Steroids, the game-changer in COVID-19 care?
CHENNAI: The medical community is still grappling without a definitive solution to deal with the COVID-19. Some experts, however, believe corticosteroids could be the game changer -- in saving lives of patients and speeding up recovery.
An alumnus of the Kilpauk Medical College, now working in the US, has found that short courses of the corticosteroid ‘methylprednisolone’, when administered early to moderate to severe COVID-19 patients, reduce mortality and need for ventilators.
Dr Mayur Ramesh is a 1993 batch student of KMC. He currently is a Transplant Infectious Diseases specialist at the Henry Ford Hospital, Detroit.
"We used to see 15-20 cardiac arrests in COVID-19 patients in our hospital daily," says Dr Ramesh.
"It was complete chaos. We then studied some data coming out of China, and came up with this pragmatic approach of treating patients with an early but short course of methylprednisolone."
Patients who presented to the hospital with difficulty in breathing upon exertion or drop in oxygen saturation upon ambulation were treated with methylprednisolone for 3-7 days.
The success, Dr Ramesh says, was dramatic. "Within 72 hours, many patients came out of ventilators."
Dr Ramesh has published his findings based on experiences with 213 patients -- with moderate to severe conditions -- in his paper titled, Early Short Course Corticosteroids in Hospitalized Patients with COVID-19.
According to the preprint of the study published in MedRxiv server for health sciences, the patients were divided into two groups for the study, with the average age being around 60 years.
One group was administered "standard of care" management. After institution of the early corticosteroid protocol, patients in the second group received the doses within two days of admission.
Early course of corticosteroids resulted in reduced death rate, faster transfer from the ICU to general wards, and reduced dependency on mechanical ventilators, said the study. "The study has been accepted for publishing by the Clinical Infectious Diseases Journal,'' said Dr Ramesh.
Surprisingly, the time patients had to spend in hospital also came down by three days "We had a treatment that worked!"
Pregnant and obese people in their thirties also responded well to the treatment, said Dr Ramesh. However, it’s important to note that the World Health Organization has expressed concerns over steroids’ use for treatment -- due to possible side-effects.
A similar study was earlier conducted in Wuhan in January with lesser samples of 46 COVID19 patients. In this, 26 were given short and early doses of methylprednisolone for 5-7 days.
Proponents, however, say early and short courses would be of great help in times like these. Dr Sujatha Nott, a 1994 batch alumnus of KMC, who now practices in Arizona, says she has has successfully treated 20 patients with severe COVID-19 pneumonia with steroids.
"Almost all of them responded well to the treatment. When our body fights COVID-19, it causes inflammation. The steroid reduces that inflammation," says Dr Sujatha.
"For example, I treated a 75 year patient whose family did not want her put on a ventilator," said Dr Sujatha. Her oxygen level was 80%, and initially she needed 6 litres of oxygen and later, her condition worsened as she needed 15 litres of oxygen via nasal cannula to breathe.
"After I gave her steroids, her breathing improved in the next 24 hours and she was discharged in three days on home oxygen at two liters," said Dr Sujatha.
"Same is the case of a 60-year-old, who came out of a ventilator in just five days, and an 82-year-old diabetic, who recovered fast. My patients are alive today because of the steroid."
In Tamil Nadu, officials say the need for steroid-based treatment has not arisen yet as the mortality rate is just around one per cent. "Using steroids is a policy decision governments must make. Currently, the supportive care itself is working well," the official said.
‘Using steroids is a policy decision govts must make’
In Tamil Nadu however, officials say the need for a steroid-based treatment protocol has not arisen yet as the mortality rate is just around one per cent. "Using steroids is a policy decision governments must make. Currently, the supportive care in the State itself is working well," the government official said.
Consider plea for using Siddha medicine: Madras High Court
A division bench of the Madras High Court has directed the Director, Directorate of Indian medicine and Homeopathy in Arumbakkam to consider the plea for use of Siddha medicines for treating Covid-19 virus. The bench of Justices Vineet Kothari and Pusha Sathyanarayana issued the directive on May 12 while disposing of two PIL petitions, one from K Muthu Kumar Nayakar and the other from Dr K M Senthamilzh Selvan, seeking to consider their representations to test the Indian traditional medicine herbal Mixture (Sidhha) for curing Covid-19.