The new semi-magic bullet for the coronavirus is Dexamethasone. Its name has recently appeared in the news because it was found to be effective in extreme cases of Covid-19. The hype is more modest because the study was carried out in the UK. And, of course, the drug is not as flashy, glamorous or profitable as those used against malaria.
Dexamethasone is a boring corticosteroid that has been around for the last 50 years, languishing away on the third row of dusty pharmacy shelves. It has the virtue of being easier to spell than hydroxychloroquine, and is used to treat a wide range of conditions related to inflammation in different parts of the body. It has also been used in cases of severe asthma, and breathing difficulties.
By now it is fairly common knowledge that widespread inflammation is one of the most devastating effects of Covid-19. Since corticosteroids are often used to treat inflammation, British doctors put two and two together and came to the conclusion that Dexamethasone just might help coronavirus patients.
At warp speed (British style), they carried out a study that found that this drug reduced mortality by 33% in ventilated patients and by 20% in patients who were only receiving oxygen therapy. However, there was no benefit to patients who could breathe normally.
Dexamethasone has been sold in pharmacies since the 1960s, and is very cheap (though Medicare will doubtlessly find a way to exponentially increase its price). In Europe, a ten-day treatment would cost the National Health Service 39 euros ($43.86).
Even so, it would not be a good idea to wheedle a prescription out of a doctor, run to the pharmacy, and load up on this medication. It will only help you if you are receiving oxygen or are hooked up to a ventilator, and even then, not always. If you take Dexamethasone just for the thrill of doing something really stupid, then your health could be seriously damaged.
Though not as toxic as Lysol, Dexamethasone has a daunting list of secondary effects, which include increased appetite, irritability, insomnia, fluid retention, and increased blood sugar, among others. Fortunately, a prescription is required because the drug only reduces coronavirus mortality when patients already have one foot in the grave.
Nevertheless, the British study on Dexamethasone is great news and may even compensate somewhat for the great hydroxychloroquine fiasco, which called the medical advice of President Trump and his equally learned colleague, President Bolsonaro, into question. The path to a magic bullet is often rocky and filled with potholes.
From a personal viewpoint, the results of the British study did not surprise me. Believe it or not, I have known about the virtues of Dexamethasone for almost 50 years and can vouch for its effectiveness.
In 1971, I was living in Malaga and suffering from a persistent eye infection. I had not been in Spain for very long, and only had faith in American medicine. All Spanish doctors were thus objects of deep distrust. I was still trying to come to terms with cultural differences, and this was just one more thing that made me wonder if I had done the right thing when I decided to permanently leave the USA.
My eye infection was severe and made me feel miserable since it seemed to drag on forever. Each ophthalmologist that I had visited prescribed something different. I felt as though I was being used as a testing ground for a wide range of eyewashes, drops, and ointments. Nothing seemed to work. One very elderly doctor even thought that the infection might be the result of female hysteria and gave me something for my nerves, which knocked me out until the next day.
So, I sought advice from my husband’s aunt, Tía Pilar, who was a pharmacist and knew which doctors in Malaga wrote the best prescriptions. She immediately took me to an eye clinic near her pharmacy.
Since the head of the clinic happened to be a good ophthalmologist, he had more patients than he could shake a stick at, and had no time for anyone else. Or so we were officiously informed by his receptionist, a rather plump lady whose hair was an alarming shade of red and who wore gold earrings that were tiny images of the Virgin Mary.
However, Tía Pilar was a resourceful woman, and knew exactly what to do. She quietly slipped a bribe to the receptionist, a custom that I was not familiar with and which fortunately has since fallen into disuse. The bribe ritual involved an offer of money, which was initially refused. This was followed by a second and third offer in which the refusal became increasingly weaker. On the fourth try, the bribe was finally pocketed.
Once the receptionist accepted the money, it was then possible to gain access to the hallowed portal of the doctor’s office.
The experience was curious since unofficial patients, such as myself, who exceeded the daily quota were not supposed to be in the waiting room with the real patients. We were thus obliged to make ourselves invisible.
Invisibility was facilitated by the receptionist who placed us in the hallway, behind one of a series of curtains that strategically covered the wall, (doubtlessly for that very purpose). Unofficial patients were slipped into the consultation between official ones.
As one progressed in the unofficial queue, it was necessary to surreptitiously change curtains without allowing the patients in the real waiting room to perceive what was occurring. It was all very cloak-and-dagger, and even made me forget my infected eye.
After about 50 minutes of sneaking from one curtain to another, I was finally allowed to see the doctor. He examined my eye and prescribed Dexamethasone ointment. After the long string of failed treatments, I had become very cynical, and did not really believe that it would work. However, I went to the pharmacy with the prescription, bought the ointment, and began to apply the treatment.
To my astonishment, it cured the infection and inflammation where everything else had failed. My eye infection was eradicated and never returned.
So, I can vouch for the effectiveness of Dexamethasone. In 1971, it was indeed a miracle drug. But now, in Times of Coronavirus, given its context of use, I only hope that I will never have to take it again.
