Dos And Don’ts Of Using Steroids In COVID-19 Treatment

Dos And Don’ts Of Using Steroids In COVID-19 Treatment

A quick lowdown on steroids and how effective or non-effective they are to tackle COVID-19 in India
Coronavirus Explainers
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Dos And Don'ts Of Using Steroids In COVID-19 TreatmentExperts draw up a list of dos and don'ts on use of steroids in COVID-19 treatment

New Delhi: Names of many steroids have now become  commonly known as India fights COVID-19’s deadly second wave. According to experts, some of the steroids are indeed effective in curing moderate to severe cases of COVID-19, who might require oxygen or ventilator support. However, experts have time and again said they are only effective if and only if the steroids are given in the right dosage and at the time. Recently, addressing the media on the rise of black fungus cases in the country, AIIMS director Dr Randeep Guleria said that the misuse of steroids is the reason behind the rise of the cases of  mucormycosis during post-Covid recovery.

NDTV speaks to experts to understand the Dos and Don’ts of using steroids in COVID-19 treatment:

Also Read: COVID-19 Explainer: All You Need To Know About Oxygen Concentrators

What are Steroids?

In layman terms, steroids are man-made version of chemicals similar to natural hormone in our bodies. When produced naturally it is called natural steroids and when introduced medically it is called synthetic steroids.

Steroids are basically designed to reduce the amount of inflammation in the body, which might happen when the body’s own natural immune system tries to fight any virus, infection or bacteria. It is important to know that steroids won’t cure the condition, but they tend to give relief to the patient by reducing the inflammation in the body.

Also Read: As COVID Cases In India Sets World Record, Centre Recommends “Proning”. Here’s All You Need To Know

What Happens To The Body, When Steroids Are Taken?

Usually, inflammation is kind of a natural response of the body towards any infection, bacteria or virus. Now, to fight out these viruses, infection or bacteria in the body. The immune system can lead to swelling, redness or heat or acute pain in one particular body part. Most of the patients will have a balanced immune response that will fight out these after effects as well, but in some of us the immune response can get dis-regulated, which causes an inappropriate level of inflammation. For example, in patients with Arthritis, the immune system produces inflammations in joint s or other parts of the body which can cause more damage if these remain untreated, in such cases steroids are used.

Experts say that basically the role of steroids in human body is to reduce the dis-regulated immune response, which is our body’s natural response against any illnesses. It doesn’t cure the illness but it gives temporary relief and it works only when taken in the right amount or dosage.

Steroids and COVID-19 

According to experts, if steroids are not given at right time or in right amount then it can do more harm than good to your body.

Dr Lancelot Pinto, Epidemiologist, Hinduja Hospital said,

Timing, dosage and duration are extremely critical in steroids, when it comes to treating any disease and not just COVID-19.  Remember 85 per cent of individuals with COVID-19 will heal on their own, their own natural immunity will take care of the disease.

Also Read: Coronavirus Explained: How COVID-19 Is Affecting Heart Even After The Recovery

When Do Steroids Work and When These Not?

Let’s take the case of A COVID-19 patient. The body of a typical COVID also means that your immune system is fighting the virus and the virus is actually on its way out. This stage is called inflammatory overdrive, experts say this is the right time to introduce steroids in your body, if there is a need.

If given too early, when the virus is already in, it may prolong the stay of virus in the body. The patient may feel good temporarily, but it will cause more damage in the days ahead. Secondary, if it is given for more time than required then it may lead to fungal infections like black fungus in the patients.

Explaining the timing bit for steroids in COVID-19 patients, Dr Pinto added,

It is the small proportion of the individuals which will develop a severe disease towards the end of the first week when the virus is on its way out but body for some reason has mounted the hyper immune response, which means it is fighting the virus suddenly with more excitement and energy. This hyper response which is seen towards the end of the first week very often causes the drop in oxygen levels. This is the time when steroids generally work. This is the time when we need to calm down the hyper immune response of the body through steroids. It is seen and observed that at this point of time, if patients are given steroids, it can save lives and reduce mortality.

Giving a warning to people on the usage, he further added,

However, if we use it too early, you can actually cause more harm in your body. As then you are disturbing the natural response of the body which could have taken care of the disease. Once you hamper the flow by giving steroids even if it was not needed at that stage, you expose the individual to prolonged disease. It is in these cases it may develop severe as you have lowered their defence mechanism via steroids.

However, since steroids have a feel good factor, many patients continue to take it even when doctors are asking them to avoid in bid to reduce the pain, in these patients’ experts are seeing more complications later.

Explaining the dose which is generally prescribed to COVID-19 patients, Dr Pinto said,

The dose which is prescribed usually is 6 milligrams of nexa for 10 days and there might be exceptional circumstances in which one may go beyond 10 days. But the thing here to know is that as long as you follow the main principles of dosage and timings, one may not see high incidence of black fungus or secondary infections.

Also Read: Coronavirus Outbreak Explained: Do All COVID-19 Patients Need CT Scans?

Key Points To Remember 

– Steroids should not be stopped suddenly
– Steroids should be tapered off
– Steroids should never be self-prescribed
– It should be used and stopped only when recommended by the doctor
– All patients, not just diabetic needs to be careful with steroids

Highlighting the fact that one should not hoard these steroids at home thinking they will need in future or take it on their own when seriously ill, Dr Sumit Ray, Critical Care Medicine, Holy Family Hospital explains some of the harms that steroids can do to the human body, he said,

All medicines have its pros and cons. So, whenever we are using any medication, we have to see its positives along with its negatives and then balance those out. Same is the case with steroids, in some cases we do need these but we also should know that the harm is there. The harm is secondary infections and fungal infections causing much more severe diseases or infections. We should know that one size doesn’t fit all patients, especially with COVID-19 disease, one should not think if x amount of dose in x days helped one, it will do the same for them. There is no perfect science to using steroids to cure COVID, the doctors may prescribe steroids depending on patient’s severity and case.

Explaining the reason why doctors are prescribing steroids to the COVID-19 Patients, Dr Arvinder Soin, Chairman Medanta added,

The reason we give steroids to severely ill patients who are in ICU or need support is that if we don’t give the steroids, they may develop lung fibrosis, which basically means lung damage. So, to control their symptoms steroids are given.

Talking about the rise of black fungus cases in India and what is the cause behind the same, Dr Vishal Rao, Member COVID Task Force, Karnataka said,

We have seen one classical factor in all the black fungus cases we have studied and why it happened in COVID-19 patients – one is that they were COVID positive, secondly, they were pre-diabetic or diabetic, thirdly, they used steroids and did not monitored it correctly and lastly they all were not vaccinated.

Long Term Side-Effects From Steroids

Explaining some of the side-effects or tell-tale signs, Dr Lancelot Pinto said,

One may instantly see a rise in blood sugar levels after taking steroids. Some of the immediate side-effects can be sleep cycle getting disturbed or insomnia, people may also tend to get very irritable. However, if steroids are continued at length for longer duration, it may suppress your natural immune response, making you more vulnerable to fungal and bacterial infections. It may also weaken your bones and muscles, you might even face difficulty getting up from a squat position. Some other effects are kidneys getting damaged and cardiovascular diseases.

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (WaterSanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene

World

17,66,30,634Cases
5,80,25,717Active
11,47,82,895Recovered
38,22,022Deaths
Coronavirus has spread to 193 countries. The total confirmed cases worldwide are 17,66,30,634 and 38,22,022 have died; 5,80,25,717 are active cases and 11,47,82,895 have recovered as on June 16, 2021 at 3:30 am.

India

2,96,33,105 62,224Cases
8,65,43247,946Active
2,83,88,100 1,07,628Recovered
3,79,573 2,542Deaths
In India, there are 2,96,33,105 confirmed cases including 3,79,573 deaths. The number of active cases is 8,65,432 and 2,83,88,100 have recovered as on June 16, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

59,24,773 7,652

1,41,440 8,982

56,69,179 15,176

1,14,154 1,458

Karnataka

27,77,010 5,041

1,62,303 9,859

25,81,559 14,785

33,148 115

Kerala

27,48,204 12,246

1,12,792 1,456

26,23,904 13,536

11,508 166

Tamil Nadu

23,78,298 11,805

1,25,215 11,669

22,23,015 23,207

30,068 267

Andhra Pradesh

18,20,134 5,741

75,134 4,879

17,32,948 10,567

12,052 53

Uttar Pradesh

17,03,207 270

7,221 890

16,74,072 1,104

21,914 56

West Bengal

14,68,044 3,268

20,046 1,125

14,30,949 2,068

17,049 75

Delhi

14,31,498 228

3,078 148

14,03,569 364

24,851 12

Chhattisgarh

9,88,172 609

11,717 943

9,63,113 1,544

13,342 8

Rajasthan

9,50,133 172

5,619 848

9,35,658 1,006

8,856 14

Odisha

8,59,526 3,405

44,358 3,436

8,11,780 6,799

3,388 42

Gujarat

8,21,078 352

8,884 658

8,02,187 1,006

10,007 4

Madhya Pradesh

7,88,649 224

3,610 331

7,76,424 528

8,615 27

Haryana

7,66,357 228

3,703 374

7,53,584 564

9,070 38

Bihar

7,17,949 410

4,360 412

7,04,075 813

9,514 9

Telangana

6,06,436 1,556

19,933 528

5,82,993 2,070

3,510 14

Punjab

5,89,153 628

10,802 1,111

5,62,701 1,691

15,650 48

Assam

4,66,590 3,415

41,184 475

4,21,378 2,906

4,028 34

Jharkhand

3,43,793 184

2,646 416

3,36,058 596

5,089 4

Uttarakhand

3,37,449 274

3,642 266

3,26,822 515

6,985 25

Jammu And Kashmir

3,08,726 715

12,407 1,125

2,92,114 1,830

4,205 10

Himachal Pradesh

1,99,197 321

4,050 382

1,91,737 691

3,410 12

Goa

1,63,048 327

4,175 231

1,55,926 548

2,947 10

Puducherry

1,13,192 355

4,668 279

1,06,828 629

1,696 5

Chandigarh

61,200 40

486 21

59,917 58

797 3

Manipur

61,096 785

8,744 301

51,354 476

998 8

Tripura

60,385 536

4,886 65

54,870 596

629 5

Meghalaya

42,759 450

4,430 99

37,579 542

750 7

Arunachal Pradesh

31,938 290

2,849 40

28,934 326

155 4

Nagaland

23,854 101

2,972 229

20,423 327

459 3

Ladakh

19,649 38

552 20

18,898 57

199 1

Sikkim

18,659 209

3,239 67

15,136 273

284 3

Mizoram

15,899 268

3,637 45

12,191 312

71 1

Dadra And Nagar Haveli

10,473 9

61 2

10,408 7

4

Lakshadweep

9,297 61

484 36

8,768 96

45 1

Andaman And Nicobar Islands

7,280 11

105 4

7,049 15

126

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