Abstract:
Our lives changed dramatically eight months ago when we went into a hard nationwide lockdown in a bid to limit the transmission of our new spiky foe, SARS-CoV-2. We endured the uncertainties of autumn, and then the winter and the cold July COVID-19 peak. At this time, Oxford University’s RECOVERY Collaborative group first reported on dexamethasone (6 mg daily for 10 days) significantly lowering the 28-day mortality in hospitalised COVID-19 patients on invasive mechanical ventilation or on oxygen alone, by as much as a third and a fifth, respectively. It was hypothesised that glucocorticoids modulate inflammation-mediated lung injury, thus reducing the likely progression to respiratory failure and death in patients with severe illness. This made us perk up because a couple of months earlier, the intravenous antiviral, remdesivir (100 mg), also administered for 10 days, had shown promise in shortening the time to recovery by a median of five days compared to placebo, but not in reducing death in hospitalised COVID-19 patients with lower respiratory tract involvement.2 The FDA granted remdesivir Emergency Use Authorization (EUA) in May for the treatment of adults and children hospitalised with suspected or laboratory confirmed COVID-19 based on this meagre evidence, as there were no other treatment options at the time. Meanwhile, dexamethasone, which is relatively cheap, quickly became the standard care in patients requiring oxygen.
