Explained: Here’s why steroids’ irrational use for COVID19 treatment could be risky
The use of steroids in treating COVID19 patients comes with tricky considerations. Its irrational use has been linked with the rising ‘black fungus’ infections in India. Experts issue instructions for its rational use. More details here.
These oral steroids are to be given once a day for a standard duration of five days and a maximum duration of 10 days.
Although steroids have proved to be life-saving in treating COVID19 patients, their ‘irrational use’ is being blamed for the rise of ‘black fungus’ infections in the country.
Yesterday Health Minister Harsh Vardhan informed that a total of 5,424 cases of mucormycosis, commonly known as ‘black fungus’, have been reported from 18 states. Of these 4,556 cases had a history of COVID19 infection.
Randeep Guleria, director of All India Institute of Medical Sciences (AIIMS), New Delhi, has often come out in the press to emphasise on the need to be cautious about the irrational use of steroids.
On May 21, Guleria advised that COVID19 patients with a mild infection should strictly avoid taking oral steroids; it increases the risk of secondary infections such as mucormycosis.
“If a COVID-infected person’s oxygen saturation level is normal, and he/she is categorised as clinically mild, steroids should be completely avoided,” Guleria was quoted as saying.
Meanwhile, Madhu Pai, a professor of epidemiology at Canada’s McGill University stated today that the incorrect use of steroids can lead to ‘black fungus’ and other adverse issues.
“Steroids are proven, life-saving meds for COVID19. But they should be used correctly and rationally. Incorrect use can result in mucormycosis and other issues,” he stated on microblogging site Twitter while sharing a set of tips released by INDIA COVID SOS, non-profit group.
Instructions for steroid use in mild COVID cases
Apart from frequently monitoring the oxygen levels and blood sugar levels, the tips stated that nasal steroids such as budesonide can be given to mild COVID cases which have also have high risk factors such as being above 65 years of age, having comorbidities and manifest an oxygen level above 92 per cent.
“Consider inhaled budesonide two puffs, twice daily (1600 mcg/day), until symptoms improve. After using the inhaler, instruct (the patient) to rinse the mouth with water and spit out safely,” it stated in a set of instructions for the medical staff.
Instructions for steroid use in moderate/severe COVID cases
The instructions issued by the coalition of experts identified moderate to severe COVID19 patients as those that have oxygen levels below 92 per cent.
For such patients, it stated that following oral steroids can be given: Dexamethasone 8mg (6mg salt), or Methylprednisolone 32 mg or Prednisone 40 mg.
These oral steroids are to be given once a day for a standard duration of five days and a maximum duration of 10 days.
It also specified that the blood sugar levels of COVID19 patients have to be strictly monitored and should be maintained at below 180 mg/dL (milligram per decilitre).
It also suggested the use of insulin in ensuring the healthy sugar levels of the COVID19 patients on oral steroids.
‘Black fungus’ infections in India
“Of the 5,424 cases of Mucormycosis, we have seen that 4,556 cases have a history of COVID19 infection, while 875 cases are amongst non-COVID patients. Diabetes was present in 55 per cent of the patients,” Vardhan informed yesterday.
As per the health minister, the majority of cases were reported from Gujarat and Maharashtra. “Gujarat reported 2,165 cases [about 40 per cent], Maharashtra reported 1,188 cases, Uttar Pradesh 663, Madhya Pradesh 590, Haryana 339, and Andhra Pradesh 248 cases,” Vardhan said.
Mucormycosis, a life-threatening infection, prevailing in COVID-19 patients or those recently recovered from the disease, has been declared as an epidemic in the country. It usually affects nasal passage, oral cavity and the infection can possibly reach the brain as well.
Meanwhile, the Union Ministry of Chemicals and Fertilizers stated today that it has allocated 19,420 more vials of the anti-fungal drug Amphotericin-B to states and union territories to treat the black fungus.
“Additional 19,420 vials of #Amphotericin- B have been allocated to all States/UTs and Central Institutions today. Besides this, 23680 vials of Amphotericin- B were allocated across the country on 21st May,” Union Minister for Chemicals & Fertilizers stated.