Yes, it is undoubtedly better news but obviously not yet the comprehensive solution that humanity has been searching for in desperation.
Oxford researchers have come up with their conclusion on the use of “Dexamethasone,” a synthetic corticosteroid, widely available, cheap, relatively safe, and not uncommonly prescribed in certain inflammatory conditions like rheumatoid arthritis, asthma, eczema, etc because of its property of reducing inflammation by mimicking anti-inflammatory hormones produced by the body.
This drug works by dampening down our immune system. The coronavirus infection triggers inflammation as the body tries to fight it off. However, it appears that in some cases, Covid-19 is capable of pushing our immune system into overdrive and the subsequent immune reaction is exceptionally heightened, culminating in attacking our body’s own cells and tissues, the cytokine storm, leading to multi-system failure and death.
Dexamethasone in small doses may calm this heightened inflammatory response while avoiding any major complication that may be associated with high doses of the drug. However, the Oxford University-led study shows that the application of dexamethasone is only suitable for people who are already in hospital and receiving oxygen or mechanical ventilation. The drug does not work on people with milder symptoms.
Though the full report is yet to be published in a scientific journal, the British government, its advisory committee on Covid-19, and WHO have already approved the use of dexamethasone. The UK authority has instructed the NHS to prescribe the drug for treatment of patients requiring oxygen and/or ventilatory support in all hospitals, making dexamethasone part of the standard care in these patients.
Previously, remdesivir, an antiviral drug, had been claimed to be reducing the time to recovery but failed to demonstrate any survival benefit. Chloroquine and hydroxychloroquine, on the other hand, have not shown any benefits, neither in reducing recovery time from the illness nor on survival. As such, the FDA in the US has recently withdrawn any support for the use of these drugs.
The dexamethasone study has been robustly scrutinized, one of the largest in the world of its kind. Dexamethasone is the first of all tried medications to conclusively demonstrate statistical significance in reducing fatality in a particular group of Covid-19 patients. Dexamethasone is a synthetic steroid produced in 1957 and has been in medical use since.
The dexamethasone study was a randomized controlled study. The trial recruited a total of 6,425 patients from 175 hospitals across the UK. 2,104 patients were randomized to receive dexamethasone in a low dose, administered once daily, for 10 consecutive days and their outcome was compared with a group of 4,321 similar patients used as control who received all the supportive treatment but no specific medication.
The study has been applauded by many as the most important trial result for Covid-19 so far. Those excited by the study results expect that dexamethasone will save lives around the world.
The study found that in the control group (no dexamethasone), the 28 days mortality (death within 28 days of hospitalization) was 41% in more severely affected patients requiring ventilation; 25% in patients who required oxygen therapy but were not severely ill enough to warrant ventilatory support; and 13% in patients not requiring any respiratory support.
Dexamethasone cut the risk of death from 41% to 28% for patients on ventilators. For patients needing oxygen, it sliced the risk of death from 25% to 20%. In simple analytical language, the use of dexamethasone thus reduced the death rate by a third in the most severely ill patients and one-fifth in patients requiring oxygen therapy. To the proponents endorsing the drug, the survival benefit is clear and large in those patients who are sick enough to require at least oxygen treatment.
I would not miss this opportunity to quote Plato, my favourite philosopher: "The curse of me and my nation is that we always think things can be bettered by immediate action of some sort, any sort rather than no sort.” The NHS deputy chief medical officer states that the dexamethasone results along with disappointing data for hydroxychloroquine illustrate the power of properly-conducted clinical trials and the inherent danger of assuming things work without robust data.
A few months ago, the FDA had issued an emergency authorization for hydroxychloroquine based on anecdotal data. After a more complete review on the drug, the agency this week revoked that authorization. The director of the US National Institute for Allergy and Infectious Disease, Professor Anthony Fauci, told The Wall Street Journal that US technical experts were now considering whether to recommend the medicine, remdesivir.
Even then, I am far from being convinced that the danger of coronavirus infection has remotely been minimized, and continue relentlessly to insist on my conviction that it is going to be with us for years to come. Everyone should use their best efforts to not be infected by this deadly virus; stay home as long as you can, and if you have to go out, maintain social distancing.
Avoid public transport or Uber/taxi at all costs and walk or cycle or use a car if you have one. If you have to use public transport, stay away from the doors. Wash hands with soap and water at least six to ten times a day, minimally following six steps to scrub, and for at least 20 seconds. If no soap is readily available, use hand sanitizers but avoid using fake ones.
Use masks whenever you are outside and use them properly -- use good-fitted ones, cover the nose, the mouth, and the chin, and don’t move it to talk. Continue to follow social etiquettes for coughing, sneezing, and no spitting. Last but not the least, if you become infected, do not self-medicate with dexamethasone. Though it is very affordable, very readily available, and beneficial, it can be potentially disastrous for coronavirus patients who do not need the drug.
Dr Raqibul Mohammad Anwar is a Specialist Surgeon and Global Health Policy and Planning Expert, Retired Colonel, Royal Army Medical Corps, UK Armed Forces.