Treatment for the severely ill
Seven months into the coronavirus crisis, scientists have confirmed the efficacy of a powerful weapon in the battle against Covid-19. In international trials published today, cheap, widely available steroid drugs were shown to reduce the risk of death in seriously ill patients. Until now, the only other drug shown to help seriously ill patients, and only modestly, was remdesivir.
Many patients who are infected do not die from the virus, but from the body’s overreaction to the infection. The new research includes three studies and an analysis of pooled data from seven randomized clinical trials, which confirmed that steroids like dexamethasone, hydrocortisone and methylprednisolone can tamp down the body’s immune system and reduce the risk of death.
The strongest results were from dexamethasone, which produced a 36 percent drop in deaths; hydrocortisone appeared to reduce deaths by 31 percent; and a small trial of methylprednisolone showed a 9 percent drop. The results were so strong that the World Health Organization issued new treatment guidance and strongly recommended the use of steroids to treat severely and critically ill patients.
The W.H.O. warned against using steroids indiscriminately, noting that patients who are not severely ill are unlikely to benefit and may suffer side effects. Steroids, especially in older patients, can cause confusion or even delirium, and may leave them vulnerable to other infections. Further, wide use could deplete global supplies, depriving patients who genuinely need the medications.
But taken together, the studies “are like the second punch of a one-two punch,” said Dr. Derek C. Angus, an author of one of the new studies and the analysis. “I had a big smile on my face when I saw the results.”
How a science reporter grappled with the school question
It’s perhaps the toughest choice that parents face this fall: Do you send your children to school or keep them home? In-person learning carries numerous educational and social benefits and can be critical for low-income, Black and Latino students who lack the resources for remote learning. But many parents fear that their children will pick up the virus at school and fall ill or spread it to others.
Our colleague Apoorva Mandavilli, a science reporter who has been covering the pandemic, wrote about the process she went through in grappling with this decision for her two children. The experts she consulted made one thing clear: Schools should reopen only if less than 5 percent of the people tested in a community are positive for the coronavirus.
In New York City, the positivity rate has remained about 0.6 percent in recent days — far lower than the national average. Apoorva and her husband ultimately decided to send their children back for the two days a week they qualified for.
The decision to have a hybrid education model in New York City, the nation’s largest school district and the only major one to hold onto plans to return to classrooms this fall, has proved challenging. Under escalating pressure from the city’s teachers’ union and facing threats of a strike, Mayor Bill de Blasio this week pushed back the first day of school 10 days, to Sept. 21, to allow more time to prepare.
The city will require monthly, random testing of 10 to 20 percent of students and staff members in all city schools, with results within 48 hours. More nurses are being hired, ventilation systems are getting upgraded and millions of masks and bottles of hand sanitizer will be doled out.
The Coronavirus Outbreak ›
Frequently Asked Questions
Updated September 1, 2020
Why is it safer to spend time together outside?
- Outdoor gatherings lower risk because wind disperses viral droplets, and sunlight can kill some of the virus. Open spaces prevent the virus from building up in concentrated amounts and being inhaled, which can happen when infected people exhale in a confined space for long stretches of time, said Dr. Julian W. Tang, a virologist at the University of Leicester.
What are the symptoms of coronavirus?
- In the beginning, the coronavirus seemed like it was primarily a respiratory illness — many patients had fever and chills, were weak and tired, and coughed a lot, though some people don’t show many symptoms at all. Those who seemed sickest had pneumonia or acute respiratory distress syndrome and received supplemental oxygen. By now, doctors have identified many more symptoms and syndromes. In April, the C.D.C. added to the list of early signs sore throat, fever, chills and muscle aches. Gastrointestinal upset, such as diarrhea and nausea, has also been observed. Another telltale sign of infection may be a sudden, profound diminution of one’s sense of smell and taste. Teenagers and young adults in some cases have developed painful red and purple lesions on their fingers and toes — nicknamed “Covid toe” — but few other serious symptoms.
Why does standing six feet away from others help?
- The coronavirus spreads primarily through droplets from your mouth and nose, especially when you cough or sneeze. The C.D.C., one of the organizations using that measure, bases its recommendation of six feet on the idea that most large droplets that people expel when they cough or sneeze will fall to the ground within six feet. But six feet has never been a magic number that guarantees complete protection. Sneezes, for instance, can launch droplets a lot farther than six feet, according to a recent study. It’s a rule of thumb: You should be safest standing six feet apart outside, especially when it’s windy. But keep a mask on at all times, even when you think you’re far enough apart.
I have antibodies. Am I now immune?
- As of right now, that seems likely, for at least several months. There have been frightening accounts of people suffering what seems to be a second bout of Covid-19. But experts say these patients may have a drawn-out course of infection, with the virus taking a slow toll weeks to months after initial exposure. People infected with the coronavirus typically produce immune molecules called antibodies, which are protective proteins made in response to an infection. These antibodies may last in the body only two to three months, which may seem worrisome, but that’s perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University. It may be possible to get the coronavirus again, but it’s highly unlikely that it would be possible in a short window of time from initial infection or make people sicker the second time.
What are my rights if I am worried about going back to work?
Students will find a very different school landscape: fewer people in classes to accommodate spaced-apart desks; windows that stay open, even in cold and rain; and hallways marked for social distancing.
What else we’re following
What you’re doing
My neighbors and I are sharing the labors of our kitchens. We just send a text in the morning to say what we’re cooking that day, and whoever likes that will let us know. We bring the food in containers and hang them at their door. We call these “Doorknob Dinners.”
— Eva Bueno, San Antonio
Let us know how you’re dealing with the outbreak. Send us a response here, and we may feature it in an upcoming newsletter.
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