We do not have drugs capable of acting against Sars-Cov-2. The only way to go today, waiting for news from the world of research, is to “control” the symptoms of Covid-19 in the best possible way. To do this, there are some molecules, already on the market for some time, which if administered in the correct time and manner can even reduce mortality. This is the case with cortisonici, powerful molecules with anti-inflammatory properties. But pay attention to easy interpretations: dexamethasone – this is the name of the most used molecule – is indicated only in some cases and with a particular timing. This is why an indiscriminate prescription only because it is positive for the virus does not find any confirmation in international guidelines.
The controversy between emergency room and general practitioners
In the past hour, a communication from the Sant’Orsola Malpighi hospital in Bologna has sparked a controversy between the doctors in the emergency room of the Bologna hospital and general practitioners. The reason for the dispute is the accusation against the latter of prescribe cortisone too lightly already at the first symptoms of the disease. Prescription that would have led to an increase in access to the emergency room by very young patients. A correlation that needs to be verified but once again raises the question of when it is useful to resort to corticosteroids.
The role of cortisone
Like all drugs on the market, the effect does not depend only on the dosage but on the time of administration. Corticosteroids, drugs that have been known for decades and that have revolutionized the treatment of inflammatory diseases, are very powerful anti-inflammatories. But stopping inflammation in the bud isn’t always good. This is especially true in the early stages of Sars-Cov-2 infection where it is helpful for the immune system to work to its full capacity. Keeping inflammation at bay becomes crucial when this response becomes excessive.
Useful yes but only under certain conditions
In a year of pandemic there have been many attempts and studies carried out to understand the role of cortisone in the fight against Covid-19. From the analysis of the most important study – the Recovery Trial (Randomized Evaluation of COVid-19 thERapY) – it emerged that compared to usual treatments, dexamethasone can reduce deaths by 35% in intubated patients and by 20% in those receiving only oxygen. . However, the same cannot be said for those patients who have symptoms that are not severe and therefore do not require the administration of oxygen. In these cases the indications are very clear. According to WHO guidelines (summarized in a publication of British Medical Journal) in these people the use of corticosteroids is not necessary. The position, summarized in a tweet from Dr. Maurizio Cecconi, Head of the Anesthesia and Intensive Care Department Operating Unit at Humanitas in Milan and one of the authors of the publication, is the following: “In patients who need oxygen, steroids save lives; in patients without the need for oxygen, steroids can increase risks ”. An indication reaffirmed also in a note from the AIFA which states: “The use of corticosteroids is recommended in hospitalized patients with serious illness who need oxygen supplementation, whether or not they have mechanical ventilation (invasive or non-invasive)”.
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