The Data Are In: Steroids Should Be Standard Of Care For COVID-19

On some level, it was understandable. This is a new disease, a horrific one at that, and it has caused death and devastation on a scale that has not been seen in more than a century.

Clinicians the world over were trying to do all that they can to help their patients suffering from COVID-19 get better. From this deep desire to help came the push for treatments such as hydroxychloroquine and now convalescent plasma.

Just because we can do something, does not mean we should do it. If a treatment can cause more harm than good, then it should not be administered, even if it “makes sense” from a logical perspective.

Well-conducted, reliable randomized studies take time, and given the breathtaking speed this pandemic is affecting the world, it is hard to wait until good data comes out either in favor or against a particular treatment.

“These trial results from diverse clinical and geographic settings suggest that in the absence of compelling contraindications, a corticosteroid regimen should be a component of standard care for critically ill patients with COVID-19.” — JAMA

Well, finally, science has provided us with an answer as to what seems to work really well for COVID-19. On September 2, multiple studies were published in JAMA with respect to steroids and outcomes in COVID-19. The most important one was a meta-analysis, which is a study of multiple randomized trial data combined, showing a statistically significant improvement in mortality for steroids in COVID-19.

Finally, science has triumphed over hype.

While the meta-analysis studied three different steroids — hydrocortisone, methylprednisolone, and dexamethasone — the strongest data indicated that dexamethasone had a 36% reduced risk of death. This data is pretty robust and reliable, and as the authors wrote:

These trial results from diverse clinical and geographic settings suggest that in the absence of compelling contraindications, a corticosteroid regimen should be a component of standard care for critically ill patients with COVID-19.

In the beginning, I admit that I was more skeptical about using steroids in COVID-19. The initial expert consensus was not to use them, as they could be harmful. Again, I didn’t want to do more harm than good. Indeed, the data with steroids and influenza are actually not good.

But now, with this data, there should be no more hesitation. Unless there is a contraindication, steroids should be part of the standard treatment for COVID-19. It doesn’t mean that it is guaranteed to work. At the same time, we should do all that we can — without known harm — to help our patients suffering from COVID-19. And it seems steroids should be part of that plan.