There is a real and emerging risk of a severe influenza pandemic this year.
In response a member of the lay public, clearly informed but afraid that a new flu pandemic may be coming asked me if “steroids” are effective in severe influenza with “cytokine storm”.
This encapsulates my answer.
*“This is a very good question which has been considered for decades. No one knows because the RCTs of corticosteroids for influenza have not been done. *
*Many observational studies have suggested that corticosteroids may lead to worse outcomes in influenza pneumonia by suppressing the immune response to the virus increasing shedding and load and increasing the rate of secondary infections but these studies are not definitive. *
***The point of my post was to note that critical care science should have done these RCTs so we have the answer but instead they performed easier RCT using the PettyBoneRCT method where they do not need to diagnose a disease but rather simply apply triage thresholds to capture a lumped set of different diseases meeting the threshold criteria for the RCT of the synthetic syndrome of “ARDS”.
*The grants flow to the easier PettyBone RCT even though the rate of reproducibility of single center critical care RCT is only 6%. This is a waste of money away from the real RCTs that need to be done to answer the question like yours. *
*I am sorry we have not done these studies to answer your question but the science is trapped in the PettyBone paradigm…
So in summary we owe you and the public an apology for failing to do these RCT. I am embarrassed to say that we don’t know the answer and this fixation on the easy PettyBone RCT is why we cannot answer your question, even though your question has been well known to be pivotal for public health for decades.