Hello and welcome to Medicine with Dr Moran. I'm Dr. Keith Moran
I'm Dr. Keith Moran
I've done several videos reviewing the data
about the odds and percentages of dying from Covid.
if you get infected.
I have had
patients over the last six months ask me this question.
We do have data on comorbidities
as well as age that allows
doctors like myself to predict
on average what the likelihood of surviving Covid is.
Many government figures worldwide have had Covid-19
Donald Trump
The president of the United States and the First Lady have now acquired the virus.
Lost of my viewers have asked me
How good his chances of survival are
Please note that this is not a political video
but simply a general medical asessment
of the likley hood that someone his age
with his risk factors
will survive Covid-19 based on current knowledge.
I would appreciate it greatly if all comments
below are respectful and if politics is kept
out of the conversation of this medical video.
As a physician I think I can speak for all
physician when I say that we try hard to treat every patient with respect
no matter what walk of life they come from
or their political background.
It is unfortunate that President Trump
has acquired SARS Cov2
and has developed mild symptoms of Covid-19.
He is now on day two of his symptomatic illness.
His physician Dr. Conley has reported
he has has a mild cough as well as a fever
and fatigue initially but in fact is felling better today
and the fever has not come back in twenty four hours.
As a disclaimer
I'm obviously not involved in his
medical care.
The data I have to work with
is what has been reported by his doctors.
He is a seventy four year old man with
a BMI of thirty five. Other than obesity
he does not have any other comorbidities.
Age is his biggest risk factor at 74.
In the latest CDC
current best estimate of infection fatality ratio IFR
Which is the odds of dying from Covid -19
if you catch it.
The risk of death in patients over 70 is
5.4%
We do not have any specific
fatality rates in smaller age groups
in patients over 70.
What I mean by this is that there isn't
a fatality rate for the age group of 70 to 75
comparing it to 75 to 80
versus 80 to 85.
As you know an 84 year old would be less likley
to survive than a 74 year old.
As a rough approximation a
three percent would seem resonable based
on his age and CDC data.
In my previous video Odds of dying
I showed several curves
which were mathimaticaly perdicted
by an extensive amount of evidence
from numerous countries around the world.
This is the United State location age specific
infection fatality rates.
This data is two or three months old now
and the infection fatality rate from
this data is slightly higher than
the CDC data presented recently in September.
If you look at the graph
the fatality rate would be about
3 to 4% at the age of 74.
So the 3% value
seems to be a resonable
approximation of death or a 97% survival.
Here are the other curves
and you will see the same kind of estimate
from those curves also.
In my video on comorbidities and Covid
there were a number of factors that increased
risk of hospitalization and by virtue of that death.
These included high blood pressure,
Corinary artery disease, Diabetes,
Obesity with a BMI of over 30
as well as severe Obesity defined by
a BMI of over 40
Chronic kidney disease, and Ashma.
President Trump has a BMI of 30.5
but he does not have any of the other conditions that
would put him at more risk.
The risk for BMI's of over 30
specifically in the 30 to 40 range in that study
according to the bar graph demonstrated
that 54% of patients
admitted to the hospital with Covid-19 had
BMI's in that range compared to 28%.
So approximately double.
Now he has a BMI of only
just 30
30.5 to be specific
So the increased risk is an estimate
would be about 1.2 times.
Now the study I quoted
was about hospitalization as opposed to death
but I think this figure would give you a resonable approximation of death.
Of course if he was not the President of the United States he would almost certainly be
at home and not in the hospital.
He is obviously getting the very best of care with a cadre of doctors
involved in his care.
If we say the baseline risk with his age is 3%
and the obesity factor is just over 30
would give you a risk
combining those two of
3.5%. Again these are rough estimates and are a average risk if you look at thousands of
patients as in the clinical studies
that I just showed.
Now at this point you also have to consider the fact that
He has been diagnosed early
and has already stared on therapy
with Remdesivir along with a antibody coctail
called REGN-Cov2.
to give him passive Covid immunity.
Currently October 3rd as I report this
he does not appear to have any pulmonary involvment
as noted by excellent oxygen saturations
described ad 96% by his personal physician
today and he
has not had
a need for oxygen during
his hospitalization so far.
Now Remdesivir works by inhibiting the replication of the
virus
and is often given for five days by IV
It has not been used in patients without pulmonary involvement.
So it's difficult to know how much
if at all this will help the president
As it has not been studied in this particular scenario.
It may very well be helpful in this
instance.
Specifically Remdesivir was used ink
a mutinational trial of a little over 1,000 patients with
confirmed Covid-19
as well as pulmonary involvment.
I make note that this is not the case with the president
currently, bur Remdesivir
in this particular instance when it was studied
did demonstrate a faster time to recovery
it was 11 days vs 15.
There was also a trend towards
a lower 14 day mortality
that did not quite reach statistical signifigance.
They did look at subgroups and
there was a reduction in mortality with Remdesivir
compared to placebo
among patients who requires supplemental oxygen.
but were not on high flow oxygen or greater support.
Again right now the president is not on
oxygen. With respect to REGN-COV2
It is currently being studied late stage clinical trials.
There
is initial data on 275 non hospitalized Cov-19 patients
that were recently announced but the data
has yet to be peer reviewed or published.
The website of the maker reported that
it reduced viral load
and the time to alleviate symptoms in
non hospitalized patients
with Covid-19
with a trend of reducing medical visits compared to a placebo.
Now there is no data on if this would reduce fatality rates.
Of course it
might given the fact that it does reduce viral load.
Studies have not been done at this time.
Even if it does not reduce the chance of death
it may very well get the president felling better
quicker and back to the White House
much faster.
This particular medication
is very similar to Convaelscent plasma
from patients who have had Covid-19.
Convalescent plasma is a emerging area of research.
This type
of passive immunity giving patients antibodies
to fight the virus is likely to be very helpful
particully in patients who cannot make
significant quantities of antibodies when they acquire the virus.
There was
an unpublished report of over 35,000
patients who had or were at risk
for severe Covid-19
and received Convalecent Plasma.
An infusion within three days of diagnosis
was associated with
lower unadjusted mortality rates
compared with transfusion
4 or more days with antibodies after diagnosis.
Now this
was 8.7 vs 11.9%
of day 7
and the difference lasted all the way to a month
in terms of a reduction in their mortality.
So these two medications that the president is on Remdesivir and well as
REIGN-COV2
have the potential to significantly increase
his survival.
It's difficult to assign a figure to this given
The lack of evidence at this time.
It is though likely to be significant.
I should note that President Trump is receving
other supplements including vitamin D and Zinc.
It may be helpful particularly if he were to have a deficincy.
Although I suspect
that this is not likely given his medical care
as president and the fact
that we know that patients
deficiency do poorly when the get the virus.
His course over the next three to five days will
give us an idea of how he will fare.
If he were to have worsening clinical condition
and require oxygen then steroids
would be indicated.
In my video
Are Steroids helpful for Covid?
I talk about how in
hospitalized patients without
intubation or ventilation
meaning life supports
there was a reduction in deaths from 26.2% down to
23.3%
If he ended up on mechanical ventilation
the risk of death would be reduced
more signifigently.
As you can see from the slide
41.4% down to
29.3%.
The column with NNT refers to
the number needed to treat to prevent one death
in each category.
Now given the therapies and the
potential therapies down the road
he has a excellent chance of surviving this illness.
I would estimate based on the stats and the clinical
studies that I've spoken about there would be
an approximate 99% chance
that he will survive this illness.
As a physician I wish all patients
a speedy recovery and I hope
that this will be the case for the U.S. President
and the First Lady. Thank you for joining me today
on Medicine with Dr. Moran. I'm Dr. Keith Moran.
Remember, Get healthy and stay healthy.