I write in response to an Open Letter to the Governor published in this paper on July 16, 2020 touting nebulized budesonide as a treatment for mild COVID-19. Unlike the author, I am a trained doctor. I am not a virologist, nor am I a dedicated medical researcher, but have worked clinically in emergency medicine for over a decade and treat COVID-19 patients daily. I was very concerned with publication of the letter as it could lead to severe side-effects and consequences for patients.
The treatment touted is not evidence-based. Multiple statistics are cited, but none are any randomized trial and no mention of number needed to treat (NNT). There is actually no mention of any research at all. This is simply a report of an anecdotal claim from a family physician in Texas who happens to have a compelling story and is a good talker. It is dangerous to tout cures which may not be cures.
While it may seem that it would be “worth a try,” it is important to remember that every medication is a powerful substance and may cause side effects. Specifically, while inhaled corticosteroids have fewer side effects than systemic steroids, they can still have significant unwanted effects on patients.
Given that this medication has been suggested for mild cases of COVID-19, which actually recover quite well with no treatment at all, the risk of side-effect is even greater. Additionally, it is quite easy to show an association between a treatment for a self-limited disease and the disease resolution. Remember, while COVID-19 can kill people, the vast majority of patients recover with no treatment whatsoever. The logic behind suggesting this treatment is similar to stating there is a cure for the common cold.
Consider this: I have developed a cocktail of medications and herbs and if you take it for seven days after the first onset of cold symptoms, you will be cured. Guess what, your own body cures a cold in seven days too. It would be very hard to “disprove” the claim that my magical treatment worked. However, it is not the duty of scientists to disprove a random claim; instead, it is the responsibility of the inventor to prove the claim.
Finally, nebulization has been shown to greatly increase the distance that the COVID-19 virus travels and can increase the spread of disease to others.
I have no idea if this treatment will work and I do believe that it is worth investigating in well designed, randomized controlled trials. It may work. I hope it does work. However it may not. Touting any medication without any evidence is irresponsible at best and dangerous at worst. And I strongly suggest that absolutely no one to search for medical advice on YouTube.
In conclusion, I agree with the author of the letter that another lockdown would be a disaster for our state. However, the way to prevent another lockdown is to practice methods shown to be effective at limiting spread and disease: Respect modest social distancing, wear a mask, isolate if you are sick, stay healthy, treat your chronic medical conditions, especially diabetes and high blood pressure. I urge our politicians to follow the logical and evidence based advice from the CDC.