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Why it matters that Trump is on dexamethasone for Covid-19

Sarah Todd
·3 mins read
photo of White House physician Sean Conley at press conference on Trump's health
photo of White House physician Sean Conley at press conference on Trump's health

As Donald Trump remains hospitalized for Covid-19, his team of doctors revealed on Sunday that the US president’s treatment includes dexamethasone, a steroid typically used for patients with severe cases of the illness.

The news that Trump is receiving dexamethasone further complicates the picture of just how sick the president is.

On one hand, his medical team suggested that the president was recovering faster than expected, and he could leave the the hospital as early as Monday.

On the other hand, White House physician Sean Conley also told reporters that Trump had received the steroid after his blood oxygen levels twice dropped below normal levels, his medical team having decided that “the potential benefits early on in the course probably outweighed any risks at this time.”

What is dexamethasone?

Both the World Health Organization (WHO) and the National Institutes of Health recommend that doctors use dexamethasone to treat only serious cases of Covid-19. A preliminary trial in the UK showed that it reduces mortality in patients on ventilators by one-third, and reduces mortality in patients receiving oxygen in other ways by one-fifth.

The study’s promising results were all the more hopeful because dexamethasone is already a common treatment for other illnesses, meaning that the drug has passed safety trials and is widely available, as Quartz’s Katherine Foley wrote this summer.

But dexamethasone has not been shown to be helpful for more mild cases of Covid-19, and may even have adverse effects.

“You don’t want to give it to a patient too early,” Nahid Bhadelia, the medical director of Boston Medical Center’s Special Pathogens Unit, told STAT. “It’s a blunt instrument, so it may suppress a good immune response as well as a bad one.”

It’s also worth noting that dexamethasone’s side effects can include mood swings and memory loss, although the WHO emphasizes that these side effects are associated with prolonged treatments of more than two weeks.

Why did Trump take dexamethasone?

Trump’s dexamethasone treatment indicates that one of two things are true.

It’s possible that Trump’s case of Covid-19 is not severe, and his doctors administered the steroid anyway out of concern over his underlying risk factors. “If something were to happen to the president—whether he became incapacitated or worse—that’s a huge national security threat,” Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, told Vox.

Alternatively, it’s possible that Trump’s condition is worse than doctors have admitted to the public thus far.

To the latter point, Conley said Sunday that the messaging at the previous day’s press conference had been overly optimistic about the president’s state of health. “I didn’t want to give any information that might steer the course of illness in another direction,” he said, “and in doing so it came off that we were trying to hide something, which wasn’t necessarily true.”

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