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:
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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.
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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.
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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.
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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 (Water, Sanitation 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 pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.