President Donald Trump announced (via Twitter, of course) last week what some considered unthinkable, and others considered inevitable — that he had tested positive for Covid-19. Over the weekend, he received various treatments — supplements like vitamin D, zinc and melatonin, an experimental antibody combination, an antiviral drug and a powerful anti-inflammatory steroid. Trump was already known to be on daily medications like statins. Many doctors have pointed out that such an aggressive treatment strategy is unlike any you’d receive as an average patient. Trump’s recent regimen is called VIP Treatment, which is special care offered only to very famous or wealthy patients. Despite the name, this course of treatment isn’t always a positive for the patient.
Sometimes it means that an individual receives more treatments than he or she needs. These treatments could be helpful, but each drug or supplement has its own risks and side effects. Plus, there could be a host of interactions. “Some of the interactions are just not known since the monoclonal antibodies and remdesivir [which Trump received] are still experimental drugs,” Kevin Kavanagh, MD, tells MedShadow.
So what do we know about the potential downsides to the various treatments the president has received?
Dexamethasone — a decades-old oral corticosteroid commonly used to treat inflammatory diseases — is the most well-studied of the treatments administered to Trump as the result of his Covid-19 diagnosis. Clinical trials for Covid-19 have shown it to help patients with severe disease. Kavanaugh told Health Watch USA that the treatment suppresses the immune system — a positive if an overactive immune response is wreaking havoc on the body, but dangerous if the patient’s immune system is working normally. Additionally, the drug’s side effects can mask symptoms while patients are still sick.
On their own, steroids like dexamethasone have the potential to produce a wide range of side effects from high blood pressure to blurry vision and upset stomach. In many patients, dexamethasone boosts energy and causes euphoria, both of which could hide COVID-19 symptoms like fatigue. In terms of an altered mental state, Kavanagh warns, “the steroids are known to cause anywhere from an euphoria to frank psychosis [a condition characterized by delusions in which a person can lose touch with reality]. Almost everyone on high dosages suffers a degree of this [side effect]. In addition, one also can experience a psychological crash when one comes off of steroids.”
Dexamethasone’s long-term effects should be taken into consideration by your doctor when prescribed. It can cause spikes in blood sugar leading to diabetes, a concern in an older man like President Trump who is overweight. It can also result in bone weakening, not as likely a problem for a man, but an older woman with thinning bones might need to be concerned.
The side effects of dexamethasone — at least when taken for other conditions — may be well-characterized, but we know considerably less about the other treatments the president has received.
Remdesivir, developed to treat hepatitis C and then later used for Ebola, was the first drug the FDA authorized for use in Covid-19 patients through an emergency-use authorization on May 1. This means that the drug is temporarily available to Covid-19 patients, even though it has not yet been evaluated through normal FDA approval pathways.
Data from a clinical trial published in JAMA in August showed that the antiviral drug may shorten Covid-19 recovery time and it can cause headaches, nausea and hypokalemia — low levels of potassium that lead to muscle cramps, weakness, constipation and in serious cases, heart arrhythmias.
Robert Solomon, MD, FACEP, an emergency medicine physician at the University of Pittsburgh Medical Center, explains that drugs similar to remdesivir have given patients, “elevated liver enzymes suggesting the possibility of liver damage.” The president is known to take daily statins to reduce his cholesterol, which can also damage the liver. “We have no idea if this effect from both drugs could be additive or even synergistic,” he adds.
- Regeneron Antibody Cocktail
The treatment is called a “cocktail” because it contains two different antibodies that are both thought to prevent the virus from entering cells. This particular combination of antibodies is new, but the concept of using antibodies to help treat infections is not. It is still in clinical trials, though early data released in June suggested that the side effects of the treatment, which is designed to mimic the body’s own immune response, were minimal.
In addition to treating pain and lowering fevers, aspirin taken daily may help reduce the risk of blood clots and heart attacks — one of the most serious dangers of Covid-19, but a well-known side effect is gastrointestinal bleeding.
A very small study suggests that the antacid can help ease symptoms of Covid-19. When taken only short-term, the drug has minimal side effects, including dizziness and occasional racing heartbeat, dry skin, insomnia, gastrointestinal symptoms and temporary forgetfulness.
- Vitamin D
President Trump also received three supplements early in the course of his treatment: vitamin D, zinc and melatonin. According to Solomon, all three fall into the category of “unlikely to be harmful and might help.” Some studies have suggested that patients who are vitamin D-deficient have worse Covid-19 outcomes. However, there is no evidence to suggest that more vitamin D is better if you already have healthy levels, and there are downsides to taking too much, like an increased risk of kidney stones. It may also interfere with the efficacy of statins.
Zinc is often taken to shorten the duration of the common cold. It’s “known to inhibit viral replication in certain other contexts,” says Solomon. It’s unclear if it can help with Covid-19, but taking too much can lead to gastrointestinal side effects like nausea.
Melatonin, which is commonly used as a sleep aid, may help reduce inflammation associated with an overzealous immune response. It may also produce mild side effects like headache, dizziness and nausea, according to a Cochrane review.
In appropriate doses, the supplements may not be too dangerous, but “using all three [Covid-19 drugs] certainly increases the likelihood of interactions,” Solomon says, even if it isn’t necessarily clear what these interactions might be just yet. What we do know is that dexamethasone especially, may have an impact on President Trump’s personality, his long-term health, or both.