The world’s first coronavirus treatment proven to save lives is being given to NHS patients after a “huge breakthrough” by British scientists.
Dexamethasone, a decades-old steroid that costs about 50p per day, was found to reduce Covid-19 deaths by up to one third for the sickest patients. NHS hospitals were advised to begin using it immediately amid hopes for a new era of treatment for the disease.
Oxford University researchers said that up to 5,000 deaths could have been prevented in Britain if doctors had been aware of its potential and it had been used from the start of the pandemic.
If the finding is borne out, the drug, a steroid called dexamethasone, would be the first treatment shown to reduce mortality in severely ill patients. Had doctors been using the drug to treat the sickest Covid-19 patients in Britain from the beginning of the pandemic, up to 5,000 deaths could have been prevented, the researchers estimated.
In severe cases, the virus directly attacks cells lining the patient’s airways and lungs. But the infection also can prompt an overwhelming immune reaction that is just as harmful. Three-quarters of hospitalized Covid-19 patients receive some form of oxygen.
The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
Until now, hospitals worldwide have had nothing to offer these desperate, dying patients, and the prospect of a lifesaving treatment close at hand — in almost every pharmacy — was met with something like elation by doctors.
“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 critical care doctor and associate professor of medicine at the Grossman School of Medicine at New York University. “I cannot emphasize how important this could be.”
But the report also comes quick on the heels of a series of blunders and retractions in the scientific literature, as scientists rush to publish research about the coronavirus. While hospitals in the United Kingdom were able to begin treating severely ill Covid-19 patients with dexamethasone on Tuesday, many experts in the United States demanded to see the data and the study itself, which have not yet been peer reviewed or published.
The drug appears to reduce deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth, but the study has not yet been peer reviewed.Credit…Marco Bertorello/Agence France-Presse — Getty Images
“It will be great news if dexamethasone, a cheap steroid, really does cut deaths by ⅓ in ventilated patients with COVID19,” Dr. Atul Gawande, the surgeon and author, wrote on Twitter, “but after all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper.”
There is no vaccine against the coronavirus, and the only treatment known to be effective, an antiviral drug called remdesivir, only shortens the time to recovery.
“Dexamethasone is the first drug to be shown to improve survival in Covid-19,” one of the trial’s chief investigators, Peter Horby, a professor of emerging infectious diseases at the University of Oxford, said in a statement. “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment.”
Dr. Horby added that dexamethasone should now become the “standard of care in these patients,” noting that it was inexpensive, was widely available and could be used immediately.
The drug was not studied in patients outside of the hospital, however, and was not beneficial to patients who were not on respiratory support.
Many steroids reduce inflammation in the body, and dexamethasone is among those that doctors have been trying in Covid-19 patients overwhelmed by so-called cytokine storms — uncontrolled immune responses so powerful they kill some patients.
Many doctors had feared the drug might actually exacerbate the infection by preventing the immune system from attacking the virus. Though Dr. Parnia had treated patients with steroids and seen improvement, “there had not been such a large trial comparing no steroids with steroids.”
Even without published results, Matt Hancock, Britain’s health secretary, said doctors in the country’s National Health Service were able to begin using the steroid as the standard treatment for hospitalized coronavirus patients on Tuesday afternoon. The drug costs less than $1 per day of treatment on a single patient.
Peter Horby, a professor of emerging infectious diseases at the University of Oxford, right, at a coronavirus press conference with Prime Minister Boris Johnson at 10 Downing Street on Tuesday.Credit…Pippa Fowles/10 Downing Street, via Agence France-Presse — Getty Images
The government started stockpiling dexamethasone several months ago based on signs that it could help patients, Mr. Hancock said, and now has 200,000 doses on hand.
The trial led by Dr. Horby was a randomized, controlled clinical trial, the gold standard for medical research. About 2,100 severely ill Covid-19 patients were given low doses of dexamethasone, orally or intravenously, once a day. Their outcomes were compared with 4,300 patients who had received the usual care.
The trial was stopped early, because the investigators felt that the benefit was obvious. But they said that the drug did not help moderately ill patients who were not receiving oxygen.
Corticosteroids like dexamethasone were used during outbreaks of SARS and MERS, which were also caused by coronaviruses. Those drugs were associated with worse outcomes, another reason for hesitation.
An earlier, much smaller trial in Spain of patients with acute respiratory distress, also seen in those ill with Covid-19, found that dexamethasone treatment may reduce the amount of time patients are on ventilators and may reduce deaths.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
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So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
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Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
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Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
- My state is reopening. Is it safe to go out?
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
- What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
- How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
- How do I take my temperature?
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
- Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
- What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
- How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
“What this is effectively doing is tamping down inflammatory responses in patients,” Stuart Neil, a professor of virology at King’s College London, said in an interview. “It’s almost certain this is affecting the body’s response against the virus, rather than inhibiting the virus itself.”
Dr. Stephen Griffin, an associate professor in virology at the University of Leeds, said that it would be important to study the use of dexamethasone in combination with antiviral treatments like remdesivir.
Dexamethasone has been around for more than 50 years and is widely used to treat diseases like lupus, arthritis, allergies and cancer. Though it may cause side effects, it is generally safe.
Steroids reduce inflammation in the body, and dexamethasone appears to tamp down the coronavirus’s effects on the lungs.Credit…Ernesto Benavides/Agence France-Presse — Getty Images
Yet many experts urged caution regarding the results of the new study. With scientists rushing to identify treatments for the virus as the outbreak spread around the world, some high-profile findings have had to be retracted or walked back in recent months.
On Monday, the Food and Drug Administration withdrew its emergency use authorization for hydroxychloroquine and chloroquine, drugs touted by President Trump as treatments for Covid-19. Earlier this month, the New England Journal of Medicine and The Lancet retracted major studies because of flawed data.
Dr. Jose Scher, a rheumatologist at New York University, said the drug may represent a “major breakthrough,” but noted that the data have yet to be published in full.
“It has to be published and peer reviewed, but if it is in fact true, this is a major breakthrough,” he said. But “all these communications, without the actual data, should be taken with caution.”
Hospitals in the United States appeared to be waiting to see the full study before making changes.
Dr. Hugh Cassiere, director of critical care medicine at Northwell Health’s North Shore University Hospital, said he would wait for the study to be peer reviewed before making changes, and would scrutinize the data personally. “I want to know, ‘What was the severity of the patients’ illness? Were the patients very, very sick?’”
Randomized controlled trials are supposed to account for the differences between patients. “But sometimes that’s not the case, and you have patients who are sicker in the placebo group, and they’re more likely to die compared to the treatment group, so you’re not really comparing apples to apples,” he said.
Doctors also need more information about the drug’s side effects, he said.
“This group has credibility,” tweeted Dr. Jeremy Faust, an emergency room physician at Brigham and Women’s Hospital in Boston. “But what are the neurological outcomes? Do we just cause prolonged suffering in one in eight patients on vents? Or did we help many? No clue!”