Some people with a Covid-19 infection show no symptoms at all and after the disease runs its course, they recover and can no longer infect others. Some people do show symptoms, feel ill for weeks or months, and eventually recover. Other people become seriously ill, require hospitalization, and many of them die. Until recently, the prognosis for patients with serious disease, on mechanical ventilation or supplementary oxygen, has not been good.

Treatments that were promoted early on, such as hydroxychloroquine and convalescent plasma have not panned out. However, several clinical trials have shown a clear reduction in mortality from the administration of corticosteroids to patients with severe illness.

Corticosteroids are cheap and widely available, which is good. The downside of corticosteroid use is their unwanted side effects, including suppression of the patient’s immune system. It is often not the SARS-Cov-2 virus that causes severe disease and death, but rather an overreaction by the patient’s immune system (a cytokine storm). The goal of corticosteroid therapy is to suppress the overreacting immune system enough, but not too much. You still want the immune system to clear the infection, but not kill the patient in the process.

Thirteen trials of corticosteroids as treatments of severe Covid-19 disease were discovered by a search of public databases. Of these, seven were selected for a meta-analysis by the WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. The primary outcome of this meta-analysis was all-cause mortality. How did the percentage of deaths in the treated patients compare with the percentage of deaths among controls who received standard care? That was the question these studies were designed to answer.

A total of 1703 patients were included in the analysis. 678 patients were selected at random to receive one of three different corticosteroids. The other 1025 patients received either standard care or a placebo. Of the 678 patients who received a corticosteroid treatment, 222 died (33.7% mortality). In the control group, 425 of the 1025 patients died (41.5% mortality). The treated group had a 7.8% advantage in survival.

33.7% mortality is horrific. It means that more than one in three patients with severe disease died, in spite of being treated with a corticosteroid. However, it is significantly better than the alternative: 41.5% mortality for standard care. It seems clear that corticosteroid therapy should be applied to patients with severe Covid-19 disease, to improve chances of survival. However, this is no miracle therapy. A lot of people are still going to die, despite being treated. The search goes on for better therapies that will carry us over to the time when an effective vaccine becomes available.

BIO:

Allen G. Taylor is a 40-year veteran of the computer industry and the author of over 40 books, including Develop Microsoft HoloLens Apps Now, Get Fit with Apple Watch, Cruise for Free, SQL For Dummies, 9th Edition, Crystal Reports 2008 For Dummies, Database Development For Dummies, Access Power Programming with VBA, and SQL All-In-One For Dummies, Third Edition. He lectures internationally on astronomy, databases, innovation, and entrepreneurship. He also teaches database development and Crystal Reports through a leading online education provider. For the latest news on Allen’s activities, check out his blog at wwwallengtaylor.com or contact him at allen.taylor@ieee.org.