Neuroscientists Find Isolation Can Provoke Similar Brain Activity Seen in Hunger

As I heard one commentator say, a pandemic or economic depression by themselves would be problematic, but both together is a much worse problem.

Since the coronavirus pandemic began in the spring, many people have only seen their close friends and loved ones during video calls, if at all. A new study from MIT finds that the longings we feel during this kind of social isolation share a neural basis with the food cravings we feel when hungry.

The researchers found that after one day of total isolation, the sight of people having fun together activates the same brain region that lights up when someone who hasn’t eaten all day sees a picture of a plate of cheesy pasta.

“People who are forced to be isolated crave social interactions similarly to the way a hungry person craves food. Our finding fits the intuitive idea that positive social interactions are a basic human need, and acute loneliness is an aversive state that motivates people to repair what is lacking, similar to hunger,” says Rebecca Saxe, the John W. Jarve Professor of Brain and Cognitive Sciences at MIT, a member of MIT’s McGovern Institute for Brain Research, and the senior author of the study.

The research team collected the data for this study in 2018 and 2019, long before the coronavirus pandemic and resulting lockdowns. Their new findings, described today in Nature Neuroscience, are part of a larger research program focusing on how social stress affects people’s behavior and motivation.

Former MIT postdoc Livia Tomova, who is now a research associate at Cambridge University, is the lead author of the paper. Other authors include Kimberly Wang, a McGovern Institute research associate; Todd Thompson, a McGovern Institute scientist; Atsushi Takahashi, assistant director of the Martinos Imaging Center; Gillian Matthews, a research scientist at the Salk Institute for Biological Studies; and Kay Tye, a professor at the Salk Institute.

Social craving

The new study was partly inspired by a recent paper from Tye, a former member of MIT’s Picower Institute for Learning and Memory. In that 2016 study, she and Matthews, then an MIT postdoc, identified a cluster of neurons in the brains of mice that represent feelings of loneliness and generate a drive for social interaction following isolation. Studies in humans have shown that being deprived of social contact can lead to emotional distress, but the neurological basis of these feelings is not well-known.

“We wanted to see if we could experimentally induce a certain kind of social stress, where we would have control over what the social stress was,” Saxe says. “It’s a stronger intervention of social isolation than anyone had tried before.”

To create that isolation environment, the researchers enlisted healthy volunteers, who were mainly college students, and confined them to a windowless room on MIT’s campus for 10 hours. They were not allowed to use their phones, but the room did have a computer that they could use to contact the researchers if necessary.

“There were a whole bunch of interventions we used to make sure that it would really feel strange and different and isolated,” Saxe says. “They had to let us know when they were going to the bathroom so we could make sure it was empty. We delivered food to the door and then texted them when it was there so they could go get it. They really were not allowed to see people.”

After the 10-hour isolation ended, each participant was scanned in an MRI machine. This posed additional challenges, as the researchers wanted to avoid any social contact during the scanning. Before the isolation period began, each subject was trained on how to get into the machine, so that they could do it by themselves, without any help from the researcher.

“Normally, getting somebody into an MRI machine is actually a really social process. We engage in all kinds of social interactions to make sure people understand what we’re asking them, that they feel safe, that they know we’re there,” Saxe says. “In this case, the subjects had to do it all by themselves, while the researcher, who was gowned and masked, just stood silently by and watched.”

Each of the 40 participants also underwent 10 hours of fasting, on a different day. After the 10-hour period of isolation or fasting, the participants were scanned while looking at images of food, images of people interacting, and neutral images such as flowers. The researchers focused on a part of the brain called the substantia nigra, a tiny structure located in the midbrain, which has previously been linked with hunger cravings and drug cravings. The substantia nigra is also believed to share evolutionary origins with a brain region in mice called the dorsal raphe nucleus, which is the area that Tye’s lab showed was active following social isolation in their 2016 study.

The researchers hypothesized that when socially isolated subjects saw photos of people enjoying social interactions, the “craving signal” in their substantia nigra would be similar to the signal produced when they saw pictures of food after fasting. This was indeed the case. Furthermore, the amount of activation in the substantia nigra was correlated with how strongly the patients rated their feelings of craving either food or social interaction.

Degrees of loneliness

The researchers also found that people’s responses to isolation varied depending on their normal levels of loneliness. People who reported feeling chronically isolated months before the study was done showed weaker cravings for social interaction after the 10-hour isolation period than people who reported a richer social life.

“For people who reported that their lives were really full of satisfying social interactions, this intervention had a bigger effect on their brains and on their self-reports,” Saxe says.

The researchers also looked at activation patterns in other parts of the brain, including the striatum and the cortex, and found that hunger and isolation each activated distinct areas of those regions. That suggests that those areas are more specialized to respond to different types of longings, while the substantia nigra produces a more general signal representing a variety of cravings.

Now that the researchers have established that they can observe the effects of social isolation on brain activity, Saxe says they can now try to answer many additional questions. Those questions include how social isolation affect people’s behavior, whether virtual social contacts such as video calls help to alleviate cravings for social interaction, and how isolation affects different age groups.

The researchers also hope to study whether the brain responses that they saw in this study could be used to predict how the same participants responded to being isolated during the lockdowns imposed during the early stages of the coronavirus pandemic.

The research was funded by a SFARI Explorer Grant from the Simons Foundation, a MINT grant from the McGovern Institute, the National Institutes of Health, including an NIH Pioneer Award, a Max Kade Foundation Fellowship, and an Erwin Schroedinger Fellowship from the Austrian Science Fund.

U.S. Hospitals Charging Patients Up to 1800% More for Services Than They Cost

The American system has produced some incredible medical advances, but it is reasons like these absurdly high costs that make it largely such a catastrophe.

Hospitals in the United States charge patients as much as 1,800% more than their costs amid the coronavirus pandemic, according to a new study.

The 100 most expensive hospitals in the United States charge between $1,129 and $1,808 for every $100 of their costs, according to a study by National Nurses United, the largest nurses union in the country.

Overall, hospitals across the US charge an average of $417 for every $100 of their costs. The average markup has more than doubled over the past two decades, according to the report.

The markups have resulted in hospital profits skyrocketing by 411% from 1999 to 2017, hitting a record $88 billion.

“The rise in charges coincides with growing hospital mergers and acquisitions by large systems,” the union said in a news release. “The result is increased market consolidation, which leads to higher profits and increased charges, not savings for patients as hospital systems often claim.”

Medical workers worry that high costs will increase the number of people avoiding medical care.

“There is no excuse for these scandalous prices. These are not markups for luxury condo views, they are for the most basic necessity of your life: your health,” nurse Jean Ross, the president of the union, said in a statement. “Unpayable charges are a calamity for our patients, too many of whom avoid— at great risk to their health — the medical care they need due to the high cost, or they become burdened by devastating debt, hounded by bill collectors or driven into bankruptcy.”

The union warned that “high hospital charges also drive up Covid-19 treatment costs.”

A study by the health care data nonprofit FAIR Health in the spring found that uninsured coronavirus patients or those that receive care considered out-of-network by their insurer face costs ranging from $42,486 to $74,310 if they require inpatient hospital treatment.

A survey by the health care research group the Commonwealth Fund also found that more than two-thirds of Americans say that “potential out-of-pocket costs would be very or somewhat important in their decision to seek care if they had symptoms of the coronavirus.”

While insurers often negotiate prices with hospitals, uninsured patients have little recourse. And as with other health care and coronavirus-related disparities, people of color are disproportionately impacted. Latinos are nearly three times as likely and Black people are nearly twice as likely to be uninsured than white Americans, according to a study from the Kaiser Family Foundation.

The National Nurses United report argued that the findings further make the case for a Medicare for All system because Medicare is the “most effective” system to limit price gouging.

“The most viable solution to slowing the growth in hospital charges and the continued inflation of hospital prices, is to bring all health care purchasers together, under a public, nationwide single-payer plan,” the report said.

The RAND Corporation, a nonprofit think tank, found that hospitals charged private insurers an average of 2.4 times more than Medicare rates.

“Nurses know that the best way to rein in these outrageous charges that create such grievous harm for our patients is with Medicare for All, as other countries have proven,” said Ross, the union president. “Medicare for All will not only guarantee health care coverage for every person in the United States, it will end medical bankruptcies, medical debt lawsuits, and the health insecurity faced by millions who make painful choices every day about whether to seek the care they desperately need.”

[…]

A study published in the Annals of Internal Medicine earlier this year found that 34% of health care expenditures go toward administrative costs alone. The US spent about $2,497 per person on administrative costs in 2017, compared to $551 per person in Canada, which has a single-payer system. Switching to a single-payer system would drive down health care costs by $600 billion on administrative costs alone, according to the analysis.

“Americans spend twice as much per person as Canadians on health care. But instead of buying better care, that extra spending buys us sky-high profits and useless paperwork,” lead author Dr. David Himmelstein, a professor at the CUNY School of Public Health at Hunter College, said in a statement.

Another study published in The Lancet earlier this year found that Medicare for All would save the country about $450 billion per year while preventing more than 68,000 unnecessary deaths annually.

Lead researcher Dr. Alison Galvani, an epidemiologist and director of the Center for Infectious Disease Modeling and Analysis at Yale University, argued that Biden’s proposal to essentially expand Obamacare could actually increase costs compared to the Medicare for All plan that the president-elect decried during the primaries as too costly.

“Without the savings to overhead, pharmaceutical costs, hospital/clinical fees, and fraud detection, ‘Medicare for all who want it’ could annually cost $175 billion dollars more than status quo,” she told Newsweek. “That’s over $600 billion more than Medicare for all.”

An analysis published in PLOS Medicine of 22 single-payer studies showed that 19 of them “predicted net savings … in the first year of program operation and 20 … predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans.”

Critics have argued that reducing costs by switching to a single-payer system would result in doctor shortages and the rationing of health care. But data shows that fewer than 1% of doctors have opted out of the existing Medicare and Medicaid programs, with nearly half of those being psychiatrists. Single-payer proponents also dismiss rationing claims, arguing that Americans are already effectively self-rationing due to sky-high costs, even for those with private insurance.

A Federal Reserve survey published last year found that about 25% of American “adults skipped necessary medical care in 2018 because they were unable to afford the cost.” Another survey found that 26% of Americans with diabetes have rationed their insulin, primarily due to the cost.

“It would be a missed opportunity for America to ignore lessons about universal coverage from other countries out of a fear that they ration health care more than we do,” researchers at the Commonwealth Fund warned in a report last year. “In reality, more people in the U.S. forgo needed health care because access to care is rationed through lack of access to adequate insurance or unaffordable services and treatments.”

App That Listens to Coughing Developed to Tell if People Have COVID-19

If this app works effectively, it will be very important in allowing people to group up more freely again.

As millions of people worldwide battle the symptoms of COVID-19, a group of “silent patients” may not even know they’re sick and spreading the virus. Asymptomatic people, by definition, have no physical symptoms of the illnesses they carry.

Researchers at the Massachusetts Institute of Technology (MIT) however, say they may be showing symptoms after all — in the sound of their cough. Their study has created an artificial intelligence program that can identify if someone has coronavirus by the way their coughing sounds. Researchers programmed their AI model with thousands of different recorded coughs from both healthy and sick volunteers. When they fed in recordings of new patients, the system accurately detected 98.5 percent of coughs coming from people with a confirmed case of COVID-19. AI also successfully picked out 100 percent of asymptomatic cases from volunteers who reported not having any symptoms but tested positive for the virus.

The team is now working on turning their model into a user-friendly app. If approved by the Food and Drug Administration, the app would give people a non-invasive and quick way to screen themselves during the pandemic daily.

“The effective implementation of this group diagnostic tool could diminish the spread of the pandemic if everyone uses it before going to a classroom, a factory, or a restaurant,” says co-author Brian Subirana in a university release.

The MIT team notes researchers have been working on audio-based medical screenings since before the coronavirus emergency began. Their group in particular originally created this AI model to screen for Alzheimer’s disease.

Although the degenerative neurological condition is mostly associated with memory loss, it also affects the muscles and vocal cords. With this knowledge, researchers trained a general machine-learning algorithm called ResNet50 to detect changes in vocal cord strength. Subirana taught the neural network using an audiobook collection with over 1,000 hours of speech files. The AI model could eventually tell the difference between similar worlds like “them” and “the” or “then.”

The system can also read the emotions of the speaker based on the tone of their voice. The team says this is a key in Alzheimer’s detection because patients tend to display more frustration when they try to get words out. The program learned to assess these moods and put them into categories including neutral, calm, happy, and sad.

Finally, the team turned to coughing. Using recordings of patients coughing, the AI model could analyze the lung and respiratory performance of the cougher. An algorithm to detect muscular degradation was also added to help AI distinguish strong coughs from weaker ones.

With all of this data, study authors discovered that the technology could effectively screen for Alzheimer’s based on a patient’s vocal cord strength, sentiment, lung performance, and muscular degradation.

Once the pandemic began, the team at MIT changed gears and started looking at their model to see if it could detect COVID. Researchers say there is growing evidence coronavirus patients also suffer from neurological symptoms and temporary muscular impairment.

“The sounds of talking and coughing are both influenced by the vocal cords and surrounding organs. This means that when you talk, part of your talking is like coughing, and vice versa. It also means that things we easily derive from fluent speech, AI can pick up simply from coughs, including things like the person’s gender, mother tongue, or even emotional state. There’s in fact sentiment embedded in how you cough,” Subirana explains. “So we thought, why don’t we try these Alzheimer’s biomarkers [to see if they’re relevant] for COVID.”

The team created a website to collect audio samples from volunteers, including many with coronavirus. From nearly 200,000 forced-cough audio samples, the group was able to find 2,500 recordings that came from confirmed COVID-19 patients. Many of these patients were also asymptomatic. After adding more random samples to act as a control, the team chose 4,000 coughing samples to train their AI model to screen for the virus.

Along with amazing accuracy in detecting coronavirus patients, researchers say the tests reveal “a striking similarity between Alzheimer’s and COVID discrimination.” They add that the same four biomarkers for detecting Alzheimer’s effectively screen out the virus as well.

“We think this shows that the way you produce sound, changes when you have Covid, even if you’re asymptomatic,” the research scientist in MIT’s Auto-ID Laboratory adds.

Subirana and his team stress that their AI system is not meant to diagnose what illness you may have; whether it be the flu, asthma, or COVID-19. The tool, instead, works by screening out who is healthy from who is asymptomatic but carrying an illness.

The MIT team is now partnering with several hospitals to collect more coughing samples to refine the system’s accuracy. Their hope is to introduce a free pre-screening app to the public which can cut down on clinical testing delays.

“Pandemics could be a thing of the past if pre-screening tools are always on in the background and constantly improved,” the study authors contend.

The study appears in the IEEE Journal of Engineering in Medicine and Biology.

Scientist’s Plasma Shot That Could Prevent COVID-19 Isn’t Being Considered by The Government

That the use of plasma (shown effective in many other cases) isn’t being considered is another inefficiency by the (U.S. at least) governmental response to the coronavirus pandemic.

It might be the next best thing to a coronavirus vaccine.

Scientists have devised a way to use the antibody-rich blood plasma of COVID-19 survivors for an upper-arm injection that they say could inoculate people against the virus for months.

Using technology that’s been proven effective in preventing other diseases such as hepatitis A, the injections would be administered to high-risk healthcare workers, nursing home patients, or even at public drive-through sites — potentially protecting millions of lives, the doctors and other experts say.

The two scientists who spearheaded the proposal — an 83-year-old shingles researcher and his counterpart, an HIV gene therapy expert — have garnered widespread support from leading blood and immunology specialists, including those at the center of the nation’s COVID-19 plasma research.

But the idea exists only on paper. Federal officials have twice rejected requests to discuss the proposal, and pharmaceutical companies — even acknowledging the likely efficacy of the plan — have declined to design or manufacture the shots, according to a Times investigation. The lack of interest in launching development of immunity shots comes amid heightened scrutiny of the federal government’s sluggish pandemic response.

There is little disagreement that the idea holds promise; the dispute is over the timing. Federal health officials and industry groups say the development of plasma-based therapies should focus on treating people who are already sick, not on preventing infections in those who are still healthy.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, said an upper-arm injection that would function like a vaccine “is a very attractive concept.”

However, he said, scientists should first demonstrate that the coronavirus antibodies that are currently delivered to patients intravenously in hospital wards across the country actually work. “Once you show the efficacy, then the obvious next step is to convert it into an intramuscular” shot.

But scientists who question the delay argue that the immunity shots are easy to scale up and should enter clinical trials immediately. They say that until there’s a vaccine, the shots offer the only plausible method for preventing potentially millions of infections at a critical moment in the pandemic.

“Beyond being a lost opportunity, this is a real head-scratcher,” said Dr. Michael Joyner, a Mayo Clinic researcher who leads a program sponsored by the Food and Drug Administration to capitalize on coronavirus antibodies from COVID-19 survivors. “It seems obvious.”

The use of so-called convalescent plasma has already become widespread. More than 28,000 patients have already received the IV treatment, and preliminary data suggest that the method is safe. Researchers are also looking at whether the IV drip products would prevent new infections from taking root.

The antibodies in plasma can be concentrated and delivered to patients through a type of drug called immune globulin, or IG, which can be given through either an IV drip or a shot. IG shots have for decades been used to prevent an array of diseases; the IG shot that prevents hepatitis A was first licensed in 1944. They are available to treat patients who have recently been exposed to hepatitis B, tetanus, varicella and rabies.

[…]

The proposal for an injection approach to coronavirus prevention came from an immunization researcher who drew his inspiration from history.

Dr. Michael Oxman knew that, even during the 1918 flu pandemic, the blood of recovered patients appeared to help treat others. Since then, convalescent plasma has been used to fight measles and severe acute respiratory syndrome, or SARS, among other diseases.

Like other doctors, Oxman surmised that, for a limited time, the blood coursing through the veins of coronavirus survivors probably contains immune-rich antibodies that could prevent — or help treat — an infection.

[…]

Throughout May, researchers and doctors at Yale, Harvard, Johns Hopkins, Duke and four University of California schools sent a barrage of letters to dozens of lawmakers. They held virtual meetings with health policy directors on Capitol Hill, but say they have heard no follow-up to date.

Dr. Arturo Casadevall, the chair of the National COVID-19 Convalescent Plasma Project, said he spoke to FDA officials who told him they do not instruct companies on what to produce. Casadevall told The Times that the leaders of the national project were “very supportive of the need to develop” an IG shot rapidly and that he believed it would be “very helpful in stemming the epidemic.”

Joyner, of the Mayo Clinic, said there are probably 10 million to 20 million people in the U.S. carrying coronavirus antibodies — and the number keeps climbing. If just 2% of them were to donate a standard 800 milliliters of plasma on three separate occasions, their plasma alone could generate millions of IG shots for high-risk Americans.

“At a hot-spot meatpacking plant, or at a mobile unit in the parking lot outside a mall — trust me, you can get the plasma,” Joyner said. “This is not a biological problem nor a technology problem. It’s a back-of-the-envelope intelligence problem.”

The antibody injections, for now, do not appear to be a high priority for the government or the industry.

Grifols, on April 28 — the same day that the U.S. topped 1 million confirmed coronavirus cases — made a major product announcement that would “expand its leadership in disease treatment with immunoglobulins.”

The product was a new vial for IG shots — to treat rabies.

Does Vitamin D Help Protect People from COVID-19? Some Evidence Suggests Yes

A comprehensive global study published in 2017 on respiratory infections would say yes:

A new global collaborative study has confirmed that vitamin D supplementation can help protect against acute respiratory infections. The study, a participant data meta-analysis of 25 randomized controlled trials including more than 11,000 participants, has been published online in The BMJ.

“Most people understand that vitamin D is critical for bone and muscle health,” said Carlos Camargo of the Department of Emergency Medicine at Massachusetts General Hospital (MGH), the study’s senior author. “Our analysis has also found that it helps the body fight acute respiratory infection, which is responsible for millions of deaths globally each year.”

Additionally, a professor of respiratory infection and immunity at Queen Mary University of London had this to say about vitamin D:

“Vitamin D could almost be thought of as a designer drug for helping the body to handle viral respiratory infections,” he said. “It boosts the ability of cells to kill and resist viruses and simultaneously dampens down harmful inflammation, which is one of the big problems with Covid.”

The pharmaceutical industry obviously can’t make enormous profits from vitamin D, and that’s part of why it hasn’t been explored more as a protective mechanism. With all the benefits of vitamin D and the lack of downsides to it however, it is worth getting enough vitamin D (through sufficient sunlight exposure and a good diet) to protect against respiratory infections such as the flu and COVID-19.

Widely Available Drug Dexamethasone Shown to Cut Deaths by a Third in Severely Ill COVID-19 Patients

The coronavirus pandemic remains severe, but dexamethasone (a steroid) is a cheap and relatively common drug that has apparently been shown in a rigorous trial to significantly reduce mortality rates in the most severely ill COVID-19 patients. This drug is not a cure and it wasn’t shown to help patients with moderate COVID-19 symptoms, but the drug has been shown to save lives, and that’s important since presumably more people will eventually be able to recover instead of dying to the coronavirus.

An inexpensive and commonly used steroid can save the lives of people seriously ill with COVID-19, a randomized, controlled clinical trial in the United Kingdom has found. The drug, called dexamethasone, is the first shown to reduce deaths from the coronavirus that has killed more than 430,000 people globally. In the trial, it cut deaths by about one-third in patients who were on ventilators because of coronavirus infection.

“It’s a startling result,” says Kenneth Baillie, an intensive-care physician at the University of Edinburgh, UK, who serves on the steering committee of the trial, called RECOVERY. “It will clearly have a massive global impact.” The RECOVERY study announced the findings in a press release on 16 June, but its researchers say that they are aiming to publish their results quickly and that they are sharing their findings with regulators in the United Kingdom and internationally.

The RECOVERY trial, launched in March, is one of the world’s biggest randomized, controlled trials for coronavirus treatments; it is testing a range of potential therapies. The study enrolled 2,100 participants who received dexamethasone at a low or moderate dose of six milligrams per day for ten days, and compared how they fared against about 4,300 people who received standard care for coronavirus infection.

The effect of dexamethasone was most striking among critically ill patients on ventilators. Those who were receiving oxygen therapy but were not on ventilators also saw improvement: their risk of dying was reduced by 20%. The steroid had no effect on people with mild cases of COVID-19 — those not receiving oxygen or ventilation.

Shortly after the results were released, the UK government announced that it had immediately authorized use of dexamethasone for patients hospitalized with COVID-19 who required oxygen, including those on ventilators.

Rigorous study

“It is a major breakthrough,” says Peter Horby, an infectious-disease specialist at the University of Oxford, UK, and a chief investigator on the trial. Use of steroids to treat viral respiratory infections such as COVID-19 has been controversial, Horby notes. Data from steroid trials during outbreaks of SARS (severe acute respiratory syndrome) and Middle East respiratory syndrome caused by related coronaviruses were inconclusive, he says. Nevertheless, given dexamethasone’s widespread availability, and some promising results from steroid studies in previous outbreaks, Horby says RECOVERY investigators felt it important to test the treatment in a rigorous clinical trial.

Treatment guidelines from the World Health Organization and many countries have cautioned against treating people with coronavirus with steroids, and some investigators were concerned about anecdotal reports of widespread steroid treatment. The drugs suppress the immune system, which could provide some relief from patients whose lungs are ravaged by an over-active immune response that sometimes manifests in severe cases of COVID-19. But such patients may still need a fully functioning immune system to fend off the virus itself.

The RECOVERY trial suggests that at the doses tested, the benefits of steroid treatment may outweigh the potential harm. The study found no outstanding adverse events from the treatment, investigators said. “This treatment can be given to pretty much anyone,” says Horby.

And the pattern of response — with a greater impact on severe COVID-19 and no effect on mild infections — matches the notion that a hyperactive immune response is more likely to be harmful in long-term, serious infections, says Anthony Fauci, head of the US National Institute of Allergy and Infectious Disease. “When you’re so far advanced that you’re on a ventilator, it’s usually that you have an aberrant or hyperactive inflammatory response that contributes as much to the morbidity and mortality as any direct viral effect.”

“Finding effective treatments like this will transform the impact of the COVID-19 pandemic on lives and economies across the world,” said Nick Cammack, head of the COVID-19 Therapeutics Accelerator at Wellcome, a UK biomedical research charity in London, in a statement. “While this study suggests dexamethasone only benefits severe cases, countless lives will be saved globally.”

Easy to administer

So far, the only drug shown to benefit COVID-19 patients in a large, randomized, controlled clinical trial is the antiviral drug remdesivir. Although remdesivir1 was shown to shorten the amount of time that patients may need to spend in the hospital, it did not have a statistically significant effect on deaths.

Remdesivir is also in short supply. Although the drug’s maker — Gilead Sciences of Foster City, California — has taken steps to ramp up production of remdesivir, it is currently available only to a limited number of hospitals around the world. And remdesivir is complex to administer: it must be given by injection over the course of several days.

Dexamethasone, by contrast, is a medical staple found on pharmaceutical shelves worldwide and is available as a pill — a particular benefit as coronavirus infections continue to rise in countries with limited access to healthcare. “For less than £50, you can treat 8 patients and save one life,” said Martin Landray, an epidemiologist at the University of Oxford, and another chief investigator on the RECOVERY trial.

The findings could also have implications for other severe respiratory illnesses, Baillie adds. For example, steroid treatments for a condition called acute respiratory distress syndrome are also controversial. “This really gives us a very good reason to look closely at that, because the mortality benefit is so extraordinarily large,” Baillie says. “I think this will affect patients well beyond COVID-19.”