COVID-19 Update: Steroids Reduce Mortality & Masks Reduce Viral Loads

As recently reported in STAT News, inexpensive and common steroids can reduce the risk of Covid-19 mortality by roughly one-third. Subsequent to the study on which this report was based, the World Health Organization issued treatment guidelines making a seven-to-10 day dose of corticosteroids a recommended “standard of care” for patients with “severe and critical” Covid-19. The Journal of the American Medical Association has published the study on which the recommendations are based, concluding that “administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality.”

Another story that came out recently involves the beneficial effects of masking. The article published in the New England Journal of Medicine summarized some of the data coming from epidemiology studies, noting that facial masking appears to reduce transmissions, but also may reduce the viral loads associated with transmissions. In doing so, it appears to increase the number of people who are asymptomatic because their immune systems can defeat smaller viral loads (at least that is the theory).

The data were summarized as follows:

In an outbreak on a closed Argentinian cruise ship, for example, where passengers were provided with surgical masks and staff with N95 masks, the rate of asymptomatic infection was 81% (as compared with 20% in earlier cruise ship outbreaks without universal masking). In two recent outbreaks in U.S. food-processing plants, where all workers were issued masks each day and were required to wear them, the proportion of asymptomatic infections among the more than 500 people who became infected was 95%, with only 5% in each outbreak experiencing mild-to-moderate symptoms. Case-fatality rates in countries with mandatory or enforced population-wide masking have remained low, even with resurgences of cases after lock-downs were lifted.

Of course, there are some downsides associated with greatly increasing the rates of asymptomatic transmission, but one of the upsides involves raising the level of herd immunity without dramatically increasing death rates. Ultimately, driving down overall transmission rates AND severity of infections is a good thing, and population-wide facial masking appears to provide both benefits.