Steroids Can Save the Lives of Severely Ill COVID Patients, Several Trials Confirm
Cheap and widely available steroids can save the lives of seriously ill coronavirus patients, a review of several trials confirmed.
The review, published in the Journal of the American Medical Association (JAMA) Wednesday, builds on the promise of a June study that found that the steroid dexamethasone reduced the risk of death for COVID-19 patients on ventilators or oxygen.
"I had a big smile on my face when I saw the results," Dr. Derek C. Angus, analysis coauthor and chair of the department of critical care medicine at the University of Pittsburgh, told The New York Times. "This is a case of, 'A question asked, a question answered,' and that's so rare."
#BREAKING Steroids cut death rates among critically ill #coronavirus patients, according to a new @WHO analysis,… https://t.co/oyE9ZrUFy0— Global Health Strategies (@Global Health Strategies)1599057342.0
The findings prompted the World Health Organization (WHO) to update its clinical care guidance Wednesday to recommend corticosteroids for severely or critically ill COVID-19 patients. The organization began work on the guidance in June, following the initial dexamethasone study, and helped with the subsequent trials.
"The evidence shows that if you give corticosteroids ... (there are) 87 fewer deaths per 1,000 patients," WHO clinical care lead Janet Diaz said during a live social media event, as Reuters reported. "Those are lives ... saved."
🆕 guideline on use of dexamethasone & other corticosteroids advises: ✅ for oral or intravenous usage in treatment o… https://t.co/ab4oepcbLa— World Health Organization (WHO) (@World Health Organization (WHO))1599072453.0
The metaanalysis was based on seven randomized trials involving 1,703 patients that were conducted by researchers in Britain, Brazil, Canada, China, France, Spain and the United States. In addition to dexamethasone, the trials also looked at the impacts of the steroids hydrocortisone and methylprednisolone.
All told, the steroids reduced death risk in seriously ill patients by 20 percent, the meta-analysis found. The New York Times offered a treatment-by-treatment breakdown of the results:
- Dexamethasone: Reduced deaths by 36 percent for 1,282 patients in three trials.
- Hydrocortisone: Reduced deaths by 31 percent for 374 patients in three trials.
- Methylprednisolone: Reduced deaths by nine percent in a smaller trial of 47 patients.
Doctors use steroids to suppress the immune system to reduce inflammation, swelling and pain. Researchers thought the drugs might help coronavirus patients because many people die of the immune system's overreaction to the virus, not the virus itself. However, there were also risks to consider.
"In intensive care we often use steroids to treat inflammatory conditions and severe infections," Imperial College London professor and hydrocortisone trial leader Anthony Gordon told The Guardian. "But we know they can also suppress the immune system, and with a new virus that none of us were immune to, that could make things worse."
Luckily, the steroids made things better. They are already being widely used, Oxford University medicine professor Martin Landray, who helped with the initial June study, told The Guardian. The number of hospital patients treated with dexamethasone rose from around seven to eight percent in May to around 55 percent by the end of June.
"This is not a drug that costs $3,000 to reduce a hospital stay by a few days," Landray said. "This is not anywhere near the sorts of costs in many, many other areas of acute and preventive medicine. So this is a widely available, widely useful strategy. I mean, treating people with dexamethasone is, give or take, 60 quid to save a life."
In its guidance, the WHO noted that it only recommended steroids for severely or critically ill cases.
"We suggest not to use corticosteroids in the treatment of patients with non-severe COVID-19 as the treatment brought no benefits, and could even prove harmful," the agency wrote.
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By Jake Johnson
Amid reports that oil industry-friendly former Energy Secretary Ernest Moniz remains under consideration to return to his old post in the incoming Biden administration, a diverse coalition of environmental groups is mobilizing for an "all-out push" to keep Moniz away from the White House and demand a cabinet willing to boldly confront the corporations responsible for the climate emergency.
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Anger, anxiety, overwhelm … climate change can evoke intense feelings.
"It's easy to feel dwarfed in the context of such a global systemic issue," says psychologist Renée Lertzman.
She says that when people experience these feelings, they often shut down and push information away. So to encourage climate action, she advises not bombarding people with frightening facts.
"When we lead with information, we are actually unwittingly walking right into a situation that is set up to undermine our efforts," she says.
She says if you want to engage people on the topic, take a compassionate approach. Ask people what they know and want to learn. Then have a conversation.
This conversational approach may seem at odds with the urgency of the issue, but Lertzman says it can get results faster.
"When we take a compassion-based approach, we are actively disarming defenses so that people are actually more willing and able to respond and engage quicker," she says. "And we don't have time right now to mess around, and so I do actually come to this topic with a sense of urgency… We do not have time to not take this approach."
Reporting credit: ChavoBart Digital Media
Reposted with permission from Yale Climate Connections.
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By Andrea Germanos
A new report released Tuesday details the "shocking" state of global land equality, saying the problem is worse than thought, rising, and "cannot be ignored."
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