The Oxford University RECOVERY clinical trial has tested a range of potential treatments for Covid-19 on a total of some 11,500 patients in 175 NHS hospitals (http://www.ox.ac.uk/news/2020-06-16-dexamethasone-reduces-death-hospitalised-patients-severe-respiratory-complications). The most interesting results, to date, have concerned low doses of the cheap anti-inflammatory steroid, dexamethasone. Daily oral or iv doses of this compound clearly reduced deaths in both patients on ventilators and those receiving oxygen supplementation (the former to a greater extent than the latter). Infected patients, who did not require respiratory help, showed no benefit (although they would presumably have a low death-rate irrespective). The studies employed substantial numbers of patients in both the experimental and control categories and appear robust. Dexamethasone is a cheap corticosteroid (it is related to the 'stress' hormones of the adrenal cortex) that has been safely used for decades as an anti-inflammatory preparation. It has been used to treat skin diseases (acne); severe allergies; asthma; chronic obstructive lung diseases; swelling of the brain and even tuberculosis. The result strongly suggests that some of the more severe complications of a Covid-19 infection involve the body's immune system. Powerful impacts of the viral infection have been expressed in some patients as changes in lung histology and the circulatory systems. The virus may cause excessive (and life-threatening) immunological responses in cohorts of patients.
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