
Coronavirus: Dexamethasone proves first life-saving drug? - smartbit
https://www.bbc.com/news/health-53061281
======
csomar
Dexamethasone is a serious drug and corticosteroid [1]. It was prescribed for
a friend after eye-surgery and having skin / eye inflammation problems, I used
it (with no doctors advice) recklessly albeit with very small quantities.

The drug was hyper-effective. An unbelievably tiny quantity can remove any
inflammation (eye, skin, hair skin rash, etc...). But the fall out and side-
effects are no joke even for seemingly super minuscule doses. It was a horror
story for me with horrible eye inflammation, small inflammations in different
parts of the body and a skin rash I still struggle with until today. Mind you
I took small localized doses and not an injection. I wasn't aware that it can
travel through your skin, get into your blood and make a mess.

I think the research will need to specify potential side-effects and their
probabilities. It's trade-off at the end of the day.

PS: Do not ever think of trying it without medical advice and doctor
supervision.

[1]:
[https://en.wikipedia.org/wiki/Dexamethasone#Adverse_effects](https://en.wikipedia.org/wiki/Dexamethasone#Adverse_effects)

~~~
gambiting
Well, yeah, steroids are incredible, shame they have such severe side effects.
Following a parvovirus B19 infection I developed severe joint
problems(basically got advanced arthritis at the age of 28, how fun), and all
it took to sort out was one steroid injection. I won't lie, for the next few
days after the injection I felt like a superhuman, all the issues went away
and in general I felt super great. Obviously that's not something you can
continue doing because the side effects get really bad after a while, my
doctor warned me that if the issues come back I probably won't be able to get
another injection because the risk is too great, but for a one-off thing it
was like a miracle cure.

~~~
koheripbal
That's the problem with evolution. Any protein in the body ends up with
multiple completely unrelated functions.

If it's in the blood stream for enough generations, the body will find some
alternate use for it. It's like a compression algorithm on your DNA.

...and so when we try to use meds to counter certain proteins or block
receptors, we discover that it has a dozen totally unrelated impacts. "Oh,
that blood pressure medication? Well let's just have it also randomly give you
prostate cancer!" (real example).

Organic evolved animals are the worst type of spaghetti code - if there was
ever something you'd want to redesign from the ground up, it's us.

Then add to that that there isn't even any "standard" type of human. We're all
different - and even different groups of us have different smatterings of
genes. Sometimes it correlates with our ancestors background - sometimes it
doesn't. Who knows! Evolution! We're all each just individual experiments
running around to see which genes can procreate the most.

...and it's not even as though each of us is a single experiment on a specific
gene, that would be too easy. We're each an experiment on a unique collection
of thousands of genes that evolution hopes will average out the results across
the entire population. Try to wrap your statistics PhD around that!

Then also factor in that modern human evolutionary pressures are _totally_
different than they were even a couple of generations ago, and it becomes
clearly evident that evolution is in a complete state of dysfunctional
disarray.

~~~
nwienert
Spaghetti code has more negative connotation than I’d attribute to our
insanely adaptive, flexible, and efficient organism.

~~~
koheripbal
Evolution is romanticized, but its ability are limited, not infinite.

The more complex a species, the _less_ adaptivity it has to fundamental shifts
in environmental pressures. The interconnections between protein functions are
directly responsible for that trade-off, and become a liability.

The time scales for evolution far beyond our current level of genetic
complexity, probably extend beyond the life span of the Earth.

Now the benefit of this speghetti-code situation is that no intelligent
designer is required - obviously a fundamental ingredient of abiogenesis, but
does it benefit an species that's capable of genetic editing?

Nope. At this point, it's really just a bottleneck to even repairing the most
straight-forward genetic diseases.

As a species, we're approaching the time where we've obviated evolution. ...I
won't say we've seen that _yet_ because reproduction rates are still very
uneven across population segments, but it's only a matter of a few more
generations (cataclysms not withstanding).

~~~
nwienert
It’s not spaghetti code... I just think your analogy is weak and misleading.

Not sure how you’re defining complex but humans pretty soundly refute that
adaptability thing.

It’s not a “bottleneck” it’s just... life. Can you point to an animal anywhere
near as successful as humans that doesn’t have.. genetic variability? No. It’s
a _requirement_ and _precondition_ for our success, not some flaw we overcame
despite.

~~~
undersuit
What's your definition of success?

~~~
orestarod
To exist.

~~~
TeMPOraL
Existence is table stakes. All interesting things happen on top of it.

~~~
perfmode
is there a greater mystery than existence itself?

~~~
antepodius
Something being more mysterious doesn't make it more interesting.

What's my private key? It's a mystery, but not a very interesting one.

Why does the universe exist? It's mysterious, maybe the most mysterious thing
of all, and 8lit's interesting, but I'd say it's not the most interesting
question of them all.

~~~
perfmode
by mystery, i mean much more than that which is not known.

i mean to convey: something that is difficult or impossible to explain.
something that is deeply interesting and provokes wonderment.

what is more difficult to explain and understand than the fundamental nature
of existence?

perhaps it is not apparently immediately _useful_.

but in a cosmic sense, of what use is it to understand thought objects in the
world when there is a complete lack of understanding of the consciousness in
which these thought objects arise?

i’m curious what are some candidates for “most interesting question of them
all” in your view. this is something which sparks a genuine curiosity in me
and would love to hear your perspective.

------
aazaa
More informative article here:

[https://www.statnews.com/2020/06/16/major-study-finds-
common...](https://www.statnews.com/2020/06/16/major-study-finds-common-
steroid-reduces-deaths-among-patients-with-severe-covid-19/)

The problem is that there is little more than a press announcement at this
point. There are no data. There is no paper. There are no details to consider.

We've seen this movie before, and it's gone badly (remdesivir,
hydroxychloroquine). Safe and effective drugs require copious details, and
you'll find none of them here.

~~~
selimthegrim
What's bad about remdesivir?

~~~
WhompingWindows
It's simply not that effective, it has a very small treatment effect and isn't
a great tool, but it's certainly much more justifiable than
hydroxychloroquine, which took much of the oxygen out of the room when POTUS
and the GOP hyped it FAR beyond its statistically shown merits.

~~~
amluto
Also: it has serious manufacturability issues, and it can only be administered
by IV.

It’s entirely plausible that giving remdesivir to COVID-19 patients when they
first show symptoms would make a big difference, but it’s impractical.

------
Tenoke
As far as I can tell it is extremely common to give steroids (and
dexamethasone is among the default choices) in those cases already. I can't
quite tell but it doesn't sounds like it was compared to other steroids so I
would hold judgement before we hear more.

At any rate, hype over initial briefly reported findings is rarely useful.

Edit: I was checking how common was it to give corticosteroids before the
trial (pretty common as I suspected) but it's almost amusing that the WHO was
recommending not to use it[0]. I wonder if this will be yet another miss for
them.

0\. [https://www.contagionlive.com/news/is-there-any-reason-to-
us...](https://www.contagionlive.com/news/is-there-any-reason-to-use-
corticosteroids-in-coronavirus-treatment)

~~~
newacct583
> it's almost amusing that the WHO was recommending not to use it

Why is everyone picking on the WHO constantly? It's like it's a reflex at this
point, as far as I can tell designed to shift "blame" off of... other parties
who got lots of stuff wrong.

In this case you're spinning really hard. The WHO guidance you're quoting,
quoted in the article you link, was really mild: " _“Given lack of
effectiveness and possible harm, routine corticosteroids should be avoided
unless they are indicated for another reason,” WHO authors wrote._ " Is that
really unreasonable? In January they didn't have evidence of effectiveness,
and drugs have side effects. Sounds like correct reasoning to me. Do you
actually disagree?

And in any case that quote is from a document in January, the current version
(from March, also linked from the article) is here, and makes a bunch of
complicated points about steroid use, citing contemporary research which was
inconsistent about effect: [https://www.who.int/docs/default-
source/coronaviruse/clinica...](https://www.who.int/docs/default-
source/coronaviruse/clinical-management-of-novel-cov.pdf)

~~~
Tenoke
>Why is everyone picking on the WHO constantly?

Because they've made multiple avoidable bad calls.

>In this case you're spinning really hard.

'WHO was recommending not to use it' is a quick summary of statements like
"routine corticosteroids should be avoided unless they are indicated for
another reason,”. How is this not a recommendation against it and 'spinning
really hard'?

At any rate, I didn't dig into that part much (WHO recommendations are much
much less important than medical trials), I just found it interesting enough
to mention.

~~~
elcomet
> Because they've made multiple avoidable bad calls.

Could you say more about this ?

~~~
newacct583
It all comes down to politics. Some people want covid to be the "fault" of
someone else. The WHO is a good target, because they did indeed have some
really bad communication work in the early days of the infection:

1\. They stated, more assertively than they probably should, that they
believed the virus was contained in Wuhan and not spreading in the community
(that's the "no human-to-human transmission" quote that gets taken out of
context).

2\. Their statements that people should not try to acquire PPE masks were
poorly phrased and seemed to imply that masks don't work (obviously they do).

3\. There was that one incident, not related to the outbreak really, where a
WHO official hung up the phone rather than take questions about Taiwan (for
geopolitical reasons, Taiwan is not a member of the WHO). This led to a
thousand "WHO is in China's pocket" takes.

I mean, just in general the WHO has not comported themselves well here.
There's been plenty of routine incompetence to complain about, and frankly
they haven't really don't much to help.

But the political vitriol you hear about them is 100% blame shifting. Most of
the people yelling loudest about the WHO failing to give good advice about
this dangerous disease tend to argue in other contexts that the disease isn't
so dangerous, we shouldn't be forced to wear masks, the economic damage is too
great, liberty is at stake, etc...

~~~
EasyTiger_
Honestly I don't think it's true to say it's about politics. The WHO tweet
from 14 January was very misleading and no doubt caused things to get worse:

> Preliminary investigations conducted by the Chinese authorities have found
> no clear evidence of human-to-human transmission of the novel #coronavirus
> (2019-nCoV) identified in #Wuhan, #China🇨🇳.

~~~
ceejayoz
As far as the WHO was aware, and at the time of posting, that tweet was
entirely accurate.

They're not the CIA. They don't have an adversarial spy arm. They rely
enormously on member nations' self-reporting, and they rely on those reports
being honest. That clear evidence came later on doesn't mean the WHO had clear
evidence _at the time_.

(And, as the saying goes, absence of evidence isn't evidence of absence.
Nothing in that tweet says "it can't spread"; it says "we can't solidly
confirm it has been yet".)

~~~
legolas2412
Sure, and a lot of misleading stuff is true.

Consider this imaginary scenario. Imagine a dead body is found in the street
in front of your house. The dead person has multiple stab wounds, and there is
a knife 20 feet away from the body.

Imagine you inform the police, but they come 2 hours later, and announce that
they'll investigate the death. Then 2 days later they come and announce that
they had no evidence that this was a murder. They also announced that staying
in and locking your doors had shown to not stop serial killers and was counter
productive.

Do you want such an investigative agency?

I would prefer if the police said something like this within 1 hours of
arriving at the crime scene "the stab wound and a bloody knife indicate that
this might be a murder. In order to stay safe, the residents should stay in,
take precautions and lock their doors"

In case you didn't get what I referred to, there is no reason to doubt via a
SARS like virus with respiratory sickness may be transmitted via air. Their
default reaction should have been to assume the worst. Further, saying that
travel restrictions do not stop a disease is a stupid statement to make.
Specially when we see South Korea, Taiwan, Vietnam, Hong Kong, NZ etc
exterminate the virus.

WHO is to blame as much as individual governments.

~~~
ceejayoz
Per [https://www.washingtonpost.com/politics/2020/04/17/trumps-
fa...](https://www.washingtonpost.com/politics/2020/04/17/trumps-false-claim-
that-who-said-coronavirus-was-not-communicable/), on _the same day_ , the WHO
said this:

> Van Kerkhove added, however, that human-to-human transmission would not be
> surprising given the WHO’s experience with SARS, MERS and other respiratory
> pathogens.

> Van Kerkhove’s message was not lost on reporters. The Telegraph in Britain
> headlined its article on the news conference: “WHO refuses to rule out
> human-to-human spread in China’s mystery coronavirus outbreak.”

Within a week (Jan 20) they'd confirmed the human-to-human transmission, too.

------
barbegal
More detailed results on this trial are coming soon but the preliminary
results can be found at
[https://www.recoverytrial.net/results](https://www.recoverytrial.net/results)

~~~
lbeltrame
This is quite big as a result, although it was done against standard of care
(so it can mean a lot of things), because it improves survival.

This brings the list of currently effective pharmacological treatments to two:

\- remedisivir (reduces hospital stay, _might_ improve survival)

\- dexamethasone (improves survival if requiring oxygen)

~~~
nerdponx
Now that the "hydroxychloroquine is dangerous" research has been retracted,
does HCQ count as a 3rd treatment? Or did we never get confirmation that it
was effective?

Edit: what's with the downvotes? Go look at my post history, I'm not some
Russian astroturfing bot. And I got a lot of informative replies, which is why
I asked in the first place.

~~~
cheaprentalyeti
Are you referring to the retracted Lancet study or the just-breaking-news
about the Oxford Recovery Trial where they were using lethal dosages of the
drug? [1]

[1] [http://covexit.com/recovery-covid-19-research-blasted-for-
to...](http://covexit.com/recovery-covid-19-research-blasted-for-toxic-dosage-
towards-oxfordgate/)

~~~
rsynnott
This seems to be the response to every trial that shows chloroquine and
friends to be ineffective, though. "Well, of course there was no positive
effect, the dose was too low." "Well, of course there was no positive effect,
the dose was too high". "Well, of course there was no positive effect, you
didn't tape a halibut to the patient's head". "No, not a cooked one, you
fools, a live one!"

At a certain point, it's possibly worth considering that there may be no there
there.

~~~
jcranmer
I've noticed on Derek Lowe's blog that there seems to be a definite
hydroxychloroquine brigade that doesn't exist for any other purported therapy.
And as you noticed, this brigade will pick apart HCQ studies for not doing X
for a bajillion different varieties of X. (Not simultaneously dosing with zinc
and/or azithromycin is the one that tends to be mocked the hardest on the
blogs).

------
dzink
The title is click-bait. This and other steroids have been used by doctors
against COVID-19 from the beginning. So have blood thinners, and plenty of
other medications, and even radiation. From what has been gathered so far,
COVID leads to an attack on the endothelial layer of your blood vessels that
is responsible for clotting. That causes potentially permanent damage and if
immunity doesn't last long, also potentially accumulating cardiovascular,
pulmonary, and renal damage. From there COVID or the body's immune response
can hit multiple organs at different times turning your life into a flimsy
house of cards. Medicines for one organ can kill another (blood thinner
targeting a clot in your body can and does cause a stroke, or some other
issue). Just like a little push of the gas pedal or the breaks. The driver's
(your doctor's) skill is far more important than a single medicine at this
point.

~~~
jryle70
NYT seems to think it's a big deal [0]

> Assuming that when it goes through peer review it stands — and these are
> well-established researchers — it’s a huge breakthrough, a major
> breakthrough,” said Dr. Sam Parnia, a pulmonologist and associate professor
> of medicine at the Grossman School of Medicine at New York University.

[0] - [https://www.nytimes.com/2020/06/16/world/coronavirus-live-
up...](https://www.nytimes.com/2020/06/16/world/coronavirus-live-
updates.html?action=click&pgtype=Article&state=default&module=styln-
coronavirus&region=TOP_BANNER&context=storylines_menu#link-2c3ace49)

------
mbostleman
Dex is an important part of a first aid kit for high altitude mountaineering
as it's somewhat unpredictable who will be afflicted by various issues related
to altitude or when.

------
christefano
I thought that name was familiar. It’s the miracle drug called “dex” and hyped
in the Chris O’Donnell movie, Vertical Limit.

My bet is Vertical Limit is the next movie to trend (after Contagion):
[https://en.m.wikipedia.org/wiki/Vertical_Limit](https://en.m.wikipedia.org/wiki/Vertical_Limit)

~~~
improbable22
Haven't seen the movie but it is one of the drugs prescribed for altitude
sickness. Or rather, one of the ones often carried for use in life-threatening
cases.

------
danans
This is good news, but it doesn't change anything from a public health
perspective, because:

> Of those who are admitted, most also recover but some may need oxygen or
> mechanical ventilation.

> And these are the high-risk patients dexamethasone appears to help.

At best this might take a little bit of pressure off the healthcare system in
the treatment of the most severe cases. As others pointed, steroids are
powerful/dangerous stuff so they won't be using this except in the most
advanced cases.

~~~
rsynnott
I mean, most people who are dying receive oxygen and/or ventilation. If it
does significantly reduce death rate there, that's not nothing.

~~~
danans
Definitely not nothing. My point is that this treatment, however effective,
isn't effective early enough in the disease's progression such that it allows
us to reduce public health response measures by any significant amount,
whereas a treatment that was very effective at an earlier stage of the disease
would.

~~~
rsynnott
Oh, yeah, definitely. Such a treatment would be a game changer, and this one
is not. Still, in the absence of such a treatment, this is very nice to have.

------
parasubvert
I had idiopathic acute pericarditis several years ago with two months of anti
inflammatories keeping it in check, but ultimately 3 days of low dose
dexamethasone finished the job. My case was thought to be autoimmune - similar
to the cytokine storm spoken of with COVID-19. Very effective and potent
steroid.

------
teknopaul
How does this information

"About 19 out of 20 patients with coronavirus recover without being admitted
to hospital.

Of those who are admitted, most also recover but some may need oxygen or
mechanical ventilation."

Get said along side a published ~10% death rate. There have 300,000 cases in
the UK and 40,000 deaths.

~~~
PureParadigm
It's possible there are more than 300,000 cases, since not everyone with the
virus gets tested, so you can't assume 40,000/300,000 is the true death rate.
There are likely many with milder symptoms who do not get tested and recover
without going to the hospital, so the true death rate is lower than the
confirmed deaths/confirmed cases figure.

------
JoeAltmaier
This drug may be a hammer, and a better tool is desirable. But finally, a
hammer that may work! I am hopeful this will move us faster along the
direction of normalizing.

------
hcarvalhoalves
Isn't administration of (potent) steroids the standard treatment for
autoimmune reactions - what seems to happen on the extreme cases of COVID -
already?

~~~
thehappypm
It’s done commonly, but steroids are such a broad field of medicine that it’s
almost like saying “don’t doctors already prescribe chemicals?”

------
axegon_
I only knew of Dexamethasone as cancer treatment. Which intuitively makes me
wanna question how good of an idea this is. That said, my knowledge on
medicine outside the sheer basics is practically none... I mean correct me if
I'm wrong here but aren't cancer treatment drugs prone to cause severe side
effects in general?

~~~
vajrabum
Dexamethasone is not cancer specific. It is used in cancer treatment but
mostly to reduce swelling and the effects of tumors. It doesn't have the side
effects of chemo. It has its own set of problems it brings with the benefits.

------
f0ok
Where is the study?

------
userbinator
This doesn't seem all that surprising --- I recall reading that steroids were
also the choice of treatment for SARS many years ago.

~~~
acallaghan
That's probably why they tested it?

------
ReticentVole
If this cuts deaths by 1/3rd, isn't that totally sufficient to end all
lockdowns and border restrictions immediately? The death rate looks basically
like the annual flu with this drug, particularly when we consider that it will
just be one bad season then fairly minor from then on, when much of the
population gets natural immunity.

~~~
mrlala
It's baffling that you are comparing the death rate that happened DURING A
LONG LOCKDOWN with a non-lockdown annual flu death rate.. and acting like if
we can drop the numbers a bit it's the same thing.

Your logic is essentially saying the lockdown did _nothing_ to reduce
deaths/infection.

~~~
jeffreyrogers
They are talking about the death rate, not the absolute number of deaths.

~~~
rsynnott
I mean, that would still be wrong. IFR for flu is about 0.1% in a normal year.
Most reputable estimates for the IFR for COVID are about 1%.

~~~
ReticentVole
CDC estimated it at 0.26%:

[https://in.dental-tribune.com/news/new-estimate-by-the-
cdc-b...](https://in.dental-tribune.com/news/new-estimate-by-the-cdc-brings-
down-the-covid-19-death-rate-to-just-0-26-as-against-whos-3-4/)

~~~
rsynnott
That estimate wasn't particularly well-received, and the facts on the ground
make it look especially dubious. NYC has has 17k deaths, for instance, mostly
in April and early May. If you assume that _everyone_ in NYC has been
infected, that would be an IFR of 0.2%. An antibody survey in late April found
a prevalence of about 25% in New York City, which, assuming it's accurate
(huge assumption, obviously) would indicate a rate of about 0.8%.

~~~
guscost
> That estimate wasn't particularly well-received

Of course not, _any_ estimate of this number is going to be controversial
because it implies that _someone_ messed up. The "reception" from one side in
an ongoing debate means precisely nothing to me.

> An antibody survey in late April found a prevalence of about 25% in New York
> City, which, assuming it's accurate (huge assumption, obviously)

Yes, fairly big assumption. I wonder if the seropositive numbers have changed
since then?

> NYC has...

NYC has/had a lot of uncommon things that you don't mention:

\- Filthy subway system with horrible ventilation that is used by _almost
everyone_ many times a week.

\- Large proportion of residents living in apartment buildings with shared
HVAC.

\- Public health protocols which were extremely quick to hospitalize and then
intubate patients (even those without positive PCR tests).

\- A directive from the state government which forced nursing homes to accept
COVID-positive patients.

------
nodesocket
I’m a little frustrated that all the doctors seemed to have gotten this wrong.
Using steroids was completely missed and ignored as a treatment for severe
patients, as I understand dexamethasone was only shown to help people on
oxygen or ventilators. It seems everybody was focused on covid being a
respiratory disease, when in fact it looks like it’s actually circulatory.

~~~
EGreg
What do you mean it was missed?

Corticosteroids were recommended to reduce the body’s overreaction.

What I am wondering about is whatever happened to Ivermectin, that was so
promising back in April. MERCK makes Stromectol since the 70s. Clears the
entire infection in 48 hours!

[https://www.medicalnewstoday.com/articles/could-an-
antiparas...](https://www.medicalnewstoday.com/articles/could-an-
antiparasitic-drug-kill-off-sars-cov-2-within-2-days)

~~~
sp332
*In cell cultures.

It's in at least one trial.
[https://clinicaltrials.gov/ct2/show/NCT04374279](https://clinicaltrials.gov/ct2/show/NCT04374279)
Estimated completion date is this month, so keep an eye out.

~~~
EGreg
When and bow will we know the results of this study?

~~~
knowaveragejoe
If nothing else you'll hear news about it if the study looks promising

------
amelius
> A cheap and widely available drug called dexamethasone can help save the
> lives of patients who are seriously ill with coronavirus.

Yes, cheap until it gets patented because that is what usually happens when a
drug is repurposed.

~~~
aroch
Given that it was discovered in the 1950's, I don't think you're going to see
a patent on the versions currently being used in clinic. Now,if someone
creates a more bio-available/active functionalized variant of it, fine that
might get patented. But I doubt it would have much of an impact on the
suggested COVID19 treatment (and would likely be years away from market)

~~~
kgwgk
You can actually get patent protection on things like dosage and indications.
But it's much weaker than for composition-of-matter patents and often courts
rule in favor of challengers.

