President Trump Hospitalized for COVID (Lung Doctor Gives Medical Analysis)

Hi guys, I’m Mike Hansen, board-certified in internal medicine, pulmonary disease, and critical care medicine for those of you who don't know me. As a critical care doctor and lung doctor, I want to take on President Donald Trump’s COVID diagnosis and prognosis and how I think his doctors at Walter Reed Medical Center will medically manage him.

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He was said to have fatigue, fever, hoarse voice, cough, and shortness of breath. While at the white house, he gets zinc, vitamin D, melatonin, famotidine, and this new polyclonal antibody treatment, a totally new therapy that we don’t even know if it works or night, as there are no RCT published about this. It’s an experimental therapy.

We see President Donald Trump walking to the helicopter. Which is significant. President Trump wasn’t in resp distress; he wasn’t requiring extra oxygen. Because he is walking without becoming short of breath or hypoxic, this is mild COVID. The concern is that this process, and with COVID, can progress slowly and gradually, or it can progress slowly and gradually. All of a sudden, there can be clinical deterioration. So why hospitalization?

According to the press secretary, he will be hospitalized for several days. That is, of course, assuming his disease does not progress. The decision to hospitalize someone with COVID is really based on breathing. Are they short of breath? Do they have hypoxia, meaning lower oxygen levels? President Trump does have risk factors, age 74, male, obesity, hypertension, cardiovascular disease. Overall, the numbers say he is likely to come out of this ok, but who knows. There is no way to predict what happens. It’s a mysterious illness. So when he is admitted to the hospital, here are things that I want to know and things that I would do.

What about treatment?
Most patients with mild disease are not hospitalized. But the president is not the most patients, and that is why President Donald Trump is hospitalized despite only having a mild illness, based on the information that I can glean so far. Dexamethasone is a glucocorticoid, a type of steroid that has been shown to have improved mortality in hospitalized patients with moderate or severe disease. Remdesivir might be somewhat helpful in hospitalized patients. But both of these might improve clinical outcomes but are far from any cure. What about convalescent plasma? Well, he already received antibodies, so giving him additional antibodies is unlikely to have any benefit.

Even if he did not receive those antibodies, CP hasn’t been proven beneficial in any RCT. I made an entire video about CP if you want to learn more about that. Anticoagulation, meaning a blood thinner, is always given to hospitalized patients, even before COVID, unless there is a contraindication like bleeding. But covid does raise the risk of people developing blood clots, especially those with cardiovascular risk factors, like obesity, HTN, and high cholesterol. This is because COVID latches onto the ACE2 receptors not just in the alveoli of the lungs but also the ACE2 receptors that line our capillaries, the tiniest blood vessels in our body. So the potential for blood clots is a big concern.

The other big concern is how extensive his COVID pneumonia is? Means, how much inflammation is there in the lungs? I guess he is getting a CT scan of the lungs and probably a CTa to look for blood clots. Another potential treatment for critically ill patients, which Trump is not, is Tocilizumab, an IL-6 monoclonal antibody. IL-6 is a central player in the cytokine storm that develops in COVID patients with severe disease.

When patients have very elevated inflammatory markers (D-dimer, ferritin) and elevated pro-inflammatory cytokines (including IL-6) are associated with critical and fatal COVID, blocking the inflammatory pathway has been hypothesized to prevent disease progression. Several drugs that target the IL-6 pathway have been evaluated in randomized trials for covid treatment; these include the IL-6 receptor blockers tocilizumab and sarilumab and the direct IL-6 inhibitor siltuximab. In one study of over 500 patients with severe covid, treatment with tocilizumab was associated with a decreased risk of invasive mechanical ventilation or death.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
Website: https://doctormikehansen.com/
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