Should you request high dose steroids for severe COVID-19?
This information may save the lives of a few people if implemented at the correct time. In reality, high dose steroid treatment needs to be administered immediately on admission into the emergency room.
Since April 2020, I have consistently stated that severe COVID-19 is a viral mediated autoimmune disease. Understanding autoimmunity is critical in order to find solutions for patients across the world.
What is lung vasculitis?
Vasculitis (inflammation of the lining of blood vessels) is a serious medical condition requiring early intervention with immunosuppression. The primary pathological impact of inflammation is the formation of small clots that then block affected vessels and prevent blood flow.
Vasculitis involving major organs often needs higher doses of immune suppression to stop progression of inflammation.
Examples of lung vasculitis include Wenger’s Granulomatosis, Churg Strauss syndrome and Goodpasture’s syndrome. Within the context of an acute onset of severe disease requiring oxygen, early immunosuppression is essential. The degree of inflammation with a COVID-19 cytokine storm could be equivalent to that of a graft rejection requiring up to 1000 mg of Methylprednisolone daily for 3 days.
The comparative 6 mg dose of dexamethasone in severe COVID-19 is equivalent to 32 mg of Methylprednisolone. This is 30 times less than what is used in severe lung vasculitis or organ rejection.
This recent paper conclusively demonstrates lung vasculitis
In this paper, it was found that increased serum levels of myosin light chain 9 (Mlc 9) was strongly correlated with poor outcomes. The importance of the paper is that it clearly demonstrates the associated lung vasculitis.
This study presents evidence that exudative vasculitis accompanied by the accumulation of SARS-CoV-2 in the arteries of the lungs develops in fatal COVID-19.
Iwamura, Chiaki, et al. "Elevated Myl9 reflects the Myl9-containing microthrombi in SARS-CoV-2–induced lung exudative vasculitis and predicts COVID-19 severity." Proceedings of the National Academy of Sciences 119.33 (2022): e2203437119.
Is there anything you can do to advocate for loved ones?
It is not easy to convince experienced doctors to treat in a pattern that is not normal or within a protocol. The truth is that even with me advocating for a loved one, it would still be a challenge.
Here is a summary of some general information and rules of engagement: