Ground-breaking treatment for COVID-19

by Dr. Rey Pagtakhan

Before the Tuesday, June 16 press statement from the chief investigators of the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial, medical science had no known drug to save the lives of critically COVID-19 patients requiring oxygen with or without the assistance of a mechanical ventilator. Although remdesivir, a new drug, has been shown recently to shorten the time to recovery in hospitalized patients, it did not reduce mortality.

That Tuesday, Dr. Peter Horby, Professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, in England, announced the preliminary results of their large-scale research study on an old commonly used anti-inflammatory drug. “Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result. The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become the standard of care in these patients.”

“Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide,” Hornby further noted. He and his team issued the advanced statement in light of the importance of the results for global public health.

The RECOVERY trial is a randomized, controlled trial comparing a range of possible treatments with usual care in patients hospitalized with COVID-19. The press statement was on the preliminary results that compared dexamethasone 6 mg given once daily for up to ten days versus usual care alone. The primary outcome was 28-day mortality – 2,104 patients randomly allocated to receive dexamethasone were compared with 4,321 patients concurrently allocated to usual care.

The results were impressive. Dexamethasone reduced deaths by one-third in patients receiving invasive mechanical ventilation, and by one-fifth in patients receiving oxygen without invasive mechanical ventilation. Equally noteworthy is the finding that the drug did not reduce deaths in patients not requiring intensive or invasive respiratory support. They noted that they did not study patients outside the hospital setting and cautioned on the possibility of harm if used that way.

The other chief investigator, Professor Martin Landray of Medicine and Epidemiology at the Nuffield Department of Population Health, also at the University of Oxford, provided additional insights.

“Since the appearance of COVID-19 six months ago, the search has been on for treatments that can improve survival, particularly in the sickest patients.” Landray continued, “COVID-19 is a global disease – it is fantastic that the first treatment demonstrated to reduce mortality is one that is instantly available and affordable worldwide.”

“To be clear, the benefit of using dexamethasone is seen in the sickest hospitalized patients,” said Dr. Bram Rochwerg, a critical care physician at McMaster University in Canada. “The drug should not be taken prophylactically or by stable outpatients with COVID-19.”

Dr. Jesus Villar, a critical care researcher at Dr. Negrín University Hospital in Spain observed, “And because the half-life of the drug is more than 36 hours, clinicians can give one intravenous dose a day, which simplifies treatment in the intensive care unit (ICU).”

“It’s a very safe, generally well-tolerated – at reasonable doses – steroid that works predominantly by its anti-inflammatory effects,” said Dr. Matthew Cheng, a medical microbiologist and infectious disease specialist at the McGill University Health Centre. “I was quite honestly elated. This is the first data that we have that suggests that a drug is able to improve the chances of survival in those that are critically ill. And so while I eagerly await the scientific publication, I was absolutely thrilled to receive the news… we need to continue building upon them and potentially trying different combination strategies to further bring the mortality rates down. It should unequivocally be celebrated from the scientific community.”

On Tuesday, June 16, 2020, the chief medical officers of England, Wales, Scotland, and Northern Ireland informed all the doctors and hospitals that dexamethasone should become standard care for admitted patients with COVID-19 who require oxygen.”

Hand sanitizers alert

Health officials in New Mexico reported to CNN onJune 27, that three persons died and four others became critically ill including one who became blind following ingestion of hand sanitizers containing methanol.

This incident alerts us to existing reminder that these products, even when there are no impurities, pose a health hazard to toddlers. Health Canada temporarily modified its rules on hand sanitizer products on March 27 to allow manufacturers to use technical-grade ethanol versus food-grade ethanol to meet the pandemic demands for the products, then in short supply. The modified rules were for a short-term period and under specific conditions, such as: clearly indicating that technical-grade ethanol is included as an ingredient; providing specific directions for use and warnings that these products are intended for adult use only; that they should not be used on broken or damaged skin, or by women who are pregnant or breastfeeding; and that they should not be inhaled.

However, Health Canada recently issued recall orders for the following sanitizers that use industrial-grade ethanol and contain the health-hazard contaminant ethyl acetate: Estraderm Hand Sanitizer 70% Ethyl Alcohol; Hand Sanitizer by Contract Packaging; Gel 700 Hand Sanitizer; Salinas Hand Sanitizer 70% Ethanol; Walker Emulsions Hand Sanitizer; Hand Sanitizer Disinfectant; Protectenol Hand Sanitizer Liquid; Tidol Hand Sanitizer 70%; Aktif Antiseptique instantane pour les mains; Smart Care Hand Sanitizer; X-Pure Vert-2-Go Gel; Gel Antiseptique Pour Les Mains by Megalab; Germzero; Tekare Instant Hand Cleanser Gel; Dash Vapes Hand Sanitizer; and Isogel. Owners of these sanitizers are advised to promptly stop using them and to consult with their health care professional on any health concerns.

It is best to wash the hands with soap and water rather than to use hand sanitizer, says Health Canada and thereby avoid the health hazards associated with impurities in sanitizers.

COVID-19 is still with us

In the half-year since its emergence and subsequent pandemic spread, COVID-19 has sickened more than 100-thousand Canadians, of whom over 8,000 have died, while nearly two-thirds had recovered, with slightly over a quarter remaining active cases. (See the table from Johns Hopkins University Tracking Dashboard, June 28, 2020).

Neighbouring USA has over 2.5 million cases, of whom over 125,000 have died, with just over a quarter recovered, and a little over two-thirds still active cases. Globally, the pandemic has over 10 million people across 188 countries sick and half a million deceased. About five million have recovered, with slightly more than 4.5 million still active cases.

These are sobering numbers awaiting a preventive vaccine.

Dr. Rey D. Pagtakhan, P.C, O.M., LL.D., Sc.D., M.D., M.Sc. is a retired lung specialist, former professor of pediatrics and member of Canada’s parliament and government. He served on the Winnipeg Police Commission and chaired the House of Commons Human Right Committee. He presented on “The Global Threat of Infectious Diseases” at the G-8 Science Ministers and Advisors Meeting held in June 2003 in Berlin, Germany. Contact: reypagtakhan@mail.com

Have a comment on this article? Send us your feedback