5 ms·

As far as I can tell it is extremely common to give steroids (and dexamethasone is among the default choices) in those cases already. I can't quite tell but it

by Tenoke 6y ago

As far as I can tell it is extremely common to give steroids (and dexamethasone is among the default choices) in those cases already. I can't quite tell but it doesn't sounds like it was compared to other steroids so I would hold judgement before we hear more. At any rate, hype over initial briefly reported findings is rarely useful. Edit: I was checking how common was it to give corticosteroids before the trial (pretty common as I suspected) but it's almost amusing that the WHO was recommending not to use it[0]. I wonder if this will be yet another miss for them. 0. https://www.contagionlive.com/news/is-there-any-reason-to-use-corticosteroids-in-coronavirus-treatment https://www.contagionlive.com/news/is-there-any-reason-to-us...

newacct583 6y ago
> it's almost amusing that the WHO was recommending not to use it Why is everyone picking on the WHO constantly? It's like it's a reflex at this point, as far as I can tell designed to shift "blame" off of... other parties who got lots of stuff wrong. In this case you're spinning really hard. The WHO guidance you're quoting, quoted in the article you link, was really mild: "“Given lack of effectiveness and possible harm, routine corticosteroids should be avoided unless they are indicated for another reason,” WHO authors wrote." Is that really unreasonable? In January they didn't have evidence of effectiveness, and drugs have side effects. Sounds like correct reasoning to me. Do you actually disagree? And in any case that quote is from a document in January, the current version (from March, also linked from the article) is here, and makes a bunch of complicated points about steroid use, citing contemporary research which was inconsistent about effect: https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf https://www.who.int/docs/default-source/coronaviruse/clinica...
- Tenoke 6y ago
  >Why is everyone picking on the WHO constantly? Because they've made multiple avoidable bad calls. >In this case you're spinning really hard. 'WHO was recommending not to use it' is a quick summary of statements like "routine corticosteroids should be avoided unless they are indicated for another reason,”. How is this not a recommendation against it and 'spinning really hard'? At any rate, I didn't dig into that part much (WHO recommendations are much much less important than medical trials), I just found it interesting enough to mention.
  - elcomet 6y ago
    > Because they've made multiple avoidable bad calls. Could you say more about this ?
    - newacct583 6y ago
      It all comes down to politics. Some people want covid to be the "fault" of someone else. The WHO is a good target, because they did indeed have some really bad communication work in the early days of the infection: 1. They stated, more assertively than they probably should, that they believed the virus was contained in Wuhan and not spreading in the community (that's the "no human-to-human transmission" quote that gets taken out of context). 2. Their statements that people should not try to acquire PPE masks were poorly phrased and seemed to imply that masks don't work (obviously they do). 3. There was that one incident, not related to the outbreak really, where a WHO official hung up the phone rather than take questions about Taiwan (for geopolitical reasons, Taiwan is not a member of the WHO). This led to a thousand "WHO is in China's pocket" takes. I mean, just in general the WHO has not comported themselves well here. There's been plenty of routine incompetence to complain about, and frankly they haven't really don't much to help. But the political vitriol you hear about them is 100% blame shifting. Most of the people yelling loudest about the WHO failing to give good advice about this dangerous disease tend to argue in other contexts that the disease isn't so dangerous, we shouldn't be forced to wear masks, the economic damage is too great, liberty is at stake, etc...
      - EasyTiger_ 6y ago
        Honestly I don't think it's true to say it's about politics. The WHO tweet from 14 January was very misleading and no doubt caused things to get worse: > Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China🇨🇳.
        ceejayoz 6y ago
        As far as the WHO was aware, and at the time of posting, that tweet was entirely accurate. They're not the CIA. They don't have an adversarial spy arm. They rely enormously on member nations' self-reporting, and they rely on those reports being honest. That clear evidence came later on doesn't mean the WHO had clear evidence at the time. (And, as the saying goes, absence of evidence isn't evidence of absence. Nothing in that tweet says "it can't spread"; it says "we can't solidly confirm it has been yet".)
- nogabebop23 6y ago
  >> Why is everyone picking on the WHO constantly? Because they are a political organization first and a medical organization second, and not a particularly effective political group either, combining the worst of bureaucracy with questionable alliance and motives. In short, they're ineffective and untrustworthy.
  - deleted 6y ago
    [deleted]
  - fredoliveira 6y ago
    > Because they are a political organization first and a medical organization second, and not a particularly effective political group either, combining the worst of bureaucracy with questionable alliance and motives. Please expand with some sources if you can, because I keep hearing this as a particular political talking point, but have never seen any real backing to these claims.
    - drocer88 6y ago
      https://www.theatlantic.com/politics/archive/2020/04/world-health-organization-blame-pandemic-coronavirus/609820/ https://www.theatlantic.com/politics/archive/2020/04/world-h...
      - snapetom 6y ago
        Don't forget the Bruce Alyward incident.
- deleted 6y ago
  [deleted]
hannob 6y ago
> Edit: I was checking how common was it to give corticosteroids before the trial (pretty common as I suspected) but it's almost amusing that the WHO was recommending not to use it[0]. I wonder if this will be yet another miss for them. So what you're saying here is that you blame the WHO for not recommending something before there was evidence for it, because now there is a study indicating effectiveness and they should have known that before the study was performed?
- Tenoke 6y ago
  No, what I was saying is "I wonder if this will be yet another miss for them." >they should have known that before the study was performed I don't even think that's necessarily true given how common the use of corticosteroids both with COVID and in comparable situations. It was just something that amused me and now I regret including it in my comment as it seems to distract from the main bit of information I was conveying.
  - danans 6y ago
    From your link: "“Corticosteroid treatment should not be used for the treatment of COVID-19 -induced lung injury or shock outside of a clinical trial,” the commentary concludes." So they're saying: don't use it until there is sufficient evidence that it works. That's not a "miss for them". It's a prudent and conservative recommendation, which is exactly the kind of recommendation they should be making.
ashtonkem 6y ago
Steroids are extremely double edged. If it actually is a miracle cure, it’s definitely going to be something that should be administered by doctors, not random patients.
- abraxas 6y ago
  Yeah, Donald Trump is probably already spiking himself with it...

by Tenoke 6y ago

newacct583 6y ago

> it's almost amusing that the WHO was recommending not to use it Why is everyone picking on the WHO constantly? It's like it's a reflex at this point, as far as I can tell designed to shift "blame" off of... other parties who got lots of stuff wrong. In this case you're spinning really hard. The WHO guidance you're quoting, quoted in the article you link, was really mild: "“Given lack of effectiveness and possible harm, routine corticosteroids should be avoided unless they are indicated for another reason,” WHO authors wrote." Is that really unreasonable? In January they didn't have evidence of effectiveness, and drugs have side effects. Sounds like correct reasoning to me. Do you actually disagree? And in any case that quote is from a document in January, the current version (from March, also linked from the article) is here, and makes a bunch of complicated points about steroid use, citing contemporary research which was inconsistent about effect: https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf https://www.who.int/docs/default-source/coronaviruse/clinica...

Tenoke 6y ago
>Why is everyone picking on the WHO constantly? Because they've made multiple avoidable bad calls. >In this case you're spinning really hard. 'WHO was recommending not to use it' is a quick summary of statements like "routine corticosteroids should be avoided unless they are indicated for another reason,”. How is this not a recommendation against it and 'spinning really hard'? At any rate, I didn't dig into that part much (WHO recommendations are much much less important than medical trials), I just found it interesting enough to mention.
- elcomet 6y ago
  > Because they've made multiple avoidable bad calls. Could you say more about this ?
  - newacct583 6y ago
    It all comes down to politics. Some people want covid to be the "fault" of someone else. The WHO is a good target, because they did indeed have some really bad communication work in the early days of the infection: 1. They stated, more assertively than they probably should, that they believed the virus was contained in Wuhan and not spreading in the community (that's the "no human-to-human transmission" quote that gets taken out of context). 2. Their statements that people should not try to acquire PPE masks were poorly phrased and seemed to imply that masks don't work (obviously they do). 3. There was that one incident, not related to the outbreak really, where a WHO official hung up the phone rather than take questions about Taiwan (for geopolitical reasons, Taiwan is not a member of the WHO). This led to a thousand "WHO is in China's pocket" takes. I mean, just in general the WHO has not comported themselves well here. There's been plenty of routine incompetence to complain about, and frankly they haven't really don't much to help. But the political vitriol you hear about them is 100% blame shifting. Most of the people yelling loudest about the WHO failing to give good advice about this dangerous disease tend to argue in other contexts that the disease isn't so dangerous, we shouldn't be forced to wear masks, the economic damage is too great, liberty is at stake, etc...
    - EasyTiger_ 6y ago
      Honestly I don't think it's true to say it's about politics. The WHO tweet from 14 January was very misleading and no doubt caused things to get worse: > Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China🇨🇳.
      - ceejayoz 6y ago
        As far as the WHO was aware, and at the time of posting, that tweet was entirely accurate. They're not the CIA. They don't have an adversarial spy arm. They rely enormously on member nations' self-reporting, and they rely on those reports being honest. That clear evidence came later on doesn't mean the WHO had clear evidence at the time. (And, as the saying goes, absence of evidence isn't evidence of absence. Nothing in that tweet says "it can't spread"; it says "we can't solidly confirm it has been yet".)
nogabebop23 6y ago
>> Why is everyone picking on the WHO constantly? Because they are a political organization first and a medical organization second, and not a particularly effective political group either, combining the worst of bureaucracy with questionable alliance and motives. In short, they're ineffective and untrustworthy.
- deleted 6y ago
  [deleted]
- fredoliveira 6y ago
  > Because they are a political organization first and a medical organization second, and not a particularly effective political group either, combining the worst of bureaucracy with questionable alliance and motives. Please expand with some sources if you can, because I keep hearing this as a particular political talking point, but have never seen any real backing to these claims.
  - drocer88 6y ago
    https://www.theatlantic.com/politics/archive/2020/04/world-health-organization-blame-pandemic-coronavirus/609820/ https://www.theatlantic.com/politics/archive/2020/04/world-h...
    - snapetom 6y ago
      Don't forget the Bruce Alyward incident.
deleted 6y ago
[deleted]

hannob 6y ago

> Edit: I was checking how common was it to give corticosteroids before the trial (pretty common as I suspected) but it's almost amusing that the WHO was recommending not to use it[0]. I wonder if this will be yet another miss for them. So what you're saying here is that you blame the WHO for not recommending something before there was evidence for it, because now there is a study indicating effectiveness and they should have known that before the study was performed?

Tenoke 6y ago
No, what I was saying is "I wonder if this will be yet another miss for them." >they should have known that before the study was performed I don't even think that's necessarily true given how common the use of corticosteroids both with COVID and in comparable situations. It was just something that amused me and now I regret including it in my comment as it seems to distract from the main bit of information I was conveying.
- danans 6y ago
  From your link: "“Corticosteroid treatment should not be used for the treatment of COVID-19 -induced lung injury or shock outside of a clinical trial,” the commentary concludes." So they're saying: don't use it until there is sufficient evidence that it works. That's not a "miss for them". It's a prudent and conservative recommendation, which is exactly the kind of recommendation they should be making.

ashtonkem 6y ago

Steroids are extremely double edged. If it actually is a miracle cure, it’s definitely going to be something that should be administered by doctors, not random patients.

abraxas 6y ago
Yeah, Donald Trump is probably already spiking himself with it...