Editor’s Note: Kent Sepkowitz is a CNN medical analyst and a physician and infection control expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion at CNN.
Rudy Giuliani, the former New York City mayor and current lawyer for President Donald Trump, was hospitalized over the weekend after testing positive for Covid-19. He was discharged Wednesday afternoon after four days in Georgetown University Hospital.
During his illness, amid his attempts to overturn the certification of election results, Giuliani quickly made medical matters worse. No, his newest missteps fall short of his press conference at the Four Seasons Total Landscaping storefront in Pennsylvania – but they do substantial damage to the country’s ongoing attempts to prevent and to treat new Covid-19 infections.
Little needs to be said about his from-the-hospital-room dismissal of the US Centers for Disease Control and Prevention (CDC) guidelines for masks by claiming “you can overdo the mask.” The mask refuseniks and the Covid-19 deniers resemble flat-earthers, anti-vaxxers and climate change deniers. Their paleo-mindset is not persuadable using the tools of rational discourse developed by Homo sapiens over the past several millennia.
But Giuliani introduced two other extremely destructive lines of non-reasoning. The first was quite deliberate: from his nice room in a nice hospital likely surrounded by nice nurses and nice doctors, Giuliani let us know that he was a real VIP. As he observed: “Sometimes, when you’re a celebrity, they’re worried if something happens to you…They’re going to examine it more carefully and do everything right.”
The Giuliani comment from his citadel of high privilege is not as repulsive to his boss’ claim that “when you’re a star, they let you do it,” but at this moment, as the country struggles to develop an equitable way to divvy up the very limited vaccine supply that will become available soon, there does indeed exist a group of well-heeled and well-connected and well-fed people who do expect – and receive – special treatment every step of the way. And they do expect to cut the line ahead of “non-celebrities” if ever the going gets tough. Whether they will try to pull rank on the vaccine line remains to be seen. But stranger events have occurred.
As provocatively cruel as this comment – and attitude – may be, this is still not the worst comment Giuliani made during his time in the hospital. In the radio interview on 77 WABC he gave to admirers, he bragged that he received the “cocktail” the President had been given. He fumbled over the specific drugs with which he was treated, listing only remdesivir, an antiviral, and the steroid dexamethasone. His use of the term “cocktail” though has suggested to some that he also meant to include the then-experimental, now emergency use authorized monoclonal antibody that Trump received back in October.
Whatever he received, he, like his boss, is singing its praises, stating, “The minute I took the cocktail … I felt 100% better. It works very quickly.” As the New York Times reported, he seemed “unaware” of the limited availability of antibody treatments available to those close to the President.
This absolute embrace of the magic new Covid-19 cocktail (whatever Giuliani in fact received) will lead to real and lasting damage. Though falling short of a pure huckster promise that “by acting now, you can get 10% off this offer while supplies last!,” his comments have placed the entire enterprise of medical care into the sham-tastic realm of the late night TV pitchman – an arena where the ever-enterprising Giuliani has already placed a stake, endorsing cigars on his YouTube channel.
To be clear – Giuliani has no idea why he feels better. Nor do his doctors. We simply don’t know enough about how and why patients with Covid-19 improve.
But here are the facts about each component of the cocktail that the President and his friend the Mayor received (and endorsed).
Remdesivir (Veklury, not to be confused with Richard Wagner’s masterpiece Ride of the Valkyries), priced at $3,120 per treatment course, is an intravenous antiviral medication that was approved by the US Food and Drug Administration on October 22.
However, since that time (and leading up to it as well) many have questioned whether the drug does much of anything. A large World Health Organization trial found no benefit on mortality or length of hospital stay. This trial and other middling results in other studies have led important leaders in the scientific field to call for a reconsideration of whether the FDA may have acted in haste in its approval.
The second possible component of the “cocktail” – one of the two monoclonal antibodies authorized for emergency use – recently has fallen under similar scrutiny with many doubting whether these therapies have the dramatic benefit that some have ascribed to them. In the blog for the prestigious Science magazine, the results for trials of each agent were reviewed and found to be “disappointing.” Not useless but hardly the Lazarus effect hoped for by many (including me).
This leads us to the under-sung third component of the cocktail – dexamethasone. This medication is a “corticosteroid” not an “anabolic steroid,” which is a different class altogether, related to testosterone and well sought after for athletic performance enhancement. Dexamethasone has been around since last century. It exists in generic form and its cost ranges in the mid-double-digits.
And unlike the other components of the cocktail (a term that evokes a “Puttin’ on the Ritz” tone), we know it actually works, according to studies.
So not only has Giuliani dissed approved public health recommendations and exerted his own brand of executive jet-setter privilege, he has also totally scrambled the public’s understanding of our fledgling medical armamentarium to treat Covid-19, a disease that has killed more than 1.5 million people worldwide, including almost 300,000 in the US.
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Giuliani’s latest nonsense will lead to many patients, those without comparable strings to pull, feeling like they didn’t receive the best treatment– the Rudy one, the real one, the one that makes you feel 100% better almost immediately. This may add to the haves versus have-nots grievances that already are crippling the country. It also may waste untold healthcare dollars on unneeded treatments.
But most destructive of all, it represents yet another nyah nyah nyah suckers! mockery of careful science and careful scientists perpetrated by the gang that believes nothing they don’t like, listens to no one who doesn’t agree with them, and skedaddles off to the next excellent adventure whenever problems begin to mount. All without a moment of doubt or remorse. It seems that those who do unconscionable things in fact have no conscience at all. Perhaps that’s a paleo-mindset too.