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'A big red flag': Trump receives steroid treatment for Covid-19

White House physician Dr. Sean Conley said the treatment started on Saturday.
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The White House physician said Sunday that President Donald Trump is now taking another drug for Covid-19, adding to his growing list of treatments for his illness.

Dr. Sean Conley said the president was given a steroid called dexamethasone following "two episodes of transient drops in his oxygen saturation," meaning his oxygen levels dropped too low.

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"We debated the reasons for this and whether we even intervene," Conley said at a news conference at Walter Reed National Military Medical Center in Bethesda, Maryland. It "was a determination of the team, based predominantly on the timeline from the initial diagnosis, that we initiate dexamethasone."

Trump received the first dose of the steroid Saturday and will be on it for "the time being," Conley said.

Dexamethasone has been shown to be beneficial in those with severe Covid-19 because it can stop the immune system from going into overdrive. When that happens, the immune system can do more harm than good, attacking the body in what is called a cytokine storm.

However, the drug is not recommended for more mild cases of the disease.

"The fact that he got the steroid sets up a bit of a red flag that there's something going on here," NBC News senior medical correspondent Dr. John Torres told Kate Snow on Sunday. "I think they might be painting a little bit of a rosy picture for everyone."

The treatment was first shown to be helpful in June in clinical trials in the U.K. Preliminary results of the trial published in the New England Journal of Medicine found that the steroid reduced the risk of death in patients with severe Covid-19 who need supplemental oxygen. But for mild cases, the treatment can be harmful.

"However, there was no evidence that dexamethasone provided any benefit among patients who were not receiving respiratory support at randomization, and the results were consistent with possible harm in this subgroup," the researchers wrote.

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The National Institutes of Health guidelines for the drug reflect those findings, stating that dexamethasone should be given only to patients who are on ventilators or need supplemental oxygen. They do not recommend using it for those with less serious illness because of the potential for harm.

"We do not recommend giving it to patients who are not on supplemental oxygen or ventilated, because, in that case, it's going to suppress the immune system and it won't be able to fight off the Covid in those early stages," Torres said.

Dr. Michael Saag, an infectious disease specialist at the University of Alabama at Birmingham, said the fact that doctors gave him the drug makes him suspect that the president might have taken a sudden turn Thursday night into Friday morning.

"The disease course of Covid-19 is very unpredictable and waxes and wanes throughout the course of illness," Saag said. "I would expect for the president, and every other symptomatic person with Covid, to have moments where he feels much worse. Perhaps it was during one of those moments they decided to treat him more aggressively."

Conley said Sunday that Trump has normal oxygen levels and no fever. He is continuing to receive an antiviral treatment called remdesivir, and he received a single infusion of an experimental antibody treatment Friday.

Trump's doctors said he could be released as early as Monday, but Torres said he is not in the clear yet.

"We're not even in that seven- to 10-day period yet, when we get really worried about the lungs," he said.

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