President Donald Trump, diagnosed with coronavirus, was discharged from Walter Reed hospital last night and is now at the White House, but his doctors say he's "not out of the woods" yet. Although they didn't offer specific details about how exactly Trump's case is progressing, there is reason for concern on a general level: "Clinicians should be aware of the potential for some patients to rapidly deteriorate one week after illness onset," the CDC warns in its clinical guidance for managing patients with COVID-19, updated last month. Trump remains in his first week. Read on to hear why experts are worried about him, and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus.
A 'Sudden, Dramatic' Crash
In an interview with Medscape's Eric J. Topol, MD, and Abraham Verghese, MD, earlier this summer, Dr. Anthony Fauci, the nation's top infectious disease expert, discussed one of the more alarming side effects of COVID-19: the "cytokine storm." Doctors, including Fauci, have observed that many patients who managed to survive COVID-19 feel better only for a short time. After that time their confused immune system reacts out of proportion causing dangerous organ inflammation—or a "storm." It can be deadly.
"The one thing that we do know is, and I don't even think this clarifies it anymore, is that when they were first looking at people who progressed rapidly — the ones who got sick, went to the hospital, they look like they're okay, and then all of a sudden, dramatically, they just crash and go on ventilators — that was felt to be a hyperactive, aberrant immunologic and inflammatory response," Fauci says. "And actually, I think it's at least partially true, based on the data from the UK study in which dexamethasone in individuals on ventilators and those requiring oxygen — but not in early patients — significantly diminished the death rate. So we do know that there's a lot of cytokine secretion. If you measure IL-1 beta, IL-6, TNF, they're all sky-high."
How a Cytokine Storm Rages
"One of the great mysteries of the new coronavirus is why it causes only mild disease in most people, but turns fatal for others," reports WebMD. "In many cases, it seems the worst damage may be driven by a deranged immune response to the infection, rather than the virus itself. In many of the sickest patients with COVID-19, their blood is teeming with high levels of immune system proteins called cytokines. Scientists believe these cytokines are evidence of an immune response called a cytokine storm, where the body starts to attack its own cells and tissues rather than just fighting off the virus."
As a cytokine storm is similar to the immune response seen in people with a type of arthritis, the scientists are investigating several anti-inflammatory drugs used to treat this disease as possible treatments for COVID-19.
In the interview, Fauci went on to wonder: "What is the nature of the protective immune system? Is it clearing virus and you have a hyperimmune and aberrant cytokine storm that's giving you pathogenic symptomatology at the same time that you're suppressing the virus? We don't know. I have to tell you, I'm humbled by it that we don't know. We have so many people who have gotten sick, and we can't write a really good paper on delineating A-B-C-D or what's going on…[and] I'm not so sure that gives you much insight because we know, prior to COVID, that when you get people in dire straits with a lot of inflammation, you get a bit of a cytokine storm anyway. We just don't know."
"It Can Go in a Lot of Different Directions"
The storm joins an ever-growing list of COVID-19 side effects, including neurological damage, blood clots and chronic fatigue syndrome, that are frightening patients and doctors alike. Will Trump experience one? It's possible. The President's case is unique because he has been given medicines that could help, with no guarantees.
"On Sunday, Conley"—Sean Conley, the White House physician—"confirmed that Trump has been given a steroid, dexamethasone, that is normally only recommended for patients with severe cases of COVID-19 who are having serious trouble breathing. The drug damps down the body's immune system, which can jump into overdrive and damage the lungs and other organs," reports BuzzFeed News. "In a large UK trial, dexamethasone was shown to reduce the risk of death in patients requiring supplemental oxygen by about one-fifth. But even after being given dexamethasone, patients who required oxygen still had a mortality rate of about 20%."
"These are not miracle drugs," Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco, told BuzzFeed, and the website continued: "Trump has also been treated with remdesivir, an experimental antiviral drug made by Gilead Sciences authorized for emergency use in May, and a cocktail of two monoclonal antibodies against the coronavirus, developed by the biotech company Regeneron. Both have yet to be proved effective."
"It can go in a lot of different directions," Wachter told Buzzfeed. "For the next few days, I'd want him 50 feet away from an ICU, not a helicopter ride," Wachter said. As for yourself: to get through this pandemic at your healthiest, don't miss these 35 Places You're Most Likely to Catch COVID.