Use of steroids could have prevented many COVID-19 deaths, says new study

Pneumonia-like symptoms are usually not treated with the help of corticosteroids, as has been evidenced in prior infection outbreaks such as the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) or various influenza outbreaks.

However, some of the early guidelines in the treatment of COVID-19 included the use of low doses of corticosteroids such as dexamethasone, an inexpensive steroid available everywhere in the world, but only under specific circumstances. However, the Recovery trial performed in the UK showed low doses of dexamethasone to be beneficial for COVID-19 patients on ventilator support.

The results of the UK trial prompted WHO to change its stance on the clinical management of COVID-19 patients with the use of dexamethasone, with the director general of the global health body explaining that it was the first treatment that reduced mortality rate in patients who needed artificial oxygen support.

According to the WHO, dexamethasone is a steroid that has been used since the 1960s to treat inflammation arising out of various medical conditions. The Recovery trial was established in March 2020 to study the effects of the drug in treating COVID-19 patients, and had recruited more than 11,500 patients for the trial across the UK.

As many as 2104 patients were given low doses of dexamethasone once every day for 10 days as compared to 4321 patients who received the standardised care until then. Mortality rate was noted on day 28 of the trial, which showed 41% of the patients died among those who needed ventilator support, along with a mortality rate of about 25% among patients who only needed supplemental oxygen. Those who did not require any respiratory intervention had the lowest mortality rate of 13%.

Read more: Severe vs mild symptoms of COVID-19

However, the dexamethasone group had a significantly lower mortality rate in comparison with the other group, as the mortality was reduced by a third of the margin among patients who were on ventilator support, and a fifth among patients who were on supplemental oxygen support. Those who did not require artificial breathing support showed no difference in the mortality rates, suggesting a higher efficacy of the drug on severely ill COVID-19 patients.

The latest study collected data from reports published by various countries to identify mortality of severely ill COVID-19 patients from around the world. Of the 10,815 cases the researchers came across of patients with ARDS, about 39% was the average mortality rate.

Read more: COVID-19 excess mortality

There was a 69% mortality among severe COVID-19 patients in China, while Poland reported the highest mortality rate among countries in Europe with 73%. But when patients who had developed ARDS from the COVID-19 infection were treated with corticosteroids, the mortality rate was down to 28% of the patients.

The study concluded that COVID-19 patients with severe symptoms must be treated with the use of corticosteroids with the appropriate dosage based on the benefits of low dosage, as explained in various studies. However, the researchers also called for more in-depth study into the treatment of patients with severe COVID-19 and ARDS with the use of corticosteroids and their appropriate doses.