CIRCULAR H 111 of 2020 - The RECOVERY Study: Interim Guidance on the Use of Steroids in COVID-19 patients

This circular was issued by the Western Cape Department of Health on 19 June 2020.

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Following on the media release of the early findings of the RECOVERY trial and the subsequent statement from the Ministerial Advisory Committee, WCG: Health has adopted the following position on the use of steroids in the management of COVID-19 patients.

This position is subject to further changes as data become available from the RECOVERY trial (https://www.recoverytrial.net/).

We recommend steroids in all patients with COVID-19 who are admitted to hospital and who need supplemental oxygen.

Steroids should only be used for adult patients with confirmed or high clinical likelihood of COVID-19 who are admitted to hospital and require supplemental oxygen, in the absence of existing risk factors for adverse events.

1. Steroids should not be started in the outpatient environment: they are ONLY for admitted patients on oxygen.
2. Steroids should not be started in the Emergency Centre unless discussed with a senior clinician or inpatient team.
3. Always seek senior clinical input in patient care decisions, through your usual supervisory pathways.
4. Follow usual clinical pathways regarding steroids in COVID-19 patients with chronic lung disease.
5. There are risks associated with short-term use of high dose steroids, including hyperglycaemia, electrolyte abnormalities, neuropsychiatric reactions, hypertension, fluid retention and susceptibility to co-infections. Monitor glucose, electrolytes and fluid status. Always aim to balance potential benefit and potential harm in clinical judgement.

Steroids can be commenced on admission; the recommended dosage for 10 days is:

1. 8mg of Dexamethasone IV once daily (ICU PATIENTS ONLY)* 
2. 40mg Prednisone orally once daily OR EQUIVALENT DOSE OF:

• 80mg Hydrocortisone intravenous twice daily OR
• 6mg Betamethasone intravenous once daily OR
• 32mg Methylprednisolone oral or intravenous once daily OR
• 6mg of Dexamethasone orally once daily (Section 21 medication)

* provided in 4mg vials, hence the higher dose recommendation