Steroids in Coronavirus Medicine
The recent pandemic caused by the COVID-19 coronavirus has disrupted lifestyle everywhere. It has affected millions of people, many of whom have died, or are very ill. It has disrupted the trade and business all around the world, and has slowed down the global economy. So, it has become a necessity to immediately find a cure or a vaccine for this deadly virus.
What is Coronavirus?
Coronavirus is a group of RNA viruses that cause mild to lethal respiratory tract infections in humans and birds. Mild disease entails some cases of common cold. Lethal diseases comprise of SARS, MERS and COVID-19.
COVID-19
Following the outbreak of pneumonia cases of unknown cause in Wuhan in December 2019, WHO identified a ne novel coronavirus. The virus is referred to as SARS-CoV-2 and the associated disease was named by WHO as Coronavirus Disease 2019 (COVID-19).
Symptoms of COVID-19
Immunocompetent people are likely to have mild to moderate symptoms and will recover without hospitalization. Old people, people with chronic disorder or immunocompromised people are likely to have serious symptoms.
Most common symptoms:
fever.
dry cough.
tiredness.
Less common symptoms:
aches and pains.
sore throat.
diarrhoea.
conjunctivitis.
headache.
loss of taste or smell.
a rash on skin, or discoloration of fingers or toes.
Serious symptoms:
difficulty breathing or shortness of breath.
chest pain or pressure.
loss of speech or movement.
What are steroids?
Steroids or corticosteroids are a class of drugs that lower inflammation and also suppress immune system activity. They closely resemble cortisol which is an endogenous hormone regulating metabolism, immune response and stress. Corticosteroids can act locally or systemically. Localized steroids target specific part of the body and are useful in asthma and urticaria. These are used as creams, drops and inhalers. Systemic steroids move through the bloodstream and assist more parts of the body and thus are helpful in systemic illnesses like multiple sclerosis and lupus.
Steroids and COVID-19
Steroids are usually not recommended in viral pneumonia. Steroids are effective in septic shock by tempering host’s immune response against bacterial toxin release. But septic shock incidence in patients with COVID-19 is relatively low (less than 15%). They are more likely to produce cardiogenic shock due to increased workload on the heart to distribute oxygenated blood. The immunosuppressant action of steroids is harmful during the treatment of infection. Steroids have been ineffective in other viral epidemics like SARS, MERS, RSV infection and influenza infection.
Steroids and Severe COVID-19
Patients with severe COVID-19 may have systemic inflammatory response leading to lung injury and multisystem organ dysfunction. Steroids, having anti-inflammatory properties, are deemed to be helpful in this situation. Steroids fight the inflammation caused by the body’s own immune response by lowering down the immunity. So, this reduces the inflammation. But, in turn it also decreases the body’s ability to fight against the virus. So, other antivirals Or antibacterials need to be prescribed along with the corticosteroid therapy.
RECOVERY Trial
The Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial is an ongoing, multicentered, randomized open label trial with patients hospitalised with clinically suspected or laboratory confirmed SARS-CoV-2 infection. The study is sponsored by the National Health Service in the United Kingdom. The trial at day 28 showed lower mortality in patients treated with low dose dexamethasone (6 mg oral or IV daily for 10 days) than the patients receiving the standard of care.
Steroid use in severe pulmonary infections
Mixed results have been reported with use of steroids (prednisone and methylprednisone) in other pulmonary infections. In Pneumocystis jirovecii pneumonia, prednisone therapy was beneficial. In Middle Eastern Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), use of steroids caused delayed viral clearance. In severe pneumonia caused by influenza virus, steroid therapy had deleterious effect. Steroid use lead to secondary bacterial infections and even death. A meta-analysis of the seven trials involving steroid use and ARDS (acute respiratory distress syndrome) shows reduced risk of mortality and reduced mechanical ventilation duration.
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