A lot of COVID deaths in India in young people who should be doing well & recovering.
I am making a plea to doctors in India to cut down the use of STEROIDS. Please.
Steroids are only useful after the patient is hypoxic. Harmful if given early, or given for too long
I am making a plea to doctors in India to cut down the use of STEROIDS. Please.
Steroids are only useful after the patient is hypoxic. Harmful if given early, or given for too long
In the first week of the illness when the virus is dividing, the use of steroids can suppress the immune response and make the virus divide even more. Steroids are not antivirals. There was a trend to more deaths in RECOVERY trial in patients who were not hypoxic.
In patients who have hypoxia, it signals that there is lung involvement. By now the virus is likely controlled by the body and the damage is from the immune system. Only at this stage are steroids useful: at small dose (Dex 6 mg) and short duration (5 days).
Giving steroids at high dose, or steroids for prolonged duration can cause secondary infections from mucor, drug resistant candida, and drug resistant bacteria.
Add to it muscle weakness and high blood sugars and any number of other problems.
Add to it muscle weakness and high blood sugars and any number of other problems.
I recognize that part of the problem in India may be a more virulent virus or a totally overwhelmed health care system. That's not in our immediate control.
But we can do things in our control: Use steroids only when necessary, at the right time, for the right duration.
But we can do things in our control: Use steroids only when necessary, at the right time, for the right duration.
I made my career on Dexamethasone. And how a lower dose saves lives. This is truly a double edge sword that when used without care can cause tremendous harm. thelancet.com/journals/lanon…
The Tamil Nadu state guidance is great. I would recommend this as a the standard for doctors in India to follow.
https://twitter.com/psampathkumarmd/status/1393336564906868736
One comment I got is that docs are using high dose of steroids in India because low doses are not working.
My response: If low dose steroids don't work it just means that the ongoing problem is not due to a hyperactive immune response. It is not something high doses will fix.
My response: If low dose steroids don't work it just means that the ongoing problem is not due to a hyperactive immune response. It is not something high doses will fix.
There are any number of reasons why lung function deteriorates besides exaggerated immune response: progressive covid virus proliferation being a main one. Or clots. Or secondary infection. A higher steroid dose won't solve this. It will just mask symptoms and make things worse.
More steroids will make us feel good and make it look like we are doing something better. But the problem with steroids is that they temporarily make everything seem good. From fever to nausea to shortness of breath. While making things worse.
Stick to the data from RCTs.
Stick to the data from RCTs.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
