Breakthrough Drug for Covid-19 May Be Risky for Mild Cases
That study about dexamethasone has arrived with a big asterisk: While it appears to help severely ill patients, it harms others.
- June 24, 2020
Scientists in Britain announced a major breakthrough in the battle against the coronavirus last week, reporting they had found the first drug to reduce deaths among critically ill Covid-19 patients.
The results were first made public in a sparsely detailed news release. Now the full study, neither peer reviewed nor published yet, has been posted online, and it holds a surprise.
The drug — a cheap, widely available steroid called dexamethasone — does seem to help patients in dire straits, the data suggest. But it also may be risky for patients with milder illness, and the timing of the treatment is critical.
The drug “may harm some patients, and we’re not entirely sure which patients those are,” said Dr. Samuel Brown, an assistant professor of pulmonary and critical care medicine at University of Utah School of Medicine in Salt Lake City, who was not involved in the research.
Following the announcement last week, officials at some American hospitals said that they would begin to treat coronavirus patients with dexamethasone, and the World Health Organization called for accelerating production to ensure an adequate supply. U.K. health officials moved to limit exports of the steroid.
The drug was tested in a clinical trial that included some 6,425 patients in Britain. One-third were randomly assigned to receive the drug, while the others received the usual care. Patients in the first group received a very low dose of the drug, given daily for up to 10 days.
Dexamethasone was beneficial for those who had been sick for more than a week, reducing deaths by one-third among patients on mechanical ventilators and by one-fifth among patients receiving supplemental oxygen by other means.
Patients given the steroid who were not receiving respiratory support, however, actually died at a slightly higher rate than similar patients who were not given the drug, although the difference was not statistically significant.
That the drug might have disparate effects at different stages of the disease makes sense, given the biology of the illness, according to Dr. Martin J. Landray, the study’s senior author and a professor of medicine and epidemiology at Oxford University.
In the most severely ill patients, the immune system flies into a harmful overdrive mode, triggering a so-called cytokine storm that damages the body, including the lungs.
“It’s almost like a disease with two phases,” Dr. Landray said in an interview. “A phase where the virus dominates, and the immunological phase, where the damage the immune system causes is dominant.”
Doctors have worried about using steroids such as dexamethasone to fight Covid-19, because steroids are anti-inflammatory drugs that dampen the body’s protective immune response. In mildly ill patients, that may do more harm than good, Dr. Landray said.
“In the early phase of the illness, the immune system is your friend,” Dr. Landray said. “It’s fighting the virus, and dampening it is not a good idea.”
- Frequently Asked Questions and AdviceUpdated June 24, 2020
- What’s the best material for a mask?Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
- Is it harder to exercise while wearing a mask?A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
- I’ve heard about a treatment called dexamethasone. Does it work?The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
- What is pandemic paid leave?The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
- Does asymptomatic transmission of Covid-19 happen?So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
- What’s the risk of catching coronavirus from a surface?Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
- How does blood type influence coronavirus?A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
- How many people have lost their jobs due to coronavirus in the U.S.?The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
- What are the symptoms of coronavirus?Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
- How can I protect myself while flying?If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
- What should I do if I feel sick?If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
“In the later phase, the immune system is no longer your friend — it’s responsible for the lungs failing, and dampening it down with steroids helps the situation and improves the chance of survival.”
Other experts agreed, saying the study showed dexamethasone cannot be used to treat mild illness, or as a preventive.
“It would likely be harmful to take dexamethasone as an outpatient treatment for Covid-19,” said Dr. Brown. Patients with mild infections “should not be trying to get people to prescribe them dexamethasone just in case.”
Many scientists want to see the trial results repeated in another study, and note that some questions aren’t fully answered in the paper, including information about long-term outcomes and neurological damage.
“If a reasonable fraction of patients are recovering in a way that’s satisfactory and welcome, what you have is a gigantic victory,” said Dr. Jeremy Faust, an emergency room physician at Brigham and Women’s Hospital in Boston.
Generally, however, patients who have spent a long time on ventilators “have a rough road ahead,” he added, even if dexamethasone improves their odds of survival.