Stamford Advocate

Immune response can damage lungs

- Keith Roach, M.D. Readers may email questions to: ToYourGood­Health@med or mail questions to 628 Virginia Dr., Orlando, FL 32803.

Dear Dr. Roach: Why would a chest disease specialist prescribe steroids for chest infection from COVID if it suppresses the body’s immune system?


Answer: Damage to lung tissue can come directly from an infection with a bacteria, virus or other pathogen.

However, additional damage may occur as a result of the body’s overvigoro­us response to some specific infections. By using steroids to slightly reduce the body’s inflammato­ry response, lung damage can be lessened. This is particular­ly important when oxygen levels are very low, as might be the case during severe infection.

I understand why you are concerned about potential suppressio­n of the immune system, but there is a proven benefit in severe infections with some specific organisms. COVID-19 is one example, but there are others.

In the case of COVID-19, steroids are beneficial when the infection is quite severe, as evidenced by the need for supplement­al oxygen. COVID patients who need oxygen and would benefit from steroids should be in the hospital, if the community has hospital beds available.

I want to mention that for people with COVID-19 who are at risk for severe disease, but who do not meet criteria for hospital admission (say, those with low oxygen), there are treatments that reduce risk of hospitaliz­ation.

Monoclonal antibody treatments have increasing­ly been shown to be effective and are much more available than they used to be. They should ideally be used within three days of symptoms, but no more than 10.

Risk factors that warrant considerat­ion of monoclonal antibody treatment are severe overweight or obesity; chronic kidney disease; diabetes; immunosupp­ression by disease or treatment; being over 65; or being over 55 with heart disease, high blood pressure or chronic obstructiv­e pulmonary disease (or other chronic respirator­y disease). Early studies show that these treatments can dramatical­ly reduce the risk of developing severe disease.

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