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What Are Steroids And Why Are They Given To COVID-19 Patients?

UPDATE: According to recent news, three under forty COVID-19 patients in Hinduja Hospital in Mumbai were reported with avascular necrosis or 'bone death' due to the use of steroids, two months after the treatment.

Experts say it could be due to the prolonged use of steroids. Remember, steroids should not be self-medicated and should only be taken if recommended by a medical expert. Also, one must avoid putting pressure on doctors to prescribe steroids.

Currently, studies related to steroid-induced avascular necrosis in recovered COVID-19 patients is limited. For now, early diagnosis is the best way to prevent the condition. Therefore, if you notice joint pain post-COVID recovery, immediately consult a medical expert for early treatment.

The term "steroids" is familiar as medications primarily administered to COVID-19 patients to lower severe symptoms. According to a study, steroids were identified around 80 years ago and were known to play a vital role in the treatment of various diseases, especially related to inflammation and immune dysfunction.

But what actually are steroids and what are their functions? Do they have any side effects? Why are they given to COVID-19 patients? Let's get the answers to these questions.

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What Are Steroids?

Steroids, also known as corticosteroids, are an artificial form of steroid hormones that are naturally produced in our body by the adrenal cortex. It includes glucocorticoids and mineralocorticoids.

Glucocorticoids are related to metabolism, anti-inflammatory, immunosuppressive and vasoconstriction effects, while mineralocorticoids help with electrolyte and water balance in the body. [1]

Steroids, which are synthesized externally or artificially, significantly behave like glucocorticoids. However, they have varying degrees of both glucocorticoid and mineralocorticoid properties.

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Glucocorticoids or stress hormones mainly get triggered during stressful events and also help regulate a range of physiologic processes which are essential for the body.

Some of the medical conditions for which steroids are used include allergies, inflammatory diseases, neurological disorders, skin problems, promotion of water excretion, shock, hematologic disorders, autoimmune diseases, treatment of pathologic hypoglycemia and many others. [2] To mention, steroids therapy is used for hundreds of medical conditions.

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Functions Of Steroids

Steroids have both endocrine and nonendocrine indications. For example, they play a role in endocrine by diagnosing endocrine disorders such as Cushing syndrome, a condition in which our body produces high amounts of cortisol hormones for a longer time.

Their nonendocrine role mainly includes anti-inflammatory and immunosuppressive effects to help in the treatment of a wide range of inflammatory and immunologic disorders. [3]

Caution, high concentration of steroids can inhibit the production of B-cells and T-cells or say, immune cells. This makes dose very important while prescribing these drugs according to the medical condition.

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How Are Steroids Administered?

Corticosteroids are administered depending on the disorder. Their route could be oral, parenteral, topical, inhaled, rectal or injected (intramuscular, intralesional, intraarticular, intradermal, etc.).

Oral administration is common while parenteral administration is used in conditions when patients are unable to tolerate medication by mouth.

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Why Are Steroids Given To COVID-19 Patients?

Steroids in certain studies were reported to have beneficial effects on patients with moderate to severe COVID-19 infection, such as those on oxygen or ventilation support.

According to the WHO report dated 2 September 2020, two recommendations were made based on the use of steroid therapy: it can be prescribed for 7-10 days to patients with severe to critical COVID-19 and should not be given to patients without any serious symptoms.

Other factors such as costs, feasibility, equity and personal choice of the patient must also be taken into consideration, as without these factors, there are chances of indiscriminate use of the steroid therapy, leading to decline in this life-saving global resource and increased mortality due to COVID-19. [4]

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Benefits Of Steroids In COVID-19 Treatment

According to a study, in the previous coronavirus pandemics like MERS and SARS, steroids administration did not significantly reduce the mortality rate in SARS-related pneumonia, but seemed to lower the inflammation and clear the respiratory tract in MERS.

Corticosteroids are often used in treating viral pneumonia that also include specific conditions like COPD, fluid accumulation, asthma and septic shock.

Since the advent of COVID-19, many treatment methods, including steroid therapy, have been adopted to treat the condition.

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High doses of steroids as treatment methods were adopted for patients with moderate to severe respiratory symptoms, such as in Acute Respiratory Distress Syndrome (ARDS) related to COVID-19. This is because many researchers believe in the potent anti-inflammatory effects of these synthetic steroids.

Even in ARDS which is not related to COVID-19, there was evidence of a reduction in mortality due to steroids administration within the first 14 days of the presence of severe lung problems

Despite that, the definitive evidence on the anti-inflammatory effects of steroids on COVID-19 is still lacking as clinical trials related to them are still ongoing.

Also, methylprednisolone and dexamethasone are the two potent steroids recommended to be used during the acute phase of COVID-19. [5]

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When Should Steroids Be Given In COVID-19?

According to experts, steroids should not be taken as self-medication and must be prescribed by a medical expert who is in charge of treating a COVID-19 patient. This is because, in both cases, early as well as delay in the administration of steroids can lead to adverse outcomes.

The initial symptoms of COVID-19 include a high fever. Sometimes, when the fever does not go down in the first few days with standard medications like paracetamol, the person gets paranoia and starts panicking.

This pressurises medical experts to treat the symptom soon, and it ends by prescribing steroids that work effectively on the fever and lowers it in a short time.

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Though the fever gets reduced immediately and the person starts feeling healthy, the body loses natural immunity and gets suppressed. This causes re-infection in individuals due to suppressed immunity, causing worsening of the symptoms.

That is why it is important to let the body build its natural immunity and fight the fever, thus preventing suppression of the immunity.

According to a study, certain effective steroids like methylprednisolone and dexamethasone show positive results only when given to patients with moderate to severe COVID-19 infections who require oxygen or ventilation, compared to non-severe patients. This depicts that steroids should be given at appropriate timing and to selected patients. [6]

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Side Effects Of Steroids

  • The use of corticosteroids for prolonged periods during the treatment of COVID-19 is considered to be among the primary causes of black fungal infection. [7]
  • It leads to the suppression of the immune system.
  • It can lead to multiplication of the COVID-19 virus if taken at an early stage and cause severe pneumonia.
  • It may increase the risk of fluid retention, hypercortisolism, hypokalemia and dysglycemia.
  • It may increase hospital stay due to triggering complications.
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    Points To Remember

    • You should not pressurise a medical expert on prescribing steroids to treat your COVID-19 symptoms.
    • If you have started on a steroid, do not stop it until said otherwise by your doctor.
    • Never self-medicate with steroids.
    • If you are a diabetic, pay more attention to your health while you are on steroids.
    • If you notice any serious complications a few weeks after the continuous administration of steroids, consult a medical expert soon.
    • To Conclude

      All medications have certain pros and cons. As steroids are also a type of medication, they must be consumed only after consulting a medical expert to avoid long-term complications.