Doctor Warns Of Risks In Rush To Embrace A COVID-19 Treatment | KUNC

Doctor Warns Of Risks In Rush To Embrace A COVID-19 Treatment

Jun 20, 2020

Earlier this week, researchers in the United Kingdom announced preliminary results from a clinical trial that showed a low-cost steroid called dexamethasone appeared to lower the risk of death in patients with COVID-19.

The researchers said the anti-inflammatory drug reduced the number of deaths in COVID-19 patients on ventilators or oxygen alone by one-third.

But details of the study did not accompany the announcement. And the announcement followed several prominent revisions in the advice that researchers have given around the coronavirus in recent weeks.

Which is why Dr. Kirsten Lyke, an infectious disease specialist at the University of Maryland School of Medicine, warns that a premature endorsement for the treatment can carry risks.

Lyke, who is running a coronavirus vaccine trial, said that, particularly when dealing with a new kind of virus, we "need to be extremely cautious" when rolling out treatments that have not gone through a rigorous vetting process.

"This is a press release, so they're going to basically give us sort of the bottom line," Lyke said about the dexamethasone announcement in an interview with NPR's Weekend Edition. "But there's a lot to unravel."

Dexamethasone has been successful at treating inflammatory conditions like arthritis and asthma. The research team behind the trial wanted to figure out whether the drug could also alleviate lung inflammation in COVID-19 patients.

"Many of us would like to see the peer review paper to understand how these people were randomized, who was not randomized. That's important to know," Lyke said.

But, in a world not pressured by a pandemic, a legit vetting process like that can take years, said Lyke. And she worries that a hasty embrace of the drug could do more harm than good.

"People really want to get results out quickly," she said. "But at the same time, if things are released too early or there's harm that occurs from the intervention, that really erodes public trust."

Lyke said researchers need to be mindful to avoid a scenario where, as was the case with the drug hydroxychloroquine, a treatment is championed before it has a chance to stand up to strict scientific scrutiny.

That wasn't the first instance of confusion over messaging related to the science around the coronavirus. For example, public health officials' guidance on whether the public should wear masks initially fluctuated until the Centers for Disease Control and Prevention officially recommended face coverings in April.

Lyke acknowledged the early mixed messaging was "frustrating" for researchers and the public alike, but reminded that one line of messaging around face coverings has been consistent.

"Typically, we say that using a mask doesn't necessarily protect you. It protects other people," she said. "It's really useless if you're the only one wearing it in a crowd. It has to be the entire crowd."

In order for such evidence-based health measures to work in the fight against the coronavirus, she said, everyone has to participate.

"There's a lot of individualism in the United States, but the pandemic and the virus don't really respect the individualism," said Lyke. "I think we need to really be stepping up as a group and protecting each other."

NPR's Elena Schwartz and Ed McNulty produced and edited this interview for broadcast. Emma Bowman produced the story for Web.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

SCOTT SIMON, HOST:

Is dexamethasone good news in the treatment of coronavirus or another exaggerated or false hope? Doctors in the U.K. say that dexamethasone, a low-cost steroid, reduced deaths in COVID-19 patients on ventilators. But the findings are preliminary and come just as we've seen several other prominent revisions in the advice that scientists have offered around the coronavirus.

Kirsten Lyke runs a coronavirus vaccine trial at the University of Maryland and joins us now. Thanks so much for being with us.

KIRSTEN LYKE: Thank you for asking, Scott.

SIMON: I gather this U.K. trial was led by a team at Oxford. They say using this steroid could save one life for every eight people on a ventilator. But as I don't have to tell you, Dr. Lyke, people want to hear, should I take it or not?

LYKE: You know, it's an easy answer to say yes or no, but these are very complex things that need to be unwound. This is a press release, so they're going to basically give us sort of the bottom line. But many of us would like to see the peer-review paper to understand how these people were randomized, who was not randomized - that's important to know - and, you know, a lot of other questions to give us a little bit more understanding as to the results.

SIMON: If we were living in a world without a pandemic, how long would it take to get the results you need to be really confident about how to use this drug?

LYKE: Yeah, interesting that you ask that question because this year, there was a groundbreaking publication that demonstrated if you start steroids early in the evolution of acute respiratory distress syndrome, or ARDS, that you can get some positive results. It took them seven years from...

SIMON: Yeah.

LYKE: ...Start to results. And so, you know, we're in unprecedented times, and people really want to get results out quickly. But at the same time, if things are released too early or there's harm that occurs from the intervention, that really erodes public trust.

SIMON: The researchers who led this trial, I gather, say that dexamethasone should immediately become standard care in patients with severe cases of COVID. It sounds like you're uncomfortable with that.

LYKE: Well, I - you know, I'm cautiously optimistic. This study - it was only people who were on oxygen or people that were ventilated...

SIMON: Yeah.

LYKE: ...That got the significant improvement. And people that were not on oxygen actually tended towards some harm.

SIMON: At the same time, Doctor, can you understand families who say, look; we have a loved one who is very sick, and we're willing to take that chance?

LYKE: Yeah, I can totally understand that. And that's not just the patients; that's also the doctors. And early on in this pandemic, everyone wanted to have an intervention. Everyone wanted to do something. Sometimes doing something feels better...

SIMON: Yeah.

LYKE: ...Than just sitting back and waiting. And I think that's why we got into trouble with hydroxychloroquine and the concomitant drug, azithromycin, which is an antibiotic. You know, the two together really, probably, had a harmful effect, particularly with the conduction of the electrical waves in the heart. So we'll be able to unravel this in retrospect, but I think we just need to be extremely cautious when we implement any new interventions. Dexamethasone is not a new intervention, so we do have a lot of background with dexamethasone. I think we just need to know when's the best time to treat our patients and not induce harm.

SIMON: I wonder if you can help us understand something, Dr. Lyke. Can you see why people get confused? At one point, we hear from the highest medical levels - I don't mean the White House - you know, the average person will not have to wear a mask, to just a few weeks later, everybody ought to wear a mask. Can you see how people begin to feel exasperated?

LYKE: Yeah, it's frustrating. It's frustrating from our side, too. This is a completely new virus which is unprecedented. And it's true. Typically, we say that using a mask doesn't necessarily protect you; it protects other people. And I think that's the consistent message. When we're telling people to wear masks, it's really useless if you're the only one wearing it in a crowd. It has to be the entire crowd. You know, there's a lot of individualism in the United States, but the pandemic and the virus don't really respect the individualism. And I think we need to really be stepping up as a group and protecting each other.

SIMON: Dr. Kirsten Lyke of the University of Maryland, thanks so much for being with us.

LYKE: Thank you, Scott.

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