What Trump’s Covid-19 experience reveals about our pandemic response

About a week after announcing that he tested positive for Covid-19, President Trump was out of the hospital and “feeling great.” He even held a rally from the White House balcony on Friday to prove that his health is back to normal. Though Trump’s bout with Covid-19 is seemingly over, there is a lot we can learn from how he was treated in the hospital and the messaging Trump uses to describe his experience.

The rich get more attention

As many health policy experts have pointed out, Trump’s experience with Covid-19 highlights the immense differences in health care access and treatments between the haves and have-nots in the US. While Trump receives Covid-19 tests regularly (likely more than once a week), there have been numerous stories of people with Covid-19 symptoms being denied a test and dying soon after. Most states still aren’t doing enough testing to mitigate the spread of the virus, and essential workers and health care workers especially are not tested enough. Yet, wealthy people in the Hamptons paid doctors thousands of dollars to conduct rapid Covid-19 tests on party guests.

Similarly, many of the treatments Trump received are unaffordable or unavailable for average Americans. Remdesivir, Gilead’s antiviral drug, costs more than $3,000 a dose for patients with private insurance. The antibody cocktail from Regeneron is currently only available for patients in clinical trials or by special request to the company (which is how Trump received the drug). Trump’s helicopter rides to and from the hospitals and the hospitalization itself make up the largest expenses; for a person with insurance they would have cost $40,000 and $32,000, respectively. As soon as Trump wanted to return to the White House, he was able to receive treatment from home.

“Covid is all about privilege. The more privilege you have, the more you can ignore some of the rules of Covid. Where one person would need to be in the hospital, another person can have the hospital come to them. That’s privilege,” said Dr. Lakshman Swamy, ICU physician at Cambridge Health Alliance, in STAT.

We still think that more = better

Trump certainly received more treatment than the average American with Covid-19 receives. But it’s not necessarily the case that he received the “best care possible,” as some news outlets reported. That’s because it is likely that Trump was overtreated– given medications that provide little or no clinical benefit.

For example, Trump received an monoclonal antibody cocktail from Regeneron which has not yet been approved by the FDA for emergency use. Early clinical trial data show an improvement in viral load (a surrogate outcome) for non-hospitalized patients, but even the CEO of Regeneron has said that we still need to see the results on ongoing randomized clinical trials to know if the treatment is effective. Despite Trump’s conviction that Regeneron “cured” him, we don’t actually know if Regeneron helped Trump, hurt him, or did nothing.

Trump also received dexamethasone, a cheap steroid that has been shown to reduce deaths in people with severe Covid-19, but can be harmful for those with milder cases. The choice to give Trump this steroid confused some clinicians, as he was reported to only have mild Covid-19 symptoms. Either Trump was overtreated with dexamethasone, or his case was more severe than reported. Trump was also given zinc, vitamin D, an antacid, melatonin, and aspirin–drugs that probably did not hurt him, but likely did not benefit him either.

Why did Trump receive so many unproven medications? His doctor, Sean Conley said,”He’s the president. I didn’t want to hold anything back. If there was any possibility that it would add value to his care and expedite his return, I wanted to take it.” The mentality that we should give patients anything that could potentially help is a dangerous one, because it does not take into account the real potential for harm. Conley mistakenly assumes that an unapproved drug is more likely to help than hurt; the truth is until we have the data, either possibility is just as likely. In fact, it is more likely that a drug in clinical trials doesn’t work, given that most drugs in development do not end up coming to market.

Throwing the kitchen sink at a patient just because they’re the president sets a bad example for clinicians treating patients with Covid-19. Had they really wanted to provide the best care to the president, they should have given him only the treatments that have proven to work for his level of Covid-19 severity.

A pound of cure beats an ounce of prevention

After Trump left the hospital, he addressed the American people, advising us not to be afraid of Covid-19 and to not let the virus “dominate” our lives. While it’s not healthy to fixate on things we cannot control, there are several aspects of Covid-19 we can control — and by ignoring these, we put our friends and neighbors at risk.

Trump’s definition of not letting Covid-19 “dominate” him was to rely on testing for protection instead of obeying social distance and masking guidelines, get infected, take a joyride out of the hospital while contagious, do no contact tracing for the White House superspreader event, and return to the Oval Office before receiving a negative test. He is setting an example that is not only personally reckless but puts the health of his colleagues, family, secret service, and residential staff at serious risk.

With all of the resources the White House has at their disposal, it was certainly possible for the president to avoid getting Covid-19 in the first place. But it’s not surprising Trump has prioritized power over prevention, as this mirrors the pattern of his administration’s pandemic response. For both the country and the White House, there has been no plan, no transparency, little invested to protect the most vulnerable, and decisions made based on politics rather than science. Maybe Trump should let Covid-19 “dominate” his life, if it would mean that he takes it seriously enough to listen to what public health experts are saying and create a plan of action.