The people involved with the RECOVERY clinical trial have announced via statements to the press that they have 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, wait. Studies in more advanced stages of the publishing process have been sunk before.
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.
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. As 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.” In addition, dexamethasone is a steroid, and indiscriminate use is quite likely to lead to adverse side effects with zero benefits.
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 allow people to contract the virus but not fear disability or their lives…
… 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.