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Covid Protocol Against Steroids ... Was Wrong

MyTeamIsOnTheFloor

MyTeamIsOnTheFloor

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I was told early to keep taking my immunosuppressant meds but avoid the steroids. Once I heard a OC on the ground in Seattle discussing how - in effect - the inflammations seen in the lungs and the inability of cells to perform the normal oxygen exchange, the steroid advice made no common sense. Inflammation-damaged lungs needed anti-inflammatory drugs. But the “we have not seen enough evidence” defensive medicine prevailed. People died. This doc says “we saw it after 4 patients” but “The Smart People With Gavels” said no.



History will tell us we blew Covid. Medically, not politically.
 
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I was given a pretty strong daily dose of IV steroids while in the hospital with Covid. I continued the course via pills once I was out (4 for 4 days, 3 for 3 days, etc).

Who are the smart people with "gavels"?
 
Early on there was fear with steroids because both MERS and SARS were made worse by steroids and are in the same family COV family. But that was very early and data came in that superceded that. By July 17 of last year studies were showing it worked, https://www.nejm.org/doi/full/10.1056/NEJMoa2021436

The preliminary paper of that study from July 17 was just the first paper I saw. We knew before that, the Henry Ford study showing hydroxy worked came out July 1. The problem with it, and I recall it being discussed here, patients receiving hydroxy were more likely to also get steroids. The Brits had already shown steroids to work.

So yes, science was slightly behind because it actually takes time to study something. SARS and MERS gave scientists concerns, but following the scientific method they changed their minds as data came in.
 
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MyTeamIsOnTheFloor said:
I was told early to keep taking my immunosuppressant meds but avoid the steroids. Once I heard a OC on the ground in Seattle discussing how - in effect - the inflammations seen in the lungs and the inability of cells to perform the normal oxygen exchange, the steroid advice made no common sense. Inflammation-damaged lungs needed anti-inflammatory drugs. But the “we have not seen enough evidence” defensive medicine prevailed. People died. This doc says “we saw it after 4 patients” but “The Smart People With Gavels” said no.

View embedded media


History will tell us we blew Covid. Medically, not politically.
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Apropos of nothing, I had cortisone shots in both knees a week ago. This was due to Osteoarthritis that was generating increasing pain, to the point I could barely walk at times.

"Give it 24 to 72 hours, and you'll feel a lot better." Holy crap. I'm ready to run shuttles again.

So, Grog say, "some steroids gooooooood."

(Did have hiccups for a day, which is a weird side-effect.)
 
Univee2 said:
Apropos of nothing, I had cortisone shots in both knees a week ago. This was due to Osteoarthritis that was generating increasing pain, to the point I could barely walk at times.

"Give it 24 to 72 hours, and you'll feel a lot better." Holy crap. I'm ready to run shuttles again.

So, Grog say, "some steroids gooooooood."

(Did have hiccups for a day, which is a weird side-effect.)
Click to expand...

Those shots are great, for 6 months or so. Then you'll be calling your doctor, "I'm jonesing, I've got to have my knee shot". My doctor warned me not to be overconfident and take up running again. And frankly I probably would have given how great the knees felt. I went through a couple rounds of shots before giving up and going to knee replacement.
 
Marvin the Martian said:
Those shots are great, for 6 months or so. Then you'll be calling your doctor, "I'm jonesing, I've got to have my knee shot". My doctor warned me not to be overconfident and take up running again. And frankly I probably would have given how great the knees felt. I went through a couple rounds of shots before giving up and going to knee replacement.
Click to expand...

As I was informed. The Doc said I'd need these every 3-6 months, or "as needed."

Trying to avoid cutting off my knees.
 
Univee2 said:
As I was informed. The Doc said I'd need these every 3-6 months, or "as needed."

Trying to avoid cutting off my knees.
Click to expand...
I know that feeling, knee amputation sounds terrible. But I'm here to say that it really, really made a difference for me. Past performance is no guarantee for future success, and your mileage may vary and all that other stuff CO's profession demands we add. But for me, the difference is amazing. The one thing I hate, and there is no solution, is that I just am not allowed to run anymore. So no more pickup basketball or just running, and knowing that sucks. but it is a small price for no pain.

My knees were horrible 20 years before I had the surgery. In fact, a knee doctor told me then that I was in dire need of replacement. On days I'd do treadmill, I'd have to hold the rails. I wasn't sure why, I just assumed I had bad balance. Even walking on the treadmill. Once I had the replacement, I could treadmill fine without holding. It was amazing. It was something about the bad knees, I don't know what.
 
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One question...when I was on the pill course at home, slowly weening off, I found myself snapping at my wife because she was annoying me. She is the least annoying person in the world, and was doing nothing annoying at all. I am usually very laid back, which is easy because she is so easy to get along with all the time. I apologized to her several times during my steroid use, and once I was off them, everything returned to normal.
Was I just imagining this, and falling victim to the placebo effect caused by hearing so much about roid-rage over the decades, or is this a real thing?
 
Dexamethasone, a steroid, has been front-and-center in COVID treatment for over a year and has probably saved tens of thousands (if not more) of Americans.
 
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CO. Hoosier said:
And those people took advice about how to treat patients from physicians who don’t treat patients.
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Isn't this normal? When a pharma rep tells a doctor they should prescribe miracle cure X, the pharma rep doesn't treat patients. The scientists that developed the drug don't treat patients. The CEO or board doesn't treat patients.

Largely speaking the people that sold the F22 Raptor to the US were not combat pilots, even the test pilots would never fly it in combat and some probably had never flown a combat mission. The engineers would never fly their design.
 
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Marvin the Martian said:
Isn't this normal? When a pharma rep tells a doctor they should prescribe miracle cure X, the pharma rep doesn't treat patients. The scientists that developed the drug don't treat patients. The CEO or board doesn't treat patients.

Largely speaking the people that sold the F22 Raptor to the US were not combat pilots, even the test pilots would never fly it in combat and some probably had never flown a combat mission. The engineers would never fly their design.
Click to expand...
The national response to treating this disease was abysmal. Your bad analogies won’t change that.
 
CO. Hoosier said:
The national response to treating this disease was abysmal. Your bad analogies won’t change that.
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I explained the issue above. SARS and MERS are Cov diseases and both were made worse by steroids. Early on the belief was not to treat with steroids for that reason, they are all related. Sars-cov-2 turns out to be treatable by steroids. But faced with no facts the people in charge made a choice to say steroids would not work. But following scientific method, something they must not teach lawyers, they studied the issue and changed their minds.

Now tell me what part of above is wrong? Tell me how you would have known immediately that sars-cov-2 was not going to behave like SARS and MERS and you would have been a steroid believer from day 1.
 
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Marvin the Martian said:
I explained the issue above. SARS and MERS are Cov diseases and both were made worse by steroids. Early on the belief was not to treat with steroids for that reason, they are all related. Sars-cov-2 turns out to be treatable by steroids. But faced with no facts the people in charge made a choice to say steroids would not work. But following scientific method, something they must not teach lawyers, they studied the issue and changed their minds.

Now tell me what part of above is wrong? Tell me how you would have known immediately that sars-cov-2 was not going to behave like SARS and MERS and you would have been a steroid believer from day 1.
Click to expand...
The Deep State didn't care about treatment or the scientific method. They're just a bunch of dim-witted bureaucrats whose only concern was making Trump look bad. Duh.
 
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Marvin the Martian said:
I explained the issue above. SARS and MERS are Cov diseases and both were made worse by steroids. Early on the belief was not to treat with steroids for that reason, they are all related. Sars-cov-2 turns out to be treatable by steroids. But faced with no facts the people in charge made a choice to say steroids would not work. But following scientific method, something they must not teach lawyers, they studied the issue and changed their minds.

Now tell me what part of above is wrong? Tell me how you would have known immediately that sars-cov-2 was not going to behave like SARS and MERS and you would have been a steroid believer from day 1.
Click to expand...
The part that was wrong was when actual patients actually got better and the doctors were ignored. Early actual info. What folks here typically call “anecdotal evidence” to be ignored in favor of political argument,

The earliest reports in the US (and elsewhere) were that the people dying from Covid were dying from cytokine storms, where the body’s immune system damages the organs, especially the lungs, and killing through pneumonia. I told my doctors in April 2020 that if the “cytokine storms” is what was killing patients, my use of immunosuppressants to treat rheumatoid arthritis seemed to indicate I was SAFER. Same with steroids. If inflammation added to the problem, steroids would make sense by reducing inflammation. No studies that take years. Just common sense. They told me DEFINITELY do NOT take steroids - which meant “live with pain” - and keep taking immunosuppressants to fight RA but to stay home until further info was available.

The reaction to a pandemic was ignore “on the ground” info about actual hospital experience, and to to “study as normal” and shut down world economies “just in case.”

Meanwhile, because New York was overrun, hospitals everywhere went into panic mode and emptied out, kicking patients to the streets to await their own overrun, which in about 95-98% of hospitals NEVER OCCURRED, and where it did, it was made worse by ignoring the use of steroids and immunosuppressants.

Being wrong for a month is understandable.
Being wrong for a year is a serious problem with fundamental process.

Our process became driven by fear and indecision and vacillation - much of it driven by partisanship and “business as usual” in seriously unusual circumstances. When a single voice was needed, we got Trump, Pelosi, Schumer, and Fauci. Doctors like Rand Paul and the guy in the video were ignored in favor of politics and status quo. People STILL blame Washington because some hospital in fly-over land didn’t have masks or vents! While ignoring what really mattered!
 
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MyTeamIsOnTheFloor said:
I was told early to keep taking my immunosuppressant meds but avoid the steroids. Once I heard a OC on the ground in Seattle discussing how - in effect - the inflammations seen in the lungs and the inability of cells to perform the normal oxygen exchange, the steroid advice made no common sense. Inflammation-damaged lungs needed anti-inflammatory drugs. But the “we have not seen enough evidence” defensive medicine prevailed. People died. This doc says “we saw it after 4 patients” but “The Smart People With Gavels” said no.

View embedded media


History will tell us we blew Covid. Medically, not politically.
Click to expand...
Mtiotf no clue whether any of this is accurate but damn as a lawyer this is a guy you’d never bring to court as an expert. As my 10 yr old says his education/background is SUS
 
Noodle said:
That's what I thought as well. Were doctors still contending that steroids would not help (or worse) into last Summer of Fall?
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Trump was given steroids in October, so the issue had to be "resolved" by that point. And I believe it was well before that.
 
MyTeamIsOnTheFloor said:
Being wrong for a month is understandable.
Being wrong for a year is a serious problem with fundamental process.
Click to expand...
They weren't wrong for a year, though.

Science isn't a body of truth. It a way of finding out what is true or not. Sometimes you start with accepted dogma telling you one thing, and then that gets supplanted by more knowledge. Simply put, you weren't "wrong", you just learned more.

In this case, they learned more in a couple of months and changed the treatment recommendation instantly.

The first very positive clinical results with steroids, specifically dexamethasone, were widely reported in June 2020 and off-label use became common basically overnight.

rebelem.com

The RECOVERY Trial: Dexamethasone for COVID-19? - REBEL EM - Emergency Medicine Blog

The RECOVERY Trial: Does dexamethasone (IV or PO) + usual care reduce 28 day mortality in patients hospitalized with COVID-19 compared to usual care alone?
rebelem.com rebelem.com

Two days later the WHO set up a web site guiding its use. By September 2, 2020, The WHO recommended its widespread use at specific doses, ahead of the full clnical results, which were published in October.

www.who.int

Coronavirus disease (COVID-19): Corticosteroids, including dexamethasone

Last updated 25 June 2020
www.who.int www.who.int
 
Last edited:
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outside shooter said:
They weren't wrong for a year, though.

Science isn't a body of truth. It a way of finding out what is true or not. Sometimes you start with accepted dogma telling you one thing, and then that gets supplanted by more knowledge. Simply put, you weren't "wrong", you just learned more.

In this case, they learned more in a couple of months and changed the treatment recommendation instantly.

The first very positive clinical results with steroids, specifically dexamethasone, were widely reported in June 2020 and off-label use became common basically overnight.

rebelem.com

The RECOVERY Trial: Dexamethasone for COVID-19? - REBEL EM - Emergency Medicine Blog

The RECOVERY Trial: Does dexamethasone (IV or PO) + usual care reduce 28 day mortality in patients hospitalized with COVID-19 compared to usual care alone?
rebelem.com rebelem.com

Two days later the WHO set up a web site guiding its use. By September 2, 2020, The WHO recommended its widespread use at specific doses, ahead of the full clnical results, which were published in October.

www.who.int

Coronavirus disease (COVID-19): Corticosteroids, including dexamethasone

Last updated 25 June 2020
www.who.int www.who.int
Click to expand...
Conservative math: March -> June = 1 year
 
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On the macro level, there were mistakes made, up and down the line. It happens in real disasters. In most wars, the first battles fought are real disasters as everyone learns the games aren't that good of an indicator. People learn and adapt. I suspect the CDC, WHO, and everyone else will be better at this for the next few years. Then the institutional knowledge fades. We do need better cooperation from China. China tends to be secretive , they are probably the worst country for a plague to begin in (North Korea has so little contact outside that it wouldn't be as bad).

Here was an early warning against steroids https://uspharmacist.com/article/av...-treatment-of-suspected-coronavirus-infection. It was wrong. So was parking all our battleships at Pearl. So was everything about the army as Kasserine.

Hopefully we are better equipped for the next plague, it will happen.
 
Marvin the Martian said:
On the macro level, there were mistakes made, up and down the line. It happens in real disasters. In most wars, the first battles fought are real disasters as everyone learns the games aren't that good of an indicator. People learn and adapt. I suspect the CDC, WHO, and everyone else will be better at this for the next few years. Then the institutional knowledge fades. We do need better cooperation from China. China tends to be secretive , they are probably the worst country for a plague to begin in (North Korea has so little contact outside that it wouldn't be as bad).

Here was an early warning against steroids https://uspharmacist.com/article/av...-treatment-of-suspected-coronavirus-infection. It was wrong. So was parking all our battleships at Pearl. So was everything about the army as Kasserine.

Hopefully we are better equipped for the next plague, it will happen.
Click to expand...
Agree in part disagree in part. The NYT did a piece about how the cdc waited its entire existence for this moment and failed. Blatant negligence re dirty labs, inability to do rudimentary tracking etc. Much of this was big gov asleep at the wheel without meaningful audits/reviews etc. Free money....
 
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Bulk VanderHuge said:
One question...when I was on the pill course at home, slowly weening off, I found myself snapping at my wife because she was annoying me.
Click to expand...
My brother did the same thing to his wife. I think that is pretty common. He was also hungry all the time. I've had a couple injections for my back in the last couple months but they didn't make me any more irritable... my wife would say that it's because I am always irritable. :)
 
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outside shooter said:
They weren't wrong for a year, though.

Science isn't a body of truth. It a way of finding out what is true or not. Sometimes you start with accepted dogma telling you one thing, and then that gets supplanted by more knowledge. Simply put, you weren't "wrong", you just learned more.

In this case, they learned more in a couple of months and changed the treatment recommendation instantly.

The first very positive clinical results with steroids, specifically dexamethasone, were widely reported in June 2020 and off-label use became common basically overnight.

rebelem.com

The RECOVERY Trial: Dexamethasone for COVID-19? - REBEL EM - Emergency Medicine Blog

The RECOVERY Trial: Does dexamethasone (IV or PO) + usual care reduce 28 day mortality in patients hospitalized with COVID-19 compared to usual care alone?
rebelem.com rebelem.com

Two days later the WHO set up a web site guiding its use. By September 2, 2020, The WHO recommended its widespread use at specific doses, ahead of the full clnical results, which were published in October.

Click to expand...
In February 2021, my rhuematologi... evidence becomes available." CYA all the way.
 
Marvin the Martian said:
I explained the issue above. SARS and MERS are Cov diseases and both were made worse by steroids. Early on the belief was not to treat with steroids for that reason, they are all related. Sars-cov-2 turns out to be treatable by steroids. But faced with no facts the people in charge made a choice to say steroids would not work. But following scientific method, something they must not teach lawyers, they studied the issue and changed their minds.

Now tell me what part of above is wrong? Tell me how you would have known immediately that sars-cov-2 was not going to behave like SARS and MERS and you would have been a steroid believer from day 1.
Click to expand...
Our national instructions to symptomatic outpatients was quarantine. Meanwhile, Many Docs were successfully treating outpatients with known medications. These examples were dismissed as being anecdotal. The policy people wanted more perfect knowledge while primary care doctors were simply trying to treat symptoms and keep people alive. Thousands died because of lack of an effective national message about this. If we have honest after-action studies, this will be an issue. We were way too focused on stopping the spread.
 
CO. Hoosier said:
Our national instructions to symptomatic outpatients was quarantine. Meanwhile, Many Docs were successfully treating outpatients with known medications. These examples were dismissed as being anecdotal. The policy people wanted more perfect knowledge while primary care doctors were simply trying to treat symptoms and keep people alive. Thousands died because of lack of an effective national message about this. If we have honest after-action studies, this will be an issue. We were way to focused on stopping the spread.
Click to expand...
They were trying to do both. They knew how to stop the spread sooner than they learned how to effectively treat it.
 
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UncleMark said:
Blame Fauci.
Click to expand...

I’m sure he could screw up software too...as long as they gave him face time to TV about it. He was popular back in the Reagan days too.

_111411517_fauci2.jpg
 
UncleMark said:
They were trying to do both. They knew how to stop the spread sooner than they learned how to effectively treat it.
Click to expand...
Right. The point is that everything about our response was burdened by heavy bureaucracy that was too top down. This included CDC’s early FUBAR of testing, the mask mixed messaging, the overreaction to contact transmission, snd the failure to listen to the front line primary care docs. Even Rand Paul took a turn at primary care and Fauci et al ignored him. Others were similarly excoriated.
 
CO. Hoosier said:
Of course it’s a valid reaction. That’s not the point marv.
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I am not sure what the point is. In the first couple months of a brand new disease we had no idea how to fight it. Why is that surprising?

Anecdotal evidence is not good for much. A patient can get better with placebo, but no one suggests passing placebos out because a single person or two people got better.

We know doctors do off label, steroids like hydroxy was always an option even if not officially endorsed.
 
Marvin the Martian said:
I am not sure what the point is. In the first couple months of a brand new disease we had no idea how to fight it. Why is that surprising?

Anecdotal evidence is not good for much. A patient can get better with placebo, but no one suggests passing placebos out because a single person or two people got better.

We know doctors do off label, steroids like hydroxy was always an option even if not officially endorsed.
Click to expand...
MTIOTF's hindsight was flat wrong, as was pointed out by several posters with strong citations.

COH's points were all valid.

For both, where it gets fun is when they start in with the blaming and fault finding. Career civil servants and health care professionals working for the gubmunt will be excoriated while politicos at the top will be given every benefit of the doubt.
 
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