Health workers shift oxygen cylinders from an ambulance outside a temporarily converted isolation ward for Covid-19 patients in New Delhi.
Health workers shift oxygen cylinders from an ambulance outside a temporarily converted isolation ward for Covid-19 patients in New Delhi.

Use of steroids in Covid-19 treatment: What experts have warned so far

Steroids in the early stage of Covid-19 can replicate the virus. Misuse of steroids can also lead to pneumonia, mucormycosis, doctors have warned.
By | Edited by Poulomi Ghosh
UPDATED ON MAY 17, 2021 12:53 AM IST

In the treatment of Covid-19 infections, doctors have time and again warned against the misuse of steroids. AIIMS director Dr Randeep Guleria on Saturday blamed the misuse of steroids behind the rise of the cases of mucormycosis during post-Covid recovery. But this is not the first time that the overuse of steroids has been flagged.

What are steroids? Steroids are to treat inflammatory conditions which may be seen in a serious Covid-19 case when the virus is replicating. But its early and wrong use leads to more complications than benefits as steroids also repress the immune system.

"Recovery trials showed that steroids will benefit but it's also important to know when they're given. If given early before your saturation (O2) falls, it has a harmful effect. Covid patients who got steroids early had higher mortality than those who didn't. It is of no use if steroids are given on day 1. They are useful only in moderate to severe illness when oxygen saturation is falling," Dr Guleria said earlier.

Taking steroid at an early stage of the disease can further replicate the virus, experts have said. Taking high doses of steroids in mild cases, on the other hand, may lead to severe viral pneumonia. Steroids should also be avoided in the first five days of the infection.

Chairman of Institute of Liver Transplantation and Regenerative Medicine Dr Arvinder Singh Soin said steroid is one of the components of a vicious Covid triangle, the other two being Covid and diabetes. "Worse the diabetes, more severe the Covid and more the requirement for steroids. More the steroids, the worse the diabetes becomes," he said.

In the Union health ministry's clinical guidance for Covid-19 patients, the use of anti-inflammatory therapy has been recommended only in moderate and severe cases, when the patient is either in the ward or in the ICU and the oxygen level is dropping. The steroid therapy is recommended only for a duration of five to 10 days, not more than that.

Now it has also emerged that the cases of mucormycosis, which is a fungal infection and existed before Covid-19, are increasing because of steroid misuse.

Dr Suresh Kumar, medical director of LNJP hospital in New Delhi, has said overuse, misuse, and rampant use of steroids in Covid-19 patients are causing black fungus cases. "If given to patients with oxygen levels over 90, black fungus is a possible side-effect. Early diagnosis is critical. A CT scan of the face would detect this infection, after which antifungal drug amphotericin will be used for treatment," he said.

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