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How researchers found that a cheap steroid can reduce COVID-19 death rates

The RECOVERY trial in the UK has found that dexamethasone can reduce deaths by one third and those receiving oxygen by one fifth.

Resource details:

Publication title: Effect of dexamethasone in hospitalised patients with COVID-19 – preliminary report

Author(s): RECOVERY collaborative group 

Publication date: 22 June 2020

What the preliminary report is about:

  • The report details the results of one of six arms of the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial at Oxford University in the United Kingdom. The clinical study evaluates potential treatments for COVID-19 of which one is low-dose dexamethasone. Dexamethasone is a medication used to treat inflammation, according to the US-based research organisation, Mayo Clinic.    
  • Over 11 500 hospitalised COVID-19 patients from 176 UK hospitals are enrolled in the trial. RECOVERY is a randomised controlled trial, which means each of the six treatments that different groups of patients receive, are compared to a group that doesn’t receive that particular medication. This preliminary report highlights the results of patients who were placed on the dexamethasone treatment arm. 

Key take-aways from the preliminary report:

Summary of the trial’s methods:

  • 2 104 COVID-19 patients were randomly selected to each receive 6mg of dexamethasone once a day (either by mouth or by intravenous infection) for ten days.  The progress of patients placed on dexamethasone was then compared to that of 4 321 patients who were randomly selected to receive just the usual standard of care.
  • Researchers divided patients into three groups: patients who were on ventilators, those who received only oxygen and patients who did not require any respiratory intervention. 
  • Researchers used 28-day mortality (i.e. who had died within 28 days after receiving the treatment) to measure how effective dexamethasone was to treat COVID-19. 

Summary of trial findings:

  • Dexamethasone reduced 28-day mortality by one-third in ventilated patients and by one fifth in patients receiving oxygen only. There was no benefit among those patients who didn’t require respiratory support.  
  • Based on these results, dexamethasone would reduce one death of around eight ventilated patients and one death among 25 patients requiring oxygen only, the study found.
  • Overall, dexamethasone reduced the 28-day mortality rate by 17%, but the greatest benefit was among patients who required ventilation. 
  • Dexamethasone is the first drug to be shown to improve the survival of certain types of COVID-19 patients.  

The preliminary results of the dexamethasone arm of the RECOVERY trial have not yet been peer-reviewed. Researchers are working to publish the full details. 

You can find and download the preliminary report here. The study protocol can be downloaded here

South Africa’s health minister, Zweli Mkhize, on dexamethasone on 19 June:

  • Is it available in the country?

“This is one of those medicines where we do have excellent local capacity. There are three major suppliers of intravenous dexamethasone in the country. One of the companies manufactures the oral equivalent and supplies it all over the world and so we are able to negotiate the security of our own supply right here at home.

In fact, to have a South African enterprise be a manufacturer and supplier of a critical medicine, especially one that will prove to be lifesaving in the current global context, is a real departure from the norm and so South Africans can take pride in being one of the countries that will provide a solution to a global crisis.”

  • Will we use it? 

“Our health care workers are very familiar with dexamethasone, having used it for decades as a registered medicine in South Africa. We are immediately able to offer all patients that need intravenous dexamethasone — we have checked our stock and we currently have around 300 000 ampoules in the country.”

[Please note: Information on the new coronavirus is rapidly changing. Please refer to the RECOVERY website for the latest information. Visit for updates on South Africa’s coronavirus response.]