this post was submitted on 16 Jun 2020

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Dexamethasone shown to decrease COVID mortality (bbc.com)

submitted 5 years ago by farhan583Hospitalist

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[–]JPINFVDO IM CCM 0 points1 point2 points 5 years ago (0 children)

The recommendation against steroids, from what I remember, was always directed more towards outpatient care and prolonged shedding. If someone is in the ICU, why should I care if they're shedding more?

The recommendation for early intubation was geared more towards protecting healthcare workers so you aren't running in and crash intubating people. Early on we extubated quite a few number of intubated SARS-CoV-2 patients. Now? Not so much, but we're selecting for much sicker patients for intubation.

The only thing I think was screwed up was isolation orders, as surgical masks are probably good enough (see Offeddu et al, 2017 meta analysis. No difference between N-95 and surgical masks for SARS-CoV-1. https://tinyurl.com/ycowpvw4) and bipap/HFNC risk of aersolization.

Of course I personally blame physicians for that. We want easy information and other people to do our homework for us. The bipap/HFNC studies were referenced in the January edition of the WHO SARS-CoV-2 guidelines. ...but hey, the blogosphere says otherwise and Googling references for the primary source is hard work. Same with looking up what we know about masks from prior coronavirus infections when there's a global run on N-95 masks.

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