[00:00:00] Dr. Samir Gupta has lots to say about these issues. He's our regular Wednesday guest, but because he's a researcher, allergist, and this is very much the issue that we want to know about the president. He is here for a bonus visit. And we thank you very much. Hi, Dr. Gupta. Good morning again. The question of discharge. Why don't we start right there with you meeting with his team today, still hoping to be heading back to the White House and discharged from hospital later today. How prudent does that seem to you?
Dr. Gupta: It seems very imprudent. I would not discharge a patient like this. Obviously, there's a lot of conflicting information here in terms of how sick he was. But we do know that he, for some period of time required oxygen. They talked about a CT scan showing expected findings. To me, that means he probably has some pneumonia on the CT scan and he's a high risk patient on three drugs. So this is a person who obviously they're worried about even just practically, you know, the Remesvider. for example, is a five day course and that's meant to be given in hospital. So what's the idea here? Are they going to stop that treatment early? It just really doesn't make sense for him to be able to go home this quickly.
[00:01:11] Ok, you've raised three separate areas that I'd like to probe further with you. And as I watch your facial expressions, I feel a little bit relieved because the whole thing has been very confusing from a layperson's perspective, getting these medical briefings. And so I'm hoping that you as a for allergies can help us understand a little bit more clearly the drops in oxygen level. We know that he was receiving supplemental oxygen on two occasions, but just how low it went. They weren't they would not specify below 90 for. So how what is important in that?
Dr. Gupta: Well, I think, you know, Dr. Connelly kind of said we started oxygen because he dipped below ninety four or dipped to ninety four. But the reality is that a normal oxygen saturation in someone the president's age is actually ninety three percent. So that really doesn't make any sense. And we don't typically administer oxygen unless and until someone saturation drops significantly below that. So below 88 percent is where we would start oxygen. So obviously, either they're trying to hide something or they're they just have completely different thresholds for treatment, which really doesn't make any sense. I think we have to assume that his oxygen levels went substantially lower than 90 for at some point during the press conference, he kind of admitted that they didn't go into the low 80s. So I'm thinking they probably had saturations in the mid-80s, which would have justified that one important.
[00:02:33] What is what would that be? That would show that the illness is progressing in his lungs if they it was if it went to that level.
Dr. Gupta: Absolutely. You know, if he's at ninety three, ninety four percent, that's within normal. If he's in and below 88 percent, that really does suggest that the illness is preventing his lungs from being able to absorb oxygen, which is what this illness does. And that's a red flag that would be an indication for starting him on oxygen and that would indicate that he's sicker than they're letting on right now.
[00:03:00] Now, there were questions of the doctors in terms of what the chest scan or the X-ray revealed. And as you said, they would say, well, they were the expected findings, but it wasn't clear whether that was in a normal patient or in a covid-19 patient. So what information is in a chest scan or an X-ray that would be important to know about?
Dr. Gupta: Many patients who have this infection will have an abnormal CT scan, and many of the patients in some studies that are asymptomatic or minimally symptomatic will have an abnormal CT scan. So, you know, in the context of him having had low oxygen levels, almost certainly he has an abnormal CT scan. And what we're looking for is some haziness in the lungs, some what we call infiltrates in the lungs or density in that lung tissue that suggests that there is inflammation and infection. And those would be the same kinds of abnormalities that would lead to the low oxygen levels and cough and shortness of breath and the various symptoms associated with the infection onto the drugs.
[00:04:00] As you mentioned, he's on three. There is the new Regeneron therapy, which is a cocktail of a couple of antibodies. It's not yet approved by the FDA. We should say there is Remesvider, which is the antiviral we've talked about before for the most severely ill patients. And then there is the steroid Dr. Gupta dexamethasone shown to be effective in severely ill cases, but not recommended at all in mild cases of covid-19. So those are the three. What are the red flags in there for you?
Dr. Gupta: Again, it really doesn't hold together. Probably no one on the planet has received this cocktail of medications. They really are throwing the kitchen sink at him. You talked about regenerations, product. That's something we were going to talk about last week, but we didn't because we don't have the study. All we have is a press release. And as lax as the FDA has been with approving medications, even the FDA hasn't approved this medication. All we have is phase two data. So. It's a monoclonal antibody, it's promising, and it's one of the only ones that would have been hopefully if we see the data might have been shown to reduce the effect of this infection before people get really sick. So first he gets that, and that's meant to keep people out of the hospital. Then he gets a drug, as you mentioned, Remesvider , which really is only effective in sick patients on oxygen. And then he gets a drug, which I would say is even more aggressive in the form of dexamethasone, which we really reserve for our sickest patients. The biggest benefit from that drug is in patients who are on a ventilator, although it also benefits people on oxygen. So he's getting the kinds of drugs you would give your your sickest patient patients that you're very worried about. But at the same time, he's giving a four minute address without oxygen on TV, seemingly really not breathless during that address. So not sort of matching what I would have thought for someone on those drugs. And then he's doing this tour in his vehicle around the hospital again without oxygen. Really bizarre. And it doesn't fit with this picture of how he's being treated.
[00:06:03] So as I listen to this, I mean, three as far as covid-19 patients could go, may be considered experimental to varying degrees, three drugs together in combination. I mean, would there be concerns about interaction? I'm thinking of the steroid, Dr. Gupta, that is pretty know, reaching deep into the arsenal here. Are there any particular side effects of that in terms of behavior, in terms of mind, in terms of thinking all of this happening? Should this man be really in a position of authority right now? Because there are questions about whether he should transfer the power of authority to the vice president. But as I listen to all of the things that you're talking about, he's really being blasted with with things that we don't know how they'll work together.
Dr. Gupta: I mean, I would start with the Regeneron product. We again, we haven't seen the data, so we don't know what the safety data are around that product. We also don't have phase three trial, so we don't have a large number of people who have been exposed to it. So just that drug, what are the potential side effects? We don't know. The combination of these various drugs is uncharted territory, so we don't know. And then you mentioned specifically dexamethasone being a steroid at a high dose. Steroids can certainly have side effects, all sorts of side effects. A concerning one for the commander in chief would be neurocognitive side effects, we call them, so people can get confused, people can become agitated. Some would argue that that was already the case before any of this happened. So how would this drug affect him? And so there's that question. But then there's also the question, should he be carrying on if he's sick enough to even require these three drugs and if his oxygen levels were low, if someone's oxygen levels are low, that does affect their ability to process information, their ability to make decisions. So just the illness itself would raise questions around how fit he is to leave the country.
[00:08:00] Dr. Gupta, really appreciate your expertise on this this morning. And we'll be seeing you again doubtless on this. But thank you for today. My pleasure.
