Remdesivir was the first antiviral drug used to treat COVID-19. Oxford University researchers recently discovered that a different medication, Dexamethasone, attacks the inflammation associated with the disease.

“Dexamethasone, an oral steroid that’s readily available, decreased mortality by about a third in these very sick patients, particularly patients on respirators,” Dr. Steven J. O’Day said. “It’s a real proof of principle that both attacks the virus specifically, but also now attacking inflammation in very sick patients can reduce mortality.”

What You Need To Know

  • Antiviral drug Remdesivir targets the novel coronavirus

  • Oral steroid Dexamethasone attacks the inflammation associated with COVID-19

  • Masks and physical distancing are essential for slowing the spread of COVID-19

  • Respirators cause more harm than good for some COVID-19 patients

Dr. O’Day, the executive director of the John Wayne Cancer Institute and Cancer Clinic, said the effectiveness of Dexamethasone is extraordinary: “We’re making progress. Science is really moving quickly, and we’re starting to see some real improvement.”

Over the last several months, doctors have discovered that respirators might cause more harm than good for COVID-19 patients. In order to circumvent the issue, Dr. O’Day said some patients are given a treatment called extracorporeal membrane oxygenation (ECMO) instead of a ventilator. ECMO uses a pump to circulate blood through an artificial lung back into the bloodstream. Some patients also benefit from lying on their stomachs instead of their backs.

“We have to adapt to what’s happening to us in the moment, and we’ve had to adapt to this virus very quickly in terms of how it’s affecting people,” Dr. O’Day said. “We learned very early on that ventilators in of themselves were not as successful as they were with other respiratory viruses. It’s actually causing more problems sometimes than helping.”

Dr. O’Day said the COVID-19 death rate will drop tremendously if scientists can find treatments for patients who test positive for COVID-19 but are not in the hospital yet.

“We want to prevent people from ever having to get onto ventilators. And so in addition to obviously Remdesivir and oral steroids now, we’ve got a number of trials around even more specific inhibitors of inflammation that are more designer drugs, and we have active clinical trials with that,” he said.

COVID-19 patients who are released from the hospital might have lasting issues.

“When you have severe inflammation of the lungs, there’s the whole rehab around getting the lungs back to working order so to speak, and many of these patients may have more long standing issues with their lungs. But we’ve also learned that this is a virus that not only attacks the lungs, but blood vessels and kidneys and hearts and even the brain,” Dr. O’Day said. “When someone gets so sick from the virus that they’re required to be hospitalized, not only are the lungs defective in a similar way but many other organs too, and we’re learning more about that.”

Dr. O’Day said there’s more to recovery than just being released from the hospital.

“These are going to take probably months to recover,” he said. “This is a devastating virus, both in its ability to lead to death in a percentage of patients, but also how it’s affecting the overall health for months or even permanently after recovery.”

Californians who haven’t experienced COVID-19 first or second hand might not understand the severity of it.

“Unfortunately, a large percentage of the population hasn’t really been face-to-face with how serious this virus is, particularly in vulnerable populations, but also now in younger people with other risk factors,” Dr. O’Day said. “I think when you’ve seen it, as the medical profession has seen it, you have a tremendous respect, and unfortunately not everyone has that view of this virus.”

Big risk factors for COVID-19 are obesity, diabetes, and high blood pressure, among other chronic diseases. However, Dr. O’Day said anyone can catch a bad case of COVID-19 even if he or she doesn’t have an underlying condition.

“We have treated 24-year-olds with no obvious risk factors who are on ventilators, so it can happen. And you’ve seen kids that may not get sick at the time that they’re sort of in the midst of the virus, but then weeks later develop this inflammation. I think in young people with very robust immune systems, whether it’s kids or young adults, sometimes the virus itself is not the problem, but it’s the overactive immune inflammation,” he said. “I think people at higher risk, it’s probably more a combination of the virus and the inflammation, so we’re learning. But no one’s out of the woods here. Anything can happen, and we have to be mindful of that.”

Asymptomatic spread of the novel coronavirus has contributed to a significant rise in cases.

“Young people who are healthy and who may never get symptoms -- or if they do get symptoms, have mild symptoms -- can spread this disease to more vulnerable people who get very, very sick,” Dr. O’Day said. “We know that this is a very contagious virus, it has an airborne quality to it, and therefore masking is essential and distancing remains essential until the population has enough herd immunity, which may take several years.”

Dr. O’Day said “we still have a big road ahead” as doctors and scientists scramble to find effective cures and develop a safe vaccine.

“We just have to be smart and learn to open up our economies and our world, but with some new rules of the game. It’s not that difficult. We can do this,” he said.

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