Many hospitals across the world are under increased pressure as the number of COVID-19 patients rises every day. Some have to find ways to provide emergency care for the most severely ill patients. Thus, health professionals continuously remind people who have underlying conditions to be more careful when going out of the house or interacting with others as they are the most susceptible to the worst impacts of the virus.
1 in 5 People are at Risk of Developing Severe COVID-19
A recent study published in the journal Morbidity and Mortality Weekly Report revealed that COVID-19 hits some people harder than others. For instance, some people experience only mild symptoms, while others are hospitalized and require ventilation. The findings showed that rates of hospitalizations were six times higher and rates of death were 12 times higher among COVID-19 patients with underlying conditions than patients without underlying conditions.
Patients who are admitted to hospitals may suffer from breathing difficulties that necessitate admission to the intensive care unit (ICU). According to The Conversation, a network of not-for-profit media outlets that publish news stories written by academics and researchers, in the most severe cases, patients are given extracorporeal membrane oxygenation. This is because their lungs have already failed and it’s not possible to deliver enough oxygen by a ventilator.
Another recent study found that 22% of the world’s population or 1 in 5 people had at least one underlying condition that put them at risk of developing severe COVID-19. The researchers analyzed several datasets to estimate the risk of severe disease. The data included information from 188 countries reported in a 2017 study that analyzed the global burden of diseases, injuries, and risk factors as well as information from a UN population estimate for 2020.
The team then grouped the underlying conditions that most affected the risk of severe COVID-19 into 11 categories using the guidelines from the World Health Organization and agencies in the UK and the US. The categories include cardiovascular disease, chronic kidney disease, chronic respiratory disease, chronic liver disease, diabetes, cancers with direct immunosuppression (suppression of the body's immune response due to the cancer), cancers without direct immunosuppression but with possible immunosuppression from treatment, HIV/AIDS, tuberculosis, chronic neurological disorders, and sickle cell disorders.
The findings also revealed that 1 in 25 people are at risk of severe COVID-19 and would require hospitalization if infected. According to Live Science, a science news website that features groundbreaking developments in science, space, technology, health, the environment, our culture and history, the risk is increased with age. The researchers reported that less than 1% of people younger than 20 and around 20% of those 70 and older would require hospitalization.
The good news is that scientists may have found a drug that can help in severe cases of COVID-19: a cheap, widely available steroid called dexamethasone.
Dexamethasone May Reduce COVID-19 Deaths
A recent breakthrough has made scientists excited—dexamethasone can potentially reduce the deaths of COVID-19. At first, the World Health Organization (WHO) advised against the use of steroids as a cure for COVID-19 infection because these can hinder the immune system's attempts to clear the virus from the body. But recent studies showed that dexamethasone may help ward off an overblown immune response known as a cytokine storm. A cytokine storm is a condition that can trigger acute respiratory distress syndrome (ARDS) when the virus reaches the lungs, causing fluid to build up in the air sacs of the lungs.
The findings are based on a large randomized controlled trial in the UK. According to Science Mag, an online site that features daily news articles, feature stories, reviews, and more in all disciplines of science, the study evaluated whether existing drugs can treat COVID-19. It was participated by 2,104 patients who were given a relatively low dose of 6 milligrams of dexamethasone for 10 days. The results showed that the steroid reduced deaths by one-third in patients who are using ventilators and by one-fifth in patients who are receiving supplemental oxygen in other ways.
Tedros Adhanom Ghebreyesus, director-general of the WHO, said that the results were impressive since it is the first drug that has clearly been proven to reduce mortality. “The results are pretty remarkable for severely ill patients. I can see ICU [intensive care unit] physicians being more likely to provide steroids in the critically ill who are mechanically ventilated and who are not improving from other interventions based on these results,” Nahid Bhadelia, a physician at Boston Medical Center, said.
But this isn’t the first time steroids have been used to cure diseases. Wei Shen Lim, a respiratory physician at Nottingham University Hospital, said that health professionals have already used steroids to treat viral pneumonias in the past, including those caused by the severe acute respiratory syndrome virus or H1N1 influenza. The drug has also been used for treating a wide variety of conditions, from psoriasis to rheumatoid arthritis, asthma, and some cancers, including leukemia.
Many scientists and health professionals are optimistic about steroids as a treatment for patients hospitalized with the most severe coronavirus infections. For one, a common steroid like dexamethasone is inexpensive and can be used to immediately save lives worldwide. "It is highly affordable, easy to make, can be scaled up quickly and only needs a small dosage," Nick Cammack of Wellcome, a British charity that supports science research, who was not involved in the study, added.
Scott Gottlieb, a former commissioner of the US Food and Drug Administration, said that the findings of the study still need to be validated. However, the drug could be extremely beneficial. Peter Horby, a professor in the Nuffield Department of Medicine at the University of Oxford, also said that dexamethasone should now become the standard treatment for patients with COVID-19 who need oxygen.
"It will be great news if dexamethasone, a cheap steroid, really does cut deaths by [one-third] in ventilated patients with COVID19, but after all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper," Atul Gawande, a surgeon, writer and public health researcher, said.
While the drug can definitely reduce COVID-19 mortality, experts say that it doesn’t solve the problem of COVID-19 patients potentially overwhelming a health care system because the drug can’t prevent the illness in the first place. “The real game-changer will be a drug that prevents people going from mild symptoms to a severe state, and a vaccine,” Devi Sridhar, an expert on global public health at the University of Edinburgh, said.