News of the day: inhaled budesonide can keep people with COVID19 out of hospital. https://www.medrxiv.org/content/10.1101/2021.02.04.21251134v1

Small, but blindingly effective study using an off the shelf, cheap, widely used drug to give a short treatment course shows faster symptom resolution and even reduced incidence of #LongCovid. Asthmatics take it routinely and might explain observations.

We know steroids improve outcomes, but their use is not suited to all COVID19. Inhaled asthma steroids however are- and they need no fridge or freezer. Just pocket lint. There are established production lines, billions of doses available, ramping up will costs fractions vs Vx.

Can we rid of lockdowns? Not fully. You don’t want people using inhalers as Pez dispensers. 90% reduction of hospitalisation won’t matter if transmission explodes in the absence of NPIs. Can we do away with Vx? No for the same reasons.

Do we need to suppress transmission to maybe a few hundred a day in the U.K., then start reopening? Yes when vulnerable populations are covered by Vx. Can we forget about getting longcovid or possible development issues? No- it’s not eliminating longcovid, it reduces it.

So what next? High incidence countries ought to start a follow up RCT trial with K individuals to confirm findings ASAP. By this paper, in the US, U.K. and Brazil outcomes should take a few weeks. If validated, then we are good to go.

On the other side of the tunnel we will still need to test respiratory symptoms to prescribe antibiotics (strep), paracetamol (rhino) or inhaled budesonide (COVID19) and the PH/productivity advantage sets the rationale for isolating infected cases and contacts for 1-2 weeks.

In other words if you get the sniffles, get a test, get treatment, stay at home for necessary time to study/work, then go back out. Minimal community transmission, most human resource stays at work, minimal disruption. If you have C19, inhale budesonide unless you get hairy.

People keep asking will this or that work? Is there hope? Do variants matter? Budesonide won’t affect disease burden but may shorten transmission time. The evolutionary pressure will be slower and less selective for new variants. It will last us a longer time.

So is there hope? Yes, finally, I feel there is hope. Will this work to go back to normal? Quite likely, but it will take us a few months to start returning to normal. Don’t book holidays yet (it’s illegal in the U.K.) but remember the sun always shines after winter.