Abstract
The recent outbreak of respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), has led to the widespread use of therapeutics, including dexamethasone (DEXA). DEXA, a synthetic glucocorticoid, is among the widely administered drugs used to treat hospitalized COVID-19 patients. The global COVID-19 surge in infections, consequent increasing hospitalizations, and other DEXA applications have raised concerns on eminent adverse ecological implications to aquatic ecosystems. Here, we aim to summarize published studies on DEXA occurrence, fate, and effects on organisms in natural and engineered systems as, pre-COVID, the drug has been identified as an emerging environmental contaminant. The results demonstrated a significant reduction of DEXA in wastewater treatment plants, with a small portion, including its transformation products (TPs), being released into downstream waters. Fish and crustaceans are the most susceptible species to DEXA exposure in the parts-per-billion range, suggesting potential deleterious ecological effects. However, there are data deficits on the implications of DEXA to marine and estuarine systems and wildlife. To improve DEXA management, toxicological outcomes of DEXA and formed TPs should entail long-term studies from whole organisms to molecular effects in actual environmental matrices and at realistic exposure concentrations. This can aid in striking a fine balance of saving human lives and protecting ecological integrity.
Highlights
The effects were linked to likely changes of cellular were observed at the highest concentration, and there were no effects on E. coli, irrespec membrane properties by the hormones used
COVID-19, anticipated increases in the use of DEXA for treatment may lead to elevated influent concentrations, with treatment systems incorporating membrane biological reactors (MBR) technology plausibly effectively treating hospital effluent before it is discharged into municipal sewage systems
The data reviewed demonstrate the occurrence of DEXA in different environmental matrices and drinking water at variant concentrations, from 3.7 μg/L
Summary
A new coronavirus disease (COVID-19), caused by severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2) [1,2], emerged in 2019 from a zoonotic source [3,4] and was subsequently declared a global pandemic by the World Health Organization (WHO) in. By 23 June 2020, infections had risen to 9.1 million, with 472,700 deaths associated with the disease in 188 countries [6] recorded. These infections increased exponentially in a month (4 October 2020) to 35 million COVID-19 cases and over 1,034,000 related deaths worldwide [6], showing a dramatic upward trend. Dexamethasone (DEXA)—a synthetic glucocorticoid—has been reported as the first effective treatment for the sickest patients with COVID-19, and, given its low cost, known safety profile, and widespread availability, it is a likely candidate for immediate worldwide use [9]. For COVID19 patients, DEXA has been demonstrated to prolong the analgesic effect as the disease causes diffuse lung damage mediated through pro-inflammatory cytokines. Increasing emissions of DEXA into ecosystems from sources that include hospitals, households, and manufacturing plants is of increasing global concern
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