COVID-19 – Oral Corticosteroids?

The Oxford COVID-19 Evidence Service Team have published a guide to “Rapidly managing pneumonia in older people during a pandemic” [NB: not yet peer-reviewed] – which includes the following about the possible role of oral corticosteroids:

In the initial phase of pneumonia, elderly patients can present with wheezing and respiratory distress. It is not uncommon to consider corticosteroids at this stage, because of their anti-inflammatory effects. Corticosteroids were widely used during the 2002-3 SARS outbreak. However, in a subsequent systematic review, including 29 low quality studies of steroid use, 25 studies were inconclusive and four reported possible harm from steroid use. A further evidence review did not support corticosteroid treatment, reporting no evidence of net benefit with corticosteroids in “respiratory infection due to RSV, influenza, SARS-CoV, or MERS-CoV”, and that
corticosteroids probably impair clearance of SARS-CoV.

In contrast to pneumonia, corticosteroids show much clearer benefit in patients with sepsis.