Common Drug Reduces Coronavirus Deaths, Scientists Report

Common Drug Reduces Coronavirus Deaths, Scientists Report

A steroid, dexamethasone, is the first drug shown to help save severely ill coronavirus patients, according to scientists in Britain.

In an unexpected sign of hope amid the expanding pandemic, scientists at the University of Oxford said on Tuesday that an inexpensive and commonly available drug reduced deaths in patients with severe Covid-19, the illness caused by the coronavirus.

If the finding is borne out, the drug, a steroid called dexamethasone, would be the first treatment shown to reduce mortality in severely ill patients. Had doctors been using the drug to treat the sickest Covid-19 patients in Britain from the beginning of the pandemic, up to 5,000 deaths could have been prevented, the researchers estimated.

In severe cases, the virus directly attacks cells lining the patient’s airways and lungs. But the infection also can prompt an overwhelming immune reaction that is just as harmful. Three-quarters of hospitalized Covid-19 patients receive some form of oxygen.

The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

Until now, hospitals worldwide have had nothing to offer these desperate, dying patients, and the prospect of a lifesaving treatment close at hand — in almost every pharmacy — was met with something like elation by doctors.

“Assuming that when it goes through peer review it stands — and these are well-established researchers — it’s a huge breakthrough, a major breakthrough,” said Dr. Sam Parnia, a pulmonologist and associate professor of medicine at the Grossman School of Medicine at New York University. “I cannot emphasize how important this could be.”

But the report also comes quick on the heels of a series of blunders and retractions in the scientific literature, as scientists rush to publish research about the coronavirus. While hospitals in the United Kingdom were able to begin treating severely ill Covid-19 patients with dexamethasone on Tuesday, many experts in the United States demanded to see the data and the study itself, which have not yet been peer reviewed or published.

“It will be great news if dexamethasone, a cheap steroid, really does cut deaths by ⅓ in ventilated patients with COVID19,” Dr. Atul Gawande, the surgeon and author, wrote on Twitter, “but after all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper.”

There is no vaccine against the coronavirus, and the only treatment known to be effective, an antiviral drug called remdesivir, only shortens the time to recovery.

“Dexamethasone is the first drug to be shown to improve survival in Covid-19,” one of the trial’s chief investigators, Peter Horby, a professor of emerging infectious diseases at the University of Oxford, said in a statement. “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment.”

Dr. Horby added that dexamethasone should now become the “standard of care in these patients,” noting that it was inexpensive, was widely available and could be used immediately.

The drug was not studied in patients outside of the hospital, however, and was not beneficial to patients who were not on respiratory support.

Many steroids reduce inflammation in the body, and dexamethasone is among those that doctors have been trying in Covid-19 patients overwhelmed by so-called cytokine storms — uncontrolled immune responses so powerful they kill some patients.

Many doctors had feared the drug might actually exacerbate the infection by preventing the immune system from attacking the virus. Though Dr. Parnia had treated patients with steroids and seen improvement, “there had not been such a large trial comparing no steroids with steroids.”

Even without published results, Matt Hancock, Britain’s health secretary, said doctors in the country’s National Health Service were able to begin using the steroid as the standard treatment for hospitalized coronavirus patients on Tuesday afternoon. The drug costs less than $1 per day of treatment on a single patient.

The government started stockpiling dexamethasone several months ago based on signs that it could help patients, Mr. Hancock said, and now has 200,000 doses on hand.

The trial led by Dr. Horby was a randomized, controlled clinical trial, the gold standard for medical research. About 2,100 severely ill Covid-19 patients were given low doses of dexamethasone, orally or intravenously, once a day. Their outcomes were compared with 4,300 patients who had received the usual care.

The trial was stopped early, because the investigators felt that the benefit was obvious. But they said that the drug did not help moderately ill patients who were not receiving oxygen.

Corticosteroids like dexamethasone were used during outbreaks of SARS and MERS, which were also caused by coronaviruses. But those drugs were associated with worse outcomes, another reason for hesitation. An earlier, much smaller trial of Covid-19 patients with acute respiratory distress in Spain found that dexamethasone treatment may reduce the amount of time patients are on ventilators and may reduce deaths.

“What this is effectively doing is tamping down inflammatory responses in patients,” Stuart Neil, a professor of virology at King’s College London, said in an interview. “It’s almost certain this is affecting the body’s response against the virus, rather than inhibiting the virus itself.”

Dr. Stephen Griffin, an associate professor in virology at the University of Leeds, said that it would be important to study the use of dexamethasone in combination with antiviral treatments like remdesivir.

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SOUTH AFRICA: Report Clearing Soldiers in South African Man's Death Sparks Anger

FILE - A member of the South African National Defense Force looks on during a patrol in an attempt to enforce a nationwide lockdown, aimed at limiting the spread of the coronavirus disease, in Alexandra township, South Africa, March 28, 2020.

By VOA News

JOHANNESBURG - The legal team representing the family of a South African man allegedly beaten to death by soldiers enforcing COVID-19 lockdown restrictions reacted with outrage to a leaked army report that said they are not liable for his death.

Forty-year-old Collins Khosa died April 10 in this city's poor township of Alexandra, following an altercation in his yard with security forces. They had accused him of drinking alcohol in public, an offense under emergency regulations put in place to prevent the spread of coronavirus.

Witnesses say soldiers and police officers strangled Khosa, slammed his head against a cement wall and a steel gate, and hit him with the butt of a rifle. Afterward, Khosa couldn't walk or talk. He began vomiting. A few hours later, he was dead.

A postmortem described the cause of death as "blunt force head injury."

FILE - A member of the South African National Defense Force keeps watch as shoppers leave a grocery store, after being ordered by law enforcement during a lockdown to contain the coronavirus disease, in Alexandra, South Africa, March 27, 2020.

But VOA has seen a report by the South African National Defense Force, or SANDF, that concludes "the injuries on the body of Mr. Khosa cannot be linked with the cause of death."

The military board of inquiry report further states: "The board concluded that the death of Mr. Khosa was not caused by the SANDF members" nor police officers.

Wikus Steyl, an attorney on the legal team representing Khosa's family, called the report "rubbish."

"We do not accept it. The evidence completely contradicts this report," Steyl told South Africa's News.24.

The news outlet reported that police still are investigating.

Defense minister's response

During a media briefing Thursday, Defense Minister Nosiviwe Mapisa-Nqakula said the only official ruling on the matter was a judge's decision to suspend the accused soldiers.

"That has been done; it is a correct decision," she said, declining to comment on "whether this was a murder case or not" until "all investigations have been concluded."

Military spokesman Siphiwe Dlamini said he was not aware of the report.

Dlamini declined to explain to VOA why a military inquiry had cleared the soldiers of wrongdoing if witnesses had not been interviewed and the investigation was incomplete.

The military board also found that Khosa and his brother-in-law were responsible for the altercation with security forces, as the two had been "provocative" and had "undermined" two female soldiers.

The report says the soldiers merely "pushed" and slapped Khosa when he refused to comply with their orders.

Due process

Pikkie Greeff heads the South African National Defense Union, which represents thousands of soldiers. Also a lawyer, Greeff said the army command hasn't followed due process.

"There should be a formal board of inquiry in terms of the Defense Act, which should make findings and recommendations, (which) should include that people be charged in a military court," Greeff said. In the case of a murder charge, "then the military court will not have jurisdiction. Then that will be trialed in a criminal, civilian court."

Khosa's widow, Nomsa, said she doesn't understand all the legal procedures involved in the case. But she no longer trusts the army and police to responsibly enforce COVID-19 regulations.

"Collins is gone; he's not coming back," she said. As for the soldiers allegedly involved in assaulting him, "we would like to see them behind bars. Behind bars for life."

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How long can the coronavirus survive on surfaces?

How long can the coronavirus survive on surfaces?

     Several studies have attempted to estimate how long the COVID-19 virus remained infectious on inert surfaces, but the figures are more complex to understand than they first appear.

     Is there a risk of becoming infected by touching surfaces with hands that are or have been in contact with Covid-19 patients?

     This is possible, based on studies that have attempted to determine the duration of "survival" of Sars CoV-2 on inanimate surfaces.

     But even if the risk exists, these durations should not be taken literally and should be put into perspective with the way researchers are trying to measure them.

How long can the virus survive on surfaces and objects?

     It should be made clear at the outset that it is inappropriate to speak of the "survival" of the virus since the virus is not really "alive".

     "Rather, we are talking about maintaining infectivity, how long it remains infectious," says Astrid Vabret, head of the virology department at Caen University Hospital and coronavirus specialist.

     The stability of the SARS-CoV-2 virus (responsible for Covid-19 disease) depends on the type of surface considered, according to the two main scientific studies published to date on the subject.

     The first, published on February 6 in the Journal of Hospital Infection, tested the virus on eight different surfaces and compared it to other coronaviruses (such as those responsible for SARS 2003 or MERS 2012).

     Researchers have found viable strains of the virus up to five days after spraying steel, glass, or ceramics

     Results show that the virus can persist on these surfaces for between two hours and six days (less if the ambient temperature approaches 30°C).

     Researchers found viable strains of the virus up to five days after spraying steel, glass or ceramics, without being able to measure how much was found on each of these surfaces.

     The results were quite variable (two to six days) for plastic, while on latex and aluminum, a few hours were sufficient to kill all strains.

     A second study, published in the New England Journal of Medicine on March 17, tested the resistance of the virus on other materials, such as cardboard and copper, or in the air by aerosol spraying.

     The results show shorter persistence times than those published in previous studies, ranging from three hours (aerosols) to a maximum of three days (steel, plastic), with intermediate values (twenty-four hours for cardboard) for the same amount of virus sprayed.

     But the two studies agree on one point: plastic and steel are the surfaces where the virus has been stable for the longest time.

     A third publication, from the US Centers for Disease Control and Prevention, recently reported that the genetic material of the virus had been detected in the infected passenger cabins of the Diamond-Princess ship, where 3,700 people were quarantined in February until 17 days after they left.

     But it is not possible to infer that transmission from these contaminated surfaces occurred, the authors of the study said, calling for further investigation.

     As the material conditions (e.g. temperature, humidity) are not known, it is relatively difficult to assess the validity of such a duration, and any conclusion would be imprudent and hasty at best, or at worst totally false.


     "We can't even be sure that the virus we find can reinfect. It's far too vague," says Bruno Grandbastien, medical officer of health and president of the French Society of Hospital Hygiene.

     "You mustn't cling to a specific number, because it doesn't correspond to anything in life."

     What, then, should we think of the durations evoked in these two studies? These studies are important to give an idea, an order of magnitude of the time during which the virus remains infectious," replies Astrid Vabret.

     We shouldn't cling to a precise figure, because it doesn't correspond to anything in the living world.

     The interest of these studies is that the way of counting is the same throughout the duration of the experiment, the comparison between two surfaces remains valid. »

     "The doses are rather representative of a real situation since it is estimated that this order of magnitude will be found in nasal swabs," says Dr. Grandbastien.

     But the doctor points out that the duration of persistence in aerosols is probably longer than in reality. "We don't find aerosols as fine as that in reality, because this virus is transmitted via large droplets which, by gravity, will fall back more quickly. »

     In summary, depending on the surface, the SARS-CoV-2 virus can persist for approximately :

What are the risks of contamination?

     This is the central question, but it is also a question that is very difficult to answer. In their study, the researchers make it clear that the transmissibility of the virus to people who come into contact with infected surfaces has not been demonstrated due to a lack of data.

"The real problem is that we don't know the infective dose."


     The real problem is that we don't know the infecting dose," says virologist Astrid Vabret, "which is the amount of virus sufficient to generate an infection.

     But this changes the way you interpret how long the virus persists: if the infecting dose is low, it would mean that a surface remains infectious for much longer than if the infecting dose is high.

     "The transmission of a virus is a complex phenomenon that is very difficult to quantify. We don't know how many viruses it takes to generate an infection in contact with the mucous membrane.

     It's probably not the same for different people. You have an enormous diversity of everything: local defenses vary depending on the individual, as does the state of their mucous membranes. »

     A point confirmed by Bruno Grandbastien. "We have zero data on this, we just know that there is a gradient: the higher the viral load, the greater the risk of infection. But it's highly variable depending on the virus. »

Do we have to clean all the products we touch?

     This is a question many people ask themselves after receiving WhatsApp or Facebook messages recommending to "leave groceries in your car for 1.5 hours" and then "pass everything that may have been touched by others with diluted bleach".

     This recommendation is anxiety-provoking and excessive, according to Professor Vabret: "If you wash your hands regularly, and don't put them to your mouth, you eliminate what you could have picked up. »

     "We are not in a situation where we are asked to disinfect the food we eat, there is no risk of becoming infected through ingestion".

     This information is not at all scientifically supported," says Bruno Grandbastien. We are not in a situation where we are asked to disinfect the food we eat, there is no risk of becoming infected through ingestion.

     On the other hand, we can recommend washing both the products we have touched and our hands, which are basic hygiene rules that should be applied outside of any epidemic. »

     Leaving your shopping for an hour and a half in the car is therefore useless given the persistence of the virus on cardboard and plastic surfaces: it is above all recommended to wash your hands after shopping, as they are the main vector of transmission.

     Cleaning or even disinfecting work surfaces that we often come into contact with do not seem unreasonable either.


     For the most worried, even if the risk is "absolutely minimal" according to Anne Goffard, a virologist at the Lille University Hospital, interviewed by France Culture, cleaning cardboard or plastic packaging brought in from outside contributes theoretically to further minimize the risk; remembering all the same that the capacity of the virus present on surfaces to infect the organism has not been established at all.

     As for textiles, there is no scientific data on the ability of the virus to resist it. The virus is easily destroyed at temperatures as low as 30°C, according to Dr. Georgine Nanos, interviewed by HuffPost. It is, therefore, unnecessary to opt for washing programs at 60°C.

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