The president has had a life-threatening, infectious disease for over a week, and he and his doctors haven’t been very transparent about the timeline and course of his affliction. In lieu of detailed disclosures, reporters have to piece together his condition based on the treatments he’s been receiving. 

Trump was started off on an experimental therapeutic — an antibody cocktail — and then advanced to another — remdesivir. The other biomolecules coursing through Donald Trump’s system (and this week’s headlines) are corticosteroids, called dexamethasone.

You may have heard of cytokine storms, where the body’s immune response to severe COVID-19 bombards healthy cells, making the illness worse. Trump has been given dexamethasone, an immuno-supressant that doctors prescribe to temper that effect. Unlike the other experimental treatments, dexamethasone is common and somewhat easy to access. However, it is rarely administered to a patient with a case as (self-)reportedly mild as Donald Trump’s.  In an interview with New York Magazine’s Intelligencer, the co-author of a recent study testing dexamethasone elaborates:

James D. Walsh: Is there any reason to administer steroids to a patient who isn’t a severe case?

Bryan McVerry: I don’t think so. I don’t think that steroids are a preventive treatment in terms of progression of COVID-19 and if you look at the data from the recovery trial, which was the study published out of the U.K. in September, that was sort of the first steroid paper, a dexamethasone study, in patients with less severe disease, there was no clinical benefit, and potentially a trend towards worse clinical outcomes in patients who got it with milder disease. That didn’t reach statistical significance, but the odds ratio was headed in the wrong direction with the patients that they had recruited. I’m not sure you can draw any real conclusions from that except to say but there was no benefit — at least no trend towards benefit — on the population.

That lack of evidence is concerning as Trump heads into a critical point in the course of his illness. COVID-19 is known for being a bit of a roller coaster, with intermittent fevers, mysterious symptoms, and rapid declines. Abraar Karan, a physician with experience treating patients with COVID-19, told Monique Brouillette at Scientific American that some people have turned corners and left the hospital, only to  “come back feeling much sicker, with even worse oxygen levels and possibly other harm to the body’s organs.”

It is theoretically possible that the early steroid treatment may ward off a dangerous auto-inflammatory reaction. But beyond the inherent risks of immuno-supression, corticosteroids may also cause behavioral side effects in the President. Trump’s cognitive and behavioral state has been a point of concern for years. Potent steroids such as dexamethasone are known to increase appetite, decrease restful sleep, and bring about heightened “maniacal” energy states.

As the nation enters the weekend, Speaker of the House Nancy Pelosi is rolling out a 25th amendment commission, Trump is boasting a miraculous recovery with a Fox News doctor, and the rest of us continue to wait and learn how biology will run its course. For better or worse, the side effects our president experiences may prove to have historical consequences. To my knowledge, “roid rage” has never been a factor in nuclear geopolitics.