I have followed Trump’s Covid case very closely and it has been very confusing as the timeline of symptoms and treatment has not matched up to what we know about the progression of this virus. I am left thinking that the main difference between the particular case of Trump and others was his use of Regeneron. He claims it is a cure, I’m thinking it may have made him worse.
- Tuesday Sep 29th – We see Trump debate for 90 minutes. I see no signs of any symptoms.
- Thursday Oct 1st – He tests positive. The only symptoms are reports of fatigue on the Wednesday and Thursday, but clearly not severe as he attended a fundraiser without major incident.
- Friday am Oct 2nd – Trump personally requests and takes “Regeneron”, supplied by his golf buddy from the company Trump has held shares in. This is an experimental drug not approved by the FDA, but he gets emergency clearance to take it and Dr Conley agrees to administer it. His doctor then reports that his only symptom is mild fatigue.
- Friday evening Oct 2nd – Trump has a rapid drop in his oxygen levels and takes a helicopter to hospital. Scans show signs of lung damage (i.e. pneumonia) and he is seen by a team of world class pulmonary experts. He is treated with remdesivir and notably the strong steroid dexamethasone.
- Over next week – only very sketchy and misleading medical reports. From his videos we can see indications of pneumonia with a cough and shortage of breath. However he does appear to be improving and so the reason for the lack of transparency is not obvious.
- Oct 13th Trump appears much improved, reportedly testing negative for Covid.
Is this a normal timeline?
It really isn’t. The onset of mild symptoms and rapid recovery would imply that he had a mild case of Covid, which is the most common outcome, even for people of his age and weight.
The hospital admission, lung damage and use of dexamethasone prescribed by highly regarded experts in their field can only mean that he was genuinely very ill and in real physical stress. For this to have been caused by Covid, it would imply a much more serious case – but in a Covid case these more serious symptoms typically occur 7 days after the onset of symptoms because they are caused by the overstimulation of the immune system going into overdrive. Further, if it had been caused by Covid, then it would not make sense that he could be released from hospital after only 3 days.
The evidence of serious illness is certainly clear, but the timeline is not consistent with it being caused by Covid.
How to reconcile this inconsistency?
Trump’s explanation that Regeneron cured him fits his view of himself as a genius who can treat himself better than anyone. He asked for this specific drug just as he asked for Hydroxychloroquine earlier this year, which Dr Conley also agreed to administer to him. But the timeline is exactly the wrong way round. He took the Regeneron before the emergence of the lung damage and drop in oxygen levels so it is hard to see it as the cure.
A common theory is that Trump had Covid for a week before he admitted to having it, and so the emergence of the overactive immune response is still the correct timeline. This does not reconcile with his rapid recovery unless we combine the theory that he had been sick for week with the theory that the Regeneron helped shorten his illness. This does not explain why he had no visible symptoms all week, whilst having a severe case of Covid which was about to get much worse.
I am left wondering if it was the Regeneron that caused the problems. In this hypothesis, Trump has a mild case of Covid but takes a massive dose (8g) of monoclonal antibodies which strongly stimulate his immune response. This overstimulation might have lead to pneumonia which is then treated by dexamethasone, after which he is recovering well. Trump does not want to admit that he caused the problems which would explain why he did not allow his doctors to give details on his condition.
Perhaps his Covid case was always mild and so it would have gone away without much intervention.
Eli Lilly has a very similar drug to Regeneron. Their trial has been paused due to safety concerns.
Would I take Regeneron?
I do not want to make a judgement from such sketchy information on a new drug. I would prefer to wait until clinical trials are completed and then we can see if it works or not.