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Health Desk articles

How can we tell if an increase in cases is the result of an increase in testing or something else?

A lot can be learned and based off of the percent-positive rate (e.g. how many tests result positive out of all the tests taken) and the number of cases in total. We cannot assume that an increase in cases or a growing percent-positive rate is purely a result of an increase in testing instead of a growing outbreak. Instead, we need to look at all of them together. A rise in the number of reported cases of COVID-19 could be related to an expansion of testing if the percentage of positive tests decreases or stays the same at the same time that the number of cases increases. Should percentage of positive tests increase while case counts also go up, this indicates that we cannot entirely blame the increase on expanded testing. The biggest indicator of a growing outbreak is if the percentage of positive tests increases along with the number of cases despite testing data staying the same or decreasing. When testing is not always widely available and reserved just for symptomatic people, the percent positivity will increase as with the number of cases. If testing is expanded and made more available, we will gain a better understanding of the true number of cases and percent-positive rate. If this percent positivity continues to grow along with the number of cases, this would be an indicator that the outbreak is worsening.

What do we know so far about inhaled steroids as a treatment or cure for COVID-19?

In early September of 2020, the World Health Organization (WHO) issued guidance that a class of steroids called corticosteroids - specifically dexamethasone, hydrocortisone, and methylprednisolone - should be considered treatments for severe cases of COVID-19, but should not be used in milder cases. These steroids are given systemically, meaning through the veins or in an oral pill form. Inhaled steroids have not be recommended or approved for use in COVID-19 cases by the WHO or U.S. FDA. Inhaled corticosteroids (ICSs) are used to treat asthma and other lung diseases, such as chronic obstructive lung disease (COPD). Due to lack of sufficient scientific evidence, whether ICSs protect or contribute to worse outcomes in COVID-19 patients is still debated. According to NIH Clinical Trials website, a randomized clinical study by Oxford University is underway to understand if ICSs can prevent or treat COVID-19. The Lancet Respiratory Medicine Journal published more information in September 2020 on the relation of COVID-19 mortality and inhaled corticosteroids. The publication states that using ICS might reduce immunity to fight viruses and increase pneumonia in patients with COPD. ICS use has also shown protection against COVID-19 by reducing the frequency of exacerbations and replication of SARS-CoV-2. However, there were significant differences in age and underlying illnesses about the groups studied. Common devices used as inhalers include a metered-dose inhaler (MDI), nebulizer and dry-powder or rotary inhaler. There have been rumors circulating about using "nebulizers" to inhale steroids, such as the anti-inflammatory drug budesonide (brand name Pulmicort), to potentially treat COVID-19. "Nebulizers" are a type of inhaler that change liquid medications, like budesonide, into a mist that can be more easily inhaled into the lungs. Nebulizers can be more expensive than the most common type of inhaler used by people with asthma, and patients usually use nebulizers for specific reasons, such as if a child or someone with severe asthma is having difficulties inhaling medicine. Inhaled steroids like budesonide can have side effects, and are also crucial for patients with health conditions who do not have COVID-19, so these should only be used when recommended by your doctor. Budesonide can be inhaled or taken orally, and when inhaled is part of a family of anti-inflammatory medications called inhaled steroids that are primarily used to help manage symptoms for conditions like asthma and chronic obstructive pulmonary disease (COPD). Budesonide is a prescription-only drug that is not approved by the U.S. Food and Drug Administration (FDA) for treatment of COVID-19.
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