidneys and other organs in your body. Studies show that dexamethasone reduces death rates in hospitalized COVID-19 patients who are very sick and require ventilation and oxygen (NEJM, July 17, 2020). Because dexamethasone dampens down your immune system, it should not be given early in the disease because it can spread the virus rapidly through your body. On the other hand, if your own immune system is destroying your lungs and heart, dexamethasone can save your life by stopping this deadly attack.
Available Treatments
The vast majority of people who develop COVID-19 have a relatively mild disease and can recover without medication. However, if you have a defective immune system, you can suffer serious consequences. For President Trump, the risk factors included his age (74 years old), obesity, high blood pressure, high cholesterol, his pro-inflammatory diet, and his lack of exercise. He was reported to have had two episodes of low oxygen saturation levels and was given supplemental oxygen. In addition to the drugs discussed above, he was also taking various over-the-counter medicines and supplements, including melatonin, zinc, vitamin D, Pepcid (famotidine), and aspirin. Aspirin blocks clotting and therefore might help to treat COVID-19, since the disease can cause clots to form in all major organs (Blood, 2020, 136(11): 1317–1329).
There are many ways to treat COVID-19; some may help, some are ineffective and others may seriously harm you. For example, interferon may help to treat COVID-19 if it is given early in the disease (Metrix, May 30, 2020) because it can help to protect you from invading germs before you can produce specific antibodies against them. However, if interferon is given late in the disease, it could trigger a cytokine storm that would worsen the course of the disease.
The drugs chosen for the president have reasonable scientific backing, and more choices will probably be available in the not-too-distant future. Note: I discussed this and many other topics during the radio show this week on WRTA in Altoona PA. You can listen here: https://soundcloud.com/talkradio985/dr-gabe-mirkin-october-2020-wrtas-the-11th-hour-with-doug-herendeen
