President Trump has boasted that the treatment he has received for COVID-19 has cured him of the disease and made him feel better than ever. It’s very difficult to know whether that’s true, given how little we know about his condition, how unreliable his health reports have been and how experimental his course of treatment is. But we do know that these drugs often come with considerable side effects — side effects that could change the behavior of the leader of the free world.
In particular, one of the drugs he has been given, dexamethasone, can cause psychiatric side effects, which has raised concerns. Of course, just because side effects could affect behavior doesn’t mean they are doing so.
“We need to exercise caution in attributing any particular form of behavior to side effects of medication,” said Edward Shorter, a medical historian at the University of Toronto. “Trump has such a long history of bizarre and erratic behavior that the latest manifestation of it need not be a medication side effect at all.”
Rather than jumping to conclusions, it’s helpful to take a step back and consider what the science tells us about these therapeutics. Let’s run through the three major drugs doctors have prescribed to Trump and what their side effects might be.
Regeneron: Little is known
This antibody cocktail is the treatment we know the least about, because it’s a new, experimental therapeutic that has not yet been approved by the U.S. Food and Drug Administration. Regeneron has conducted a drug trial of its treatment — which uses lab-grown, antibodies specific to the novel coronavirus to help fight off an infection — but the results have not been published, aside from a promising press release from the company last week. The release didn’t mention any potential side effects. We do know the cocktail is administered intravenously, and any IV treatment can potentially cause certain side effects like fever and chills. But other than that, until more details are published, it’s hard to say whether the cocktail changed anything for the president, including his claims of it “curing” him.
Remdesivir: Mostly mild side effects
This antiviral drug was originally developed in 2009 as a potential treatment for hepatitis-C. While it didn’t prove effective for that disease, early trials in the COVID-19 pandemic found it could reduce the duration of infection and increase the likelihood of survival. It was authorized for emergency use by the FDA in May.
While there is still work to be done to learn the full scope of the drug’s effects, so far the most common side effects reported, such as nausea and constipation, are mild. Some COVID-19 patients have experienced more severe symptoms while taking remdesivir, including worsening respiratory failure and high levels of certain enzymes in the liver, which can cause damage, but these are more rare. In a phase 3 trial of remdesivir published in May, 8 percent of patients experienced worsening respiratory distress and 7 percent had elevated enzymes in their liver. But because the research on this drug is still limited, we don’t fully understand the link between the drug and these adverse effects.
“Even though any drug can have side effects, including remdesivir, on balance it doesn’t have a lot,” said Dr. Rajesh Gandhi, an infectious diseases physician at Massachusetts General Hospital and Harvard Medical School. “It can have effects on the liver occasionally, which is why we routinely do liver checks and I’m sure the president is having routine liver checks.”
Indeed, in a briefing on Sunday, Trump’s physicians said they’re monitoring the president’s liver functions, which are indicating “normal findings.” (Though we don’t know to what norm they’re comparing Trump’s levels. Normal for a COVID-19 patient, or normal for a healthy person?) On Monday, his doctors said Trump was given a five-day course of remdesivir, with the final dose on Tuesday.
Dexamethasone: A long list of side effects
We know the most about this drug because it’s been around for half a century, and perhaps as a result it comes with the longest list of possible side effects, ranging from acne and hair growth to severe psychiatric effects. This is typical for corticosteroids like dexamethasone — they’re versatile and effective but also can wreak all kinds of havoc on the body and mind. Corticosteroids are synthetic versions of hormones the body naturally produces and are effective in reducing inflammation. For this reason, they’re typically used to treat conditions such as lupus and rheumatoid arthritis. But dexamethasone has also been found to be effective in treating COVID-19 in cases in which the patient required oxygen or ventilation.