Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

COVID-19 and the use of outpatient steroids

William Mazzella, MD
Conditions
December 28, 2020
Share
Tweet
Share

In some people, COVID-19 causes mild or no symptoms at all. In others, it can cause significant respiratory distress that can lead to death. Once infected with COVID-19, is there anything that someone can do to foster a less severe infection?  The answer is likely “yes,” avoid the use of outpatient steroids.

The risk factors for a poor outcome with COVID-19 include age over 65, obesity, diabetes, and a compromised immune system. By looking at the use of steroids, we can influence this fourth critical factor. Steroids come in two categories: anabolic and catabolic. Anabolic steroids such as testosterone and growth hormone promote building muscle and bone. Catabolic steroids such as prednisone and methylprednisolone promote muscle and bone loss, suppress the immune system, and impair healing.  Thus, treating mild cases of COVID-19 with steroids may allow the virus the spread more extensively while impairing the body’s ability to heal itself from the infection.

For example, Frank M.is a 48-year-old male who runs a chain of family-owned convenience stores who tested positive for COVID-19 two weeks earlier. Frank had mild symptoms, so he continued to work from home. However, after two weeks of a nagging dry cough, his outpatient provider gave him an antibiotic, an intramuscular shot of steroids, and oral steroids to take at home. Within 72 hours of receiving the steroids, Frank ended up in the Emergency Room, and I admitted him for respiratory distress. He required increasing supplemental oxygen for over a week before improving. Because Frank and a handful of other patients did not have the usual comorbid conditions associated with a severe case of COVID-19, I began asking all of my patients in the hospital whether they had received steroids as an outpatient.  It turns out that in patients under 55 years-old without comorbidities, over 91 percent of them received steroids as an outpatient.

After reviewing the medical literature, large trials have not focused on the use of outpatient steroids. Frank may have been improving when his provider tried steroids to suppress an annoying dry cough. These steroids may have suppressed the cough as well as suppressing his immune system, which allowed the virus to replicate and spread itself further. Additionally, steroids may have hampered his lungs’ ability to heal themselves, which may have prolonged his course combatting COVID-19. The medical literature is still evolving in the treatment of COVID-19, but it does not support using outpatient steroids alone or in combination with an antibiotic.

So, why do we use steroids at all with COVID-19?  In the early days of the pandemic, treatment options, including steroids, were hypothesized since the virus may cause a significant inflammatory response. Since the immune system damages the virus and our own tissue, decreasing the immune system may theoretically decrease damage to our lungs. However, the opposite hypothesis may also be true: steroids may allow greater spreading of COVID-19 within the body and reduce the body’s ability to heal itself.  Thus, steroids in the outpatient setting may act to turn a mild infection into a more severe one.

The RECOVERY Collaborative Group published a study in the New England Journal of Medicine looked at steroids’ efficacy in hospitalized patients. While the study showed some benefit for patients who require mechanical ventilation/life support, it showed harm to those who did not require supplemental oxygen. Likewise, the CDC does not recommend using outpatient steroids in the setting of a COVID-19 infection. Yet, steroids are used with worrisome frequency for COVID-19 in the outpatient setting.

The medical literature takes years to collect enough data for a definitive answer. However, individuals must make decisions today. Based on the available data and my clinical experience, I would suggest avoiding outpatient steroids whenever possible. When treating COVID-19 as an outpatient, patients should carefully discuss any possible use of steroids with their physician.

William Mazzella is an internal medicine physician.

Image credit: Shutterstock.com

Prev

Food allergies are not funny [PODCAST]

December 27, 2020 Kevin 0
…
Next

Should playing football require informed consent?

December 28, 2020 Kevin 0
…

Tagged as: COVID, Infectious Disease

Post navigation

< Previous Post
Food allergies are not funny [PODCAST]
Next Post >
Should playing football require informed consent?

ADVERTISEMENT

Related Posts

  • How to get patients vaccinated against COVID-19 [PODCAST]

    The Podcast by KevinMD
  • COVID-19 divides and conquers

    Michele Luckenbaugh
  • State sanctioned executions in the age of COVID-19

    Kasey Johnson, DO
  • A patient’s COVID-19 reflections

    Michele Luckenbaugh
  • Starting medical school in the midst of COVID-19

    Horacio Romero Castillo
  • COVID-19 shows why we need health insurance

    Jingyi Liu, MD

More in Conditions

  • How declining MMR vaccination rates put future generations at risk

    Ambika Sharma, Onyi Oligbo, and Katrina Green, MD
  • How one unforgettable ER patient taught a nurse about resilience

    Kristen Cline, BSN, RN
  • Why regular exercise is the best prescription for lifelong health

    George F. Smith, MD
  • When the weight won’t budge: the hidden physiology of grief, stress, and set point

    Sarah White, APRN
  • Why peer support can save lives in high-pressure medical careers

    Maire Daugharty, MD
  • Addressing menstrual health inequities in adolescents

    Callia Georgoulis
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician
    • Time theft: the unseen harm of abusive oversight

      Kayvan Haddadan, MD | Physician
    • How one unforgettable ER patient taught a nurse about resilience

      Kristen Cline, BSN, RN | Conditions
    • The future of clinical care: AI’s role in easing physician workload

      Michael Wakeman | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician
    • Time theft: the unseen harm of abusive oversight

      Kayvan Haddadan, MD | Physician
    • How one unforgettable ER patient taught a nurse about resilience

      Kristen Cline, BSN, RN | Conditions
    • The future of clinical care: AI’s role in easing physician workload

      Michael Wakeman | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...