A “silver bullet” for COVID-19?

Several readers have written to inform us about Richard Bartlett, a Texas doctor and onetime congressional candidate who says he has discovered a “silver bullet” for COVID-19. His proposed cure? Inhaled steroids.

This would be world-changing news, probably deserving a Nobel Prize, if true. It would save thousands of lives, end the economic and social upheaval caused by preventive measures, and save billions of dollars on hospital treatments.

As the ancient Spartans famously said: “If.”

I can’t say with certainty Dr. Bartlett hasn’t discovered a cure, for the same reason he shouldn’t imply that he has: What he currently has is a hypothesis, one whose evidence is as yet too limited to conclude that the treatment works at all, much less that it works in most or all COVID-19 patients. We simply don’t know. So how could we find out whether it’s a blockbuster—or a bust?

Back in March, we discussed a statistic called the “number needed to treat” (NNT). The NNT is the number of patients we’d need to treat in order to expect a medicine to have the desired effect in one patient. For a perfect treatment that benefits every patient who receives it, the NNT is 1. For many common prescriptions, though—statins for prevention of a heart attack, for instance—the NNT is more in the range of 20 to 100. You’d need to treat 20 to 100 patients in order to benefit just one.

Many medical conditions and illnesses go away by themselves. Given the relatively high NNT of many treatments, it’s often hard for researchers to tease out whether a new treatment is improving patient outcomes, or whether those patients would have fared equally well without the treatment.

This timeless source of job security for research statisticians brings us back to Dr. Bartlett and his series of patients. According to CBS7, Bartlett says he’s treated “dozens” of COVID-19 patients and all have survived. Since most patients with COVID-19 do survive, it raises the question: Did his patients benefit from the steroids, or were they patients who would have survived anyway?

Answers are on the way: Oxford and the Queensland University of Technology are already investigating this idea with their STOIC (Steroids in COVID-19) clinical trial. Queensland University of Technology elaborates on its origins: Two researchers “had noticed early on in the pandemic that people with asthma and the chronic lung disease COPD were under-represented in the numbers of seriously ill COVID-19 patients.” This struck them as unusual, since you’d normally expect patients with sick lungs not to have an advantage against respiratory viruses. That made them wonder whether those patients’ inhaled steroid treatments might be what was helping them.

In light of the recent discovery that another corticosteroid can help in severe cases of COVID-19—but not in less severe disease—I’m very curious to learn what the STOIC trial will reveal. STOIC aims to reach a conclusion by September.

In the meantime, let’s not—pardon the pun—jump the gun in our search for a silver bullet.