WHO Analysis of over 1,700 cases confirms that inexpensive steroids significantly reduce mortality among hospitalized Covid-19 patients, according to a meta-analysis encompassing seven different clinical trials conducted by the World Health Organization (WHO) and published in the Journal of the American Medical Association (JAMA).
This is an extremely positive finding that creates a lot of optimism in the medical community. The optimism is 2-fold. First, the scientific community is desparately searching for effective treatments and preventions of severe Coronavirus disease, and steroids are a relatively simple and low-risk therapy. Second, steroids are quite inexpensive when compared to other emerging treatments, in particular the antiviral drugs being investigated and employed thus far in the pandemic. The low cost of intervention with steroids means that Covid patients in the developing world will (or should) have access to an effective treatment, so long as there is enough supply.
The WHO is now recommending that steroids be the standard of care for severe disease, but it cautioned against use of the steroids in patients with non-severe illness, saying that “indiscriminate use of any therapy for COVID-19 would potentially rapidly deplete global resources and deprive patients who may benefit from it most as potentially life-saving therapy.” This touches on the potential for inappropriate allocation of supplies for preventative use rather than reserving supplies for patients in critical condition.
As a physician, I believe the way to curb the use of steroids for mildly ill patients is to educate the public about the mechanism of action of steroid drugs. In short, steroids suppress our immune system. This is exactly what is needed in the inflammatory storm that occurs in critically ill Covid patients, to dampen the overreactive immune response, and reduce the production of pro-inflammatory molecules in the body. People aren’t dying because of a direct effect of the Coronavirus, they are dying from their own immune system’s reaction to the virus. Hence, if we can manually suppress that reaction then we may be able to survive our own reaction. However, on the flip side, if we take steroids before we have an overreactive immune response, then we run the risk of suppressing our natural immune defenses, which can make us more vulnerable to a more extensive viral infection, which can then lead to complications that may not have existed otherwise. In other words, taking high dose steroids creates a sort of immunodeficiency state, which could possibly lead to more serious complications from Covid, but also from other pathogens, such as Influenza and other viruses and even bacteria and fungi, not to mention adverse reactions to the drugs themselves, such as ulcers, gastrointestinal bleeding, pancreatitis, aseptic meningitis, and more. These risks are not exceedingly common but are real, which argues for reserving steroid use for severe Covid infections.
Looking ahead, I would like to see how steroids would work when co-administered with effective antiviral therapies, as a 1-2 punch.
I’d love any comments or feedback about this post, especially if any new perspectives or additional data could be shared to support or dispute these research findings.
Justin Groode MD | Patient Advocate Alliance LLC
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