US hospitals in hard-hit areas step up steroid use on patients, COVID-19 patients


NEW YORK (Reuters) – Several US hospitals in the states with fresh COVID-19 surge cases have started treating their sickest patients with dexamethasone rather than waiting for confirmation of preliminary study results by British researchers, who said that the cheapest means of steroids saves lives.

PHOTO FILE: A vial of Dexamethasone is seen during the coronavirus disease (COVID-19) epidemic in this illustrative photo taken on June 17, 2020. REUTERS / Yves Herman / Photo archives

The movement illustrates how the pandemic is changing the way hospitals work, at least with regard to COVID-19 patients.

Traditionally, doctors wait for detailed data to be published in a peer-reviewed journal or by medical company guidelines – before embracing a new treatment, so that they can better assess the risks and the benefits of the product. The urgency of the pandemic coronavirus and the lack of other treatments has changed these calculations.

Dexamethasone is the first drug indicated to reduce the risk of death in critically ill COVID-19 patients in what the researchers in the trial execution hailed as a “major breakthrough.”

The University of Oxford researchers said in a statement that dexamethasone reduces death rates by about a third between COVID-19 patients requiring mechanical assistance or oxygen ventilation. Britain’s Department of Health has already approved its use in the department’s health.

“It almost feels unethical not to use the drug,” said Dr. Kartik Cherabuddi, an infectious disease specialist at the University of Florida (UF) medical school.

UF of Gainesville in the hospital updated its COVID-19 treatment guidelines on Tuesday to include the use of dexamethasone. He already used the very low price of generic drugs sparingly for patients.

Cherabuddi reported that her hospital and many others – likewise started treating COVID-19 patients with Gilead Sciences (GOLD.O) antiviral drug remdesivir based on data from a press release.

Drugs, which unlike dexamethasone have not yet been approved by regulatory agencies for all other conditions, in the hospital are reducing recovery time in a clinical trial. It had no effect on mortality.

Several hospital systems, including New York Northwell Health and the University of Washington (UW), had not been using steroids on COVID-19 patients. There was some concern, it could lead to worse results because it suppresses the immune system.

“For us, the number of cases is low and therefore there is not much pressure to do something new,” said UW is Dr. Mark Wurfel, who is anxious to see the final data. Places like Florida and Oklahoma, where COVID-19 hospitalizations are on the rise, are under pressure, he said.

“The urgency of having hundreds, if not thousands, of COVID patients in hospitals and intensive care units changes in differential and integral calculus. Many lives could be saved if the results of the trial are real, ”Wurfel added.

AdventHealth, which has nearly 50 hospitals in nine states, has been using dexamethasone for COVID-19 patients on ventilators successfully since the beginning of April, said Eduardo Oliveira, medical director for critical care for AdventHealth of the central region of Florida.

At its eight Orlando area hospitals, Oliveira, said the death rate for patients requiring ventilators was around 26%, “lower than almost any other mortality report in the literature for instant. ”

He noted that it was unclear whether this success was due to the use of steroids.

PHOTO FILE: A pharmacist displays a box of Dexamethasone at Erasme Hospital, amid the coronavirus disease (COVID-19) outbreak, in Brussels, Belgium, June 16, 2020. REUTERS / Yves Herman / Photo archives

After reviewing the British press study and test protocols, Advent expanded its dexamethasone use to also include patients receiving oxygen support, but not on ventilators.

Dr. Brent Brown, medical director of the University of Oklahoma, intensive care unit, said that his hospital added the steroid to his treatment guidelines for patients in the intensive care unit of this week. Oklahoma is one of several states in the United States with the rapidly increasing coronavirus case.

“We changed our practice completely. It was kind of a flip-flop, ”he says. “But we are delighted to have something that looks so promising.”

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