1 INTRODUCTION
According to the World Health Organization (WHO), viral diseases are
emerging as a serious public health issue worldwide. In the last two
decades, many viral epidemics such as severe acute respiratory syndrome
coronavirus (SARS-CoV) disease from 2002 till 2003, and hemagglutinin
type 1 and neuraminidase type 1 (H1N1) influenza in 2009, have been
reported. Most recently, SARS-CoV2 was detected for the first time in
Wuhan, China, in December 2019. On February 11, 2020, the WHO named this
disease, coronavirus disease 2019 (COVID-19). This new virus is highly
contagious and has rapidly spread globally. On January 30, 2020, the
outbreak was declared a Public Health Emergency of International Concern
(PHEIC) by the WHO. On March 11, 2020, as the number of COVID-19 cases
outside China increased 13 times and more than 114 countries were
involved, the WHO declared the COVID-19 a pandemic.1To date (December 26, 2020), Pakistan has 469,482 confirmed cases of
COVID-19 with a total death toll of 9816.2 The
majority of the patients with COVID-19 have an uneventful recovery.
However, approximately 19% of the patients suffer from a progressive
worsening of the disease leading to severe pneumonia in 14% and
critical pneumonia in 5% of the patients, which leads to acute
respiratory distress syndrome (ARDS).3 Multiple
therapeutic agents are being used and tried across the world for
COVID-19 treatment and the management of its symptoms and
complications.4
Immune-mediated response from the host of COVID-19 can lead to cytokine
storm that leads to enormous vascular inflammation, disseminated
coagulation, and shock, leading to multi-organ failure and death. This
inflammatory pathophysiology has led to the use of corticosteroids in
COVID-19 management.3 Since corticosteroids cause
immune suppression by impairing the innate immunity, their use has
largely been discouraged due to the fear of worsening of viral
propagation.5 The majority of the earlier studies
involving the use of steroids in SARS-CoV disease and the Middle East
respiratory syndrome coronavirus (MERS-CoV) disease showed adverse
outcomes.6,7 The WHO and the Center for Disease
Control and Prevention (CDC) specifically advised against the use of
corticosteroids in COVID-19 management earlier in the
pandemic.3 The recent RECOVERY trial has shown
significantly improved outcomes with dexamethasone, in severe COVID-19
patients who required oxygen therapy or were on a mechanical
ventilator.8 Initially, we did not use steroids for
COVID-19 management at our center as per the earlier WHO and CDC
recommendations. However, subsequently, steroids became part of our
COVID-19 management protocol based on the emerging evidence as well as
our national clinical management guidelines for COVID-19
infection.2 In this study, we retrospectively compared
the outcome of COVID-19 patients (recovery versus mortality) who were
treated with steroids with those who were not treated with steroids
during their course of hospital stay.