1/ The time has come for yet another #debunking, this time of sheer hype re a medication used in treatment of severe or critical #COVID19. #Dexamethasone is a bog-standard form of cortisone, & only useful to reduce inflammation. 
2/n It's nice of the report to include an extrapolation of how many lives would be saved if you use #dexamethasone in the treatment of certain cases of severe to critical #COVID19, but as you can see from the figure, it actually isn't all that much.
bbc.com/news/health-53…
bbc.com/news/health-53…
3/n #Dexamethasone is being *deliberately* hyped up. Not for financial reasons. It's a bog-standard form of cortisone, *nobody* is going to get rich from making a financial killing in it.
4a/n If you want my opinion, I'm just a bit surprised that it hasn't been used *more* for patients with severe to critical #COVID19, **once the immediate viral attack fades into the inflammation attack**. It's bog-standard therapy for much inflammation.
4b/n You can't use it *before* the first viral attack in a patient has been dampened down, or else you run the huge risk of simply encouraging the virus. #Dexamethasone, like all forms of cortisone, does dampen your immune system a lot, after all.
5/n The hype around #dexamethasone appears to stem from two sources: the scientific team involved, and the political side. BoJo says, "remarkable British scientific achievement", I would say just a nice confirmation of what most medicos would suspect for the relevant situation.
6a/n First off: yes, I wonder too why it wasn't more used in the ICU cases. To repeat to all: it's **only of use once the viral attack, the viral load, in a patient has abated**, when your main aim then becomes to fight the inflammation. And even then...
6b/ .... even then, it doesn't save all that many lives. YES, it should be considered in treatment for any severe to critical #COVID19 case, **once the initial viral load has dropped in the patient**. BUT it won't save all that many lives even then.
7/n Now we come to the part where I bitterly laugh. Because the hype around how #dexamethasone is dirt-cheap (true) & will save many lives from #COVID19 in the poorer parts of the world is **simply, grossly untrue**. Wrong. Sheer bollocks. Ignorant piffle.
bbc.com/news/health-53…
bbc.com/news/health-53…
8/n Excuse me, or don't, while I freaking laugh about this. Exactly how many #COVID19 patients do you think will be saved in the poorer parts of the world? Global impact my [redacted]. [Redacted] How many ICU beds w/ ventilators do you think exist in a place like Tanzania? Kenya?
9/n Small interlude for an actual paper on emergency medical situation in Tanzania.
bmchealthservres.biomedcentral.com/articles/10.11…
Small interlude for COVID_19 in Tanzania.
tl;dr = tons more dying there than the official figures concede. Very few ventilators.
en.wikipedia.org/wiki/COVID-19_…
bmchealthservres.biomedcentral.com/articles/10.11…
Small interlude for COVID_19 in Tanzania.
tl;dr = tons more dying there than the official figures concede. Very few ventilators.
en.wikipedia.org/wiki/COVID-19_…
10/n Yes, whoooopidooo, fine, they worked out that giving #dexamethasone to #COVID19 patients already on ventilators or oxygen for a while already helps save some lives. No, this is rabidly **irrelevant** to a place like Tanzania, & only of limited relevance to places like India.
11a/n The UK NHS have become very protocol-bound; a short while back, there was a really sad case of a woman whose life could have been saved with blood-products transfusion, & wasn't, because a consultant got on his "evidence-based" medicine high-horse
11b/n I doubt this will get widely known as a self-own (despite that it is), b/c most people don't get the issues here. The anti-NHS assholes may use it, dishonestly; the pro-NHS ones will largely ignore this. The public will likely misunderstand it all.
12/ sure, whatever, read the above thread in which your tweet is now embedded.
13/ I basically agree with this reply tweet, despite its perhaps impolite form. It shouldn't have been tweeted out like that, uncritically, simply buying the hype. It's only hype. #Dexamethasone is NOT a game-changer.
14/ No, not really, since meds for ventilator-patients are many, and NO, this vastly over-inflates the impact of #dexamethasone on overall treatment for #COVID19.
@threadreaderapp unroll thanks
15/ This entire thread, #debunking the importance of #dexamethasone on any world level, & the hype around that, to the treatment of #COVID19, on one page here, for y'all:
threadreaderapp.com/thread/1272938…
threadreaderapp.com/thread/1272938…
16/ I am completely weirded out, *mind-boggled*, baffled, gobsmacked, at how much hype this is getting. Seriously, @DrMoragKerr, @Neurophysik, @dhambrick63, @travellator2, @bhalomanush, and I, can't be the only ones to see how the hype is sheer crap. Easily debunked crap at that.
17/ Almost the last word on this:
18/ And you should know, you must know, that comparison between #remdesivir & #dexamethasone is completely misleading. They treat different things, ffs. One treats the inflammation, one acts against the actual virus. One does NOT substitute for the other.
19/ It should go without saying,
#dexamethasone WILL NOT PREVENT THE #COVID19. It most likely won't even freaking help you a bit if you catch it, until the viral load in you is reduced.
#dexamethasone WILL NOT PREVENT THE #COVID19. It most likely won't even freaking help you a bit if you catch it, until the viral load in you is reduced.
