What You Need to Know about Coronavirus and Dexamethasone

As researchers and scientists across the globe scramble to find a way to treat the novel coronavirus, new research suggests there might be some good news. A relatively inexpensive and commonly used steroid known as dexamethasone has shown promise as a potential tool against coronavirus.

Though the research is preliminary, researchers are excited about the implications and the potential to save lives that the use of dexamethasone presents. Here is everything you should know about the early stages of this research, what it might mean, and when we might know more.

The RECOVERY Trial

The world’s largest clinical trial is known as RECOVERY (Randomised Evaluation of COVID-19 Therapy), currently being conducted at the University of Oxford. The trial is currently exploring existing treatments to test their effectiveness on COVID-19 specifically.

One of those treatments is dexamethasone, a cheap and widely available low-dose steroid. It works to reduce inflammation by mimicking certain anti-inflammatory hormones normally produced by the body.

Why It Works

Dexamethasone works to dampen the body’s immune system. Though this might seem counterintuitive, it makes sense. When affected by a virus or other infection, the body’s natural response is to try to fight off the infection. This process often causes inflammation in the body.

Ironically, it is this reaction that can sometimes wind up proving fatal in the end. When the body’s immune system goes into overdrive, the process that is intended to attack the source of the infection instead starts to attack the body’s own cells. This can have devastating consequences, even leading up to the patient’s death.

So far, the evidence on dexamethasone’s efficacy in fighting coronavirus has only been seen in the most critically ill patients. About 19 out of 20 people infected with coronavirus recover on their own without hospitalization. Of the rest admitted to hospitals for treatments, most do still recover. However, the remaining patients become critically ill and often need oxygen or other types of ventilation. These are the patients that are being helped by dexamethasone.

Cytokine Storm

One of the effects of COVID-19 can manifest as an intense, over-the-top immune system response known as a “cytokine storm." This devastating phenomenon occurs when your immune system doesn’t stop at attacking the infection or virus, and instead continues on to attack other healthy parts of the body. A cytokine storm can be fatal if the inflammation cannot be stopped.

Doctors still do not completely understand the cytokine storm phenomenon, and it is only recently they are able to identify and treat them. This makes their presence alongside coronavirus infections extremely concerning. Cytokine storms have actually been linked to other pandemics in the past, including the 1918 influenza pandemic, the 2003 SARS outbreak, and even the H1N1 ‘swine’ flu.

Common treatments for cytokine storms include the use of steroids aimed at generally dampening that broad, over-reactive immune system response. The concern with using steroids when a patient is already sick is, of course, that the immune system response (albeit at lower levels) is essential to fighting off infection.

Current research on the use of dexamethasone for COVID-19 patients shows that it is only useful for those patients that are critically ill, on oxygen or ventilators—not those showing milder symptoms. The reason is thought to be that at a mild stage, the immune system response is still necessary to fight the effects of the virus off. Those with more severe reactions may be dealing with an overactive immune system response (the cytokine storm), which a steroid can help alleviate.

How Effective Is It, Really?

Though this research is still in the early stages, the preliminary results are promising. For patients not receiving any oxygen support (in the milder stages of the virus), there was no benefit at all from dexamethasone, likely for the reasons mentioned above. For other patients, however, the benefits appear significant.

The scientists that conducted these trials suggest that around one in three deaths could be prevented in patients on ventilators and around one in five prevented for those on oxygen support. Researchers have also suggested that up to 5,000 lives could have been saved had the drug been in use at the beginning of the pandemic.

Dexamethasone is widely available at relatively low costs, and since it has been around since 1957, it is out of patent. What that means is many companies are able to produce the drug, and it can be available widely all over the world.

The implications are particularly good for poorer countries suffering from numerous cases of COVID-19, due to the widespread availability and low cost of the drug. For coronavirus patients on oxygen or ventilators, only a low dose of the drug is needed, which helps mitigate the potential for any negative side effects in the broader population.

Hopefully, this drug will prove as useful as the current research suggests in saving more lives.