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By way of a quick introduction, let me quote from an earlier report: “A cheap and widely used steroid called dexamethasone has become the first drug shown to be able to save the lives of COVID-19 patients in what scientists [involved in the study] said is a ‘major breakthrough’ in the coronavirus pandemic. Trial results announced on Tuesday showed dexamethasone, which is used to reduce inflammation in other diseases such as arthritis, reduced death rates by around a third among the most severely ill COVID-19 patients admitted to hospital.”
This is very positive news in a pandemic that has really been a parade of bad news – but this is also why our excitement should be tempered by caution.
1. The people involved with the RECOVERY clinical trial announced via statements to the press that they had found very encouraging results about the use of dexamethasone in people with severe COVID-19 who had to receive ventilator support. However, the study’s data isn’t available for independent verification yet. So irrespective of how pumped the trial’s researchers are, let’s wait. Studies in more advanced stages of the publishing process have been sunk before. (Read more)
2. Dexamethasone is relatively cheap and widely available. But that doesn’t mean it will continue to remain that way in future. The UK government has already announced it has stockpiled 200,000 doses of the drug, and other countries with access to supply may follow suit. Companies that manufacture the drug may also decide to hike prices, foreseeing rising demand, leading to further issues of availability. (Read more)
3. Researchers found in their clinical trials that the drug reduced mortality among patients with COVID-19 and who needed ventilator support by around 33%, and who needed oxygen by about 20%. This describes a very specific use-case, and governments must ensure that if the drug is repurposed for COVID-19, its use is limited to people who fulfil the specific criteria that benefit from the drug’s use.
4. The preliminary report notes, “It is important to recognise that we found no evidence of benefit for patients who did not require oxygen and we did not study patients outside the hospital setting.” Indeed, as a general-use anti-inflammatory drug with immunosuppressive abilities, dexamethasone could increase a healthy person’s risk of developing a COVID-19 infection. In addition, dexamethasone is a steroid, and indiscriminate use is quite likely to lead to adverse side effects with zero benefits. (Read more)
5. The novel coronavirus pandemic is not a tragedy in the number of deaths alone. An important long term effect will be disability, considering the virus has been known to affect multiple parts of the body, including the heart, brain and the kidneys, apart from the lungs themselves, even among patients who have survived. Additionally, it cuts mortality in patients in a later stage of the COVID-19 infection. So go easy on words like ‘game-changer’. Dexamethasone isn’t exactly one because game-changers need to change the game: i.e. allow people to contract the virus but not fear disability or their lives… (Read more)
6. … or in fact not fear contracting the virus at all – like a vaccine or an efficacious prophylactic. This is very important, for example, because of what we have already seen in Italy and New York. Many patients who don’t need ventilator support or oxygen care still need hospital care, and the unavailability of hospital beds and skilled personnel can lead to more deaths than may be due to COVID-19. This ‘effect’, so to speak, is more pronounced in developing nations, many of which have panicked and formulated policies that pay way more or way less attention to COVID-19 than is due. In India, for example, nearly 900 people have died due to the lockdown itself. (Read more)
A version of this article was previously published on the author’s blog.
Note: This article was edited at 11:20 am on June 20, 2020, to add reason #6.