A step towards recovery

At a time when COVID-19 has claimed over 4,40,000 lives worldwide and a vaccine or cure is still a long way off, a breakthrough finding in the United Kingdom randomised trial presents a slender ray of hope. From among the trials of six drugs for treating COVID-19, one trial that used low-dose dexamethasone, a commonly available steroid used to reduce inflammation in other ailments, has found that it reduces by 35 per cent the mortality of COVID-19 patients with severe respiratory complications who require ventilator support, and by 20 per cent the mortality of those requiring only oxygen support, as compared to the corresponding cohort groups who were not administered dexamethasone. “Overall,” the release said, “dexamethasone reduced the 28-day mortality rate by 17 per cent with a highly significant trend showing greatest benefit among those patients requiring ventilation.” A news report in Nature, soon after the announcement of RECOVERY results, quoted Anthony Fauci, Director of the United States’ National Institute for Allergy and Infectious Diseases, as saying: “The pattern of response matches the notion that a hyperactive immune response is more likely to be harmful in long-term, serious infections. When you’re so far advanced that you’re on a ventilator, it’s usually that you have an aberrant or hyperactive inflammatory response that contributes as much to the morbidity and mortality as any direct viral effect.” Note of caution The results of the dexamethasone trial are yet to be published in any peer-reviewed journal, although the release said, “Given the public health importance of these results, we are now working to publish the full details as soon as possible.” The writer and well-known medical specialist from Harvard, Atul Gawande, tweeted: “After all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper.” One of the greatest puzzles that remains unsolved is the cause of death in COVID-19—whether it is the virus itself or the host’s immune response that goes into an overdrive and overwhelms the patient. For moderate cases requiring oxygen support, the document says: “Consider intravenous methylprednisolone 0.5 to 1 mg/kg for 3 days.” For severe cases, among the many recommended therapeutic interventions, it has included: “For patients with progressive deterioration of oxygenation indicators, rapid worsening on imaging and excessive activation of the body’s inflammatory response, glucocorticoids can be used for a short period of time.