Can steroid use at early stages cause a drop in oxygen? What AIIMS chief has to say

As many people are reeling under the Covid-19 infection, one of the most noted impacts is a drop in oxygen saturation level. During the second wave, people having a drop in oxygen saturation level have increased and more people are turning in for hospitalisation. According to AIIMS chief Randeep Guleria, many people with mild symptoms are being prescribed steroids, CT scans and other tests. He noted that hospitals are now seeing patients with mild symptoms who have consumed steroids and as a result, virus replication was triggered leading to drop in oxygen levels.

A report by The IE citing Guleria said that the people need to understand that when steroids are consumed at the early stage, it can give more stimulus to virus replication. There are many cases where mild infection virus has become severe with patients now reporting pneumonia. In the first five days of infection, steroids have no role, Guleria highlighted.

Discussing the treatment for moderate disease, AIIMS chief who is also a member of the national task force on Covid-19, said that there are three specific treatments that are effective. This includes oxygen therapy. Secondly, if the illness is moderate along with low oxygen saturation, steroids play a role. The third treatment is prescribing anticoagulants as Covid-19 pneumonia being different from viral pneumonia can promote blood clotting. It is to note that there could be some blood clots in lungs that result in a drop of blood saturation. Guleria pressed that in mild illness, anticoagulants do not play any role.

Apart from this, the doctor also advised against CT scans and biomarker tests for people having mild symptoms. He added that these tests are to be taken when doctors advise upon moderate illness. Unnecessary reliance on biomarkers can lead to possibility of over-treatment. This means that people isolating at home with mild symptoms and having normal oxygen levels do not need to get CT scans done after getting a Covid positive report. CT scans are to be avoided as they increase the risk of exposure to radiation.

As far as other biomarkers like blood tests for C-reactive protein (CRP), complete blood count, D dimer are concerned, the AIIMS Director said that there is no requirement for these tests in the cases where oxygen saturation is under control. Since the biomarkers are for acute phase reactants, they will increase to an extent if there is any kind of inflammation. When people see increased CRP, they rush for steroids which causes more panic as well as damage.

Meanwhile, the Centre has announced postponement of the NEET-PG exam till next four months. The decision has been taken to ensure that more qualified doctors can be made available for Covid duties. The medical department has also allowed deployment of medical interns for Covid duties including tele-consultation. This will be done under the supervision of faculty.