China’s National Health Commission recommended that corticosteroids be used in low doses over a short period of time for those who are not responding well.

Michigan State University

A study on patients in Wuhan, China, indicated that systemic corticosteroid treatment may have no significant effect, or potentially a negative effect, on in-hospital mortality rates for severe and critical COVID-19 cases.

Effect of Systemic Corticosteroids on Mortality in Severe and Critical COVID-19

Wu, J., Huang, J., Zhu, G., Liu, Y., Xiao, H., Zhou, Q., ... & Xiao, H. (2020). Systemic corticosteroids and mortality in severe and critical COVID-19 patients in Wuhan, China. The Journal of Clinical Endocrinology & Metabolism, 105(12), e4230-e4239. https://doi.org/10.1210/clinem/dgaa627

Wu et al. (2020): Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China

- The use of systemic corticosteroids may result in viral replication, worsening one’s current COVID-19 condition.
  - This could be a result of the suppression of the immune system
- Levels of lymphocytes were still low after administration of systemic corticosteroids
   - Results in higher susceptibility to superinfections
- Systemic corticosteroids could also result in high blood glucose levels
- Complications more likely in the elderly


Issues with Corticosteroid Treatment

- Different baseline conditions for those provided and not provided with corticosteroids
- Most patients were put on prednisone along with corticosteroids
- Yet, it was found that dexamethasone prevents inflammation
   - Its potency is 4-5 times that of prednisone
   - Over 20 times more potent than cortisol in its natural state
- After baseline conditions were balanced, however, it was still found that corticosteroid used was still not linked with lower risks of mortality


Corticosteroids: Conflicting results with the recovery trial

Corticosteroids and Dosage

In the Wu et al. (2020) Wuhan, China cohort, baseline characteristics differed between the corticosteroid-use and non-corticosteroid-use groups. Among critical cases, the two groups differed significantly in several admission laboratory values. Among severe cases, they differed significantly in age, gender, smoking status, and several admission laboratory values. These baseline imbalances confound direct comparisons of mortality between the two groups.

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