Finally, a Drug That Helps With the Worst COVID-19 Infections

Finally, a Drug That Helps With the Worst COVID-19 Infection

A bit of good news on the COVID-19 front this week:

New research reveals a drug that might actually help save severely ill patients, and data suggests that distancing policies may have saved millions of lives over the last few months.

While most patients with COVID-19 pull through,worldwide, the pandemic has caused more than 435,000deaths. So, doctors have been trying pretty much everything they can think of to lower the disease’s fatality rate. Unfortunately, even our most promising drugcandidates have turned out to be ineffective. But now, we have anotheroption. According to an announcement made by the researchersrunning a trial in the UK called the RECOVERY trial on June 16th, there’s a drug that helps save people withserious infections. And it’s one you probably have not heardabout in relation to the pandemic: dexamethasone.

While everyone has been fighting about hydroxychloroquine and remdesivir, the researchers in this trial have also been testing other commonly used drugs, including dexamethasone. It’s what doctors call a corticosteroid—so,a steroid that resembles the natural hormone cortisol. You’ve probably heard of cortisol in the context of stress, because it helps prepare your body to reactto danger. But one of the ways it does that is by rampingdown the immune system. In other words, cortisol — and drugs thatmimic it like dexamethasone — help reduce inflammation. And that’s why those designing the Recovery Trial thought dexamethasone might help people with severe COVID infections. People who are hospitalized with COVID-19are generally experiencing extreme immune reactions and a lot of inflammation.

Essentially, their immune systems are trying so hard to kill the virus that they end up damaging healthy tissues—which can be fatal. Medications that can reel in the immune system a bit may be able to help prevent that damage, and save lives. And that seems to be exactly what dexamethasone does.

In the trial, researchers gave a little over2100 patients dexamethasone for 10 days, while another 4300or so got the usual hospital care. And when they compared the final outcomes for those patients, the ones that received the drug had a higher chance of surviving —but only if they were sick enough to need oxygen or a ventilator. It had no effect on the 13% of patients thatdidn’t need that kind of aid, probably because their immune systems weren’t overreacting as much.

In fact, early on in an infection, or in people who don’t have severe symptoms, steroids like dexamethasone could be harmful, as they reduce the body’s natural ability to  fight the virus. For those in the trial that were really sick,though, dexamethasone reduced deaths. It lowered them by one-third in the sickestgroup —those that were put on ventilators. And it cut mortality by one-fifth in those who needed supplemental oxygen. Doctors are already buzzing about these results,as this is the first drug we know of that seems to helpthose who need it most. But, we would be remiss if we didn’t pointout that these results are very preliminary.

The team running the RECOVERY trial hasn’teven released the actual data yet! So, we shouldn’t get too excited until experts have a chance to examine the results. Still, the findings are promising enough that the drug will likely be added to other ongoing trials. And frankly, it’s kind of nice to have some good news to talk about. It’s been a long few months, what with lockdowns and school closings. And, sure,  it helps to know that we’re doing our part by staying in and such, but so far, the benefits have been pretty vague. Well, I have some more good news. Thanks to two new papers, we have a much moreconcrete idea of how many lives have been saved by all ofthat work. And the numbers might be higher than you’dexpect. Two papers published in Nature last week looked at the effects of distancing policies as a whole — thingslike stay-at-home orders and closing schools. One of these papers used data from 11 countriesin Europe to estimate how many people would have diedfrom COVID-19 if lockdown measures hadn’t been implemented. They based their model on the number of reporteddeaths. It’s not a perfectly reliable metric, butit’s better than using the reported number of cases, since in mostplaces, not everyone who’s had the virus has beentested. Specifically, they wanted to look at one ofthe most important factors in how a disease spreadsover time, with interventions: its effective reproduction number, or R. That’s the number of people that, on average,are infected by each sick person over the course of theirillness. You may have heard this referred to as R0,but that’s only the basic reproduction number, which is howmany people can be infected by a single person when everyoneis vulnerable and there are no restrictions in place.

In the real world, R changes over time—like,thanks to social distancing recommendations thatkeep people separated. Based on early numbers, the researchers estimated the initial reproductive number for COVID-19 in Europe to be around four at the beginning of thepandemic. But by early May, after several weeks of differentnon-pharmaceutical interventions like stay-at-home orders and wearing masks, the effective reproduction number went down to between 0.44 to 0.82, depending on the country. Which is huge, since an effective reproduction number less than one translates to fewer and fewer people contracting the disease. And that is how you contain an outbreak. Researchers also used their model to estimate roughly how many people would have died from COVID-19 without interventions. Through early May, the number of reported deaths in just these 11 countries was about 130,000.

Without restrictions, the team estimated thatthe number would have been over 3.2 million. The other Nature study looked at the effectsof lockdowns on overall infection rates from six countries: China,South Korea, Italy, Iran, France, and the US. They based their model on confirmed infections,which, as they point out, is a bit complicated thanks to the different testing rates we mentioned earlier. But, they also point out the value of using multiple types of data to model the pandemic, since you can compare the models to learn more about the situation as a whole. The researchers estimated that restrictions in these six countries may have prevented about 530 million infections. And that’s only through the first week Of April.

So, yes — these lockdowns are not fun, fora lot of different reasons. But the data suggest that they also saved millions of people’s lives, and kept hundreds of millions more from getting sick.

And when we’re stuck at home now, or inthe future, missing the way things used to be,
I think this knowledge will help a bit.

Thanks for reading this post of Sciencefacthow news!