Steroid use too early may be causing drop in oxygen: AIIMS

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Context

  • Member of the national task force on Covid-19, said hospitals were seeing mild patients who had consumed steroids, triggering virus replication and causing a drop in oxygen levels.
  • With many patients in the current Covid-19 wave reporting a drop in oxygen saturation levels, in turn requiring hospitalisation, AIIMS Director Dr Randeep Guleria on Monday warned against indiscriminate prescription of steroids, as well as CT scans and tests, for those with mild symptoms.

Important findings 

  • We have to understand that taking steroids at the early stage can give more stimulus to virus replication.
  •  In many cases, mild cases are becoming severe and patients are reporting severe pneumonia. Steroids have no role in the first five days of illness,

For moderate disease, only three specific treatments are effective

  • First is oxygen therapy; second, when the illness is moderate and oxygen saturation is low, then there is a role for steroids; third is anticoagulants, because we know Covid-19 pneumonia is a little different from viral pneumonia and promotes the clotting of blood. There could be blood clots in lungs resulting in a drop in blood saturation. Again, in mild illness, there is no role for anticoagulants
  • One CT scan is equal to getting 300-400 chest X-rays. There is data from the International Atomic Energy, which deals with radiation protection and medicine, that conducting CT scan multiple times increases the risk of cancer in later life, especially in the younger age group.

Conditions for Biomarkers

Those testing positive are undergoing blood tests for C-reactive protein (CRP), complete blood count, D dimer. Again for mild illness and when oxygen saturation is under control, there is no requirement for these blood tests.

These only cause a panic reaction. These biomarkers are for acute phase reactants, which means that whenever there is inflammation, these will increase. We don’t come to know if the infection is spreading. People think they should take steroids if CRP is more, this causes more damage.

Additional invocation of doctors on covid duty 

The Centre announced that the NEET-PG exam was being postponed for at least four months. “This will make a large number of qualified doctors available for Covid duties,” it said, adding it had also decided to allow deployment of medical interns in Covid duties such as tele-consultation, under the supervision of faculty.

Recent way ahead 

The Centre also talked of “early signs” of a drop in cases in the last 72 hours. “There are early signs of plateauing in one or two states. However, many are still showing increase in daily cases,” it said, noting that 22 states had a positivity rate of more than 15%.

 

SOURCE: IE

 

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