The capacity of Brabant hospitals, including intensive care, will be insufficient in the coming week. Due to overload, approximately 500 to 700 patients will have to be taken to intensive care and other departments in hospitals outside the province, Marcel Visser reported on behalf of the Regional Consultation Acute Care Chain in Brabant in a conversation at the Elisabeth-TweeSteden Hospital in Tilburg. (Photo by Robin Utrecht/SOPA Images/LightRocket via Getty Images)
- A new drug dexamethasone was found to be effective in reducing COVID19 mortality
- However, doctors are skeptical about its use as there is no research evidence
- Doctors using it for treatment warn about side effects
- Meanwhile WHO updated their COVID19 guidance asking it to be used only in severe patients
- The drug has been reported to reduce mortality by a third in patients in ventilator and reduce deaths by a fifth in the severely ill
- However, it doesn’t work on mild cases of COVID19
- As the drug is cheap and easily available countries are strangling to authorize its use and stock it up
According to a Reuters report, the news of a COVID19 breakthrough treatment published on Tuesday brought skepticism along with optimism among U.S. doctors, who said the recent withdrawal of an influential COVID-19 study left them wanting to see more data.
Confusion Over What’s Valid
Global pressure to find a cure or vaccine has accelerated the process of reporting coronavirus study results, feeding confusion over whether therapies have been proven effective. One influential COVID study was withdrawn this month by respected British medical journal The Lancet over data concerns.
Researchers in Britain said dexamethasone, used to fight inflammation in other diseases, reduced death rates of the most severely ill COVID-19 patients by around a third, and they would work to publish full details as soon as possible.
But hours later South Korea’s top health official cautioned about the use of the drug for COVID-19 patients due to potential side effects.
Once Bitten Twice Shy
“We have been burned before, not just during the coronavirus pandemic but even pre-COVID, with exciting results that when we have access to the data are not as convincing,” said Dr. Kathryn Hibbert, director of the medical intensive care unit at Harvard’s Massachusetts General Hospital.
Hibbert said published data would help her evaluate the findings and see which patients benefited the most and at what dose.
“I am very hopeful this is true because it would be a huge step forward in being able to help our patients,” she said, but added she would not change practice at this point.
Read More COVID19 Lifesaving Drug Found, WHO Backs Its Use in Critically Ill
Cautious About Steroids Doctors Ask for Data
Steroids can suppress immune systems, warned Dr. Thomas McGinn, deputy physician-in-chief at New York’s largest healthcare system, Northwell Health where, he told Reuters, physicians are using steroids on a case-by-case basis.
“We have to see what the study looks like given the current environment of retractions,” said McGinn. “I just wait to see the real data, see if it’s peer reviewed and gets published in a real journal, he said.
University of Washington professor of medicine Dr Mark Wurfel urged the researchers to put out data before official publication.
“That would be very, very helpful in terms of helping us align our patient populations with theirs and decide whether it’s appropriate to apply this therapy to our patients.”
Meanwhile, another Reuters report suggests that WHO reiterated this point when they updated the COVID19 guidance on Wednesday.
A cheap steroid that can help save the lives of patients with severe COVID-19 should be reserved for serious cases in which it has been shown to provide benefits, the World Health Organization
WHO Describes It As Hope
WHO chief Tedros Adhanom Ghebreyesus said research was at last providing “green shoots of hope” in treating the virus, which has killed more than 400,000 people worldwide and infected more than 8 million.
- Trial results announced on Tuesday by researchers in Britain showed dexamethasone, a generic drug used since the 1960s to reduce inflammation in diseases such as arthritis, cut death rates by around a third among the most severely ill coronavirus patients admitted to hospital.
- That makes it the first drug proved to save lives in fighting the disease.
- Countries are rushing to ensure that they have enough of it on hand, although medical officials say there is no shortage.
Treatment Vs Side Effects
Some doctors were cautious, citing possible side-effects and asking to see more data.
A patient in Denmark received dexamethasone on Wednesday, local news agency Ritzau reported. The doctor who prescribed the drug said the medical profession was well acquainted with its side-effects.
The head of the WHO’s emergencies programme, Mike Ryan, said the drug should only be used in those serious cases where it has been shown to help.
“It is exceptionally important in this case, that the drug is reserved for use in severely ill and critical patients who can benefit from this drug clearly,” he told a briefing.
- Britain has increased the amount of dexamethasone it has in stock and on order to 240,000 doses, Health Minister Matt Hancock said.
- Methylprednisolone, a steroid similar to but less potent than dexamethasone, has been used in Sweden since March, a Stockholm-based doctor told media.
- The steroid was introduced to standard practice after it proved effective on a coronavirus patient who wasn’t showing signs of recovery with other treatments, Lars Falk, of the New Karolinska Hospital, told Sweden’s Dagens Nyheter.
The dexamethasone study’s results are preliminary, but the researchers behind the trial said it suggests the drug should become standard care in severely stricken patients.
First Drug To Reduce Mortality
For patients on ventilators, the treatment was shown to reduce mortality by about a third,
and for patients requiring only oxygen, deaths were cut by about one fifth,
-according to preliminary findings shared with the WHO.
“This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support,” Tedros said in a statement late on Tuesday.
Meta-analysis To Understand the Treatment
“WHO will coordinate a meta-analysis to increase our overall understanding of this intervention. WHO clinical guidance will be updated to reflect how and when the drug should be used in COVID-19,” the agency added.
South Korea’s top health official expressed caution about dexamethasone and the European Union and Switzerland both said they were awaiting more information.
‘NO SILVER BULLET’
An Italian expert said that dexamethasone was no silver bullet.
“The study showed a marginal reduction in deaths,” said Lorenzo Dagna, immunology head at IRCCS San Raffaele Scientific Institute in Milan. “We’re light years away from being able to say we’ve found the cure against COVID.”
Countries To Authorise It?
- On the positive side, he added, the drug is cheap and plentiful.
- As the new coronavirus has wreaked havoc on global economies, some countries have moved quickly to authorise emergency use of medicines only to later backtrack.
The U.S. Food and Drug Administration, for instance, withdrew emergency authorisation for hydroxychloroquine, a malaria drug touted by U.S. President Donald Trump and others against COVID-19, after studies showed it did not help.
Caution Is the Only Way?
The WHO said on Wednesday that testing of hydroxychloroquine in its large multi-country trial of treatments for COVID-19 patients had been halted after research showed no benefit.
“We have been burned before,” Dr. Kathryn Hibbert, director of the medical intensive care unit at Harvard’s Massachusetts General Hospital, said, expressing caution about dexamethasone.
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Source: Reuters
