Background and Rationale of Experimental Use of Steroids for Outpatient
Covid-19 Management to Avoid Cytokine Storm and Oxygen Supplementation
Indian people are facing an unprecedented Covid-19 health emergency in which thousands are dying every day, primarily due to oxygen desaturation. In the coming few weeks, even though the current peak will start receding in many Metropolitan cities and developed areas in India, there is no single peak or decline, but there will be a series of peaks and declines in different parts at different times, within the broader, overall national trend. Given the grossly inadequate healthcare in India both in quantity and quality, especially in rural areas, there is acute, severe, wide-spread shortage of oxygen beds, which are so essential to manage Covid-19 complications. This is leading to unnecessary deaths. This death toll is likely to continue to play havoc especially in less developed areas and remote areas for some indefinite period. In this dastardly situation, there is a great need to experiment with novel ideas to reduce deaths especially in resource poor settings.
It is widely accepted that most of the morbidity and mortality in Covid-19 is due to the consequences of cytokine storm, which are most detrimental in the elderly people and those with certain co-morbidities. It is widely accepted that timely and appropriate use of steroids in hospitalized patients is extremely valuable in reducing mortality by countering the cytokine-storm and that anticoagulants play an important role in preventing thrombotic lesions which are the hallmark of Covid-19 disease. Based on this background knowledge and their clinical experience, some rational doctors have experimented with novel use of oral steroids in a subset of outpatients. Their anecdotal experience indicates that based on defined indicators, if oral steroids are given in the early second week of Covid-19, the cytokine storm can be preempted and the consequent oxygen desaturation can be prevented. This is especially valuable in resource poor settings where there is great paucity of oxygen beds. Randomised Clinical Trials are needed to explore further this innovative approach before accepting or rejecting or modifying it for general use. However, given the surging deadly Covid-19 epidemic and widespread collapse of the hospital system in India, it is necessary that this innovative approach be tried in different areas in a cautious manner, pending such clinical trials.
Since there is dire shortage of qualified rational doctors especially in rural areas, it is felt that it is worth experimenting with this novel approach through certain NGO-run rural health care set ups and in Public Health Care setups in certain areas. This should be done by specifically training paramedics to work strictly as per protocol and preferably with some telephonic guidance from qualified doctors. Desperate situations justify innovative, desperate attempts. However, it is agreed that this experimental use should be reviewed in the light of more experience with it.
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