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

19,89,21,889Cases
6,44,02,340Active
13,02,83,678Recovered
42,35,871Deaths
Coronavirus has spread to 194 countries. The total confirmed cases worldwide are 19,89,21,889 and 42,35,871 have died; 6,44,02,340 are active cases and 13,02,83,678 have recovered as on August 3, 2021 at 3:55 am.

India

3,17,26,507 30,549Cases
4,04,9588,760Active
3,08,96,354 38,887Recovered
4,25,195 422Deaths
In India, there are 3,17,26,507 confirmed cases including 4,25,195 deaths. The number of active cases is 4,04,958 and 3,08,96,354 have recovered as on August 3, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

63,15,063 4,869

78,700 3,650

61,03,325 8,429

1,33,038 90

Kerala

34,25,473 13,984

1,65,834 2,057

32,42,684 15,923

16,955 118

Karnataka

29,08,284 1,285

24,045 123

28,47,627 1,383

36,612 25

Tamil Nadu

25,63,544 1,957

20,385 139

25,09,029 2,068

34,130 28

Andhra Pradesh

19,70,008 1,546

20,582 437

19,36,016 1,968

13,410 15

Uttar Pradesh

17,08,500 24

646 18

16,85,091 42

22,763

West Bengal

15,29,295 575

10,803 171

15,00,331 734

18,161 12

Delhi

14,36,401 51

538 44

14,10,809 95

25,054

Chhattisgarh

10,02,458 236

1,918 1

9,87,012 234

13,528 3

Odisha

9,79,737 1,032

13,318 820

9,60,386 1,785

6,033 67

Rajasthan

9,53,704 16

241 9

9,44,509 25

8,954

Gujarat

8,24,922 22

251 3

8,14,595 25

10,076

Madhya Pradesh

7,91,862 17

132 7

7,81,217 10

10,513

Haryana

7,69,956 14

703 12

7,59,614 25

9,639 1

Bihar

7,24,917 37

401 34

7,14,872 71

9,644

Telangana

6,45,997 591

8,819 54

6,33,371 643

3,807 2

Punjab

5,99,162 32

473 31

5,82,395 63

16,294

Assam

5,68,257 1,275

12,429 213

5,50,534 1,469

5,294 19

Jharkhand

3,47,223 23

239 15

3,41,855 38

5,129

Uttarakhand

3,42,198 37

574 35

3,34,261 71

7,363 1

Jammu And Kashmir

3,21,725 118

1,254 43

3,16,090 73

4,381 2

Himachal Pradesh

2,06,369 208

1,304 75

2,01,543 132

3,522 1

Goa

1,71,295 90

1,027 16

1,67,118 72

3,150 2

Puducherry

1,21,059 54

944 38

1,18,320 92

1,795

Manipur

99,872 541

9,814 591

88,480 1,120

1,578 12

Tripura

79,026 304

3,104 12

75,167 292

755

Meghalaya

65,939 350

5,843 200

58,987 537

1,109 13

Chandigarh

61,960 6

33 3

61,116 3

811

Arunachal Pradesh

48,565 305

3,508 167

44,823 469

234 3

Mizoram

40,111 748

12,316 127

27,642 618

153 3

Nagaland

28,004 59

1,300 44

26,130 99

574 4

Sikkim

26,880 126

3,323 131

23,211 256

346 1

Ladakh

20,345 5

57 0

20,081 5

207

Dadra And Nagar Haveli

10,650

15 9

10,631 9

4

Lakshadweep

10,207 12

79 4

10,078 8

50

Andaman And Nicobar Islands

7,539

6 1

7,404 1

129

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