Use of steroids could have prevented many COVID-19 deaths, says new study

As the COVID-19 death toll neared the 800,000-mark on Saturday, 22 August, scientists and medical experts continue to research and find the best possible treatment options to prevent more deaths from severe symptoms of the deadly disease that has infected close to 23 million people globally.

It was as far back as June 2020 when a study looking into the treatment of hospitalised and severely COVID-19 patients with the use of steroids was deemed to be surprisingly effective.

And now, a new study on the efficacy of common corticosteroids such as dexamethasone on COVID-19 patients with severe ARDS (acute respiratory distress syndrome) on ventilator support has suggested that an earlier intervention could have been able to save many lives.

The new study, published in July 2020 in the journal Expert Review of Respiratory Medicine, also shed light on the delay in the use of corticosteroids to treat severely ill COVID-19 patients because of a World Health Organization (WHO) directive early in the pandemic, that did not recommend the use of steroids as it could delay the clearance of the new coronavirus infection from the body.

Read more: What is viral load

However, research led by scientists at the University of Huddersfield by April 2020 indicated that the mortality rate among patients who died in the steroid group (28%) was significantly lower than those who were not treated with corticosteroids (69%).

The WHO recommendation was in stark contrast to many government health bodies such as the National Institute of Health (NIH), as well as similar bodies in China as well.

Many countries, as a result, did not begin using corticosteroids to treat patients with COVID-19 until much later, including the United Kingdom. It was only after the Recovery Trial, performed in collaboration with the University of Oxford in the UK that showed the benefits of treating COVID-19 that made the country change their treatment methods in the month of June.

UK Recovery Trial and role of corticosteroids in treatment of COVID-19
Studying the mortality data among severely ill COVID-19 patients who were treated with corticosteroids

UK Recovery Trial and role of corticosteroids in treatment of COVID-19

Pneumonia-like symptoms are usually not treated with the help of corticosteroids, as has been evidenced in prior infection outbreaks such as the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) or various influenza outbreaks.

However, some of the early guidelines in the treatment of COVID-19 included the use of low doses of corticosteroids such as dexamethasone, an inexpensive steroid available everywhere in the world, but only under specific circumstances. However, the Recovery trial performed in the UK showed low doses of dexamethasone to be beneficial for COVID-19 patients on ventilator support.

The results of the UK trial prompted WHO to change its stance on the clinical management of COVID-19 patients with the use of dexamethasone, with the director general of the global health body explaining that it was the first treatment that reduced mortality rate in patients who needed artificial oxygen support.

According to the WHO, dexamethasone is a steroid that has been used since the 1960s to treat inflammation arising out of various medical conditions. The Recovery trial was established in March 2020 to study the effects of the drug in treating COVID-19 patients, and had recruited more than 11,500 patients for the trial across the UK.

As many as 2104 patients were given low doses of dexamethasone once every day for 10 days as compared to 4321 patients who received the standardised care until then. Mortality rate was noted on day 28 of the trial, which showed 41% of the patients died among those who needed ventilator support, along with a mortality rate of about 25% among patients who only needed supplemental oxygen. Those who did not require any respiratory intervention had the lowest mortality rate of 13%.

However, the dexamethasone group had a significantly lower mortality rate in comparison with the other group, as the mortality was reduced by a third of the margin among patients who were on ventilator support, and a fifth among patients who were on supplemental oxygen support. Those who did not require artificial breathing support showed no difference in the mortality rates, suggesting a higher efficacy of the drug on severely ill COVID-19 patients.

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Studying the mortality data among severely ill COVID-19 patients who were treated with corticosteroids

The latest study collected data from reports published by various countries to identify mortality of severely ill COVID-19 patients from around the world. Of the 10,815 cases the researchers came across of patients with ARDS, about 39% was the average mortality rate.

Read more: COVID-19 excess mortality

There was a 69% mortality among severe COVID-19 patients in China, while Poland reported the highest mortality rate among countries in Europe with 73%. But when patients who had developed ARDS from the COVID-19 infection were treated with corticosteroids, the mortality rate was down to 28% of the patients.

The study concluded that COVID-19 patients with severe symptoms must be treated with the use of corticosteroids with the appropriate dosage based on the benefits of low dosage, as explained in various studies. However, the researchers also called for more in-depth study into the treatment of patients with severe COVID-19 and ARDS with the use of corticosteroids and their appropriate doses.