The President’s medical team started him on the steroid dexamethasone yesterday. Of the COVID therapeutics I’ve discussed this weekend, dex is the only one shown to reduce mortality in patients w/ severe COVID-19. But it can also be risky for patients with mild illness. 1/7
Data published earlier this year showed that dex reduced deaths by one-third in COVID patients who had been sick >7 days and were on mechanical ventilators. Among patients receiving oxygen by less invasive means it reduced deaths by one-fifth. 2/7
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10…
However, here’s a key point: patients given dex who weren't on respiratory support died at a *higher* rate than similar pts who didn’t get dex. This wasn’t statistically significant, but if there’s no benefit & may be harmful, this is not a drug you start w/out good reason. 3/7 
Taken together, all of this suggests that Trump’s medical team is treating him as if he has severe COVID-19. 4/7
Trump’s docs say he could be discharged as soon as Mon. This strikes me as misleading - if I were treating a patient hospitalized with COVID and they had just been started on dexamethasone for multiple desats, I certainly wouldn’t tell them to expect discharge in 24 hrs. 5/7
Trump is now on the major drugs we have to support patients as they battle COVID. One add'l option his docs may reach for is convalescent plasma, but this is still poorly understood and not routinely used outside clinical trials (despite Trump touting it as a breakthrough). 6/7
It will be several more days before we know if the President is in the clear. Next concerning steps to watch for would be escalation of respiratory support: oxygen by nasal cannula → high flow nasal cannula → intubation. Hope it doesn't come to that. 7/7
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