WASHINGTON _ Americans hospitalized with the coronavirus currently have access to every one of the medications that President Donald Trump received _ with one exception.
The president's doctors have tried nearly every drug available to treat his infection with COVID-19 in recent days, a strategy described in the medical field as "VIP syndrome," when caretakers afraid of losing their celebrity patient opt for unusually aggressive care.
But out of the many medications administered to Trump _ a potent mixture of remdesivir, an antiviral, and dexamethasone, a steroid, as well as prolific drugs with no proven effect against COVID-19 such as zinc, aspirin, vitamin D, famotidine and melatonin _ only an antibody cocktail produced by Regeneron remains publicly unavailable.
That drug cocktail has only been tested in clinical trials on a few hundred people, scientists say, and has generated very limited results among a pool of clinical trial participants who are, on average, significantly younger than the 74-year-old president.
"That is not available to most Americans, and shouldn't be," said Dr. Theodore J. Iwashyna, director of health services research and professor of internal medicine, pulmonary and critical care medicine at the University of Michigan. "We do not know if it works and do not know if it's safe, and the vast majority of treatments don't work."
The Regeneron cocktail is seen as promising, however, and aims to lower the amount of virus in a patient.
Ideally, the treatment would be administered early on in a patient's disease course. The White House has not disclosed when the president last tested negative before receiving a positive diagnosis Thursday night, nor has it detailed when he first began experiencing symptoms, making it difficult for outside physicians to determine how far along the president is in his infection.
"The monoclonal antibodies from Regeneron are an investigational medication that has not been authorized for use _ it's not a licensed product and it does not have emergency use authorization," said Dr. Eric Toner, senior scholar at the Johns Hopkins Center for Health Security.
"So it is not generally available to people. The only way it's available is through a process called compassionate use, which is intended generally for people with a life-threatening use. It's used under conditions of desperation," he said.
Toner said that the president could well be benefitting from the experimental drug. Trump took an 8 gram dose of the Regeneron cocktail on Friday _ the largest dose available to clinical trial participants.
"We still don't have a lot of data, but the data that I have seen has been promising, and it does seem like it decreases viral load," said Dr. Rachel Presti, who is leading an effort at the Washington University in St. Louis to conduct COVID-19 vaccine trials and is also investigating monoclonal antibody treatments.
While most Americans do not have access to the Regeneron drug, they can get convalescent plasma _ another form of antibody treatment. The difference is that convalescent plasma does not offer as targeted a treatment as monoclonal antibodies, such as the Regeneron treatment.
"It's quite often given despite the fact that we don't have a lot of data on convalescent plasma, partly because you're getting plasma from an individual donor, and because every person that recovers might have different antibodies that may or may not work as well for your virus," Presti said. "The advantage of the monoclonal is you know exactly what you're getting."
The combination of remdesivir and dexamethasone, which Trump began over the weekend, could mean that the president had a more severe case of COVID-19 than the White House or his doctors are letting on, despite the president leaving Walter Reed Medical Center on Monday.
Andrew Luks, a pulmonary and critical care physician and professor at the University of Washington School of Medicine, who treats coronavirus patients in his hospital's intensive care unit, said it is not uncommon to see patients readmitted to the hospital a second time with a bout of severe symptoms and requiring much more oxygen than they did before.
"Certainly he's an important individual, so you want to get it right, and you want to make sure he gets through this situation given his role in our country," he said. "But there's a risk of doing too much."
There is little evidence that mixing remdesivir, dexamethasone and an antibody cocktail will produce adverse effects, but the combination has not been rigorously tested before, doctors say.
According to past statements from the president's physicians on his regular check-ups, Trump takes a daily aspirin, which could help prevent blood clots _ a common complication of COVID-19.
Dexamethasone, however, could increase the chance of infection from blood clots.
"Having VIP care doesn't necessarily mean you're getting the best care, because people are more worried. You probably don't want your mother treating you or you treating your mother, because you want to do more and it might not be quite as evidence-based," said Presti.
Trump left the hospital on Monday evening, after tweeting that he feels "better than I did 20 years ago."
While outside physicians acknowledge that the president, unlike most Americans, has sophisticated medical care at the White House, some expressed concern with the decision to release him given the limited, yet concerning picture portrayed by his doctors.
"I think what may be happening is that he's sicker than he's letting on, or they're engaging in VIP syndrome," said Dr. Nicholas Christakis, an expert on COVID-19 at Yale University and author of the upcoming book, "Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live."
"The thing about the coronavirus in a patient with his profile is that they can crump very fast," Christakis said. "He could end up flying right back to the hospital."
Doctors recommend that patients receive remdesivir as early as possible if they are experiencing the symptoms of a moderate or severe case. Dexamethasone, on the other hand, is typically prescribed when a coronavirus patient has a severe or critical case, and its use in patients with mild cases may actually worsen their condition.
Both drugs are widely available to the public, although "there have been some issues about the availability of remdesivir in some hospital systems," Luks said.
The day before Trump's diagnosis, the Department of Health and Human Services announced that hospitals would now be able to buy remdesivir directly from the main distributor, increasing availability.
Iwashyna described remdesivir as like a Tamiflu for the coronavirus, alleviating symptoms in moderate cases. Both remdesivir and Regeneron's monoclonal antibody treatment are delivered through an IV in hospital settings.
But only dexamethasone has a proven track record of decreasing the death rate among COVID-19 patients.
"That's the drug for which we have the most compelling evidence for impact on mortality. There are some hints that remdesivir has an effect," Christakis said.
Experts say that the number of anti-inflammatory drugs that the president is taking could be the reason Trump _ who, according to his doctors, had a high fever and required supplemental oxygen on Friday morning _ was able to move around the presidential suite at Walter Reed on his own.
"Dexamethasone is absolutely superb at suppressing fevers, so I don't know whether he would be having fevers or not off the drug," said Iwashyna. "If you put somebody in an ice bath, and then they're not hot, it doesn't actually tell you if they're not hot anymore.
"Part of why you put someone in the hospital is so you can observe them over a long period of time," he added, "not just for intentionally selected moments chosen to make them look as good as possible."
