Dexamethasone: A Cure for COVID-19?

Introduction to COVID-19

If you have been keeping up with the news lately (and chances are you have), amidst the chaos, you may have heard of the new ‘miracle’ drug named dexamethasone to treat the ongoing pandemic of COVID-19. COVID-19 is an illness spread by the virus SARS-CoV2, which originated in Wuhan, China in December 2019 [1].

Currently, COVID-19 tends to have the highest mortality rate for those who are of a higher age [2] and those who express several other risk factors. Common symptoms include fever, chills, difficulty breathing, fatigue, muscle/body aches, headaches, loss of taste/smell, sore throat, congestion, nausea, and diarrhoea [3]. There are many hoaxes and medicines that claim they alleviate symptoms or get rid of the disease altogether, but few genuinely do.

This article will break down the drug dexamethasone, how it works, its mechanism of action, and discuss whether it is a viable treatment for COVID-19.

Dexamethasone: An Overview

Despite first appearances, Dexamethasone actually may not be as novel as you think. It is a drug used to treat arthritis, different hormonal, blood, and immune system disorders, and numerous conditions involving the skin and eye [4]. As you can tell, it is pretty versatile.

Additionally, dexamethasone is a corticosteroid, meaning that it lowers inflammation in one’s body and reduces immune system activity. Based on the name itself, it is easy to tell that corticosteroids are types of steroids, which are forms of hormones [5].

Specifically, dexamethasone, as a steroid, is reportedly able to reduce cytokine storms and tame the very active immune system of patients with COVID-19, which is a majority of the problem itself [6].

For reference, cytokine storms are mass releases of molecules called cytokines into your system, which is part of what causes inflammation [7]. To understand how steroids stop this, we need to understand inflammation. Inflammatory genes cause inflammation once they are activated. To activate these genes, various molecules must bind to coactivators, which regulate activation. Then, through a process called histone acetylation, which is the changing of the chemistry of genes, the transcription of inflammatory genes is turned on which causes inflammation [8].

Histone acetylation is the process where genes wrapped around proteins called histones in the cell are regulated. Different enzymes move acetyl chemical groups from one molecule to a histone. There is also histone deacetylation, a process that essentially does the opposite [9].

Corticosteroids can suppress the inflammatory genes causing inflammation in the first place! They also reverse histone acetylation and have the ability to block these genes as a result. Think about it like an on and off button unlocked by a fingerprint ID. The enzymes have the authorization to turn them on and the corticosteroids have the authorization to turn them off [8].

Additionally, the immune system of those with COVID-19 is a problem too. A lot of the symptoms people typically experience are due to the immune system because COVID-19 leads the immune system to wildly overreact and trigger the events leading to inflammation [10]. Dexamethasone can then stop the ongoing inflammation and also lessen future inflammation, which is what makes it so effective [8]. In the United Kingdom, it was found to stop ⅓ of deaths and have astoundingly positive results in patients with severe cases [11, 12].

However, what happens during inflammation that makes it so bad? When there is an inflammatory response, cytokines and inflammatory molecules are released into the blood. This leads to blood clotting, leaking of blood vessels, high fever, dangerously low blood pressure, oxygen loss, low blood pH, and fluid build-up in a person’s lungs.

As you can tell, this is not great. In reality, how close are we to curing this? What future steps are being taken, and is there hope? 

What Will Happen Next?

First off, a quick reminder not to take medical advice of any kind from this article. Consult your physician before doing anything. This article is simply here for information and to fuel scientific curiosity.

There are numerous plans and ideas being laid out as to what we should do next, but you may be wondering what will happen. You are probably asking: When will we be able to meet our friends for ice cream again? When will we be able to go to school or work again?

This article will not be able to give you an answer. Not because it is too difficult to say, but because nobody knows at this time. Nobody except Dr. Peter Hotez [13] knew this pandemic was approaching. Even so, he was unaware of the extent and severity of the pandemic.

However, what this article can do is outline where we are currently and our situation in the future. So, where are we?

Right now, we have many drugs and vaccines in the works. There is dexamethasone, hydroxychloroquine [14], remdesivir [15], Moderna’s mRNA vaccine [16], and many other treatments, preventions, and cures in the pipeline.

Vaccines will likely come by the beginning of next year, according to the United States government [17]. Furthermore, the current drugs available are running out fast [18].

The next steps are to continue social distancing for the time being, until we know that vulnerable populations are protected. It might be until we have a widely available vaccine, or even sooner when endangered populations have access to drugs to overcome their risk of severe symptoms and death due to COVID-19.

Now that you have an idea of what we are doing next. What can you do?

Ways to Contribute

If you are experiencing COVID-19 symptoms, please fully quarantine yourself for at least 14 days. Even though in many countries and states the cases are going down, there is a risk of them climbing back up if we do not keep taking precautionary measures like physical distancing.

There are lots of organisations – both in local communities and globally – who are doing important work in the COVID-19 response.  If you are in a position to do so, you could make a donation, or share your time and skills to make a difference.

Conclusion

Overall, dexamethasone has been proven to be effective in treating the inflammation and reaction of the immune system in severe cases of COVID-19. We will have to do more trials and testing to confirm its usability, but it looks promising.

Future steps include more trials and the dissemination of the treatment to people who need it most, whether it be patients with COVID-19 or at-risk populations.

References

[1] H. Li, S.-M. Liu, X.-H. Yu, S.-L. Tang, and C.-K. Tang, “Coronavirus disease 2019 (COVID-19): current status and future perspectives,” International Journal of Antimicrobial Agents, vol. 55, no. 5, p. 105951, 2020.

[2] D. Santesmasses, J. P. Castro, A. A. Zenin, A. V. Shindyapina, M. V. Gerashchenko, B. Zhang, C. Kerepesi, S. H. Yim, P. O. Fedichev, and V. N. Gladyshev, “COVID-19 is an emergent disease of aging,” 2020.

[3] “Symptoms of Coronavirus,” Centers for Disease Control and Prevention, 13-May-2020. [Online]. Available: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. [Accessed: 29-Jun-2020].

[4] U. of Illinois-Chicago, “Dexamethasone | Side Effects, Dosage, Uses, and More,” Healthline, 16-Jun-2053. [Online]. Available: https://www.healthline.com/health/dexamethasone-oral-tablet. [Accessed: 29-Jun-2020].

[5] A. Gotter, “Corticosteroids: Types, Interactions & Tips to Minimize Side Effects,” Healthline, 30-Oct-2018. [Online]. Available: https://www.healthline.com/health/corticosteroids-what-are-they. [Accessed: 29-Jun-2020].

[6] Ians, “Steroid Drug Dexamethasone Found to be Beneficial in Saving Lives of COVID-19 Patients,” The Weather Channel, 17-Jun-2020. [Online]. Available: https://weather.com/en-IN/india/coronavirus/news/2020-06-17-drug-dexamethasone-proved-beneficial-covid-19-treatment. [Accessed: 29-Jun-2020].

[7] J. R. Tisoncik, M. J. Korth, C. P. Simmons, J. Farrar, T. R. Martin, and M. G. Katze, “Into the Eye of the Cytokine Storm,” Microbiology and Molecular Biology Reviews, vol. 76, no. 1, pp. 16–32, 2012.

[8] P. J. Barnes, “How corticosteroids control inflammation: Quintiles Prize Lecture 2005,” British Journal of Pharmacology, vol. 148, no. 3, pp. 245–254, 2009.

[9] L. Verdone, “Histone acetylation in gene regulation,” Briefings in Functional Genomics and Proteomics, vol. 5, no. 3, pp. 209–221, 2006.

[10] M. Dykstra, “How COVID-19 kills,” ScienceDaily, 13-May-2020. [Online]. Available: https://www.sciencedaily.com/releases/2020/05/200513081810.htm. [Accessed: 29-Jun-2020].

[11] H. Ledford, “Coronavirus breakthrough: dexamethasone is first drug shown to save lives,” Nature News, 16-Jun-2020. [Online]. Available: https://www.nature.com/articles/d41586-020-01824-5. [Accessed: 29-Jun-2020].

[12] J. S. Hopkins, “Dexamethasone Demand Soars After Positive Covid-19 Study,” The Wall Street Journal, 25-Jun-2020. [Online]. Available: https://www.wsj.com/articles/dexamethasone-demand-soars-after-positive-covid-19-study-11593079202. [Accessed: 29-Jun-2020].

[13] M. Hixenbaugh, “Scientists were close to a coronavirus vaccine years ago. Then the money dried up.,” NBCNews.com, 08-Mar-2020. [Online]. Available: https://www.nbcnews.com/health/health-care/scientists-were-close-coronavirus-vaccine-years-ago-then-money-dried-n1150091. [Accessed: 29-Jun-2020].

[14] Kai Kupferschmidt “Three big studies dim hopes that hydroxychloroquine can treat or prevent COVID-19,” Science, 09-Jun-2020. [Online]. Available: https://www.sciencemag.org/news/2020/06/three-big-studies-dim-hopes-hydroxychloroquine-can-treat-or-prevent-covid-19. [Accessed: 29-Jun-2020].

[15] J. Walker, “Covid-19 Drug Remdesivir to Cost $3,120 for Typical Patient on Private Insurance,” The Wall Street Journal, 29-Jun-2020. [Online]. Available: https://www.wsj.com/articles/covid-19-drug-remdesivir-to-cost-3-120-for-typical-patient-on-private-insurance-11593428402. [Accessed: 29-Jun-2020].

[16] D. Grady, “Moderna Coronavirus Vaccine Trial Shows Promising Early Results,” The New York Times, 18-May-2020. [Online]. Available: https://www.nytimes.com/2020/05/18/health/coronavirus-vaccine-moderna.html. [Accessed: 29-Jun-2020].

[17] “Coronavirus: Fauci says vaccine possible by end of 2020,” Medical Economics. [Online]. Available: https://www.medicaleconomics.com/view/coronavirus-fauci-says-vaccine-possible-end-2020. [Accessed: 29-Jun-2020].

[18] C. Eli, “Drug recently shown to reduce coronavirus death risk could run out, experts warn,” Science, 21-Jun-2020. [Online]. Available: https://www.sciencemag.org/news/2020/06/corticosteroid-drug-recently-shown-reduce-coronavirus-death-risk-could-run-out-experts. [Accessed: 29-Jun-2020].