In the last few days we are assisting to a complex situation, difficult top explain from the scientific point of view. Just to summarize:
- The France Minister of Health declare that people using NSAIDs or corticosteroids have an increased risk of COVID. He also says that anyone having fever should use just paracetamol.
- A series of reactions, also from important public institutions are initially accepting this suggestions, and immediately after denying their own statements.
- At the moment, there is a general consensus on the fact that there are no data at all that show some relationship between the use of NSAIDs (and especially ibuprofen), corticosteroids and the risk of COVID-19
What do you think about? In case you would have some more material, please feel free to ask.
In acutely unwell patients I recommend avoidance of non-steroidal anti-inflammatory agents as these agents increase the risk of acute kidney injury and GI tract ulceration. The risk of these adverse effects is increased in the elderly.
Cooling measures such as fans and ice packs have virtually no side effects and are probably as effective as NSAIDs for the control of fever.
Numerous clinical studies have reported the efficacy of glucocorticoids in the treatment of coronavirus pneumonia (such as SARS and MERS) or influenza pneumonia. However, Wang et al. reported 44.9% patients of COVID-19 were given glucocorticoid therapy, with no effective outcomes observed. Russell et al. reported clinical evidence did not support corticosteroid treatment for COVID-19 lung injury. Due to the lack of evidences, the interim guideline of WHO does not support the use of systemic corticosteroids for the treatment of viral pneumonia and ARDS for suspected COVID-19 cases in 22 February 2020
However, in the case of NSAIDs there is no data indicating a direct correlation between their use and the development of COVID-19. I would be careful when it comes to completely discouraging NSAIDs. Decisions should be treated individually for each patient.
In the articles:
Article New agents modulating the renin-angiotensin-aldosterone syst...
and
Article Angiotensin-Converting Enzyme 2 (ACE2) Is a Key Modulator of...
Gromotowicz-Poplawska (2016) states that ACE2 is a target for (SARS)-CoV, and that ACE2 might be protective. I think the same might be true for for COVID-19. Tikellis (2012) states that ACE2 has a beneficial role in many diseases. And, once again, I think this might also be the case with COVID-19.
In the article:
https://www.preprints.org/manuscript/202003.0191/v1
Chen (2020) states that "Our findings are contrary to the expectation from ACE2 being only a receptor for the virus, instead, its expression level is high in Asian females and young people, those who are known to be less susceptible, and even less inflicted by severe or fatal outcome, while it is low in males, further decrease with age and T2D, those who are most susceptible to bad outcome, suggesting at a population level a negative correlation between ACE2 expression and Covid19 severity and fatality." and "Our results established a counter argument against the speculation that high ACE2 is a culprit in Covid-19 outcome, and on the contrary supports a protective role of high ACE2 expression against SARS-CoV2 fatality."
Based on all of the above, an argument could be made that medication that increases ACE2 (such as NSAID's) potentially has beneficial effects on (severe) COVID-19-complications.
However, having said that, I have done some research on the effect of fever-mitigating medication (and the possible effect on COVID-19), as can be read in the article:
Preprint Fever & COVID-19-Complications
In short, I believe that fever-mitigating (COX-2 inhibiting) medication, such as paracetamol and NSAID's, might increase the risk of (severe) COVID-19-complications; not because of ACE2 but because of fever-mitigation.
Rather than advising people what not to do, it is better to tell them what they should do...
What to do if you get Covid-19. These recommendations apply to young adults with no medical conditions. If you have medical conditions or any concerns it is best to speak to your doctor for specific advice. This is particularly important if you have a pre-existing lung condition or are taking immunosuppressant medications.
Prepare for a nasty chest infection.
Things you have to hand
• face tissues,
• Acetaminophen; for a fever over 38°c, take acetaminophen rather than Ibuprofen.
• Generic, cough medicine to thin mucus (check the label make sure that it does not contain paracetamol; otherwise you could double dose and get side effects)
• vaporub for your chest is also a great suggestion.
• humidifier would be useful; however, turning on a hot shower and breathing in the steam in the bathroom may also help.
• Food: soups are ideal
• Drink: stay well hydrated, water is fine
• Rest and do not leave your house. You could be infectious for fourteen days. Avoid elderly people and those with pre-existing health conditions.
• Wear gloves and a mask to avoid transmitting the infection
• If you do not live alone. Isolate yourself in your bedroom. Ask those you live with to leave things outside to avoid contact.
• Wash your bed linen and clothes frequently. Clean your bathroom with sanitisers.
The vast majority of Covid-19 cases in healthy adults can manage at home with rest, hydration, acetaminophen, cough medicine.
Go to hospital if you are having trouble breathing or your fever is very high (over 39°C) and not settling with acetaminophen and cooling with ice packs or if you are worried, in distress or feel your symptoms are getting worse
We should use caution in the use of NSAIDS and corticosteroids in combination in patient s with COVID-19.
Further reading:
1. Article Non-steroidal anti-inflammatory drugs and covid-19
2. Article COVID-19 and treatment with NSAIDs and corticosteroids: Shou...
Covid-19 is a mild self-limiting illness that does not require any treatment in the vast majority of cases.
Current evidence based medicine is based on the presumption of significance when P