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WHO to update COVID-19 clinical guidance, stresses that steroids should not be used as prevention

"It’s exceptionally important that this drug is used under medical supervision," the World Health Organization said.
Image: A Day with A Covid-19 Intensive Care Unit at Hospital General de Mexico
Doctors treat a patient with COVID-19 at a hospital in Mexico City on May 30, 2020.Hector Vivas / Getty Images

The World Health Organization will update its clinical guidance for COVID-19 following the University of Oxford's announcement of results from a trial on the steroid dexamethasone.

WHO Director-General Tedros Adhanom Ghebreyesus called the findings "very welcome news" during a media briefing Wednesday, but stressed that the drug should only be used in severe cases under close clinical supervision. "We will update our clinical guidance to reflect how and when dexamethasone should be used," Tedros said.

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Oxford researchers said in a press release Tuesday that dexamethasone was found to reduce deaths in patients with severe COVID-19, such as those on ventilators or oxygen.

The full data have not yet been released, but the WHO said in a statement Tuesday that "the researchers shared initial insights about the results of the trial with WHO, and we are looking forward to the full data analysis in the coming days." In addition, the organization will look at data from other clinical trials on dexamethasone to further its understanding of the drug.

During the briefing Wednesday, WHO officials underscored that the drug's use should be limited to severe cases, and it should not be used for prevention.

"Dexamethasone was shown to not have a beneficial effect for those with milder disease, who did not need respiratory support," Tedros said. "We need more therapeutics that can be used to tackle COVID-19, including those with milder symptoms."

"It’s exceptionally important that this drug is used under medical supervision," Dr. Mike Ryan, executive director of the WHO's health emergencies program, said. "This is not for mild cases. This is not for prophylaxis."

In fact, steroids could make infections worse in some cases, by helping the virus replicate, he said.

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The drug does not block the virus; it works by reducing inflammation in and around the lungs, Ryan said. When patients are very ill with COVID-19, this inflammation can make it difficult to get enough oxygen into the blood.

Dexamethasone "is not a treatment for the virus itself," h esaid. Rather, the drug should be seen as one part of a combination approach to treating COVID-19, along with oxygen, ventilation and antiviral drugs.

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