Steroid use too early may be causing drop in oxygen: AIIMS chief Randeep Guleria

With a rush in patients seeking medical care, Prime Minister Narendra Modi held a review meeting on Monday to boost resources, including making available services of medical students.

“We have to understand that taking steroids at the early stage can give more stimulus to virus replication. In many cases, mild cases are becoming severe and patients are reporting severe pneumonia. Steroids have no role in the first five days of illness,” Guleria said.

For moderate disease, only three specific treatments are effective, he said. “First is oxygen therapy; second, when the illness is moderate and oxygen saturation is low, then there is a role for steroids; third is anticoagulants, because we know Covid-19 pneumonia is a little different from viral pneumonia and promotes the clotting of blood. There could be blood clots in lungs resulting in a drop in blood saturation. Again, in mild illness, there is no role for anticoagulants,” Guleria said.

The AIIMS Director also advised against CT scans and biomarker tests in case of mild symptoms. “Patients must undertake these tests only when they have moderate illness and on the basis of advice by doctors. There is a possibility of over-treatment due to unnecessary reliance on biomarkers,” Guleria said.

“Many people are getting CT scans done on getting a positive report. We are also seeing people getting scans every three-four days. We are exposing the body to radiation. There is no benefit of CT scan in mild disease, or if you are in home isolation and have normal oxygen levels. Studies have shown that in 30-40% of asymptotic patients, some patches will show in CT reports, however they recover on their own without any treatment,” the doctor said.

Underlining other risks of CT scans, Guleria said, “One CT scan is equal to getting 300-400 chest X-rays. There is data from the International Atomic Energy, which deals with radiation protection and medicine, that conducting CT scan multiple times increases the risk of cancer in later life, especially in the younger age group.”

On biomarkers, the AIIMS Director said, “Those testing positive are undergoing blood tests for C-reactive protein (CRP), complete blood count, D dimer. Again for mild illness and when oxygen saturation is under control, there is no requirement for these blood tests. These only cause a panic reaction. These biomarkers are for acute phase reactants, which means that whenever there is inflammation, these will increase. We don’t come to know if the infection is spreading. People think they should take steroids if CRP is more, this causes more damage.”

Following the review meeting by Modi, the Centre announced that the NEET-PG exam was being postponed for at least four months. “This will make a large number of qualified doctors available for Covid duties,” it said, adding it had also decided to allow deployment of medical interns in Covid duties such as tele-consultation, under the supervision of faculty.

The Centre also talked of “early signs” of a drop in cases in the last 72 hours. “There are early signs of plateauing in one or two states. However, many are still showing increase in daily cases,” it said, noting that 22 states had a positivity rate of more than 15%.