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'When you can change mortality, you can really change what we do'

Joliet medical director hopeful dexamethasone can change outcomes for covid patients

Packages of Dexamethasone are displayed in a pharmacy, Tuesday, June 16, 2020,  in Omaha, Neb. Researchers in England said Tuesday they have the first evidence that the drug can improve COVID-19 survival. The cheap, widely available steroid called dexamethasone reduced deaths by up to one third in severely ill hospitalized patients. (AP Photo/Nati Harnik)
Packages of Dexamethasone are displayed in a pharmacy, Tuesday, June 16, 2020, in Omaha, Neb. Researchers in England said Tuesday they have the first evidence that the drug can improve COVID-19 survival. The cheap, widely available steroid called dexamethasone reduced deaths by up to one third in severely ill hospitalized patients. (AP Photo/Nati Harnik)

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Intriguing.

That's how Dr. John Walsh, medical director of AMITA Health Saint Joseph Medical Center in Joliet and a pulmonologist with Midwest Respiratory in Joliet, called results of a study that showed an inexpensive steroid medication - dexamethasone - may reduce deaths in patients with the virus that causes COVID-19.

“Steroids for a short course: many of us have been using them to some degree,” Walsh said. “Our group’s [Midwest Respiratory] been doing this for about six weeks.”

Walsh said this study regarding dexamethasone treatment is part of a larger study that showed the antimalarial medication hydroxychloroquine was not an effective treatment for COVID-19.

On June 15, the U.S. Food & Drug Administration also revoked its emergency use authorization for both hydroxychloroquine and chloroquine, another antimalarial drug.

In this recent study 2,104 people received steroids and 4,321 received standard care.

“What they did was give 6 milligrams of dexamethasone a day, which is about 40 milligram of prednisone for 10 days either by IV or by mouth," Walsh said.

What the study doesn't yet say is what comprised the standard care. For instance, did patients receive the antiviral remdemsivir?

Walsh said “virtually everyone" receives remdesivir if they are sick enough to be in the hospital on oxygen or a ventilator.

On April 29, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said remdesivir is now that standard of care for patients with COVID-19.

“They’re probably going to get [convalescent] plasma early on, too,” Walsh said. “We’re [St. Joe's] still doing that that through the Mayo Clinic study."

What impressed Walsh about the dexamethasone study is that patients on ventilators had a 33% reduction in mortality, “which is huge,” Walsh said and those on oxygen has a 20 percent reduction in morality, he added.

“If you weren’t on oxygen, you had no change in mortality,” Walsh said.

Walsh said the news information that’s circulating online appears to be a new release form the authors.

“It’s good in that this is the most immediate way to get communication across the world,” Walsh said. “But it also carries a little risk because it’s not been reviewed by one other those performing the study.”

In the pandemic's early days, steroids were thought to cause the virus to replicate, Walsh said.

But the inflammatory cascade (cytokine storm) "was really hurting people," so health care providers turned to Actemra (tocilizumab), an immunosuppressive drug, Walsh said.

“It’s associated with an increased risk for infections so there is a downside,” Walsh said

Cytokines are part of the immune system and a "storm" of them might release when the body is fighting an infection. But a large amount can be harmful, the National Cancer Institute website said.

Because of the infection risk, Walsh said he is using Actemra less than in the past, only when risk of non covid-related infection of low, he said.

Walsh said he never did use the combination of interferon beta-1b, lopinavir–ritonavir and ribavirin as a treatment for mild to moderate COVID-19 because he was able to get remdesivir.

Still, Walsh is hopeful dexamethasone and might really change the outcomes for “super sick people.”

“When you can change mortality, you can really change what we do,” Walsh said.

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