6 ms·

Where does dexamethasone fit in? Does it target part of the viral lifecycle or simply treat the effects?

acqq 6y ago
https://www.nature.com/articles/d41586-020-01824-5 https://www.nature.com/articles/d41586-020-01824-5 "The [steroid] drugs suppress the immune system, which could provide some relief for patients whose lungs are ravaged by an overactive immune response that sometimes manifests in severe cases of COVID-19. But such patients may still need a fully functioning immune system to fend off the virus itself." "no effect on mild infections" Basically if taken too early it does the wrong action, but it helps some of those already on oxygen. And it's cheap.
- Gibbon1 6y ago
  It's like what a friends brother (cardiac surgeon) said about clot busting drugs. That knife is sharp on both sides.
CyanLite2 6y ago
The first week or two, your immune system ramps up to fight the infection. During this battle, the collateral damage is what gives you symptoms like joint pain, runny nose, sore throat, etc. Near the 3rd week of infection, 85% of patients are recovering and feeling better because their immune response has naturally turned itself off. For some reason, this doesn't happen in about 15% of patients. We call this a 'cytokine storm'. This is where your immune system has gone nuclear and is still destroying anything and everything it sees, including normal healthy tissue. This can ultimately lead to multi-organ failure and death if it can't be stopped. Dexamethasone tamps down that immune response, allowing your body to heal. Obviously it has to be timed right. It doesn't do anything to the virus, only your immune response.
- __blockcipher__ 6y ago
  To connects the dots, pathological cytokine release syndrome is highly likely to be causing the (extremely rare) instances of stroke in non-elderly COVID-19 patients, organ damage, etc. I get incredibly annoyed when people act like (a) these strokes / organ damage are happening in significant quantities and (b) that it’s unique to SARS-2
  - dreamcompiler 6y ago
    Are you saying cytokine storms are the only mechanism causing thrombosis in COVID-19? I was under the impression that SARS-2 itself also had the ability to cause clots. Is that incorrect?
  - acqq 6y ago
    > extremely rare Is it? From all lab confirmed cases in USA until end of May, almost every 200th in age group 20-29 was admitted to ICU. Almost every 100th in age group 30-39. (1) Admitted to ICU means "probably considered intubation (or received it immediately)" Which is very, very unpleasant thing: https://en.wikipedia.org/wiki/Tracheal_intubation https://en.wikipedia.org/wiki/Tracheal_intubation Is that "extremely rare" to you? (In the USA there are 7.2% inhabitants aged 20-29, 6.7% aged 30-39. Even if the number of "unconfirmed but infected" is 10 times higher, that still gives around 24000 people in the USA aged 20-39 needing ICU, or 8 times more than died on 9/11. And those are just provably "non-elderly". All those 40 and older would need even much more ICU beds. I hope it's obvious that if there are not enough ICU beds much more people would die.) 1) It can be calculated from https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm For 20-29 182469 confirmed, 864 ICU, for 30-39 214849 confirmed, 1879 ICU. (Additionally, males were admitted to ICU almost twice as much as females)
    - gridlockd 6y ago
      The comment said "(extremely rare) instances of stroke", not ICU admissions.
      - acqq 6y ago
        This is a thread about dexamethasone, not "strokes", and we also know that from 8 patients that are intubated the treatment with dexamethasone saves one, compared to those intubated never treated with dexamethasone. We also know that dexamethasone is at best not helping if given outside of ICU. Once again, dexamethasone has to be given to 8 intubated people to save one, and that's considered the drug with the most visible effect in fighting Covid-19 up to now -- i.e. the most successful drug up to now! You can imagine how little effect other drugs produced in the verified trials. In that context, talking about ICU and intubated is exactly on topic, hand-waving "strokes" isn't. Moreover, the comment actually said "strokes / organ damage" not "strokes." Nevertheless, the main effect of dexamethasone is on the intubated patients.

acqq 6y ago

https://www.nature.com/articles/d41586-020-01824-5 https://www.nature.com/articles/d41586-020-01824-5 "The [steroid] drugs suppress the immune system, which could provide some relief for patients whose lungs are ravaged by an overactive immune response that sometimes manifests in severe cases of COVID-19. But such patients may still need a fully functioning immune system to fend off the virus itself." "no effect on mild infections" Basically if taken too early it does the wrong action, but it helps some of those already on oxygen. And it's cheap.

Gibbon1 6y ago
It's like what a friends brother (cardiac surgeon) said about clot busting drugs. That knife is sharp on both sides.

CyanLite2 6y ago

The first week or two, your immune system ramps up to fight the infection. During this battle, the collateral damage is what gives you symptoms like joint pain, runny nose, sore throat, etc. Near the 3rd week of infection, 85% of patients are recovering and feeling better because their immune response has naturally turned itself off. For some reason, this doesn't happen in about 15% of patients. We call this a 'cytokine storm'. This is where your immune system has gone nuclear and is still destroying anything and everything it sees, including normal healthy tissue. This can ultimately lead to multi-organ failure and death if it can't be stopped. Dexamethasone tamps down that immune response, allowing your body to heal. Obviously it has to be timed right. It doesn't do anything to the virus, only your immune response.

__blockcipher__ 6y ago
To connects the dots, pathological cytokine release syndrome is highly likely to be causing the (extremely rare) instances of stroke in non-elderly COVID-19 patients, organ damage, etc. I get incredibly annoyed when people act like (a) these strokes / organ damage are happening in significant quantities and (b) that it’s unique to SARS-2
- dreamcompiler 6y ago
  Are you saying cytokine storms are the only mechanism causing thrombosis in COVID-19? I was under the impression that SARS-2 itself also had the ability to cause clots. Is that incorrect?
- acqq 6y ago
  > extremely rare Is it? From all lab confirmed cases in USA until end of May, almost every 200th in age group 20-29 was admitted to ICU. Almost every 100th in age group 30-39. (1) Admitted to ICU means "probably considered intubation (or received it immediately)" Which is very, very unpleasant thing: https://en.wikipedia.org/wiki/Tracheal_intubation https://en.wikipedia.org/wiki/Tracheal_intubation Is that "extremely rare" to you? (In the USA there are 7.2% inhabitants aged 20-29, 6.7% aged 30-39. Even if the number of "unconfirmed but infected" is 10 times higher, that still gives around 24000 people in the USA aged 20-39 needing ICU, or 8 times more than died on 9/11. And those are just provably "non-elderly". All those 40 and older would need even much more ICU beds. I hope it's obvious that if there are not enough ICU beds much more people would die.) 1) It can be calculated from https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm For 20-29 182469 confirmed, 864 ICU, for 30-39 214849 confirmed, 1879 ICU. (Additionally, males were admitted to ICU almost twice as much as females)
  - gridlockd 6y ago
    The comment said "(extremely rare) instances of stroke", not ICU admissions.
    - acqq 6y ago
      This is a thread about dexamethasone, not "strokes", and we also know that from 8 patients that are intubated the treatment with dexamethasone saves one, compared to those intubated never treated with dexamethasone. We also know that dexamethasone is at best not helping if given outside of ICU. Once again, dexamethasone has to be given to 8 intubated people to save one, and that's considered the drug with the most visible effect in fighting Covid-19 up to now -- i.e. the most successful drug up to now! You can imagine how little effect other drugs produced in the verified trials. In that context, talking about ICU and intubated is exactly on topic, hand-waving "strokes" isn't. Moreover, the comment actually said "strokes / organ damage" not "strokes." Nevertheless, the main effect of dexamethasone is on the intubated patients.