St. John’s Health CEO Dr. Paul Beaupre wants you to know one thing: If you end up in the hospital because of COVID-19 you’ll get almost the same treatment as President Donald Trump.
“Everything the president received at the Army hospital he was at, we can duplicate here, with the exception of the monoclonal antibodies, which is totally experimental,” Beaupre said.
When Trump was hospitalized with COVID-19, doctors gave him a bevy of medications and supplements that trod the thin line between helping his body ward off infection and keeping his inflammatory response from producing some of the devastating symptoms other patients have experienced. Trump’s doctors said his treatment relied on three main medications: a steroid, dexamethasone; an antiviral, remdesivir; and a monoclonal antibody cocktail from drugmaker Regeneron.
Monoclonal antibodies are a synthetic version of the antibodies created by a person’s body when it fights the coronavirus. Much like convalescent plasma, they are intended to kick-start a person’s immune response.
The Food and Drug Administration has approved it for “compassionate use,” meaning it can be given to patients with “serious or life-threatening conditions who do not have any viable or available treatment options, and are unable to participate in ongoing clinical trials,” according to the company. Clinical trials have shown the monoclonal antibodies lower the viral load in nasopharyngeal swabs.
Trump appears to have recovered from his bout with the virus, though Regernon CEO Leonard Schleifer said he is a “case of one” and his result was the “weakest evidence that you can get” that the treatment is successful. It’s impossible to know how effective each part of Trump’s treatment was, but it might be heartening for St. John’s patients to know they can receive everything else the president did.
“Remdesivir and dexamethasone we could get by the boatload,” Beaupre said.
Remdesivir is an antiviral that makes it more difficult for the virus to replicate, and it is the only antiviral the FDA has approved for use in COVID-19 treatment. Like monoclonal antibodies, it is best given early in a patient’s treatment, and some trials have found it reduces the number of days someone experiences symptoms.
A World Health Organization study of global hospital data found the drug has no “morbidity effect,” meaning it didn’t prevent COVID-19 deaths. However, The New York Times reported some doctors dispute the study’s findings, saying that the drug does show an effect and that the way the study gathered data makes drawing conclusions difficult.
Dexamethasone is a corticosteroid used to treat conditions that include skin and eye disorders, arthritis and complications from altitude sickness in mountaineers. In COVID-19 patients it suppresses the immune response, keeping the body from entering a cytokine storm, an overinflammatory response.
The WHO recommends that doctors give the steroid to patients with a severe illness but avoid giving it to those with mild cases.
Trump’s doctors also reported that he received an array of supplements — zinc, vitamin D, famotidine, melatonin and aspirin. None are specifically recommended for COVID-19 patients, though many play a role in a healthy immune system, and aspirin can thin the blood to avoid the clotting syndrome some patients have developed.
The kind of treatment Trump received isn’t necessarily cheap. The New York Times data project The Upshot estimated that his treatment would have cost an average patient $100,000, though Trump’s care was paid for by the federal government through taxpayer dollars.
Much of that comes from the helicopter ride Trump took to Walter Reed National Military Medical Center. As the News&Guide has reported, air ambulance rides can be very expensive and vary widely by provider.
Remdesivir, the antiviral Trump received, can cost a patient with private insurance $3,120 and those with Medicare or Medicaid $2,340. Overall, a hospital trip, especially for someone the president’s age, can run up a huge bill, even for those with health insurance, who pay a median price of $31,575, claims database FAIR Health found.
Blue Cross Blue Shield of Wyoming, the only insurance company on the state’s Affordable Care Act marketplace, has said it will cover all diagnostic and treatment costs related to COVID-19 at least through Dec. 31.
Treatment like President Trump received represents a step forward in the fight against COVID-19. At the beginning of the global pandemic, with few medical treatments, doctors put many severe patients on ventilators, but research has found that nearly 1 in 3 patients who go on ventilators for the disease don’t survive.
Ventilating a patient changes the pressure inside that person’s lungs. That can cause barotrauma, a rupturing of the alveoli, which Beaupre likened to blowing up a balloon and poking it until the wall becomes stressed and starts to leak air.
“We’re doing everything humanly possible to prevent people from getting on ventilators,” Beaupre said.
Beaupre said his staff plan to use supplemental oxygen and a combination of the drugs Trump received before turning to ventilators. Patients who need a ventilator often need other associated treatments, so St. John’s usually transfers them to a larger regional hospital.
But when it comes down to fighting a disease that has killed more than 215,000 people in the United States and caused long-lasting damage to others, all options are on the table.
“If, unfortunately, you get COVID, you’re not disadvantaged simply because you live in this rural community,” Beaupre said. “We really have state-of-the-art care here.”