I volunteered for a COVID-19 vaccine trial in New Jersey. Here’s what it’s been like since the shot.

On the afternoon of Sept. 22, I became a data point in the search for a vaccine to prevent COVID-19.

Why a vaccine for coronavirus will take longer to develop than you might think



That’s when I received the first of two shots in a clinical trial to develop a vaccine, and became one of 30,000 volunteers to take a needlestick for science.

Why am I doing it? A combination of altruism, curiosity, and a sense of duty as a journalist. But more on that later.

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Aside from the nurse who injected me and the hospital pharmacy that supplied her with the injection, no one else knows whether I received a placebo or the would-be vaccine. Not me. Not even Dr. Bindu Balani, the principal investigator in the trial at Hackensack University Medical Center, one of 89 study sites around the country.

This is called a double-blind study because both the researchers and the participants are blind to what was inside that syringe.

I admit, I have a hunch. But I won’t share it, in case the team monitoring me reads this.

The vaccine being tested was developed as part of America’s Operation Warp Speed by ModernaTX, a decade-old Cambridge, Massachusetts biotech company. Moderna has been awarded $955 million in government funding for the project, although it has never brought a vaccine to market. If this vaccine is shown to be safe and effective, the federal government has contracted to buy 100 million doses, with an option for 400 million more.    

For seven days after my injection, I took my temperature each evening, measured the size of the mosquito-bite-sized bump on my arm as it faded away, and noted that at first my arm hurt a little, but “not enough to affect daily activities.” I recorded this and other information — including my lack of headaches, fatigue, muscle aches and nausea — on a secure phone app that sends the data to Moderna.  

Weighing the pros and cons

My journey to the curtained cubicle where I received the first injection began on the job. I’m a health care reporter, and I had been covering the pandemic for six months when I wrote a story about clinical trials for the vaccine starting in New Jersey.   

I wanted to do something to help, and was fascinated by how a vaccine could be developed and brought to market so rapidly amid a pandemic. I thought a first-person account of what it’s like to be a guinea pig these days might make a good story. 

So I completed an online questionnaire declaring my interest in volunteering. A few weeks later, a nurse followed up with a phone call.

Her enthusiasm was contagious. She and other nurses had volunteered to work weekends to recruit volunteers, she said. She was excited to be part of a project to bring an end to the pandemic. 


As COVID-19 cases rise again, how will the US respond? Here’s what states have learned so far

<span class="caption">States have tried shutting down bars and limiting restaurants to outdoor seating to slow the coronavirus's spread.</span> <span class="attribution"><a class="link rapid-noclick-resp" href="http://gettyimages.com/detail/news-photo/patrons-dine-at-an-outdoor-restaurant-along-5th-avenue-in-news-photo/1227674724" rel="nofollow noopener" target="_blank" data-ylk="slk:Sandy Huffaker/Getty Images">Sandy Huffaker/Getty Images</a></span>
States have tried shutting down bars and limiting restaurants to outdoor seating to slow the coronavirus’s spread. Sandy Huffaker/Getty Images

When COVID-19 began spreading in the U.S. in early spring, governors in hard-hit states took drastic steps to reduce the threat and avoid overloading their health care systems. By shutting down nonessential businesses and schools and ordering people to stay home, they slowed the virus’s spread, but several million people lost jobs.

Since then, we’ve witnessed a series of ad hoc experiments with more targeted approaches. As states started to reopen, they tested different levels of restrictions, such as face mask mandates and capacity constraints on restaurants. Some closed bars when cases rose again but left other businesses open. Others set restrictions that would be triggered only for hot spots when a county’s positive case numbers passed a certain threshold.

Now, as cooler weather moves more people indoors and daily case numbers rise, states and communities are looking to those successes and failures as they consider what future strategies should look like. Could more targeted closures and restrictions be effective, or will a return to statewide stay-at-home orders be needed again?

As public health researchers, we’ve been following the strategies as they evolve, and we see lessons those experiments hold for the country.

Better testing and treatment, but a long way to go

The nation’s ability to respond to the virus has improved since COVID-19 first reached U.S. cities.

Testing capacity has expanded and results are available faster. That means people who become infected can be isolated faster. Treatment methods have also improved. For the most severe cases, innovative use of low-cost steroids and repositioning patients to support breathing have helped seriously ill patients recover faster.

However, there is still no vaccine, a lot of questions remain about new therapies, and shortages are predicted for personal protective equipment as a new flu season approaches.

People stand in line at a clinic offering quick coronavirus testing near Long Beach, California.
Rapid tests and more testing supplies at clinics have helped pinpoint coronavirus hotspots. Brittany Murray/MediaNews Group/Long Beach Press-Telegram via Getty Images

With colder weather now arriving, the nation faces a greater potential for virus outbreaks to spread. More person-to-person contact will be inevitable with more indoor activities and in-person classes in schools and colleges.

The upcoming holidays will also mean more inside gatherings and travel. Throughout the pandemic, data have revealed a pattern of increased cases within two weeks of holidays and other events that increase contact and related exposures. For example, an uptick in cases in the Midwest was linked to late summer gatherings around Labor Day and the reopening of colleges. State and local leaders need to be prepared.

So what works?

From the nationally reported and global case data, it seems clear that requirements for social distancing and mask-wearing combined with stay-at-home orders and business closures can effectively reduce virus transmission.

New Jersey and New York initially implemented strict, prolonged measures and were able to keep case rates lower through the summer, while several states that quickly lifted restrictions saw their

You should smile behind your mask. Here’s why.

The short answer: Yes, because it can affect your emotions as well as theirs. Here are the reasons you should continue smiling behind your mask.

Social contact is important for humans (including introverts)

Bea de Gelder, professor of cognitive neuroscience at Maastricht University in the Netherlands, says that, as social creatures, humans weren’t designed to obscure our facial expressions with cloth coverings. “Social contact,” she says, “is as essential to survival as food and drink.” It’s more than the fact that we rely on others to meet our basic needs in both the early and late stages of life, she says. Research shows that social contact improves physical and mental health, increases immunity and reduces stress.

This sense of connection supports our well-being, whether we realize it or not. Michelle “Lani” Shiota, associate professor of psychology at Arizona State University, explains: “When we’re smiling and engaging with other people, it’s the engagement with other people that makes us feel better,” adding, “it turns out that that’s even the case if you’re introverted.” She was referring to the work of psychology researcher Luke Smillie, including a 2019 Journal of Experimental Psychology study and a 2017 Emotion study, which found that people — including introverts — tended to experience better moods when acting like extroverts.

Facial expressions are key to social contact

According to Alex Sel, psychology lecturer at the University of Essex, the face is one of, if not the most “important places in the body to look at for social information.”

Shiota says smiling can convey much more than happiness or pleasure. She cites a 2018 PLOS One study that found that living in a geographical area with a high level of ancestral diversity and a history of cultural heterogeneity was a predictor of smiling. According to Shiota, this data suggests we smile to signal that we’re “safe.” Smiles, she says, are “this big kind of obvious way that we say, ‘Not a threat!’ ”

Research also shows that when you smile, you tend to view others’ facial expressions as more positive. Sel performed a study in which subjects were asked to adopt a smile or a neutral expression while rating the happiness level of people in pictures as electrodes measured their brain activity. Her team found that, based on activity in the visual cortex, people were more likely to perceive neutral faces as positive when they themselves were smiling.

Sel says it’s reasonable to extrapolate that if you stop smiling beneath your mask, you might “perceive other people as less cheerful or less happy.”

But don’t fake it till you make it

Although smiling conveys important social cues, it may not affect our emotional state as strongly as the psychology community was led to believe by a widely cited 1988 study.

The two experiments were designed to test the facial feedback theory, which hypothesizes that the act of smiling, regardless of the feeling underneath it, influences our sense of well-being. Subjects were instructed to view cartoons while either holding

Doctors die by suicide at twice the rate of everyone else. Here’s what we can do.

That Monday when I asked Skip’s opinion — this time, on a troubling case of weight loss — I knew I would find him with his tie askew and his glasses crooked, which I did. He sat in his chair and listened, asking questions about food insecurity and other social determinants of health.

But that Monday was different. After we talked, Skip canceled his patients for the week, left the office and killed himself.

We were all blindsided. How did we not know? Was he depressed? Was he reaching out for help? If this could happen to him, who else could it happen to?

We would later learn about his struggles with other health issues, including possible dementia, but confusion still reverberated in our exam rooms and meetings. Administrators from the hospital met with us and talked of “making time for wellness” and “taking care,” but it rang hollow, and grief was soon swallowed up by the coming tide of the coronavirus pandemic.

I think of Skip often these days, as our community of Chelsea is one of the epicenters of the novel coronavirus in Massachusetts. He dedicated his 40-year career to the MGH Chelsea HeathCare Center caring for refugees and immigrants. I am certain he would have been the first to volunteer to see covid-19 patients in our respiratory illness clinic, or he would have been handing out food supplies. Perhaps seeing the worsening disparities in our community would have further depressed him.

Although suicide across the world is declining in some areas, this is not true in our country. Suicide rates in the United States are increasing, and now account for about 1.5 percent of deaths annually since 2000. Physicians, in turn, have the highest rates of suicide of any profession, with roughly one doctor dying every day. That is nearly double the rate of the general population.

Self-care has been increasingly difficult for patients and physicians alike during these unprecedented times. Some experts note a potential “perfect storm” of growing isolation, economic stress and decreased access to community support leading to a potential jump in suicide rates during the pandemic. For health professionals in particular, this warrants particular attention.

Last spring, I found myself poring over the story of Lorna Breen, an emergency room physician who killed herself in New York after treating countless patients with the coronavirus. I related to the overwhelming duty and guilt described in her obituary. Breen kept saying, “I couldn’t do anything.”

I’ve never been suicidal, but I felt despair in April. I remember coming home from hours on duty at the overwhelmed covid-19 clinic and I felt overwhelmed myself. I couldn’t really describe what I was feeling — we’ve failed to normalize talking about mental health. Breen’s family established a fund for mental health care in the wake of her suicide, noting the difficulty she had seeking mental health care in a system that often failed to acknowledge the deep burden of its providers.

At our hospital, a lot of time

Trump received dexamethasone for COVID-19. Here’s what that says about his condition

A pharmacy worker holds a box containing dexamethasone. <span class="copyright">(Yui Mok/PA via Associated Press)</span>
A pharmacy worker holds a box containing dexamethasone. (Yui Mok/PA via Associated Press)

Overly aggressive treatment of very important patients is a timehonored tradition, doctors say.

But if the decisions of President Trump’s physicians are guided by strong and publicly available research, they suggest his early response to his coronavirus infection prompted serious worry about his prognosis.

Although the use of the anti-viral remdesivir is now standard for a wide range of COVID-19 patients, the steroid dexamethasone is considered safe only when a patient appears to be at high risk of developing the kind of overactive inflammatory response that can lead to organ failure and death.

The United Kingdom’s Recovery study, which first revealed that dexamethasone could be helpful to COVID-19 patients, found “no evidence of benefit for patients who did not require oxygen.”

It was followed by a U.S. study that identified potential dangers of giving dexamethasone to patients who did not appear to be on the road to severe illness.

In patients with very high levels of C-reactive protein, which is produced by the liver in response to inflammation, corticosteroids like dexamethasone reduced the likelihood of mechanical ventilation or death by 75%, according to the U.S. study, which appeared in the Journal of Hospital Medicine.

But in patients whose C-reactive protein levels were not greatly elevated, the steroids appear to have harmed rather than helped. In fact, these COVID-19 patients were three times more likely to die or require mechanical ventilation than were similar patients who didn’t get the steroids, the study reported.

If Trump’s physicians are following the recommendations from the Recovery study and giving him 6 mg of dexamethasone once per day for 10 days, his treatment could stretch to Oct. 14 — one day before the second presidential debate is scheduled to take place in Miami.

In addition to nudging up his blood pressure and his blood sugar levels, that dose for that period of time could affect the president’s mood, his sleep and his memory.

“Corticosteroid-induced psychiatric disturbances are common,” according to a review published in the Mayo Clinic Proceedings. Side effects could include “mania, depression, psychotic or mixed affective states, cognitive deficits, and minor psychiatric disturbances (irritability, insomnia, anxiety, labile mood).”

In one analysis, researchers calculated that just over one-quarter of patients with no previous psychiatric history developed mild to moderate symptoms while on doses similar to the one the president is likely receiving. One of the studies included in that analysis found that distractibility and intermittent memory impairment were evident in 79% and 71% of patients, respectively.

In addition, a study in the Journal of Neuroscience concluded that deficiencies in declarative memory — the ability to retain and recall known facts and events — may emerge in those on standard treatments with dexamethasone after only four to five days.

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Trump reports feeling better, but here’s why the next few days are ‘the real test’ in his COVID-19 battle

President Donald Trump’s battle with COVID-19 will come to a critical turning point in the next few days as the disease tests his immune system.

Donald Trump wearing a suit and tie: President Donald Trump is pictured speaking during the first presidential debate in Cleveland, Ohio.

© Julio Cortez, AP
President Donald Trump is pictured speaking during the first presidential debate in Cleveland, Ohio.

On Saturday, Trump and his doctors acknowledged the importance of the coming days as the illness enters what White House physician Dr. Sean Conley called “phase 2.”

In a video statement released Saturday evening from Walter Reed National Military Medical Center, Trump echoed the concern: “I’m starting to feel good. You don’t know over the next period of a few days, I guess that’s the real test, so we’ll be seeing what happens over those next couple of days.”

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The course of COVID-19 can be highly variable, but the next three to five days are likely to be crucial, physicians who have treated hundreds of coronavirus patients told USA TODAY.

Several days after symptoms of COVID-19 appear, the body’s immune system must make an important switch to fight the virus with precision — or possibly face life-threatening consequences.

COVID-19 patients can “look pretty good for a few days, then they go south,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University.

That rapid deterioration can occur when the body’s immune system, unable to successfully target the virus, causes widespread collateral damage as it “brings in the troops,” Schaffner said.

A typical timeframe for patents’ decline is about five to 10 days after the person starts getting sick, said Dr. J. Randall Curtis, a professor of pulmonary and critical care at the University of Washington school of medicine in Seattle. 

Conley on Saturday said Trump is in his third day of fighting the virus.

During the early part of a patient’s COVID-19 illness, the body uses an “agnostic” immune response, said Dr. Greg Poland, director and founder of Mayo Clinic Vaccine Research Group. It doesn’t know what it’s fighting, but realizes something potentially dangerous is occurring. That’s called the innate immune system.

Key to a successful recovery is an immune response that targets the coronavirus itself. That’s called the adaptive immune system. 

To avoid serious illness, a patient’s innate and adaptive immune systems must stay in balance, and the virus itself must not cause serious complications along the way.

Age is a risk factor. Older patients tend to be less successful in activating the adaptive response, according to Melissa Nolan, an infectious disease expert and professor at the University of South Carolina.

Trump turned 74 in June, putting him at 90-times higher risk of death than someone in their 20s, according to data from the U.S. Centers for Disease Control and Prevention.

But the course of COVID-19 can be highly variable. The president’s VIP medical treatment and access to cutting-edge therapies make the trajectory of the illness even tougher to predict.

Patients tend to see short-term fluctuations in their symptoms

Here’s What Trump’s Physician Said About the President’s Condition Following His COVID Diagnosis

From Men’s Health

President Donald Trump is “doing very well” after his first night at Walter Reed Medical Center, White House physician Dr. Sean Conley said Saturday in a press conference. Dr. Conley was flanked by other members of the president’s medical team, who briefed the press on the president’s condition and revealed new details about the timeline of his diagnosis and treatment.

The president has been fever-free for 24 hours and has normal organ function, according to the doctors. Trump will be on a five-day course of the experimental antiviral therapy remdesivir. Reporters repeatedly pressed Dr. Conley on whether Trump has received supplemental oxygen at Walter Reed. Dr. Conley said Trump is not currently on supplemental oxygen, but would not confirm whether the president has needed it so far.

Conley also shared that the president asked about hydroxychloroquine—a drug Trump has championed despite there being little evidence it can treat the coronavirus—but his medical team has not prescribed it.

Conley said Trump was “just 72 hours into the diagnosis now,” which could mean he was diagnosed as early as Wednesday. The president traveled to New Jersey on Thursday for a campaign fundraiser and revealed at 1 a.m. on Friday that he and his wife, First Lady Melania Trump, were diagnosed only after reports emerged that close aide Hope Hicks had tested positive for coronavirus. On Friday, the White House issued a statement that the president was experiencing “mild symptoms” of the virus and would be transported via helicopter to Walter Reed Medical Center in Bethesda, Md. When asked why the decision was made to transfer Trump to Walter Reed, Conley said, “Because he’s the President of the United States.”

Photo credit: Men's Health
Photo credit: Men’s Health

Trump falls into a high-risk category for COVID-19 given that he’s male, 74 years old, and clinically obese. The disease has so far killed over 200,000 Americans and more than one million people worldwide.

Several Republican lawmakers and members of the Trump administration announced positive coronavirus diagnoses on Saturday. Sens. Mike Lee of Utah, Thom Tillis of North Carolina, and Ron Johnson of Wisconsin, former White House counselor Kellyanne Conway, the president of the University of Notre Dame Rev. John Jenkins, former New Jersey Gov. Chris Christie, Trump campaign manager Bill Stepien, and Republican National Committee chair Ronna McDaniel all have announced they have tested positive for COVID-19. This wave of new diagnoses comes a week after more than 100 people gathered—most without masks—in the White House Rose Garden to celebrate Trump’s third nominee to the U.S. Supreme Court, Amy Coney Barrett. An indoor reception followed the outdoor ceremony.

On Friday, Vice President Mike Pence and Second Lady Karen Pence, as well as former Vice President and current Democratic presidential nominee Joe Biden and his wife, Dr. Jill Biden, tested negative for the virus.

This is a developing situation. This story will be updated as new details become available.

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Coronavirus in Illinois updates: Here’s what happened Sept. 30 with COVID-19 in the Chicago area

“IDPH recognizes that some who will choose to gather together anyway, and instead of denying that reality, we are issuing guidance and recommendations for safer ways to celebrate together in person,” IDPH director Dr. Ngozi Ezike wrote in a statement. “Remember, we know what our best tools are: wearing our masks, keeping our distance, limiting event sizes, washing your hands, and looking out for public health and each other.”

Additionally, the central Illinois region around Champaign-Urbana could be hit with stricter restrictions on restaurants, bars and other businesses as the percentage of positive coronavirus tests is on the rise, state public officials warned on Wednesday.

Here’s what’s happening Wednesday with COVID-19 in the Chicago area and Illinois:

8:35 p.m.: American Airlines to furlough 19,000 employees as clock runs out on deal for federal aid

American Airlines will begin furloughing 19,000 employees on Thursday after lawmakers and the White House failed to agree on a broad pandemic-relief package that includes more federal aid for airlines.

CEO Doug Parker said Wednesday night that if Washington comes up with a deal for $25 billion in airline aid “over the next few days,” American will reverse the furloughs and recall the employees.

The move by American represents the first — and likely the largest — involuntary jobs cut across the industry in coming days. United Airlines has indicated it could furlough nearly 12,000 workers.

8:15 p.m.: Pelosi, Mnuchin have ‘extensive’ talks on coronavirus relief

House Speaker Nancy Pelosi and Treasury Secretary Steven Mnuchin held an “extensive conversation” Wednesday on a huge COVID-19 rescue package, meeting face to face for the first time in more than a month in a last-ditch effort to seal a tentative accord on an additional round of coronavirus relief.

After a 90-minute meeting in the Capitol, Pelosi issued a statement saying the two would continue to talk. “We found areas where we are seeking further clarification,” she said. Talks resume Thursday.

“We made a lot of progress over the last few days. We still don’t have an agreement,” Mnuchin said after meeting with Pelosi and briefing top Senate Republican Mitch McConnell.

At the very least, the positive tone set by Pelosi and Mnuchin represented an improvement over earlier statements. But there is still a considerable gulf between the two sides, McConnell said.

“I’ve seen substantial movement, yes, and certainly the rhetoric has changed,” White House Chief of Staff Mark Meadows said.

7 p.m.: Cook County Board commissioner tests positive for COVID-19

A Cook County commissioner who appeared in a news conference with board President Toni Preckwinkle last week announced on Wednesday he tested positive for coronavirus.

Commissioner Kevin Morrison, D-15th, released a statement late afternoon that he will self-isolate for 14 days and not resume activities until he tests negative. He said he is mostly asymptomatic.

“Unfortunately, I have tested positive for COVID-19,” Morrison wrote. “Fortunately, I am feeling well with very little symptoms. … I encourage everyone to continue to follow public health guidance and to stay safe.”


Trump wanted fewer tests. Here’s what he’s getting

“Many people are mistaken in thinking that testing protects against covid,” Joshua M. Sharfstein, a professor at the Johns Hopkins Bloomberg School of Public Health and former deputy commissioner of the Food and Drug Administration, said in an email. “What protects against covid is masking, hand-washing and distance. Testing just helps identify covid when it happens, creating a chance to limit spread.”

President Trump has taken different approaches to testing in recent months. Early on, he left test acquisition to governors and mayors, then he sought to get testing kits to people faster, then he said the reason the number of positive test results was going up was that the United States was doing too much testing.

“I put a mask on, you know, when I think I need it,” Trump said at his debate against former vice president and Democratic presidential hopeful Joe Biden, whom he mocked for so often wearing a mask. Trump, who some doctors believe was already infected, said, “Tonight, as an example, everybody’s had a test and you’ve had social distancing and all of the things that you have to.”

Sharfstein said the White House has acted as if testing in and of itself confers protection. “It’s not to say testing isn’t important, but it’s part of a responsible approach to the virus,” he said. “It’s not the whole thing.”

The White House has not disclosed which brand of test or how many tests Trump took this week. Trump physician Sean P. Conley, a Navy commander, said that he obtained “PCR confirmation of the President’s diagnosis.” PCR stands for polymerase chain reaction, a method of detecting viruses that is considered the gold standard for accuracy.

But even the most sensitive tests will fail to detect the early stages of the virus and some people who are infected can keep testing negative for a few days.

Republican National Committee Chairwoman Ronna McDaniel, for example, saw Trump a week ago at a Sept. 25 fundraiser, then tested positive for the virus Wednesday. It remains unclear when she was infected and when her infection became contagious.

“It’s helpful to keep in mind that tests discover the presence of coronavirus once there’s enough viral material in a person to be able to detect it,” John Koval, spokesman for Abbott Labs, said in an email. “No test detects the virus immediately after the person becomes infected. There is no such thing as a 100 percent perfect and instantaneous test — for any disease.”

Some academic institutions have said that Abbott’s ID Now test misses infections 20 to 30 percent of the time. Koval said that the Abbott test “performs in the mid-80s to mid-to-high 90s when used as intended.”

The first step of any coronavirus test in the White House involves taking a swab and getting a sample from deep inside the nasal passages, nose or throat. When using the Abbott ID Now test, the swab, which can be as long as 15 centimeters, is then wiped into a device

President Trump’s COVID-19 Treatment Is Already Unique. Here’s What Doctors May Do Next

Trump COVID-19 Treatment
Trump COVID-19 Treatment

Marine One, the presidential helicopter, arrives at the White House to carry U.S. President Donald Trump to Walter Reed National Military Medical Center October 2, 2020 in Washington, D.C. Credit – Win McNamee—Getty Images

Just a few hours after revealing that he tested positive for COVID-19, U.S. President Donald Trump on Friday was helicoptered to Walter Reed Army Hospital, where he will be hospitalized for at least a few days “out of an abundance of caution,” the White House says; the First Lady, Melania Trump, has also tested positive.

How the President of the United States is treated for COVID-19 will likely be very different from how the 7 million-plus other Americans who have contracted the disease were taken care of, at least in some ways. To start, before Trump was hospitalized, his physician Sean Conley revealed that the President received an experimental drug duo from Regeneron of so-called monoclonal antibodies. The treatment can help the body’s immune system fight viruses like SARS-CoV-2, which causes COVID-19, by preventing them from infecting healthy cells.

But the treatment is still undergoing trials; an initial study was promising but involved only 275 people. The cocktail not yet been approved by the U.S. Food and Drug Administration (FDA) nor authorized for emergency use. That leaves two other ways for a person to get such a treatment. The first and most common is by signing up for a clinical trial, though there’s no guarantee that a volunteer would get the treatment rather than a placebo. The second, which Trump took advantage of, is for a person’s physician to apply to the company behind a treatment and the FDA for so-called “compassionate use,” a one-time, patient-specific authorization based on the doctor making a strong case that it’s worth trying an experimental treatment despite the inherent uncertainty and risk.

“Often we [as doctors] have to make decisions without the results of a clinical trial,” says Dr. Matthew Neal, associate professor of surgery and critical care medicine at University of Pittsburgh. “And the President’s doctors did that.”

That Trump has contracted COVID-19 well into the pandemic means that, unlike those who were sickened early on, the President will benefit from months of scientific and medical understanding of the disease. While there is still no truly standard way to treat COVID-19, Trump’s treatment both reflects what doctors have learned about the potentially fatal disease over the past nine months, and pushes the boundaries of that knowledge.

One such lesson from the past year is that COVID-19 may be best understood as two different diseases, requiring two different types of treatments. The infection itself can lead to the hallmark symptoms of fever, fatigue, headache and shortness of breath, as the virus burrows into a person’s respiratory tract and starts to replicate in the first few days after exposure. But as the virus continues to gain a foothold, the body’s immune system can mount a hyper-aggressive response. That attack on the virus, along with the inflammation