Keep Hope Alive
MEDICAL AND MENTAL HEALTH UPDATE
Today we’ll talk about some COVID-19 news and STEROIDS.
Last summer I had a wicked case of poison ivy, and as a Hail Mary I prescribed myself a course of oral steroids. It did the trick, but BOY, was I wired!! I was up all night mopping my kitchen floor and organizing my sock drawer.
My itchy rash was gone after a few days, but so was my family’s faith in my mental sanity.
Indeed doctors commonly prescribe oral steroids for acute inflammatory conditions—from asthma flare-ups to poison ivy—basically to knock back our body’s immune response when it overreacts.
But steroids also have immediate side effects like hyperactivity, insomnia, and agitation. (You really ought to see my color-coded sock drawer.)
And they can have long-term effects like promoting diabetes, obesity, and cataracts if used at high doses and for longer periods of time (like weeks to months). So even though steroids are cheap, widely available, and help with inflammation, we prescribe them judiciously.
As you may know, for some people with COVID-19, it is the body’s own immune response that can cause the most damage. The coronavirus itself can directly damage the lungs and other organs, but sometimes our own bodies go into overdrive trying to fight it.
Indeed we have learned over the past few months that for some patients, COVID-19 triggers a hyper-active immune response that we call a “cytokine storm” that in and of itself is dangerous. Cytokines are proteins made by the immune system to help fight infection, but they can pose danger when the body releases too many into the blood too quickly. Sometimes, a cytokine storm may be severe or life threatening and lead to multiple organ failure.
A drug called Dexamethasone—a commonly used steroid for inflammation in different organ systems—yesterday was announced to show promise in treating our sickest COVID-19 patients.
It is the first drug to be shown to reduce deaths among people requiring oxygen and/or on ventilators in the hospital. The press release was announced yesterday and offers hope for saving lives.
So what does this mean for you? On a practical level, NOT MUCH.
Because there is no current evidence that Dexamethasone (or any steroid for that matter) helps prevent COVID-19 or treat patients with mild to moderate COVID-19 symptoms, there is nothing for you to do with this information—except to NOT get sick in the first place. And perhaps to not read the news so often.
But for our mental health, it’s further evidence that hope is alive. We have learned a great deal about this virus since its emergence in a wet market in China six months ago, and this study is yet another example of science working hard for us.
So we’re back to the basics, folks: washing hands, wearing a mask, distancing, and calling your pals on Zoom.
And if you saw this news story and were planning to call your doctor for a Dexamethasone prescription “just in case,” hold that thought!
And if you currently have a stash of Dexamethasone in your medicine cabinet and are itching (pun intended) to slug it back tonight “just in case,” be prepared not to sleep and to channel your inner Mari Kondo. And STILL practice all of the regular rules of COVID risk mitigation.
To hear about decision-making during the pandemic, particularly for families, here is my live interview from earlier today with NYC pediatrician Kelly Fradin, MD, in case you missed it.
Also, a few more upcoming events on COVID-19 news and guidance:
Join me and BBC’s Katty Kay on INSTAGRAM LIVE: Friday, June 19 at 12 noon ET
Join me and my colleague Dr. Clay Ackerly on FACEBOOK LIVE: Monday, June 22 at 8 pm ET
We will try to cover many of the questions that are coming in! Meanwhile, I will check in tomorrow. Until then, be well.