Associate Professor Warrick Inder, Princess Alexandra Hospital, Brisbane has provided the following advice to AADAI members in dealing with illness and the overriding threat of COVID-19.
1. Use the lowest maintenance dose of glucocorticoid that keeps you well. Do not increase your normal maintenance dose in the mistaken belief that this will be better if you get sick. In fact, higher glucocorticoid doses will make you more prone to getting the virus and weaken the initial immune response to attacking it.
2. Do increase your glucocorticoid dose if you get sick, using the advice provided by your regular specialist.
3. Make sure you have 2 vials of Solu-Cortef Act-o-Vial on hand and know how and when to administer this by an intramuscular injection.
A person living with you should also be trained on how to do this. If someone is sick enough to need this, they need to be taken immediately to hospital, preferably by ambulance. Taking the IM hydrocortisone first puts you ahead of the game and has been shown to reduce the chance of needing a hospital admission (compared to not having any until reaching hospital).
We all know the problems with the ambulance service and triaging in hospitals causing delays in receiving this potentially lifesaving treatment.
Warrick Inder
Associate Professor,
Diabetes and Endocrinology,
The University of Queensland
18th March 2020