Richanne C. Mankey, Defiances president, said the college had been following local and federal health standards. Unfortunately, Dr. Mankey said in a statement, one breach can have significant consequences.
Misery in the Sun Belt has receded, helping to hold down the nations new case growth despite increases in the Midwest and West.
Summer outbreaks sent national case tallies soaring to more than 66,000 a day by late July. Arizona, California and Florida reported new records, then broke them, day after day. In some cities, officials shut down bars again and demanded that residents wear masks.
Florida is now averaging about 2,300 new cases a day, roughly one-fifth of what it was seeing at its worst. In Arizona, where overtaxed hospital capacity was once a concern, intensive care beds are now plentiful, and daily case reports have dropped to about 500 on average, down from more than 3,600. New infections have also plunged in California, Georgia, Louisiana and South Carolina. Mississippi, Texas and Alabama have made significant progress since midsummer as well, though case numbers there remain persistently high.
Thankfully, we did not have a surge in Covid-19, as was predicted, after the Labor Day weekend, Gov. Kay Ivey of Alabama, a Republican, said this week as she announced an extension of the states mask order. But my friends, this isnt just luck or coincidence. The fact is, our mask order that we imposed on July 16 is working, and the numbers speak for themselves.
The question ahead is whether regions can hold on to their progress or whether new outbreaks will crop up quickly as limits are lifted and old hot spots surge again.
The nations effort to stop the coronavirus remains a constantly shifting amalgam of state and local rules. And that has meant starkly different realities from state to state, and from county to county.
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With Trump Hospitalized, Covid-19 Continues Its Onslaught on the U.S. - The New York Times
To treat his Covid-19, President Trump has started receiving dexamethasone, a common steroid that has been shown to be helpful in people with severe cases of the disease but that doctors warn should not be used early in the course of the illness.
The announcement from Trumps medical team Sunday morning that the president is on dexamethasone is sure to increase speculation about the presidents illness and was at odds with the generally upbeat description of his condition provided by his physicians. His doctors said Trump had not had a fever since Friday morning and did not have any shortness of breath. One even said that, if Trump continues to feel and look as well as he does today, their goal was for him to return to the White House on Monday.
Dexamethasone is generally reserved for patients who have serious disease. The National Institutes of Healths treatment guidelines for Covid-19 say dexamethasone should be used only in hospitalized patients who are on ventilators or who require supplemental oxygen, and specifically recommends against using dexamethasone for the treatment of Covid-19 in patients who do not require supplemental oxygen.
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Trumps doctors confirmed that the president received oxygen for about an hour on Friday after a temporary drop in his oxygen levels something they danced around saying during a Saturday briefing. Sean Conley, the presidents physician, told reporters on Sunday outside Walter Reed National Military Medical Center, where Trump is being treated, that the president also experienced a transient drop in oxygen levels Saturday but said that he wasnt sure if oxygen was given.
Conley said that drop in Trumps oxygen saturation to 93% on Saturday morning prompted the decision to initiate the steroid therapy, believing the potential benefits early on in the course outweighed any downsides.
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Our plan is to continue that for the time being, Brian Garibaldi, another of Trumps doctors, said about the dexamethasone.
Ethan Weiss, a cardiologist at the University of California, San Francisco, who went to New York to treat critically ill Covid-19 patients during the citys surge, told STAT, Nothing matches up. Weiss said that Trumps medical team had an impossible job, but that you cant say hes fine and hes going home tomorrow and by the way hes getting dexamethasone, which was shown in [a clinical trial] to be helpful in only the sickest patients.
The concern with dexamethasone is that it can suppress the immune systems activity broadly. While that can be helpful in severe illness which is typically caused by the immune system overreacting to the infection, not the virus itself giving the steroid too soon could hinder the immune system from fighting the virus in the first place.
You dont want to give it to a patient too early, Nahid Bhadelia, the medical director of Boston Medical Centers Special Pathogens Unit, told STAT Friday about dexamethasone. Its a blunt instrument, so it may suppress a good immune response as well as a bad one.
In a clinical trial, dexamethasone reduced deaths by a third in patients hospitalized with Covid-19, but the benefit differed depending how sick patients were. In patients not receiving supplemental oxygen, the study showed no benefit and potential harm.
Those patients who were not requiring oxygen actually had a statistical trend toward worse outcomes the dexamethasone was only beneficial in patients who were requiring oxygen, said C. Michael Gibson, a professor of medicine at Harvard Medical School. He also noted that the effect for dexamethasone was only seen in patients who had been sick for longer than seven days. Trump started feeling sick Thursday, his doctors have said.
Trump is also in the middle of a five-day course of the intravenous antiviral remdesivir. His doctors said the president could continue receiving the infusions at the White House if he were discharged from Walter Reed.
Overall, Trumps medical team continued to portray Trump in good spirits and relatively good health. But as during a Saturday press briefing, Conley answered questions about certain aspects of Trumps condition vaguely. He was asked several times about potential damage to the presidents lungs and said there are some expected findings without giving additional details.
Conley was also asked why he had avoided saying during the Saturday briefing whether Trump had ever been given supplemental oxygen.
I was trying to reflect the upbeat attitude the team, the president through his course of illness has had, Conley said. I didnt want to give any information that might steer the course of illness in another direction, and in doing so it came off that we were trying to hide something, which wasnt necessarily true.
Damian Garde and Matthew Herper contributed reporting.
Continued here:
Trump getting a steroid usually for patients with severe Covid-19 - STAT
With the president hospitalized, his doctors evading basic questions and an election 29 days away, chaos reigned after Trump tested positive for the virus thats killed more than 200,000 Americans. Now, after a four-day stay at Walter Reed medical center, the president said he will return to the White House. But more questions than answers remain.
Unlike a normal residence, the White House has its own medical unit, offering full-time care and facilities for emergency surgery, including the ability to administer supplemental oxygen which he previously received at the White House and even a crash cart for resuscitation.
If the president leaves the hospital Monday evening, the situation could become even more opaque. Trump is eager to return to an image of normalcy, but hes still a high-risk patient in the throes of a wildly unpredictable and deadly virus that seldom charts a linear course to recovery. And because its clear that Trump is eager to feign normalcy at any cost with less than a month to go before the election, his return to the White House is not a reliable sign that hes anywhere near being in the clear.
One result of obfuscating the presidents health? The internet is left to eagerly fill in the gaps.
Doctors provided the first update about the status of Trumps health on Saturday, but that event backfired, with White House Physician Dr. Sean Conley later admitting that he omitted information in order to keep the presidents spirits high. Conley also threw the timeline of Trumps diagnosis into question confusion thats only been partially resolved since.
The White Houses coronavirus outbreak is a big opening for opportunists, according to Yonder, an AI company that monitors online conversations and tracks disinformation. In an online info ecosystem the company says is broken, a fresh crisis is rocket fuel for false claims and conspiracies.
From groups suggesting the diagnosis was a hoax for political gain to QAnon supporters suggesting it was all part of a plan to isolate and protect the President from his adversaries in the deep state, social media continues to act as a weaponized rumor mill, Yonder CEO Jonathon Morgan said.
In every case, agenda-driven groups on social media are using another national crisis to their advantage, and obscuring the truth in the process.
On Friday, left-leaning conspiracy theories like #TrumpCovidHoax posited that the president wasnt actually sick with COVID at all, suggesting he might have been malingering to elicit sympathy or avoid facing off with Joe Biden after a disastrous debate performance just days earlier.
Those beliefs are still rampant on social media even as the White Houses COVID-19 outbreak sidelines Trumps own press secretary Kayleigh McEnany and campaign manager Bill Stepien, with the chaos threatening to take Trumps reelection campaign completely off the rails.
Hubris about the basic facts of the virus is undeniably what got the White House into this mess to begin with. Last week, a study by Cornell University found that President Trump is indeed the nexus of misinformation about the pandemic, with mentions of his name driving 38% of the broader COVID-19 misinformation ecosystem.
The biggest surprise was that the president of the United States was the single largest driver of misinformation around Covid, the studys lead author Sarah Evanega said of the results. Thats concerning in that there are real-world dire health implications.
Those dire real-world implications took root over the weekend, as the virus threatened the presidents health seriously enough that his treatment team administered at least three powerful experimental treatments: the monoclonal antibody therapy Regeneron, which is still in clinical trials and not broadly available, the antiviral drug Remdesivir and the steroid Dexamethasone, which is prescribed in severe COVID-19 cases.
Hydroxychloroquine isnt part of his current drug cocktail, but the unproven COVID treatment the president touted and took earlier this year is again making the rounds online among some of the his supporters who are urging doctors to throw it into the mix.
Stella Immanuel, who was central to the Americas Frontline Doctors viral video that pushed false claims about COVID-19 treatments earlier this year, tweeted Friday that Whoever told the president to stop taking HCQ should be punched in the face.
In July, Trump called Immanuel an important voice who had tremendous success treating the virus before claiming that he is not familiar with her moments later.
Arizona Rep. Andy Biggs also tweeted his support for hydroxychloroquine in the presidents treatment, in spite of the fact that the drug has not been shown to effectively fight the virus.
Circles promoting the pervasive pro-Trump conspiracy theory known as QAnon have their own ideas about the presidents condition, even viewing Trumps announcement that he had the virus as a breadcrumb encoding a secret message about Hillary Clinton. On Friday, 17 Republicans refused to support a bipartisan House measure condemning QAnon.
QAnon supporter DeAnna Lorraine Tesoriero, who ran a failed bid for Congress, suggested that Trump actually contracted the virus from a microphone at Tuesdays debate rather than from his open disregard for mask-wearing and social distancing, two measures the CDC and global health experts say effectively reduce transmission.
While misinformation is thriving in the absence of answers about the presidents health, factual medical advice emerged in at least one place amidst the chaos. After initially publishing and then removing facts about airborne transmission of the virus, the CDC added that information back to its website on Monday.
According to the CDCs new guidance, which reflects scientific consensus, the virus can linger in the air for minutes to hours and infect people more than six feet away.
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Trumps fight with COVID-19 adds fresh fuel to the misinformation fire he started - TechCrunch
CHICOPEE, Mass. (WWLP) The Chicopee Police Department announced on Monday that a fourth police officer has tested positive for COVID-19.
According to the Public Information Officer Danusia Liszka, the officer worked closely with the other three officers that tested positive last week.
All other officers that have come in contact to these four have been tested and no other positive test results have appeared as of Monday.
The Chicopee Police Department continues to work with the Chicopee Health Department to prevent further spreading of the virus.
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Fourth Chicopee officer tested positive for COVID-19 - WWLP.com
At Walter Reed, doctors put Mr. Trump on remdesivir, an antiviral drug that has hastened the recovery of some coronavirus patients, and gave him a second dose on Saturday. In another statement, issued after 9 p.m., Dr. Conley said Mr. Trump remains fever-free and off supplemental oxygen with a saturation level of 96 percent to 98 percent. While not yet out of the woods, the team remains cautiously optimistic, he said.
The outbreak infected a third Republican senator on Saturday as Ron Johnson of Wisconsin reported testing positive as did former Gov. Chris Christie of New Jersey, who helped prepare Mr. Trump for his campaign debate on Tuesday. Nicholas F. Luna, the director of Oval Office operations, also tested positive, an administration official said Saturday night. In the course of barely 48 hours, the president, his wife, his campaign manager, his party chairwoman, his senior adviser, his assistant, his former counselor, his debate coach and three Republican senators all tested positive for the virus, along with at least three White House reporters.
The White House medical unit was investigating Mr. Trumps announcement of his nomination of Judge Amy Coney Barrett to the Supreme Court last weekend as a likely source of the viruss spread. More than a half-dozen people who attended the event on Sept. 26 or were with the president on Air Force One flying to a campaign rally in Pennsylvania later in the evening have now tested positive.
Two of the three senators who have now tested positive for the virus, Mike Lee of Utah and Thom Tillis of North Carolina, were at the Barrett announcement and serve on the Senate Judiciary Committee that will consider her nomination, further complicating a confirmation drive that was already testing speed limits and a razor-thin majority to get done before the election, as Mr. Trump has insisted.
Mr. Johnson, the third senator now infected, was not at the event because he was quarantining from a previous exposure to someone with the virus. He emerged from 14 days of quarantine after testing negative and returned to Washington on Tuesday, his office said, but attended lunch with other Senate Republicans that put him in the same room with Mr. Lee and Mr. Tillis. He was tested again on Friday and it came back positive.
If all three Republicans were unable to vote, Senator Mitch McConnell, the Republican majority leader from Kentucky, would not have enough support to force through confirmation of Judge Barrett because two moderate Republican senators, Susan Collins of Maine and Lisa Murkowski of Alaska, have already indicated that they oppose installing a new justice before the election.
Even as Mr. McConnell said on Saturday that the full chamber would not meet this coming week as planned, Senator Lindsey Graham, Republican of South Carolina and chairman of the Judiciary Committee, issued a statement saying the panel would proceed with plans to meet on Oct. 12 to begin considering Judge Barretts nomination.
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Trumps Covid-19 Symptoms Are Said to Be Very Concerning - The New York Times
When Jeff Pleiss, associate professor of molecular biology and genetics in the College of Arts and Sciences, began studying RNA biology two decades ago, he could not have known that the kind of high-volume RNA analysis his lab performs on single-cell yeast would have any importance in fighting a pandemic.
Pleiss studies rare RNA species in different, changing environments, elucidating pathways in RNA biology that are critical for gene expression in eukaryotes. To do this, he must take cellular mixes and robustly and carefully separate RNA in order to identify different RNA species. Identifying COVID-19 in humans requires similar separation of RNA.
The Cornell COVID-19 Testing Lab, housed in the College of Veterinary Medicines Animal Health Diagnostic Center, had been handling thousands of clinical samples from animals a day. Beginning in August, it adapted and expanded routine testing for COVID-19.
In a typical day, Pleiss lab examines up to 20,000 specimens at a time. When Cornell was faced with the challenge of developing its own testing system, Pleiss stepped forward to offer his labs experience with RNA processing. They use a robotic process to pool specimens to achieve such a high volume. The Cornell COVID-19 Testing Laboratory (CCTL) acquired similar robots, and the Pleiss lab Ph.D. candidate Zach Dwyer helped to write the scripts for the liquid handlers to prepare sample pools.
CCTL is housed in and led by the College of Veterinary Medicines Animal Health Diagnostic Center (AHDC). The AHDC had been handling thousands of clinical samples from animals a day and now was adapting and expanding their routine testing for COVID-19. As a Level 1 laboratory of the National Animal Health Laboratory Network (NAHLN) the center was set up to test 800 to 1,200 samples for animal infectious diseases in one work shift; using robotic liquid handlers with Pleiss input now facilitated the processing of 5,000 to 7,000 tests a day.
Members of the Pleiss lab, which like the AHDC and CCTL use a 96-well format and similar equipment, are looking for ways to further streamline and enhance efficiencies of CCTLs critical work by investigating the possibility of testing larger pools.
The Pleiss lab also has experience using standard, off-the-shelf components for the testing process rather than more expensive commercial kits, which enables them to achieve their high volume of testing in an affordable way. And commercial kits can be subject to global supply limitations, Pleiss said, adding that such kits are like pre-made chocolate chip cookie dough.
Pre-made dough is easy to make into cookies, but package availability may be limited, he said. Sugar and flour and eggs, though, are almost always available, so youll never run out of the components.
With high-volume testing underway at CCTL, Pleiss and his students continue to explore ways that their expertise can support Cornells COVID-19 testing system.
Jeffs lab illustrates how researchers from different fields have mobilized to support Cornell through this pandemic, and how scientists doing foundational, curiosity-driven research can make meaningful contributions to applied problems, said Andrew Bass, the Horace White Professor of Neurobiology and Behavior and senior associate dean in Arts and Sciences.
We are working in parallel with CCTL, staying out of their way while looking for ways to optimize what theyre doing, Pleiss said. The goal is to getthroughput higher and costs even lower, all withoutsacrificing sensitivity.
Kate Blackwood is a writer for the College of Arts and Sciences.
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RNA analysis at heart of COVID-19 testing | Cornell Chronicle - Cornell Chronicle
Is that sneezing or coughing fit a sign of allergies, a cold, the flu or COVID-19? If you also have a fever a temperature above 100.4 degrees Fahrenheit or higher those symptoms probably signal infection and not just allergies acting up. (Wait 30 minutes after eating or drinking to get an accurate measurement.) sestovic/Getty Images hide caption
Is that sneezing or coughing fit a sign of allergies, a cold, the flu or COVID-19? If you also have a fever a temperature above 100.4 degrees Fahrenheit or higher those symptoms probably signal infection and not just allergies acting up. (Wait 30 minutes after eating or drinking to get an accurate measurement.)
You might have hoped the coronavirus pandemic would cancel what we doctors usually think of as "sick season," but as cool weather signals the annual arrival of autumn allergies, colds and flu in the U.S., sick season is still right on schedule.
In my clinic, that means a flurry of visits and calls from patients worried about their runny noses, coughs and sore throats.
Before the emergence of COVID-19, it was already tough for patients to know how seriously to take those common symptoms. Allergies and colds are mostly just a nuisance, but a severe case of the flu can kill.
Now our unprecedented times are about to merge with the highly precedented. The flu routinely kills between 12,000 and 61,000 people in the U.S. each year, and COVID-19 has already killed more than 200,000, just since February.
Those big combined numbers of deaths can be scary, especially if you've skipped or postponed your usual health routines and check-ins with a doctor this year. Now's the time to get back in gear: Here are a few steps to improve your chances of staying healthy, even during sick season.
Establish a relationship with a primary care provider before you get sick
Do this now. Being an established patient can help you more quickly get in to see a doctor or other health care provider when you get sick. Having a clinician who already knows your medical history when you call helps, too the clinician may feel more comfortable making certain treatment recommendations online or over the phone and will know when it's better to have you come in for a physical exam because you have certain risk factors.
Keep your vaccinations up to date
Primary care providers, as well as pharmacists, can help track whatever vaccinations you need and those immunizations are especially important during a pandemic. This fall, as every year, the Centers for Disease Control and Prevention recommends vaccines against influenza for pretty much everyone older than 6 months, including pregnant women and the elderly. The agency also recommends immunization against pneumococcal pneumonia as part of routine vaccines for children and for healthy people age 65 or older, or sooner for some adults with underlying health problems. These are two respiratory illnesses seen more often in the fall and winter months that can turn nasty.
But other serious, vaccine-preventable illnesses can be circulating in your community too whooping cough and measles, just for starters. Talk to your clinician about which vaccines are appropriate for you and for the kids in your life. There's no benefit to waiting to get this year's flu shot, by the way the CDC says September and October are "good times to get vaccinated."
Justin Ortiz, a critical care doctor and professor of medicine at the University of Maryland, notes that vaccines are lifesaving in another way this year by helping to reduce cases of flu and pneumonia that would otherwise deplete resources needed to fight the pandemic. "Severe flu can fill up our hospitals," he says. "If another wave of COVID-19 coincides with influenza and pneumonia season, there will be fewer health care resources to treat both."
Got seasonal allergies that flare in the fall? Nip symptoms in the bud with early treatment
While vaccines can help keep some respiratory infections away, they don't prevent ragweed, pollen, dust or mold in the air from triggering symptoms like runny nose, sneezing, itchy or watering eyes, headache and even fatigue. If you know you struggle with airborne allergens this time of year, start your usual medicines before symptoms develop, or at the first sign, to prevent or help stop the inflammation that makes symptoms escalate. Allergies can develop at any age; if your symptoms are new, talk to a health care provider about your best treatment options.
Timing is key, says Dr. Stuart Cohen, chief of primary care for the University of Alabama at Birmingham: "The one thing we're telling our patients is go ahead and start taking their nonsedating antihistamines or use their steroidal nasal sprays if they usually suffer with allergies. They shouldn't wait until their symptoms progress to start using those every day."
It's important to remember that although allergies can cause upper respiratory symptoms and possibly a change in your sense of smell, they don't cause fever, which is common with COVID-19 and the flu.
And, speaking of fever, be ready to check for one
Keep a thermometer in your home, since checking your temperature is a good place to start in distinguishing allergies from an infection if you're feeling unwell. Just remember the definition of a true fever a temperature at or above 100.4 degrees Fahrenheit, or 38 degrees Celsius.
Fever is a key symptom that helps clinicians make a diagnosis and decide what level of care you need, so having that information when you first reach out can be important.
Even if you have a slight fever, recognize that your doctor may tell you to simply rest, drink plenty of fluids and "watch and wait" to see how the symptoms develop. Many of the old rules still apply, even in a pandemic: COVID-19, colds and flu are all caused by viruses, not bacteria, so antibiotics won't treat them.
Make online tools work for you
Many medical offices now have links online to help you sign up for a telehealth appointment, even for routine health maintenance. If you have chronic health issues, call or check online with your health care provider soon before the cold and flu season is in full swing. A clinician can review your routine medications and doses, help make sure you have an ample supply at home and may also suggest more ways you can reduce your risk of getting sick, based on your individual history.
Also, familiarize yourself now, before you get sick, with the CDC's Coronavirus Self-Checker or other online support tools from your local health care system, like this one put together by Johns Hopkins Medicine. These resources can help you differentiate among symptoms and provide a way to search for and contact health care providers if you don't already have one who routinely manages your care.
Keep maintaining social distance, wearing a mask and washing your hands
We're likely to see a jump in coronavirus cases as cooler weather pushes us together indoors for longer periods, so don't let down your guard. These now familiar basics of public hygiene will be even more important over the next several months.
And while the cool air alone is enough to cause a runny nose, it can also be a symptom of the common cold, flu or COVID-19 all very contagious respiratory diseases. So although wearing a mask when you have a runny nose may be uncomfortable, doing so will help keep you from spreading whatever you have to people you love and will help protect you from catching another bug. Wearing a mask may be even more important if you have allergies that make you sneeze propulsive sneezes are definitely a way the coronavirus spreads.
When patients ask Ortiz if they can be co-infected with the coronavirus and another virus like the influenza virus, he says "absolutely" and reminds them that though it may feel harder to breathe when you have an upper respiratory illness and wear a mask, covering your nose and mouth this way "won't cause problems with air exchange," even for many people with asthma or COPD. Mask wearers, even those with bad head colds or the flu, can still get plenty of oxygen.
Pay attention to your symptoms and know the red flags
It's helpful to keep track of any respiratory symptoms you develop as they begin or change, to help distinguish the signs of allergies from an infection. But don't go it alone check with your doctor's office if you're uncertain, to let the office also help you triage symptoms and decide on a plan. And if you have chronic medical problems, especially lung disease, it's important to reach out for care at the first sign of illness.
How do you know if what you're experiencing is an emergency? Some common red flag symptoms that signal you should call 911 include sudden chest pain or pressure; new confusion, a change in consciousness or inability to stay awake; or any signs of a lack of oxygen (such as blue or purple lips or gasping for air).
Bottom line this fall: Don't panic. Do ask for help
Never hesitate to seek help from your primary care provider when it comes to your health worries, no matter how small, because no one is immune to the fear of getting really sick. The medical community has adapted to COVID-19 by building more ways for patients to be informed and get guidance and this should be welcome news, since good communication may save lives and ease us all through the challenging months ahead.
Kristen Kendrick is a board-certified family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.
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HAMILTON COUNTY, Tenn. (WDEF)- Governor Bill Lee and Mayor Jim Coppinger may have lifted covid-19 restrictions, but the mask mandate is still in place in Hamilton County.
Thats caused some confusion for both business owners and their customers.
Restaurants like The Local have taken covid precautions pretty serious for several months.
We havent opened our lobby back up for dine-in even though a lot of places have said Manager Caroline Coppock.
Coppock noticed the juice bar has received mixed receptions from patrons after restrictions were lifted statewide.
We were used to a lot of people following the mandate which is great and then were also used to customers who dont said Coppock.
Manager of Mean Mug Nicholas Knable says the coffee shop is looking for ways to accommodate people who will not wear masks, We allow them to order but we take it out to them. We dont really let them come in.
News 12 caught up with Erin Meeks before walking into Mean Mug.
Shes hopes Mayor Jim Coppinger extends the mandate again, I dont feel like were at a point where lifting restrictions make sense. Having mask on really does help stop the spread.
Knable says some customers have dont wear mask for legitimate reasons, Im told its just medical reasons.
Hamilton County Mayor Jim Coppinger will discuss the status of the mask mandate during a briefing on October 6th.
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Business Owners and Their Customers: Lack of Covid-19 Restrictions - WDEF News 12
President Donald Trump has maintained a steady schedule of campaign rallies, which may have exposed him to SARS-CoV-2.
By Jon CohenOct. 2, 2020 , 9:25 PM
Sciences COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.
This afternoon, the White House announced that President Donald Trump received an experimental antibody treatment after a test revealed he'sinfected with SARS-CoV-2. He reportedly has mild COVID-19 symptoms, including fever and congestion, and he was transferred to Walter Reed National Military Medical Center. Later, the president's medical team confirmed he had started a course of remdesivir, an antiviral drug shown to modestly help hospitalized COVID-19 patients.
What is the antibody cocktail Trump received?
Its a combination of two antibodies directed against a key protein of the virus that causes COVID-19, SARS-CoV-2. They bind to a region on the main surface spike protein that helps the virus attach to a receptor on human cells called angiotensin-converting enzyme 2 (ACE2). The targeted region is dubbed the receptor binding domain. One antibody comes from a human who had recovered from a SARS-CoV-2 infection; a B cell that makes the antibody was harvested from the persons blood and the genes for the immune protein isolated and copied. The other antibody is from a mouse, which was engineered to have a human immune system, that had the spike protein injected into it.
Are there any data showing that the cocktail works and is safe?
Experiments in both golden hamsters and rhesus macaque monkeys that intentionally were infected with SARS-CoV-2 showed that the cocktail could reduce viral levels and disease pathology.
Regeneron, the maker of the cocktail, earlier this week presented preliminary data from its ongoing clinical trial in people who tested positive for SARS-CoV-2 but were asymptomatic or, in the most extreme cases, had moderate diseasea group that would appear to mirror Trumps current condition. No serious safety concerns surfaced, and the treatment reduced viral load and shortened symptomatic disease in patients who did not have SARS-CoV-2 antibodies at the trials start. Its unclear whether the treatment can prevent severe disease, but there were hints that it might: Participants who received a placebo had more medical visits.
A separate trial is assessing the impact of the treatment on hospitalized COVID-19 patients, but Regeneron has yet to report any results from that study.
Do the preliminary clinical trial data match the presidents treatment scheme?
Not exactly. Trump received an 8-gram infusion of the treatment. Regenerons data showed that a 2.4-gram infusion worked as well as the higher dose at reducing SARS-CoV-2 levels in people. This was widely seen as good news because monoclonals are difficult and expensive to produce, and a lower dose means that more people ultimately can receive it.
Why did the president receive the higher dose of the antibodies?
Likely out of an abundance of caution by the presidents medical team, says George Yancopoulos, the co-founder and chief scientific officer of Regeneron. Yancopoulos does not directly know why Trump'sphysicians chose to use 8 grams, but says the companys data indicate theres very, very limited risk that the antibodies will cause harm at either dose. The higher dose might last longer, he said, and at some time points in the companys study, Regeneron did see trends suggesting that the higher dose more powerfully beats back the virusthe company used the amount of viral genetic material found with nose swabs as a proxy for SARS-CoV-2 levels in the entire body.
If I had to treat one patient, Id give the high dose, Yancopoulos says. From a societal point of view and the need to treat as many people as possible, Id give the lower dose.
Did Trump match the patients in the study who benefited from the treatment?
The Regeneron study found that the treatment only worked in people who did not have SARS-CoV-2 antibodies at the start of the study. It also worked best in people who had higher levels of the virus. Whether the president had those antibodies and a high viral load has not been made public. I couldnt speculate because it has to do with an individual patient, Yancopoulos says.
The memorandum from the presidents physician said Trump was receivingRegenerons polyclonal antibody cocktail. Are these antibodies polyclonal?
No. The treatment consisted of two monoclonal antibodiesmeaning each was produced by making identical copies, or clones, of an antibody gene in a single B cell. Polyclonal antibody cocktails refer to antibodies made by mixtures of B cells.
What was the regulatory mechanism that allowed the president to receive the experimental Regeneron antibodies?
The antibodies are typically only available to people who participate in clinical trials. Trump theoretically could have enrolled in the ongoing treatment study that reported preliminary data this week, but that trial randomly assigns half the participants to receive the antibodies; the other half serves as a control group and receives infusions of an inactive placebo. A U.S. Food and Drug Administration (FDA) regulation called expanded accesstechnically known as 21 CFR 312.310allows physicians to request compassionate use of experimental treatments through an investigational new drug pathway used for individual patients or for emergencies. These are designed to be used in these rare and special circumstances, Yancopoulos says. This is not the first time weve done compassionate use for these monoclonal antibodies. This is not a mechanism for widespread distribution.
Could Regenerons monoclonal antibody treatment become more widely available through the FDAs emergency use authorization (EUA) pathway?
Yes. Both Regeneron and Eli Lilly, which similarly reported encouraging preliminary clinical trial data last month from a single SARS-CoV-2 monoclonal antibody, are discussing the possibility of an EUA with FDA. Lilly reported signs that its antibody reduced the need for hospitalization, but as with Regeneron, too few participants have so far become seriously ill to reach a convincing conclusion to this critical question.
What's the evidence for using remdesivir in COVID-19 patients?
Remdesivir is an antiviral drug developed by Gilead Sciences, originally to treat the hepatitis C virus. It did not perform well against that pathogen but has been tried against Ebola and other viruses, after showing some activity in cells and animal models. The drug inhibits a viral enzyme used for replication of the pathogen. Earlier this year, it demonstrated a modest clinical benefit in a trial with hospitalized COVID-19 patients, leading FDA to grant Gilead an emergency use authorization for the drug. That EUA has since been expanded for use in patients with mild disease although its benefit in them is not clear. The drug has become widely used for COVID-19 patients despite continuing skepticism that it has a major clinical benefit. Since it and the monoclonal antibodies target different parts of the virus, administering them together may have a synergistic effect. One COVID-19 clinical trial is testing remdesivir and Lilly's antibody, for example.
Is the president receiving any other COVID-19 treatments?
The statement released today by the presidents physician said that in addition to the antibodies, Trump has been taking zinc, vitamin D, famotidine, melatonin and a daily aspirin. That wording leaves unclear whether he was taking those substances before his diagnosed infection. Notably, the statement does not indicate whetherTrump was or is taking hydroxychloroquine, the antimalarial he controversially pushed as a COVID-19 treatment.
Famotidine has been suggested to be a treatment for COVID-19, but its also a popular heartburn remedy, sold widely under the name Pepcid. A clinical trial testing it in hospitalized COVID-19 patients in New York was not able to recruit enough patients to properly evaluate its impact. The Feinstein Institutes for Medical Research, which initiated that trial, released a statement today citing evidence it was helpful for COVID-19 but also saying, We have yet to prove [famotidines] efficacy. The institute says its eagerly awaiting FDA approval of a trial that will evaluate whether famotidine can help people who are not hospitalized.
*Updated, 3 October, 6 a.m.: Information about Trumps's use of remdesivir was added to the story.
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Here's what is known about Trump's COVID-19 treatment - Science Magazine
