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Dexamethasone Found to be a Feasible and Reliable Tool for Measuring COVID-19 Hospitalization Severity



The proportion of hospitalized patients in Massachusetts with a positive COVID-19 test, who received dexamethasone for treatment of severe infection, has been hovering around 30 percent since April, 2022.

Shira I. Doron, MD

New research led by Tufts Medical Center has found that the drug dexamethasone, part of the standard of care for treating severe COVID-19 with lung involvement, is a useful marker for determining which COVID-positive hospitalized patients are admitted specifically for the treatment of the disease, and which have mild or no symptoms and are admitted primarily for other reasons. The study, "Improving COVID-19 Disease Severity Surveillance Measures: State-Wide Implementation Experience," was published today in Annals of Internal Medicine.

The researchers examined 44,196 COVID-19 hospitalizations at all 68 acute care hospitals in Massachusetts over a one-year period between January 10, 2022 and January 9, 2023. During the first month of the study, in the midst of the Omicron surge, 49.6 percent of hospitalized, COVID-positive patients received dexamethasone at any point of their hospital stay. However, that number decreased to 33 percent by April, 2022, and remained within a stable range between a monthly average of 28.7 percent and 33 percent until the end of the study period. In total, 34 percent of patients hospitalized with COVID-19 received dexamethasone.

"We know that the severity of illness associated with COVID-19 has decreased over time, due to a combination of mass vaccination, population immunity, effective therapeutics and mutations in the virus," said study first author Shira Doron, MD, Chief Infection Control Officer for Tufts Medicine health system and Hospital Epidemiologist at Tufts Medical Center. "But over time, COVID hospitalization numbers have likely been increasingly overinflated in many states that did not differentiate between incidental and true COVID cases. We hope this study will be reassuring, but at the same time, help dispell misperceptions and misinformation about the importance of vaccination for preventing severe disease, hospitalization and death from COVID-19."

Measurement of the impact of COVID-19 on U.S. hospitals has been an important element of the public health response to the pandemic. However, due to a lack of standardization in different states and health care facilities, and the evolution of the pandemic, there have been wide variations in testing policies and criteria. Previous research by the study's authors, looking at national data from the Veterans Healthcare Administration system, showed a correlation between dexamethasone administration and the inpatient treatment of severe COVID-19, across institutions and different COVID variants.

"While dexamethasone was the ideal focus for this study, it is crucial that surveillance metrics for disease severity are constantly updated to keep pace with with the evolution of COVID-19," said study senior author Westyn Branch-Elliman, MD, Associate Professor of Medicine at the VA Boston Healthcare System. "Viruses constantly mutate, and accurate measures of severity will be crucial in determining if future variants are more dangerous, more immune evasive, or both, so we can respond quickly and effectively to achieve the best possible public health response and outcomes. It typically takes an average of 17 years for evidence-based interventions to reach the bedside, so we hope this study serves as a model for how the translation of evidence into clinical and public health practice can be expedited, and can ultimately improve care."