Coronavirus is still dangerous, but there might be some good news on the horizon. A trial conducted by the University of Oxford has found that dexamethasone, a common, low-dose steroid, radically lowers the risk of death for people hospitalized with coronavirus. The BBC reports that the dexamethasone raises survival rate for people on ventilators by a third, and for those on oxygen, the death risk is lowered by 20%. Given that survival rates for COVID-19 patients on ventilators may only be between 25 and 50%, this may be a huge life-saver.
What Is Dexamethasone?
“Dexamethasone is a systemic steroid that is used as an anti-inflammatory," Dr. Michael Green M.D., assistant medical director at Northwell Health-GoHealth Urgent Care and assistant professor at the Zucker School of Medicine at Hofstra University, tells Bustle. "It is commonly used in arthritis, allergic reactions, asthma, croup, and for testing adrenal gland disorders."
How Does Dexamethasone Work?
Dr. Mohamed Mansour M.D., director of the Medical Intensive Care Unit at Stony Brook Medicine, tells Bustle that dexamethasone is a kind of glucocorticoid, a class of drugs that also includes hydrocortisone. "The body normally produces cortisol, a weak glucocorticoid, in stressful conditions," Dr. Mansour says. Cortisol is part of the body's system for dealing with illnesses and issues, and is essential for lowering inflammation levels. "However, in some disease states or in particular individuals, the body does not produce enough or the levels are disproportionately low." In those cases, doctors often prescribe dexamethasone, as it's up to 20 or 30 times stronger than cortisol, and can help reduce inflammation.
According to the U.K. trial, dexamethasone wasn't helpful for the coronavirus patients who could breathe without help. When it came to people on oxygen or ventilators, though, it appeared to help breathing by reducing inflammatory pressure. Coronavirus can cause serious inflammation in the lungs, as white blood cells rush to attempt to deal with the virus and end up damaging the lungs themselves. Dexamethasone seems to reduce the pressure.
What Are The Side Effects Of Dexamethasone?
Dr. Thomas Balcezak, M.D., chief clinical officer at Yale New Haven Health, tells Bustle that dexamethasone has a large list of adverse reactions, both in the short and long term. Some people experience minor side effects, like nausea, vomiting, or acne, while others might deal with changes in your period or depression.
In the long term, Dr. Mansour says that people on dexamethasone for months or years at a time can also experience immune suppression, where they catch more infections and illnesses than usual, and gastrointestinal bleeding. "With longer use it can also create problems with your body’s endocrine system," Dr. Balcezak says.
Dexamethasone has only been proven to work in one study — which hasn't even been published — on hospitalized people with serious coronavirus-related breathing difficulties. We're constantly learning new data about the virus, and things can change all the time. People with far milder cases of coronavirus definitely shouldn't use it, the people behind the Oxford study say, and it can't do anything to prevent the illness. Stick to washing your hands, wearing masks, and maintaining social distancing, and let's all hope that this represents a turning point in coronavirus treatment.
Dr Thomas Balcezak M.D.
Dr. Michael Green M.D.
Dr. Mohamed Mansour M.D.
Giles, A.J., Hutchinson, M.N.D., Sonnemann, H.M. et al. (2018) Dexamethasone-induced immunosuppression: mechanisms and implications for immunotherapy. j. immunotherapy cancer6, 51 https://doi.org/10.1186/s40425-018-0371-5
Hannibal, K. E., & Bishop, M. D. (2014). Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical therapy, 94(12), 1816–1825. https://doi.org/10.2522/ptj.20130597