Dear DR. ROACH: Why would a specialist in breast diseases prescribe steroids for breast infection from COVID if it suppresses the body’s immune system? – AK
ANSWER: Damage to lung tissue can result directly from an infection with a bacterium, virus or other pathogen. However, additional damage can occur due to the powerful response of the body to specific infections. By using steroids to slightly reduce the body’s inflammatory response, lung damage can be reduced. This is especially important when oxygen levels are very low, as can be the case during severe infection. I understand why you are concerned about the possible suppression of the immune system, but there is a proven benefit in serious infections with certain specific organisms. COVID-19 is one example, but there are others.
In the case of COVID-19, steroids are beneficial if the infection is fairly severe, as evidenced by the need for supplemental oxygen. COVID patients who need oxygen and benefit from steroids should be in the hospital if there are hospital beds available in the community.
I would like to mention that there are treatments for people with COVID-19 who are at risk for serious illnesses but who do not meet the criteria for hospitalization (for example, people with a low oxygen content). It has been increasingly shown that monoclonal antibody treatments are effective and that they are far more available than they used to be. It should ideally be used within three days after symptoms, but no more than ten.
Risk factors that justify considering monoclonal antibody treatment are severe obesity or obesity; chronic kidney disease; diabetes; immunosuppression by disease or treatment; older than 65; or older than 55 with heart disease, high blood pressure or chronic obstructive pulmonary disease (or other chronic respiratory disease). Early studies show that these treatments can dramatically reduce the risk of developing serious diseases.
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Dr. Roach regrets not being able to answer individual letters, but will include them in the column where possible. Readers can email questions to [email protected] or email 628 Virginia Dr., Orlando, FL 32803.
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