Steve October 8, 2020

On Wednesday afternoon, Tweety McTreason tweeted a nearly five-minute video in which he directly attributed his progress recovering from Covid-19 to a monoclonal antibodies treatment from Regeneron, a company in which he has previously invested. In the video, Trump implied that we no longer need to worry about the coronavirus because there is a “cure.”

There are many reasons to object to the president of the United States advertising the efficacy of an experimental drug and promoting, by name, a company he has links to and whose executive is a member of his golf club, while standing in front of the White House. But there’s one in particular that doctors identified in this bizarre episode: The president’s own health updates cast a shadow of uncertainty on the treatment’s effectiveness.

Earlier that day, Dr. Sean Conley, Trump’s doctor, released a letter that didn’t itself provide much new information. Trump, it said, was reportedly symptom-free for 24 hours. (That isn’t surprising if he’s still on medications like aspirin or steroids that suppress symptoms.) Trump hadn’t needed any supplemental oxygen since he was hospitalized, Conley wrote. He also wrote that Trump had detectable levels of what are known as IgG antibodies for the coronavirus.

More telling was what the letter didn’t say. One detail that would indicate how well Trump is fighting the virus would be a decline in his viral load, i.e., the amount of virus in his body. In preliminary results on the monoclonal antibody treatment REGN-COV2, announced by Regeneron in a press release last week, the medication seemed to lower the viral loads of patients with mild illness. If the treatment is working, Trump might expect to see such a decline. But that detail was noticeably absent from this and other updates on his health. In addition, Conley’s letter noted that Trump is showing levels of IgG antibodies—but he didn’t specify if those antibodies came from the Regeneron treatment itself, which usually lingers in the body for four weeks, or whether Trump is producing any of his own antibodies.

With a history of cherry-picked updates on Trump’s health, experts say these omissions paint a startling picture. Based on previous updates, if Trump’s medical team were seeing any positive indications, they would have shared them. With that in mind, Trump’s pronouncement that he’s confident the REGN-COV2 is responsible for his miracle “cure” could be rather reckless. Not only is it experimental, he also has no actual evidence that it’s working—and he may have evidence that it’s not.

“There is zero evidence that he is ‘cured,’ and even if he’s getting better, there is nothing to prove it was (or wasn’t) the Regeneron treatment,” Dr. Megan Ranney, an associate professor of emergency medicine and public health at Brown University, told me. “Moreover, claiming ‘miracle cures’ already got people in trouble with hydroxychloroquine and bleach; I wish the president had learned to wait before making these hyperbolic statements.”

She said Conley’s mention of the president having IgG antibodies was “bizarre.” It implies that he doesn’t have IgM antibodies, a type of antibody the human immune system naturally produces before or at the same time as the IgG antibodies the treatment contains. Natural IgM and IgG antibodies would suggest that the body is mounting its own response to the virus, and they usually provide immunity for a few months. If Trump only has antibodies provided by the treatment, Ranney said, “then he likely does not have innate immunity, and when the Regeneron wears off, he will once again be susceptible to the virus.” To make matters more complicated, Trump is also taking dexamethasone, a powerful steroid that, when taken early in the course of Covid-19, could actually suppress the body from mounting its own immune response to the virus.

Ranney is taking Trump’s health updates with a hefty grain of salt. “I have to take these guesses because I can’t trust what is being told us,” she said. “All week long, the administration has provided incomplete or half-truthful press data about the president’s course. We are therefore forced to read between the lines.” Ranney said randomized controlled trials, not politicians’ statements, are the best way to know whether and how monoclonal antibody treatments work. “I do believe that this treatment is promising—it has good biologic plausibility for working—but it is just too early to say whether it is effective or not,” she said.

Dr. Ellie Murray, an assistant professor of epidemiology at Boston University School of Public Health, also emphasized the importance of the gold-standard clinical trials. Yet Trump’s endorsement of his treatment could sway the perspectives of potential participants. “When people have already prior beliefs about a medication, it can mean that it can be really hard to enroll participants. And the Regeneron trial is still enrolling,” she told me. What’s more, because Trump is on several medications, it’s difficult to tell which ones have helped him, she said.

Even if the clinical trials reveal that the treatment is effective, however, it’s not the panacea Trump promises in his video. Contrary to the astonishing production and distribution the president promised in his video, it would be very difficult, if not impossible, to produce enough monoclonal antibody treatments for everyone who is ill. Because of the limited supply, it will likely only be used among those who are at highest risk of the virus, such as health professionals and the elderly—and those who can afford it.

Companies like Regeneron and Eli Lilly haven’t announced how much their monoclonal antibody treatments might cost, but the average annual price of existing monoclonal antibody treatments was nearly $100,000 in 2018. In his video, Trump claimed “everyone will get them free,” but it’s extremely unclear how that could happen—particularly for people who are uninsured or underinsured. In addition, because the treatment was developed by testing the antibodies against fetal tissue cells, there may be ideological opposition to it. (The treatment itself, however, does not contain cells from fetal tissue.)

Perhaps most concerning, in a slew of disturbing news, is Trump’s continued efforts to overrule or politicize the normal regulatory process for new drugs and vaccines. Until recently, he has repeatedly promised a vaccine would be available by Election Day, even if the administration had to override regulations by the U.S. Food and Drug Administration. In his video Wednesday, the president said “I’ve authorized the EUA,” or emergency use authorization, to make the Regeneron treatment available to the public before the clinical trial data exists. Not only does that appear to be untrue, that’s also not Trump’s decision to make: The FDA authorizes EUAs.

While treatments like monoclonal antibodies seem promising, every expert I’ve spoken with over the past 10 months of reporting on the coronavirus has emphasized that the Trump administration continues to undermine potential progress by recommending certain treatments, vaccines, tests, and pandemic policies without having sufficient data. Far from helping, such announcements could do lasting damage to efforts to develop accessible, affordable, effective ways to stop the virus.

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