Musee, NdekeKebaabetswe, Lemme PricaTichapondwa, Shepherd MasimbaTubatsi, GosaitseMahaye, NtombikayiseLeareng, Samuel KeengNomngongo, Philiswa Nosizo2022-04-072022-04-072021-10-27Musee, N.; Kebaabetswe, L.P.; Tichapondwa, S.; Tubatsi, G.; Mahaye, N.; Leareng, S.K.; Nomngongo, P.N. Occurrence, Fate, Effects, and Risks of Dexamethasone: Ecological Implications Post-COVID-19. International Journal of Environmental Research and Public Health 2021, 18, 11291. https://DOI.org/10.3390/ijerph182111291.1660-4601 (online)10.3390/ijerph182111291http://hdl.handle.net/2263/84827SUPPLEMENTARY MATERIAL : Table S1: The ecotoxicological effects of DEXA on organisms at different levels of organization, Table S2: Removal of DEXA during wastewater treatment in WWTPs, with techniques utilized across geographical regions globally in selected studies.The recent outbreak of respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), has led to the widespread use of therapeutics, including dexamethasone (DEXA). DEXA, a synthetic glucocorticoid, is among the widely administered drugs used to treat hospitalized COVID-19 patients. The global COVID-19 surge in infections, consequent increasing hospitalizations, and other DEXA applications have raised concerns on eminent adverse ecological implications to aquatic ecosystems. Here, we aim to summarize published studies on DEXA occurrence, fate, and effects on organisms in natural and engineered systems as, pre-COVID, the drug has been identified as an emerging environmental contaminant. The results demonstrated a significant reduction of DEXA in wastewater treatment plants, with a small portion, including its transformation products (TPs), being released into downstream waters. Fish and crustaceans are the most susceptible species to DEXA exposure in the parts-per-billion range, suggesting potential deleterious ecological effects. However, there are data deficits on the implications of DEXA to marine and estuarine systems and wildlife. To improve DEXA management, toxicological outcomes of DEXA and formed TPs should entail long-term studies from whole organisms to molecular effects in actual environmental matrices and at realistic exposure concentrations. This can aid in striking a fine balance of saving human lives and protecting ecological integrity.en© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.Surface waterWastewaterAnti-inflammatory drugTransformationGlucocorticoidDrinking waterSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2)COVID-19 pandemicCoronavirus disease 2019 (COVID-19)Dexamethasone (DEXA)Article