The new dexamethasone- COVID-19 study should be viewed with caution

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A nurse has a blood sample taken by a clinical staff member before receiving a BCG injection in the trial clinic at Sir Charles Gairdner hospital on April 20 in Perth, Australia.

A new study shows a steroid, dexamethasone, improves the survival of some COVID-19 patients, especially those with severe forms of the diseases. These include some on ventilators and some who require oxygen. 

The study enrolled 2,100 participants who received dexamethasone at a low or moderate dose for ten days. The control group was 4,300 patients who received standard care for coronavirus infection. Results show a reduction in risks of dying by 30 percent in patients on ventilators and 20 percent in patients receiving oxygen. 

If you consider the fact that COVID-19 has infected more than 8 million, killed above 480,000 with 4.4 million recoveries, one would understand why it is imperative to come up with a treatment to reverse this trend. However, the global health community must exercise caution and always weigh risks against benefits. In other words, all things being equal, do the benefits of dexamethasone as a treatment for COVID-19 outweigh its risks?  

These are four points to consider as the discussions on the efficacy of dexamethasone continue:  

First, the researchers must urgently make public the methodology and full results of the study so it can be peer-reviewed. These two points are critical to understand the rigor of the research and allow other scientists to query the results. We should not allow the need to quickly get treatment for COVID-19 cause us to lower the bar of evidence-based decision-making. Lessons from the past show that this always comes back to haunt the scientific community. One example is the Wakefield Paper which alleged a link between MMR vaccine and autism. It was published by The Lancet in 1998. Although this false claim has been taken down by The Lancet, the world is still reeling from the negative impact of the paper on the rising numbers of anti-vaxxers and the reduced vaccine uptake in some countries of the global north. 

Second, we must prioritize public health interventions such as physical distancing, wearing masks, hand washing with soap and water and other respiratory hygiene procedures that have proven to reduce the incidence of COVID-19. Based on the study results so far revealed, only a fraction of those with COVID-19 would require dexamethasone. It is known that about 19 out of 20 patients with coronavirus recover without being admitted to the hospital. This implies that 5 out of 100 people with COVID-19 would require hospitalization and not all would need dexamethasone. Frontline health workers must do all within their power to save every life. However, it pays to prevent people from acquiring the infection in the first place. COVID-19 infection prevention saves more lives, reduces the morbidity and mortality due to the disease, and saves funds for the health sector. 

Third, dexamethasone is a steroid and just as every drug comes with side effects. When one considers that COVID-19 patients with severe forms of the disease have pre-existing illnesses such as hypertension, heart disease, asthma, diabetes and cancers, it means one has to be careful about administering the drug.  According to the World Health Organization, older people and those with underlying medical conditions are at a higher risk of getting severe COVID-19 disease. Therefore, health workers must be careful to ensure that this steroid does not worsen the conditions of the elderly or pre-existing conditions that they may have. Side effects of dexamethasone include fluid retention (which could worsen hypertension) and increased blood sugar levels (which could be a major problem in those with diabetes). 

Fourth, dexamethasone could have serious interactions with other drugs used to treat pre-existing illnesses in COVID-19 patients. Drug interactions could change the efficacy of a drug or increase the likelihood of side effects. Drugs that may interact with dexamethasone include blood thinners such as warfarin (used for treating blood clots in individuals with cardiovascular diseases like atherosclerosis); certain cancer drugs; and ephedrine (used for managing asthma). It is easy to see how administering dexamethasone to a COVID-19 patient with diabetes could worsen his/her condition. 

To be sure, the researchers must be commended for searching for possible treatment options for COVID-19. The British government must also be commended for funding the research. However, let all decisions on COVID-19 be led by scientific evidence which has methodology and results that are peer-reviewed. 

As the world awaits the full disclosure of study data, we should focus on public health interventions and other clinical protocols that are known to be efficacious against COVID-19. 

Dr. Ifeanyi M. Nsofor M.B.B.S is the CEO of EpiAFRIC and director of policy and advocacy at Nigeria Health Watch. He is a current 2019 Atlantic Fellow for Health Equity at George Washington University and a 2018 New Voices Fellow at the Aspen Institute. He has written opinion pieces for Devex, African Arguments, AllAfrica and Vanguard Nigeria. Follow him on Twitter: @ekemma. 

Tags Coronavirus COVID-19 dexamethasone Research

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