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https://blogs.sciencemag.org/pipeline/archives/2020/10/05/the-presidents-coronavirus-treatment

The President’s Coronavirus Treatment

By Derek Lowe 5 October, 2020

I’ve had emails asking me what I think about President Trump’s illness and the course of treatment that he’s under. To be honest, this wasn’t a subject that I really felt like writing about – every time I write anything about Trump here, I regret it – but the reports have been so increasingly odd that I think that a discussion is in order.

I have to start off by admitting that the timeline of the president’s coronavirus infection is hopelessly confused. It’s very hard to say how long he’s been infected. But I also have to say that even if we had that figured out, it still might not be much help. Different people can have radically different courses of disease in this pandemic – a fact that’s been made abundantly clear over the last several months. But since the president has several risk factors working against him (age, gender, and BMI), one has to be ready for anything.

So what can we infer from his course of treatment so far? He got Regeneron’s monocolonal antibody cocktail very early, it seems, and at the highest clinical dose (8 grams). There has been no formal publication of Regeneron’s results, not even an unreviewed preprint, and I haven’t blogged about their recent press release (which is all we have). Like all press releases, it tells us some things and leaves some out. The company states that the antibody treatment reduced viral load and alleviates some coronavirus symptoms, particularly in patients that had not mounted a good antibody response of their own at the time of treatment. That all makes sense. But we don’t know if it actually helps with mortality, chances of being hospitalized (or going to an ICU once there), total time hospitalized, and so on. We also have only the earliest safety readouts (which so far don’t look problematic).

I would assume that Regeneron knows more than this, in unpublished form, and that this knowledge was part of their interaction with the president’s physicians when they provided the monoclonals. If I had to bet, I would bet that this would be an appropriate therapy. But betting the president’s health is another thing entirely, and I’m glad that I didn’t have to make that call. And this leaves Regeneron’s executives with even more reason than others to hope that the president recovers well, obviously.

Overall, though, it would seem that if you’re going to give monoclonal antibodies, that they would be best given early in the course of the disease, when therapy is still in antiviral mode. The addition of a five-day course of remdesivir to the treatment regimen fits that as well: both of these are designed to lower the amount of virus present and (in theory) keep the disease from progressing to a more severe stage.

That severe stage shows up as an overactive immune response leading to the well-known “cytokine storm”, and potentially big trouble. It really looks like the best therapy we have for that at the moment is dexamethasone. So I found it interesting – and not in a good way – that the president’s medical team had actually put him on dexamethasone, because its mode of action is to damp down the inflammation response. And if a person is still in the early stages of infection, that’s the opposite of what you want to do. There’s a real gear-shift in the treatment of coronavirus patients, when you have to switch from treating the viral infection to treating the immune consequences of the viral infection, and what’s appropriate for one phase of treatment is definitely not appropriate for the other.

So since the Walter Reed physicians are, in fact, very competent, the only conclusion I can draw from this is that the president’s infection is further along than we had thought. They may well be seeing signs of inappropriate over-response to the coronavirus and are trying to knock that down before it gets more serious. Another possibility, I suppose, is a similar over-reaction to pneumonia (which is the only reason I have ever had a short course of dexamethasone myself). OK, then. . .but how on Earth do we square any of that with the physician’s comment yesterday that Trump was doing so well that he might be discharged today? Discharging a 74-year-old man with coronavirus in the middle of remdesivir and dexamethasone therapy makes no sense at all.

But neither did Trump’s motorcade trip around Walter Reed yesterday. The news is full of people talking about what a bad idea that was, and I would especially single out Dr. James Phillips, whose views I agree with completely. The New York Times reports that the president wanted to be discharged yesterday, in fact, and that the limo ride was some sort of compromise. You have to imagine that his doctors are being put in some nearly impossible situations, but there are a lot of things about the president’s illness that simply are not adding up. It’s obvious from the oh-yeah-in-retrospect statements about his oxygen levels dropping on Friday and Saturday that we are not hearing anywhere close to the whole story about his illness. And what we are hearing makes very little sense.

I do not expect things to get any more sensible today, if you’re wondering.

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The latest round of positive results is still leading me to  that if Barr tests positive we won’t hear it. Mostly due to his trip to OK last week which would be a very bad look for him. I don’t think he would care about that so much, but it’s another hit on his boss. 
 

 

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2 minutes ago, Macanudo said:

Buck there little camper.  He was also Charles De Mar in Better Off Dead.

Yeah well, That show didn’t exist before the internet and when I used to beat off 15 times a day. 

Revenge of the Nerds did and served a very vital purpose in that endeavor. Almost wore that VHS out.

Although looking back on that movie now...  yikes. There’s straight sex crimes going on at Lambda Lambda Lambda. Different times indeed.

 

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49 minutes ago, workswithseed said:

I didn't know that Trump made sure he wasn't able to see him in person. 

 

Fellas, I think we've got a strong contender for Swam's old job here.

 

 

26 minutes ago, Dark Horse said:

I believe type O is associated with a lower risk of severe Covid. I think they found the same connection with the original SARS. 

 

YES! O+ here, bitches.

 

 

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13 minutes ago, Anastasis said:

https://blogs.sciencemag.org/pipeline/archives/2020/10/05/the-presidents-coronavirus-treatment

The President’s Coronavirus Treatment

By Derek Lowe 5 October, 2020

 

 

this fits with the narrative i choose to believe, so i'm going to go with it:

Quote

So since the Walter Reed physicians are, in fact, very competent, the only conclusion I can draw from this is that the president’s infection is further along than we had thought. They may well be seeing signs of inappropriate over-response to the coronavirus and are trying to knock that down before it gets more serious. Another possibility, I suppose, is a similar over-reaction to pneumonia (which is the only reason I have ever had a short course of dexamethasone myself). OK, then. . .but how on Earth do we square any of that with the physician’s comment yesterday that Trump was doing so well that he might be discharged today? Discharging a 74-year-old man with coronavirus in the middle of remdesivir and dexamethasone therapy makes no sense at all.

 

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58 minutes ago, workswithseed said:

I didn't know that Trump made sure he wasn't able to see him in person. 

 

53 minutes ago, workswithseed said:

I mean he can only close borders, and give advice, and even Fauci said he didn't say anything wrong in that sense. 

 

52 minutes ago, workswithseed said:

I can hear the trains coming.

 

48 minutes ago, workswithseed said:

No, I'm not. Trump never told people that they couldn't see thier relatives. If you're going to lay blame, you might want to do it to the person who actually implemented it.

 

47 minutes ago, workswithseed said:

Oh, I should get a special sign, just cause you don't like my thoughts. What are you going to do about the Conservative question?

what exactly are you trying to accomplish with this idiotic series of posts?

i'm asking honestly, because i've always sort of treated you like a benign young naive person who is actually trying to learn about his world. now you just look like you want to troll. 

come out and state your point, please.

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13 minutes ago, Dnaguy said:

Yeah well, That show didn’t exist before the internet and when I used to beat off 15 times a day. 

Revenge of the Nerds did and served a very vital purpose in that endeavor. Almost wore that VHS out.

Although looking back on that movie now...  yikes. There’s straight sex crimes going on at Lambda Lambda Lambda. Different times indeed.

 

kmgjoc.gif

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14 minutes ago, Dnaguy said:

Yeah well, That show didn’t exist before the internet and when I used to beat off 15 times a day. 

Revenge of the Nerds did and served a very vital purpose in that endeavor. Almost wore that VHS out.

Although looking back on that movie now...  yikes. There’s straight sex crimes going on at Lambda Lambda Lambda. Different times indeed.

 

That movie came out like a year after Revenge of the Nerds....

 

(Two dollars....I want my two dollars)

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3 minutes ago, DefinitelyNotHollywoodColt said:

how on Earth do we square any of that with the physician’s comment yesterday that Trump was doing so well that he might be discharged today? Discharging a 74-year-old man with coronavirus in the middle of remdesivir and dexamethasone therapy makes no sense at all.

Either the President is malingering/magnifying his symptoms (demanding excess treatment)  - or - the White House is well equipped to duplicate the conditions at Walter Reed. 

My guess is the treatment made available to the President would be denied to an ordinary citizen by an insurance carrier stating it is unreasonable, unnecessary and/or unrelated to objective findings. His little car ride would not be tolerated for an ordinary patient.

This is America, after all. 

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13 minutes ago, Prepuce of Doom said:

I think you hear a trolley coming. 

 

COVID-19-trolley-problem-403x403.png

late march / early april was the closest this country has ever come to a general strike and the investor class and its cronies in government completely panicked. 

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10 minutes ago, DefinitelyNotHollywoodColt said:

Discharging a 74-year-old man with coronavirus in the middle of remdesivir and dexamethasone therapy makes no sense at all.

 

1 minute ago, washparkhorn said:

My guess is the treatment made available to the President would be denied to an ordinary citizen by an insurance carrier stating it is unreasonable, unnecessary and/or unrelated to objective findings. His little car ride would not be tolerated for an ordinary patient.

This is America, after all. 

Dude...."makes no sense, unreasonable, unnecessary, unrelated to objective findings".....I mean, you DO know that we're talking about the Trump admin, right?  That shit may well be their goddamned motto.

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33 minutes ago, SizzleChest said:

O is good if you don't want to worst effects of COVID.

Trump's blood type is Ragu.

Correct -- allegedly

17 minutes ago, High Plains Drifter said:

YES! O+ here, bitches.

Same. Didn't stop me from getting it. But maybe it kept my case on the mild side although it was a lengthy process to completely clear it.

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2 minutes ago, Brisketexan said:

 

Dude...."makes no sense, unreasonable, unnecessary, unrelated to objective findings".....I mean, you DO know that we're talking about the Trump admin, right?  That shit may well be their goddamned motto.

new motto!

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3 hours ago, Hank Kingsley said:

 

https://continuagroup.com/article/surges-of-energy-during-the-dying-process/
 

One to two days prior to death, patients may have a surge of energy. They may be able to physically do things they were previously incapable of doing and may become mentally alert and verbal when they were previously disoriented and withdrawn.

Dying patients may also have a sudden surge in appetite. This is often confusing for the families who were anticipating death and now see their loved one as physically, mentally, and spiritually “renewed”. They may take this as a sign of recovery; only to have the patient’s condition quickly change and death occur.

Edited by Pato del Muerto
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4 minutes ago, DDD Dad said:

That movie came out like a year after Revenge of the Nerds....

 

(Two dollars....I want my two dollars)

Ohhhh yeah. Man I had my wife’s crossed and haven’t thought about that movie in forever.

apparently only movies from that era with significant nudity are burned into my brain. 

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21 minutes ago, Anastasis said:

https://blogs.sciencemag.org/pipeline/archives/2020/10/05/the-presidents-coronavirus-treatment

The President’s Coronavirus Treatment

By Derek Lowe 5 October, 2020

 

 

Thanks Anastasis. I don't know who Derek Lowe is, but this is an exceptional read. I like the approach he took to explain his rationale and it serves as yet another exhibit in how complicated this disease is, how much is still undetermined about the nature of this virus related to its effects on humans, and how to attack it (or prevent it) with vaccines and pharmacotherapy. The explanation of dexamethasone is particularly useful. People who don't understand this stuff (media types and politicos) jump to erroneous conclusions and it leads to dumb statements like bashing Sanjay Gupta or even Fauci. BTW, all scientists (including the smartest, best trained ones) are wrong some of the time due to the fact that we rarely have data generated by trials that are randomized and that control for all the confounding variables (like blood type, or even the amount of virus inoculum, ie, dose of the virus). That's why we rate the evidence based on study designs and we inform future studies based on emerging evidence. The process takes a very long time, which sucks because this virus is unique and had been unheard of until late last year.

 

But let's face it, some scientists have taken some unorthodox positions during this pandemic, which has only worsened the crisis. There has been an attack on science, and the recent events almost seem like science itself has called for a reckoning.

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2 minutes ago, Pato del Muerto said:

https://continuagroup.com/article/surges-of-energy-during-the-dying-process/
 

One to two days prior to death, patients may have a surge of energy. They may be able to physically do things they were previously incapable of doing and may become mentally alert and verbal when they were previously disoriented and withdrawn.

Dying patients may also have a sudden surge in appetite. This is often confusing for the families who were anticipating death and now see their loved one as physically, mentally, and spiritually “renewed”. They may take this as a sign of recovery; only to have the patient’s condition quickly change and death occur.

I mean it's OANN so probably true, right?

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3 minutes ago, Pato del Muerto said:

https://continuagroup.com/article/surges-of-energy-during-the-dying-process/
 

One to two days prior to death, patients may have a surge of energy. They may be able to physically do things they were previously incapable of doing and may become mentally alert and verbal when they were previously disoriented and withdrawn.

Dying patients may also have a sudden surge in appetite. This is often confusing for the families who were anticipating death and now see their loved one as physically, mentally, and spiritually “renewed”. They may take this as a sign of recovery; only to have the patient’s condition quickly change and death occur.

Steroids. They pumped me up. 

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2 minutes ago, Pato del Muerto said:

https://continuagroup.com/article/surges-of-energy-during-the-dying-process/
 

One to two days prior to death, patients may have a surge of energy. They may be able to physically do things they were previously incapable of doing and may become mentally alert and verbal when they were previously disoriented and withdrawn.

Dying patients may also have a sudden surge in appetite. This is often confusing for the families who were anticipating death and now see their loved one as physically, mentally, and spiritually “renewed”. They may take this as a sign of recovery; only to have the patient’s condition quickly change and death occur.

Anyone that has known anyone with the virus that was symptomatic knows that you can't really get your hopes up over a good day.  

This fucker comes and goes.  I suppose the flu does too because the last two times I had it, I went back to work too early and had a shattering relapse.

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24 minutes ago, Dnaguy said:

Yeah well, That show didn’t exist before the internet and when I used to beat off 15 times a day. 

Revenge of the Nerds did and served a very vital purpose in that endeavor. Almost wore that VHS out.

Although looking back on that movie now...  yikes. There’s straight sex crimes going on at Lambda Lambda Lambda. Different times indeed.

 

 

I watched it a month or so ago out of boredom.  It's so...cringeworthy today.  

 

 

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15 minutes ago, NAVY said:

I wonder if they were a death rattle 

No way, this dude is a cockroach, no one likes him and as such he has a low chance of dying.

Anytime a nice, well liked and relatively healthy patient shows up who has done a good job of taking care of themselves we are in trouble.

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10 minutes ago, Pato del Muerto said:

https://continuagroup.com/article/surges-of-energy-during-the-dying-process/
 

One to two days prior to death, patients may have a surge of energy. They may be able to physically do things they were previously incapable of doing and may become mentally alert and verbal when they were previously disoriented and withdrawn.

Dying patients may also have a sudden surge in appetite. This is often confusing for the families who were anticipating death and now see their loved one as physically, mentally, and spiritually “renewed”. They may take this as a sign of recovery; only to have the patient’s condition quickly change and death occur.

I think the stuff you're quoting is more typical of people at the end of prolonged battles. Trump's appetite I'm sure is just due to taking steroids. 

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9 minutes ago, StruggleBus said:

Bad sex and bad cocaine. That’s the title track to my early twenties.

No such thing as bad sex, it's like bad pizza...even when it's bad...it's still pretty good. 

Bad cocaine, however, is very real and is what leads you to behaving like Don, Jr.  Which of course can lead to bad sex with Kimberly Guilfoyle.  Who, by all indicators, should be fantastic in the sack.  But I'm guessing their sex is quite weird.  I'm guessing about six lines in, Don, Jr. breaks into this song: 

 

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6 minutes ago, MoJames said:

No way, this dude is a cockroach, no one likes him and as such he has a low chance of dying.

Anytime a nice, well liked and relatively healthy patient shows up who has done a good job of taking care of themselves we are in trouble.

Let me dream, man 

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14 minutes ago, C-Man said:

Same. Didn't stop me from getting it. But maybe it kept my case on the mild side although it was a lengthy process to completely clear it.

See, where you went wrong was not fully taking on your avatar's approach to life in your recovery to replenish your energy, C-Man.

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