Steroids aren’t risk-free, however. They can have side effects, and they could do more harm than good in patients with milder cases of COVID-19.
Who Benefits From Taking Steroids?
It’s important to understand that steroids can benefit the sickest patients hospitalized with COVID-19, but they’re not a treatment for relatively mild cases.With COVID-19 and other infectious diseases, there are two key components: the infection itself and the body’s response to that infection.
How Do Corticosteroids Help Critically Ill Patients?
When an infection triggers an inflammatory response, specialized white blood cells are activated to go find the virus or bacteria and destroy it. It’s more of a bomb effect than a targeted missile strike. The immune cells attack broadly, and the inflammation created can damage other cells in the vicinity.In patients with severe COVID-19, corticosteroids are likely able to calm that inflammatory response and prevent the progression of organ damage, potentially in the lungs.
Steroids Not Used in Cases That Aren’t Severe
No treatment comes without risk.Steroids are well-known immune-suppressing medications that have been used for decades. They’re commonly used for treating chronic diseases that are inflammation-related, such as asthma, or autoimmune disorders such as lupus or rheumatoid arthritis. But there may be consequences.
The potential harms from using steroids in a hospital include an increased risk of bacterial or fungal infections, hyperglycemia, acquired muscle weakness and gastrointestinal bleeding.
For people with milder cases of COVID-19, taking steroids could mean increasing their risks with little potential benefit.
Do Steroids Carry Risks for Critically Ill Patients?
It’s common for ICU patients, particularly those on ventilators, to develop hospital-acquired infections such as pneumonia or bloodstream infections related to intravenous catheters. Being on corticosteroids can increase a patient’s risk of developing secondary infections, or it can contribute to muscle weakness which may impact the patient’s ability to come off of a ventilator when the disease resolves.How Large Should the Dose Be?
Part of the challenge in treating critically ill patients with steroids is determining the dose and timing of the medication.In the context of this study, the dose of steroids is relatively low and it’s also a short duration. The trials haven’t shown a significant increase in adverse events in the context of using the short-course, relatively low dose of steroids. So, in that patient population, the benefit outweighs the risk, but the risk is not zero.
Which Steroids Are Most Effective?
I don’t think it matters which corticosteroid is used as long as the steroid has some glucocorticoid activity.How Will This New Advice Change Treatment?
Based on the studies to date, hospitalized patients with COVID-19 pneumonia and requiring oxygen should be started on a low-dose course of steroids. That should certainly be the case if they’re 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.Importantly, however, steroids have not been shown to benefit asymptomatic patients with COVID-19 or patients with mild disease without pulmonary problems based on the data we’ve seen so far.
Physicians should think of steroids at low doses as the standard of care for critically ill patients with COVID-19 pneumonia.