SEATTLE, Washington — Since the COVID-19 spread was declared a worldwide pandemic, researchers have worked to gather new data on the virus and which communities are most impacted and which countries are positively combating the effects of COVID-19. While there is no current vaccine available, the University of Oxford began a national clinical trial on June 23 called the COVID-19 RECOVERY Trial, which clinically tests proposed COVID-19 treatments. Dexamethasone, one of the proposed treatments being tested, is a corticosteroid hormone used to treat arthritis, a variety of disorders, lung problems and specific cancer types. It works to decrease the body’s natural defense reactions, like swelling and allergic reactions.
COVID-19 RECOVERY Trial and Results
With the whole world scrambling for solutions, the COVID-19 RECOVERY Trial, standing for “Randomised Evaluation of COVID-19 Therapy,” has shown notable progress for patients hospitalized for the virus. Clinical research discussed whether the addition of the drug dexamethasone, along with basic medical care, reduces 28-day mortality in COVID-19 patients. The clinical trial tested approximately 6245 patients, with half receiving dexamethasone along with the usual care, while the other half only received the usual hospital care. The trial successfully resulted in the reduction of 28-day mortality in patients in need of both intermittent mandatory ventilation (IMV) and oxygen therapy.
The COVID-19 RECOVERY Trial results are promising and should make significant improvements to hospitalized and critically ill patients. High-income countries often use dexamethasone as its fairly inexpensively. However, the transfer of accessibility from upper to lower class regions has significant challenges.
COVID-19 and Low-Income Communities
Although COVID-19 can affect anyone regardless of wealth, it has become clear that impoverished populations are most vulnerable to the virus. Unfortunately, they are also the least likely to receive access to quality treatments, if they can afford it at all. According to the World Bank, a few factors contributing to these disparities include:
- Little to no access to quality resources
- Employment in crowded, urban areas
- High dependence on public services
- Little to no access to health insurance
- Limited savings
As a result of these factors, governments must accommodate these communities when testing and refining COVID-19 treatments. Higher-income countries like the United Kingdom and the United States have the technology and funding needed to provide these treatments. However, this is not the case for regions with high poverty levels.
Predicted Effects of Dexamethasone in India
To predict the effects of the COVID-19 RECOVERY Trial in a low-income community, the Center for Global Development constructed a model for urban and rural areas in India, where 16,475 people have died from the virus as of July 2. “We estimate that, if the RECOVERY trial results are transferable to the Indian context, approximately 2,733 (16.59%) of all COVID-19 deaths in India so far could have been averted if dexamethasone was used as per the trial protocol in patients receiving oxygen or mechanical ventilation.”
Clinical research also shows that these figures correlate with the finding that one in every 8.5 patients can be saved by adding dexamethasone in COVID-19 treatment. Moreover, the research found that the COVID-19 RECOVERY Trial treatment is impactful in communities similar to those in India and saw that it could be the key to slowing the spread of COVID-19 within the global poor.
Expanding the RECOVERY Trial to Low-Income Communities
While the proposed model looks promising, it isn’t quite as simple when discussing the transfer of technological treatments from higher-income areas to low-income areas. The Center for Global Development proposed the solutions listed below and concluded further research is essential to fully understand the effects of dexamethasone in different socio-economic contexts.
- The transfer of resources and trial equipement to low-resource communities needs to consider the significant changes in settings and health care factors
- Further study and information are required on dexamethasone’s impact in severe COVID-19 patients who have limited or no accessibility to oxygen and mechanical ventilation.
- Increasing the availability of oxygen in lower middle income countries positively impacts critical cases and helps correlate with the benefits of dexamethasone.
The COVID-19 RECOVERY Trial is a significant step toward the effective handling of the COVID-19 pandemic. But in order for this treatment to have a significant impact on the fatality rates, it must also be evaluated and incorporated within low-income communities that have been hit the hardest by the virus.
COVID-19 has taken 645,426 lives globally as of July 23, 2020, and most of the hotspots contribute to regional areas with low income and high population rates. Expanding medical trials like those involving dexamethasone to include urban and rural populations would not only prevent loss of life but it also allows funding for the improvement of hospital technology and supplies.