Covid -19 Second Wave: Steroids and Plasma Therapy


FamHealth speaks with Dr. Shamsher Dwivedee, Chairman Neuroscience and Director Clinical Services, Vimans Nayati Hospital to understand steroids and plasma therapy 

Dr. Dwivedee: Since COVID 19 is a new disease, the medical experts have not been able to gather complete research on this novel virus. There is one approach which prescribes medicine for the first 5 days to stop the multiplication of the virus. Once a cytokine storm starts, medicine which calms the cytokine storm will have to be given. Now, there is debate on which medicines stop viral multiplication and which calm cytokine storm.  

All the studies taking place right now are being rushed and coming with hurried conclusions. Now, a solution is the Remdesivir antiviral drug which stops viral multiplication. Its effect on a patient who has entered a cytokine storm may be negligible. This is because by now the immune system has already killed the virus, scavenging for bodies due to which cytokine is being released. Ineffective scavenging leads to cytokine storms. Remdesivir will only be effective once you use it early and the viral multiplication will stop. 

Now, there are also medicines prescribed to calm the cytokinesis and only one shares a global consensus. This is steroid. Another method is using plasma, a controversial topic since it is a human donation, unable to be produced in factories. Plasma has two components; the first are the antibodies, produced in the bodies of cured COVID patients and through passive immunity, passed onto the patients. This should be done during the early stages of the infection to kill the virus. The other component of the plasma are the immunoglobulins  We have observed that in many cases, the cytokine is responsible for the tissue damage. If immunoglobulins are provided, the tissue damage calms down. In 90% of the diseases where the body’s immune system is killing the body tissues, this method of treatment is used. Now, some newspapers also say that the immunoglobulins that are pharmaceutically produced, for diseases that are cytokine storm mediated, should be prescribed to fight the cytokine storm. 

Famhealth: When to give plasma therapy? 

Dr. Dwivedee: The CT score on the RC-PTR test will tell you if the patient is a high viral load case. This can potentially enter the severe cytokine storm stage. This is the ideal candidate for plasma therapy which should be started before the saturation levels dip too low and also, to stop viral replication. 

Famhealth: When to give steroids? 

Dr. Dwivedee: If these are given early on, the body’s immune system is being suppressed, leading to faster viral replication and a higher chance for the patient to go into a cytokine storm. Observing the virus’ behaviour, the cytokine storm begins around the 5th day. Symptoms for this would be trouble in breathing, values of CRP, ESR, IL-6 start jumping from the baseline, meaning that the inflammation is building up. This is when the steroid should be introduced. 

Famhealth: What about patients suffering from high diabetes? 

Dr. Dwivedee: They are then shifted to insulin. This is done for a better titration of blood sugar. Do not resist this since the COVID virus can itself worsen your diabetes. 


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