Early Steroid Use Can Worsen Covid Infection, Caution Doctors

Mumbai, 6 Oct 2020: 

Steroids, the latest class of medication given to US President Donald Trump, are a double-edged sword as far as Covid patients are concerned. Doctors said steroids could worsen the infection if given too early, but work like magic in critically ill patients.
 
Traditionally associated with inflammatory conditions such as asthma and arthritis, steroids have been a part of Covid treatment in India since early April when the first guidelines were drawn up.
 
But Dr Rahul Pandit, a member of Maharashtra’s Covid task force, said steroids — either dexamethasone or methylprednisolone — are only recommended for Covid patients with hypoxia (a condition in which the body or a part of the body is deprived of adequate oxygen supply). “On rare occasions, a patient with high levels of c-reactive proteins (a marker for inflammation) may be given steroids based on the doctor’s clinical judgement,” added Dr Pandit, who uses it for patients in his ICU at Fortis Hospital, Mulund. The thumb rule, said a civic hospital doctor, is to give it to patients whose oxygen saturation levels are below 94%.
 
However, steroids should be used with utmost caution — more so in the case of Covid. Pulmonologist Dr Lancelot Pinto from Mumbai’s Hinduja Hospital said, “The first week of Covid illness is mainly about the virus causing havoc. In the second week, the body mounts an immune response. It is in the second state that steroids have a role to play.”
 
If a patient is incorrectly given steroids in the first week, it many actually worsen the infection spread or allow other bacteria in the lungs to multiply (secondary infection).
 
Unfortunately, some doctors prescribe steroids even for Covid patients in home isolation. “This is wrong, but it is being done,” said Dr Pinto.
 
There are other problems too. A team from AIIMS Delhi’s pulmonary medicine wing in July mentioned in a medical journal that the use of steroid therapy for moderate to severe disease could have an adverse effect on patients with diabetes. ET HealthWorld