Written by Dr. Daniel Dube, FACP
The Case of Dexamethasone and COVID-19
This post is for Malawian patients. It is not for Malawian medical professionals or US based patients. The post is oversimplified in the interest of illustrating important issues.
How is COVID-19 causing harm to the body?
As everyone understands by now, COVID is affecting the airways. We also know that the virus is affecting the lining of body cavities such as the intestines, it is also affecting the skin, the kidneys, the heart, the brain as well as large and small blood vessels. The virus causes damage by over activating the body’s defense system. It is the overactivated immune system that causes a lot of the harm that we see in COVID infection. Think about it like the house guard dog that is too excited and tries to attack a thief but ends up biting the master as well. (The dog is the immune system; the master is your body)
Dexamethasone is supposed to work by calming down the immune system. So, when you have the COVID infection AND the immune system is overactive, Dexamethasone prevents the damage caused by the over activation. Dexamethasone does not attack the virus.
HOW DID WE COME TO USE DEXAMETHASONE?
At the beginning of the COVID pandemic, we were told not to use steroids for reasons that are very technical. It was thought that suppressing the immune system would make the virus cause more damage to the body.
British doctors wanted to find out if there was a situation where steroids could be used in COVID infection. They tested the question by giving dexamethasone to different groups of COVID infected patients with different levels of seriousness and comparing them to patients with similar levels of illness who had COVID infection but were not given Dexamethasone.
THIS IS WHAT THEY DID
They gave Dexamethasone to these groups of patients.
- Group 1. Were extremely sick COVID patients who had Low oxygen and were on a breathing machine.
- Group 2. Were patients who had COVID infection. and were on oxygen and were using a special mask connected to a machine that pushes air into the lungs (BIPAP)
- Group 3. Patients who had COVID infection who were not on a breathing machine and not needing oxygen.
WHAT THEY FOUND
If you have low oxygen and you are on a breathing machine or using the special breathing mask and were given Dexamethasone (group 1 and 2) you had more chances of surviving.
IF YOUR OXYGEN WAS NORMAL AND YOU HAD COVID AND YOU WERE GIVEN DEXAMETHASONE YOU DID NOT BENEFIT. IN FACT, THEY SAW MORE DEATHS AMONG THOSE THAT WERE GIVEN DEXAMETHASONE THAN THOSE WHO WERE NOT. (Group 3)
This last group is the largest group of COVID patients. They do not need Dexamethasone.
Dexamethasone used before you have COVID will lower your immune system and you will not fight the COVID infection when you get it. YOU cannot take Dexamethasone like some kind of preventative measure.
There is a lot of undiagnosed diabetes in Malawi. Dexamethasone raises blood sugar and may cause dangerously high sugars that could kill you.
If your immunity is low for whatever reason and you take high doses of Dexamethasone your body will be more likely to get serious infections like fungus.
If you have ulcers and you are taking high dose Vitamin C, the combination with Dexamethasone could cause serious bleeding in your stomach.
Dexamethasone May also interfere with some TB medications by lowering their levels.
If you are on treatment for fungus infections, Dexamethasone may interfere with some of those medications.
Dexamethasone May also interfere with some cancer medications.
While there may not be a class specific interaction with many ARVs, extreme care should be taken before taking some medicines if you are on ARVs.
It is important that Dexamethasone is prescribed by competent PHYSICIANS or a provider who has experience in administering steroids. The dose that was recommended IS LOW DOSE 6 mg once a day. It is dangerous to take higher doses than this.
The public are scared and hanging onto anything that gives hope. A lot of harm can be done if we do not regulate the practice of pharmacy and medicine. We need public guidance on the use of supplements and medicines. Please talk to a doctor or competent medical professional about COVID.
Dr. Daniel Dube, FACP
Pulmonologist and Intensivist