Can steroids reverse the severe COVID‐19 induced “cytokine storm”?

Severe coronavirus disease (COVID‐19) is characterized by an excessive proinflammatory cytokine storm, resulting in acute lung injury and development of acute respiratory distress syndrome (ARDS). The role of corticosteroids is controversial in severe COVID‐19 pneumonia and associated hyper‐inflammatory syndrome. We reported a case series of six consecutive COVID‐19 patients with severe pneumonia, ARDS and laboratory indices of hyper‐inflammatory syndrome. All patients were treated early with a short course of corticosteroids, and clinical outcomes were compared before and after corticosteroids administration. All patients evaded intubation and intensive care admission, ARDS resolved within 11.8 days (median), viral clearance was achieved in four patients within 17.2 days (median), and all patients were discharged from the hospital in 16.8 days (median). Early administration of short course corticosteroids improves clinical outcome of patients with severe COVID‐19 pneumonia and evidence of immune hyperreactivity. Research Highlights Severe COVID‐19 is characterized by an excessive pro‐inflammatory cytokine storm resulting in acute lung injury and development of ARDS. Early, short‐course of corticosteroids in severe COVID‐19 pneumonia and associated hyper‐inflammatory syndrome may be beneficial. Routine use of corticosteroids in COVID‐19 is not recommended.