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What drug treatments will President Trump get?

The president of the US, Donald Trump, has tested positive for the coronavirus. The question now: what medical treatment will he receive?

As the leader of the free world and the head of the US government, Trump and his wife, who also tested positive, will have access to the best medical care the country can provide and experimental drugs not available to others.

Because he is overweight and 74 years old, the president is at higher risk for developing a serious case of covid-19. And the chance of death for someone like him is not small—it’s at least 5%, about 100 times as risky for him as for someone under 30 years of age.

Trump’s doctors will have to make some tough decisions in deciding what drugs to give him. For one, they will be assessing medical evidence that’s been consistently clouded by the White House itself and treating a patient who has consistently shown interest in hokum covid treatments, like bleach, has second guessed medical authorities, and even given a bullhorn to a doctor who believes in witchcraft.

The president has “mild symptoms” according to his chief of staff, Mark Meadows. It usually takes several days before more serious covid-19 symptoms manifest, if they do. As long Trump isn’t in the hospital  he would be classified as an lower risk “outpatient.”

For nearly any other American, that would mean being told to wait and see how the symptoms develop, because there aren’t any covid-19 drugs approved for outpatients. Two treatments, blood plasma and the anti-viral drug remdesvir, did receive emergency approval, but only for people who are hospitalized.

But Trump isn’t just anyone. So expect his doctors to consider—and maybe get ahold of—experimental drugs that have shown promise, including ones with no approval yet. The same could go for Melania Trump, and other members of the inner circle who tested positive.

Drug company analysts at Raymond James put out a note to clients rating what experimental treatments they thought Trump was “most likely” to get. At the front of their list: an antibody drug manufactured by Regeneron Pharmaceuticals, which is still being studied.

The antibodies Regeneron makes are similar to those developed by people who catch the virus and survive it. Given though an I.V. drip, a concentrated dose of manufactured antibodies is designed to grab hold of the viral particles and neutralized them.

The expectation for such treatments is, if given early to patients like Trump, they might stop the disease from ever progressing to its most serious stage of pneumonia and death.

Just this week, Regeneron said a study of nearly 300 outpatients showed the antibody treatment cut down the amount of virus. There were also hints that those who got the drug were less likely to end up in doctor’s office, making it one of the most exciting new candidate treatments. (A similar antibody is being made and tested by Eli Lilly.)

When contacted by MIT Technology Review, Regeneron was not willing to say whether the White House had already asked for doses of its antibody, REGN-COV2. “As a matter of policy, we don’t identify individuals without their consent who have or have not submitted a request,” spokesperson Alexandra Bowie said in an email.

Although Regeneron’s drug is not approved, many companies run “compassionate use” programs that can allow people who are not in their trials to get the drug on a case-by-case basis. “There is limited product available for compassionate use requests that are approved under certain exceptional circumstances on a case-by-case basis,” Bowie said.

A presidential request would not be easy to turn down and Trump appears to have a warm relationship with the New York company’s billionaire CEO and co-founder, Leonard Schleifer, who, back in March, was among a select group of executives brought to the White House for a meeting and photo-op about how biotech might solve the crisis with drugs or vaccines. What’s certain is that any company whose drug Trump takes could get a massive boost of publicity, including directly from the Presidential twitter feed.

Another drug doctors will have to consider is remdesivir, an antiviral made by Gilead Pharmaceuticals. It’s never been shown to benefit just-diagnosed patients, like Trump, and is approved only for hospitalized ones. But in the case of a sitting president doctors might have to judge the risk and benefit differently.

And don’t forget that Trump will have a say in his treatment and that’s a wildcard because he has a pattern of taking medical advice from partisan sources, rather than medical ones. For instance, he announced in May that he was taking hydroxychloroquine, an anti-malarial then touted by conservative personalities including Rudy Giuliani as a covid-19 cure all.

His doctor, the military osteopath Sean Conley, later confirmed Trump had taken the pills, even though most health experts say the drug doesn’t prevent infection or cure it.

The same doctor, in a memo, assured the American people that Trump would beat all the medical odds and sail through his bout with the coronavirus. In a short statement, in which he confirmed the diagnosis of the president and the first lady, Conley said “rest assured I expect the President to continue carrying out his duties without disruption while recovering.”

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