To this day, the Infectious Disease Society of America and the National Institutes of Health Guidelines do not advise prehospital use of corticosteroids in COVID-19 illness.

Conversely oral and or nebulized steroids have been a part of the FLCCC and McCullough protocols since 2020. Justification for early steroids sadly comes from an autopsy study of fatal cases by Kato et al who evaluated 61 cases from the NIH, Cornell, and University of North Carolina Chapel Hill.

The bottom line is that after 20 days, SARS-CoV-2 is gone from the trachea and the big problem is mucus plugging and congestion. Within the small blood vessels of the lungs, blood clots are forming. Kato showed the only factor associated with reduced mucus in these fatal cases was dexamethasone most commonly used at 6 mg a day in the IDSA and NIH protocols.

For reference, dexamethasone is routinely administered for brain swelling at 10 mg intravenously every 4-6 hours. In respiratory inflammation (asthma, allergic pneumonitis), the most commonly administered steroid is intravenous solumedrol 60-125 mg every 6 to 12 hours. In the McCullough protocol, I did not hesitate to initially recommend oral prednisone 60 mg a day and later come into the practice of using 20 mg every 12 hours with a 5-10 day taper.

It is interesting to note none of these deceased patients received the FLCCC or McCullough protocols prior to admission. If they did, they wouldn’t be on the autopsy table.