The investigations into Covid-19 do not stop in the face of the many questions that the virus still raises. Some of the more recent studies have begun to confirm that treating critically ill patients with steroids can reduce the risk of dying by 30%.
The results presented by these new documents are so conclusive that the World Health Organization has modified its assessment of the beginning of September and now recommends corticosteroids as first-line treatment for these types of patients.
The same studies warn about the risks of its use, because, as they indicate, for milder patients its use can be counterproductive.
The three new studies that analyzed data from clinical trials involving the effect of steroids in thousands of critically and severely ill Covid-19 patients leave some important references to consider. One of the overlapping points is to warn that steroids can benefit the sickest patients hospitalized with coronavirus, but are not a treatment for relatively mild cases.
In any infectious disease, there are two key components: the infection itself and the way the body responds to it. In the sickest patients, it has been observed that the immune system response can be so strong that it can damage organs. Therefore, calming the immune response may be important. But a person with a less serious illness may need the body’s immune response to prevent the infection from getting worse. For this reason, then, you do not want to interfere with that natural reaction of the body, as long as you do not put other organs at risk.
The process that is triggered when an infection appears is, in the first instance, an inflammatory response, in which specialized white blood cells are activated to search for the virus or bacteria and destroy it. Bryan McVerry, associate professor of medicine at the University of Pittsburgh and leader of one of the studies on this topic explains that this reaction “is more of a pump effect than a targeted missile attack: immune cells attack widely and the inflammation created can damage other nearby cells ”.
That response, explained in one of the studies, can spiral out of control and continue even after the infectious agent is gone, attacking other organs like an uncontrolled vehicle. In an exaggerated immune response, the patient reaches respiratory failure and requires a ventilator, or has a circulatory crisis or could develop kidney failure from shock.
In critically ill patients, corticosteroids may work to stop the excessive response and prevent the progression of generalized organ damage. Although scientists are not entirely sure if the mechanism of steroids is this, it has been confirmed in new studies that in severe cases, especially those with respiratory complications, the situation is improved with small doses of corticosteroids . A pooled analysis of recent studies found that the death rate four weeks after infection was significantly lower in severe COVID-19 patients who received steroids than those who did not.
“No treatment comes without risk,” warned McVerry. Steroids are immunosuppressive drugs. They are commonly used to treat chronic diseases related to inflammation, such as asthma, or autoimmune disorders such as lupus or rheumatoid arthritis. But they can have consequences.
The potential harms of steroid use include an increased risk of bacterial or fungal infections, hyperglycemia, acquired muscle weakness, and gastrointestinal bleeding. For people with milder cases of COVID-19, taking steroids could mean increasing your risks with little potential benefit.
“Taking steroids long-term also carries other risks, including predisposition to infections and the development of osteoporosis, cataracts and glaucoma. Therefore, taking steroids as a possible preventive measure against COVID-19 could carry a significant potential risk for otherwise healthy people, ”explained the specialist.
Among the common situations experienced by patients in intensive care, especially those who require respirators, is the possibility of developing infections acquired in the hospital, such as pneumonia or infections of the bloodstream related to intravenous catheters. Taking corticosteroids can increase a patient’s risk of developing secondary infections, or it can contribute to muscle weakness that can affect the patient’s ability to disconnect from the ventilator when the disease resolves.
Still, the benefits of steroids for treating critically ill Covid-19 patients appear to outweigh the possible risks when not used.
“Part of the challenge in treating critically ill patients with steroids is determining the dose and timing of the medication,” McVerry cites. In the context of the specialist-led study, the steroid dose is relatively low and also short-lived. Trials have not shown a significant increase in adverse events in the context of the use of relatively low doses of short-acting steroids. So in that patient population, the benefit outweighs the risk, “but the risk is not zero,” McVerry insisted.
The risk profile increases with higher doses. So the recommendation would be to start with the relatively low doses which is what all the studies agree on. In fact, the WHO recommends low doses for 7-10 days.