In Search of Rationality: Systemic Steroid Use in COVID 19

The following institutions have recommended against using systemic steroids in nonhypoxic Covid-19 patients.

World Health Organisation (WHO) guidelines

systemic corticosteroids may increase the risk of death when administered to patients with non-severe COVID-19¹

Infectious Diseases Society of America guidelines (IDSA)

systemic corticosteroids may increase the risk of death when administered to patients with non-severe COVID-19(Non-severe illness is defined as patient with a SpO₂ > 94% not requiring supplemental oxygen)².

National Institute of Health guidelines (NIH_USA)

benefit was observed in patients who were mechanically ventilated or required supplemental oxygen at enrollment. No benefit of dexamethasone was seen in patients who did not require supplemental oxygen at enrollment³

National Institute of Health and Clinical Excellence guidelines (NICE- UK)

Do not routinely use corticosteroids to treat COVID-19 in people who do not need supplemental oxygen, unless there is another medical indication to do so⁴

European Respiratory Society guidelines (ERS)

The panel recommends NOT to offer corticosteroids to patients with COVID-19 requiring hospitalisation but not requiring supplementary oxygen or ventilatory support ⁵

These recommendations are based on the Recovery trial⁶ whose findings showed there was no evidence that dexamethasone provided any benefit among patients who were not receiving respiratory support at randomization, and the results were consistent with possible harm in this subgroup. This arm of the trial had 1535 patients.

We are gravely concerned at the advice for overly liberal prescription of steroids to mildly ill Covid-19 patients which seems to have no science or data behind it and has a potential to cause grave harm to a lot of patients who would never be seriously ill.

1. WHO. Corticosteroids for COVID-19. Accessed April 14, 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1
2. IDSA. COVID-19 Guideline, Part 1: Treatment and Management. Published 2021. Accessed May 6, 2021. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/
3. NIH. Corticosteroids | COVID-19 Treatment Guidelines. Accessed April 16, 2021. https://www.covid19treatmentguidelines.nih.gov/immunomodulators/corticosteroids/
4. NICE. Overview | COVID-19 rapid guideline: managing COVID-19 | Guidance | NICE. Published 2021. Accessed April 18, 2021. https://www.nice.org.uk/guidance/NG191
5. Chalmers JD, Crichton ML, Goeminne PC, et al. Management of hospitalised adults with coronavirus disease-19 (COVID-19): A European Respiratory Society living guideline. Eur Respir J. Published online January 1, 2021. doi:10.1183/13993003.00048-2021
6. Peter Horby, F.R.C.P., Wei Shen Lim, F.R.C.P., Jonathan R. Emberson, Ph.D., Marion Mafham, M.D., Jennifer L. Bell, M.Sc., Louise Linsell, D.Phil., Natalie Staplin, Ph.D., Christopher Brightling, F.Med.Sci., Andrew Ustianowski, Ph.D., Einas Elmahi, M.Phil FRCP. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704. doi:10.1056/NEJMoa2021436

1. Dr Suranjan Mukherjee MBBS, MD,FRCP(Glas), FRCP(Lon), FCCP, CCT UK Pulmonology, Senior Consultant Pulmonologist
2. Dr Suresh Ramasubban FACP, FCCP , AB Pulmonary and CCM
3. Dr Susruta Bandyopadhyay MD , Dip Card, Director Critical Care AMRI Hospitals Salt Lake
4. Dr Anshuman Mukhopadhyay , MD, DNB, Consultant Respiratory Physician
5. Dr Chandrashish Chakravarty, MBBS, MD, Fellow in Critical Care USA, Senior Consultant Critical Care at Apollo Kolkata
6. Dr Sushmita Roychowdhury, MD MRCP HERMES Diplomate
7. Dr Yashesh Paliwal; MD, FRCA, EDIC,Director & Head , Critical Care , Fortis Hospital , Kolkata
8. Dr Ranjan Sarkar MD,FRCP Consultant Nephrologist
9. Dr P S Mandal MD, MRCP(UK), FRCP(Edin)  Consultant Physician & Diabetologist AMRI Hospital, Salt Lake
10. Dr Samit Ghosal MD, FRCP, MSc, PG. Dip. Endo (UK)
11. Dr Binayak Sinha MBBS, MRCP (UK) CCST (Diabetes Endocrinology GIM) (UK); FRCP (UK)
12. Dr Rajarshi Roy MD, Consultant Critical Care AMRI Hospital, Salt Lake
13. Dr. Ritam Chakraborty  MD ( Pulmonary Medicine) . DNB . FNB ( critical care) . European Diploma  in Adult Respiratory Medicine
14. Dr. A. K. Singh MD, DM (Endo)
15. Dr Nabarun Guha MBBS(Cal),MRCP(UK),FRCP(Edin) Consultant Physician
16. Dr Raja Dhar MD, FRCP, FCCP, Director, Department of Pulmonology C K Birla Group of Hospitals
17. Dr Ajoy Krishna Sarkar, MD(MEDICINE); MRCP(UK); FRCP( LOND), Clinical Director, ICU   Peerless Hospital
18. Dr Sumit Sengupta MD, MRCP (UK), CCST (UK) in Respiratory Medicine, FRCP (London) Consultant Respiratory Physician