According to new research, treating critically ill COVID-19 patients with low-cost steroids can reduce their risk of death by one-third. The findings are so conclusive that the World Health Organization changed its recommendation on September 2, 2020, and now strongly recommends corticosteroids as a first-line treatment for the sickest patients.
However, steroids are not without risk. They may cause side effects, and in patients with milder cases of COVID-19, they may cause more harm than good.
Here’s what people should know about steroid-usa as a COVID-19 treatment.
Who benefits from steroid use?
It’s critical to understand that steroids can help the sickest COVID-19 patients in the hospital, but they’re not a treatment for mild cases.
COVID-19, like other infectious diseases, has two major components: the infection itself and the body’s response to that infection.
The body’s immune system response is so strong in the sickest patients that it can harm organs. As a result, calming the immune response may be necessary. However, someone who is less severely ill may require the immune response of the body to prevent the infection from worsening. You wouldn’t want to mess with the immune system unless it was causing harm to the patient.
What role do corticosteroids play in the treatment of critically ill patients?
When an infection causes an inflammatory response, specialized white blood cells are activated to seek out and destroy the virus or bacteria. It’s more of a bomb effect than a targeted missile strike; the immune cells attack broadly, and the inflammation caused can harm other cells nearby.
That response can spiral out of control and persist even after the infectious agent has been eradicated. In a truly exuberant immune response, the patient may experience respiratory failure and require a ventilator, circulatory failure and end up in shock, or kidney failure as a result of the shock.
Corticosteroids are likely to be able to calm the inflammatory response and prevent the progression of organ damage, potentially in the lungs, in patients with severe COVID-19.
Scientists aren’t yet certain that’s how steroids work. According to the new research, people with severe COVID-19, particularly those with respiratory complications, benefit from relatively low-dose corticosteroid courses. A meta-analysis of recent studies found that patients with severe COVID-19 who received steroids died at a lower rate four weeks after infection than those who did not.
Why does the World Health Organization advise against using steroids in non-severe cases?
There is no such thing as a risk-free treatment.
Steroids are well-known immune-suppressing medications that have been in use for many years. They’re commonly used to treat chronic inflammation-related diseases like asthma, as well as autoimmune disorders like lupus and rheumatoid arthritis. However, there may be repercussions.
Steroid use in a hospital may increase the risk of bacterial or fungal infections, hyperglycemia, acquired muscle weakness, and gastrointestinal bleeding.
For people with milder cases of COVID-19, taking steroids may increase their risks while providing little benefit.
Long-term steroid use carries additional risks, such as an increased risk of infection and the development of osteoporosis, cataracts, and glaucoma. As a result, taking steroids as a potential COVID-19 preventive measure may pose a significant risk to otherwise healthy people.
Do steroids pose any dangers to critically ill patients?
ICU patients, especially those on ventilators, are prone to developing hospital-acquired infections such as pneumonia or bloodstream infections related to intravenous catheters. Corticosteroids may increase a patient’s risk of secondary infections or contribute to muscle weakness, which may impair the patient’s ability to wean off a ventilator when the disease resolves.
Nonetheless, the benefits of steroids in the treatment of critically ill COVID-19 patients appear to outweigh the risks.
What should the dose be?
The determination of the dose and timing of the medication is part of the challenge in treating critically ill patients with steroids.
In the context of this study, the steroid dose is relatively low and the duration is brief. In the context of using the short-course, relatively low dose of steroids, the trials did not show a significant increase in adverse events. As a result, the benefit outweighs the risk in that patient population, but the risk is not zero.
The risk profile worsens as the dose is increased. As a result, the recommendation is to begin with the relatively low doses that have been studied. The WHO advises taking low doses for 7-10 days.
Which steroids are the most potent?
It doesn’t matter to me which corticosteroid is used as long as it has some glucocorticoid activity.
Hydrocortisone was studied in the REMAP-CAP study. Another trial involved dexamethasone; the steroid given to the president. Others investigated methylprednisolone, but their studies were smaller and provided less information. The trials all point in the same direction, indicating that the anti-inflammatory glucocorticoid activity, rather than the specific steroid, is important.
How will this new guidance affect treatment?
Based on current research, hospitalized patients with COVID-19 pneumonia who require oxygen should begin a low-dose course of steroids. If they are in the intensive care unit and require more intensive organ support, such as being on a ventilator, receiving non-invasive ventilation, or receiving high-flow oxygen, this should certainly be the case.
Importantly, based on the data we’ve seen thus far, steroids have not been shown to benefit asymptomatic COVID-19 patients or patients with mild disease without pulmonary problems.
Steroids at low doses should be considered the standard of care for critically ill patients with COVID-19 pneumonia.