Corticosteroids

Short-term corticosteroid use carries a different and less severe risk profile than chronic use. Hydrocortisone 50 mg IV every 6 hours was the typical steroid regimen for hemodynamically compromised COVID-19 patients, tapered as vasopressors were weaned. Early WHO and CDC guidance against steroids in COVID-19 was extrapolated from influenza data showing prolonged viral shedding, not from COVID-specific evidence. Bone marrow suppression from corticosteroids causes white blood cell counts to drop severely, eliminating immune defenses. COVID-19 appears to behave more like a systemic vasculitis than a classic viral pneumonia, providing a pathophysiological rationale for steroid use. Long-term corticosteroid use suppresses bone marrow, which is responsible for producing red blood cells, white blood cells, and platelets. Patients on chronic corticosteroids have died from mild infections such as the common cold or a sore throat. The accumulation of side-effect risks from chronic steroid use drives the clinical principle of tapering as quickly as possible. Patients on long-term corticosteroids require stress-dose steroids during COVID-19 illness because chronic exogenous steroid use suppr…