Steroids for COVID-19

What role do Steroids play in COVID-19 treatment? Let me try to answer this question.

First we need to understand how our immune system responds to the detection of an antigen (foreign substance) in our body. The immune system sends certain cells to the site of infection to fight off the antigen. One effect or side effect of this immune response is inflammation. Inflammation is fundamental to how our body cells respond to injury or invasion. Inflammation is regulated by cytokines within our cells. The cytokines are proteins (peptides) or glycoproteins (which are proteins with sugar in their side chains). Some cytokines are pro-inflammatory and others are anti-inflammatory. If a particular immune response is unbalanced in favor of pro-inflammatory cytokines, the result is called a “cytokine storm,” which then becomes more destructive to the cells than the antigen itself. 

Many COVID-19 patients have actually died of ARDS (acute respiratory distress syndrome) caused by excessive inflammation in the lung cells.  That is they have died because their immune response was unbalanced. This is the irony of our immune system. 

Steroids have been known for their ability to reduce inflammation. Dexamethasone is a very popular anti-inflammatory steroid. It has been used quite successfully to treat COVID-19 patients. But it is very very important to note that Steroids such as Dexamethasone DO NOT treat the viral infection itself,  rather they reduce mortality due to inflammation caused by cytokine storm. Steroids do not kill the virus. One needs other therapies for reducing the viral load if it is too high. The use of steroids for COVID-19 is a delicate balance of reducing inflammation without disrupting the overall immune response.