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Corticosteroids to treat severe cases of COVID-19

On Sept. 2, the World Health Organization published guidance for the use of corticosteroids when treating COVID-19.

This guidance is the result of a meta-analysis of seven different studies, which looked at how effective steroids were In treating the virus.

For local hospitals, many which have used steroids for several weeks to treat severely ill COVID-19 patients, this news doesn’t change their treatment plan, for now, at least.

“But it does confirm what we’ve been doing,” said Dr. Philip J. Cozzi, medical director of critical care for Elmhurst Memorial Hospital. “It’s nice to know there’s an effective intervention.”

Cozzi recalled an early study that showed 6 milligrams of the steroid dexamethasone for 10 days improved the mortality rate of hospitalized patients. That now is part of the standard dosing regimen.

In its report, WHO recommended 6 mg of dexamethasone orally or intravenously daily or 50 mg of hydrocortisone intravenously every 8 hours for seven to 10 days in patients “with severe and critical COVID-19.”

Cozzi agreed that patients with mild cases of COVID-19 should not receive corticosteroid therapy.

“Those patients who are not ill and not requiring oxygen and not hospitalized may actually do worse with the additions of steroids,” Cozzi said.

Steroids work by suppressing the immune system, which isn’t desirable in a patient with mild COVID-19, Cozzi said.

However patients with severe cases of COVID-19 often experience an overreaction of their immune system, which is called cytokine storm.

Cytokines, which are part of the immune system, can harm the person when the body suddenly releases a huge amount (a “storm”) during an infection.

Steroid use in this case calms down the immune system.

But steroids must also be used “very, very carefully” in diabetic patients with [COVID-19], said Dr. Gary Lipinski, chief medical officer at AMITA Health Saint Joseph Medical Center in Joliet.

“Steroids can increase their blood sugar,” Lipinski said. “Sometimes it goes quite a bit out of control.”

Also, steroids can’t take all the credit for reducing mortality, Lipinski said. Patients with severe cases of COVID-19 are typically receiving more than one medication. One is remdesivir, a broad-spectrum antiviral medication.

“We use steroids; we use remdesivir and we know they get better,” Lipinski said. “But exactly how much each one contributes to them getting better is a little unclear. But everybody now, if they have severe illness and in critical care – all are getting dexamethasone or steroids.”

The WHO also said stressed that indiscriminate use of any therapy for COVID-19, including steroids, could deplete global supplies and prevent the patients who needs it most from receiving it.

Dr. Christopher Udovich, chief medical officer at Silver Cross Hospital in New Lenox, said the hospital, which has treated its severe COVID-19 patients with steroids for the last several weeks, has a good supply of the medication.

“It’s something we look at right away, to make sure we had plenty in stock,” Udovich said.

Udovich echoed Cozzi by underscoring that, while steroid treatment is helpful in treating the patients with severe covid, the treatment cannot be used indiscriminately.

“Given early in the disease course, it can make the patient sicker,” Udovich said. “And of course, it [steroids] don’t come without their side effects, either.”

Dr. Sadiya Khan, a board-certified cardiologist at Northwestern Medicine and assistant professor of medicine and preventive medicine at Northwestern Medicine’s Feinberg School of Medicine, said proning works well, too, for patients with severe COVID-19.

To “prone” patients, even patients on ventilators, means to position them on their stomach to take pressure off their lungs.

Khan also feels the guidance from WHO is a good reminder of the value of clinical trials. For instance, convalescent plasma as a potential therapy for COVID-19 needs more randomized clinical trials, she said.

“I think the trials allow us to be able to have data specifically for COVID-19, for what seems to make sense,” Khan said.

Source: The Daily Chronicle

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