The thing about steroids is that they do multiple things at once. This is true for most drugs, but it really does seem to be ESPECIALLY true of steroids.
https://twitter.com/carlzimmer/status/1312789495083929600
Two of the major effects of oral steroids:
1. They reduce inflammation.
2. They suppress your immune system.
They're really good at both of these things and are in fact used for both of these clinically. Occasionally you want to do both at once!
1. They reduce inflammation.
2. They suppress your immune system.
They're really good at both of these things and are in fact used for both of these clinically. Occasionally you want to do both at once!
However, if someone is sick with a virus, the "suppress the immune system" response is more likely to be a bug than a feature. (Not always, but a lot of the time.)
I assume this is why they concluded that dexamethasone is super useful for people who've hit a certain level of fucked-up-by-covid degree of sick, but harmful for the people who are less sick.
Less sick: you want your immune system working at full power. You do not want to tell it to take the afternoon off.
More sick: inflammation is bad enough you want to bring the anti-inflammatory Big Guns.
More sick: inflammation is bad enough you want to bring the anti-inflammatory Big Guns.
I mean, there is also a situation called a cytokine storm (this is apparently what killed a lot of the flu victims in 1918 and is happening with some covid patients) where your immune system goes absolutely berserk and tries to kill you with massive inflammation.
And that's one of the times that the fact that steroids BOTH reduce inflammation AND suppress your immune system is a huge, huge plus.
Anyway, if Trump is only as sick as they're telling us he is, he probably shouldn't be on dexamethasone.
There are kind of two possible explanations for a lot of what we've been hearing.
The obvious explanation is that he's a lot sicker than they're saying.
The obvious explanation is that he's a lot sicker than they're saying.
But, he may also be experiencing the downside of presidential health care: overtreatment.
The thing about boutique health care is that doctors want to look like they're doing SOMEthing, and so sometimes they'll give you treatments that won't help and might hurt.
The thing about boutique health care is that doctors want to look like they're doing SOMEthing, and so sometimes they'll give you treatments that won't help and might hurt.
Americans tend to assume that the newest and most expensive treatments are also the best treatments. This is pretty regularly not the case. I think this is largely the result of having to fight insurers so frequently.
Anyway. When Ronald Reagan was shot, he was taken to the nearest ER because there wasn't time to take him anywhere else, and I've read some analysis of the fact that this is probably why he survived: he got exactly the same care as any other gunshot victim.
Anyway, if you're going to give someone a very expensive placebo, don't give them steroids, steroids if you don't actually need them will FUCK YOU RIGHT UP.
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