By Lenny Bernstein and Laurie McGinley,
There was no missing the message when a phalanx of white-coated doctors and nurses stood in the bright sunshine outside Walter Reed National Military Medical Center for a briefing on President Trump’s health Saturday, and White House physician Sean P. Conley ticked off 13 names on the president’s medical team.
Trump’s caregivers are sparing nothing in their attempt to treat his coronavirus infection.
From his team of providers to his helicopter flight to the hospital to the experimental drug that fewer than 10 others have received outside a clinical trial, Trump has access to care available to few of the other 7.3 million people in the United States infected so far by the coronavirus. Even with symptoms that Conley appeared to describe as moderate at worst, the 74-year-old president is the VIP of VIPs in his battle against covid-19, the disease caused by the coronavirus.
“I think about it as a realist,” said Robert Wachter, professor and chair of the department of medicine at the University of California at San Francisco. “He is the president of the United States. For him to get the most vigorous therapies . . . even if we have not yet reached the point where there is enough evidence to make it available to everyone in the country, doesn’t seem off to me.”
“I think access to treatment and frequent monitoring is probably a good thing for evolving medical care of a new disease,” added John W. Mellors, chief of infectious diseases at the University of Pittsburgh Medical Center.
VIP treatment is a feature of American medicine. Major hospitals throughout the country have private spaces for celebrities, the super-rich and the influential, patients who want to be shielded from the public and just may make a large donation if they are happy with their care. They are U.S. citizens and foreign nationals from places including Saudi Arabia, China, Canada and Mexico.
The coronavirus pandemic, in contrast, has featured memorable scenes of community hospitals from New York to Texas nearly overwhelmed by desperately sick people, of doctors and nurses working around-the-clock with insufficient equipment. At least 208,000 people in the United States have died of covid-19, according to a Washington Post analysis.
Trump has been widely criticized for his handling of the pandemic, especially in the early months, when the federal government left states to scramble for face masks, ventilators and other equipment needed by caregivers and patients. That performance is his greatest weakness in next month’s election against his Democratic rival, former vice president Joe Biden, polls show.
In addition to his suite at the military hospital in Bethesda, Md., the most notable advantage Trump enjoys is access to an experimental antibody treatment that has been given to fewer than 10 people under the “compassionate use” program that the president’s doctors employed to obtain the drug from its manufacturer, Regeneron Pharmaceuticals. About 2,000 others have received the drug or a placebo because they are enrolled in the company’s clinical trial.
“The VIP treatment around antibodies is ethically troubling and yet there are many, many other things we do to support the president that are different from what you and I get, and we live with it every day,” Wachter said.
The drug has been touted as a potential game-changer by prominent scientists — a way to keep people from getting so sick that they must be hospitalized. The company announced recently that data showed the drug appeared to knock back the virus, reducing levels and relieving symptoms when given to people recently diagnosed with the coronavirus who weren’t in the hospital.
“Do we offer therapies to the president of the U.S. that we would not offer anyone else?” asked Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. “I don’t know the doctors who made the decision, but it is hard for me to second- guess them. If he died, the security risk would be extraordinary, especially the way things are so revved up with conspiracy theories and everything else. It could have been very destabilizing.”
The special medical treatment often provided the powerful “reflects the inherent inequities in our health-care system,” said Jeanne Marrazzo, an infectious-disease expert at the University of Alabama at Birmingham. “We know that VIPs get extraordinary care — our health-care system already distinguishes between people deemed worthy of the highest level of care, and that is the fact and the reality in our society.”
It is not clear exactly how many doctors, nurses and others are attending to Trump, but for hospitalized covid-19 patients in more serious condition than the president, staff ratios are critical. At times in the pandemic, ICU nurses who should have been caring for two people have found themselves attending to four.
“The vast majority of what we do in the ICU is supportive care,” said Russell G. Buhr, a pulmonary and critical care physician at Ronald Reagan UCLA Medical Center in Los Angeles. When it comes to monitoring patients, he said, having sufficient personnel is essential.
Buhr said he is concerned that unproven antibodies may not be the best course for Trump.
“More is not always better,” Buhr said. “I cannot say after caring for dozens and hundreds of patients that giving someone more is better than appropriately monitoring the situation and giving more treatment” when it’s required.
At least one survey has concluded that people receiving VIP care may demand unnecessary tests and treatments and receive them because of who they are.
Trump is receiving another drug, remdesivir, that is increasingly available to hospitalized covid-19 patients, but he may be getting it earlier than others do as his doctors try everything to halt the progress of the virus.
Conley said Friday that the president also is taking zinc, vitamin D, famotidine, melatonin and a daily aspirin. Famotidine, which is used to reduce the production of stomach acid, is being studied as a possible therapy for covid-19. Melatonin can be employed as a sleep aid.
Jeremy Faust, an emergency room physician at Brigham and Women’s Hospital in Boston, said the aggressive care Trump is receiving reflects the circumstances his doctors find themselves in.
“I have every confidence in the quality of care he is receiving at Walter Reed. He’s in great hands,” Faust said. “But the decision-making process on treatments, I would say they represent the pressure cooker the president’s doctors are in.”
Conley, the White House physician, appeared to acknowledge as much at Saturday’s briefing. With Trump’s vital signs stable and no need for him to have supplemental oxygen on Saturday, why was Trump hospitalized at Walter Reed, a reporter asked.
“Because,” Conley said, “he’s the president of the United States.”
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