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If you’re in the hospital with coronavirus, what are they doing to help you? AND Should we avoid Ibuprofen?

Question: If you’re in the hospital diagnosed with coronavirus, what are they actually doing to help you? I’m not sure if there’s a cure or not, so do they just give you fluids and put you on a ventilator? Is there actually anything they can do?

Answer: If you have a mild case, without much trouble breathing or other complications, you should just stay home and manage yourself like you would with a bad cold. There are no treatments for COVID-19 (like tamiflu) and there is no cure. But, if you do have a more severe case, doctors and nurses can help! CDC provides clinical management and treatment guidelines, which describe some measures. This paper from the Society of Critical Care Medicine provides far more comprehensive guidance for clinicians. To my knowledge (again: I’m a lay person not a health care provider), a patient would only be put on a ventilator if they were in critical condition with severely compromised respiratory system (e.g. their lungs were not working). Before that point, patients would get additional oxygen to supplement in the context of diminished lung capacity. Patients would also be treated for fever (likely with acetaminophen/paracetamol). Other actions could be taken based on the patient’s condition. In terms of other drugs, you may have also heard that New York is starting widespread testing/treatment using unproven hydroxychloroquine and chloroquine. There’s no evidence that this drug has positive treatment effects and scientists are highly skeptical of the drug’s potential benefit. Meanwhile, folks who need the drugs — like those suffering from rheumatoid arthritis and lupus — are having trouble getting their medication because of the surge in demand. So if/when you hear about a new and amazing treatment, please be skeptical until we have the evidence to back the claim.

Question: I have seen many warnings from non-reputable sources that we should avoid Ibuprofen and Advil because COVID-19 thrives on it. I have seen a COVID study sheet for practitioners that states “NSAIDs- strongly recommend avoiding NSAID use as reports of NSAID use have preceded clinical deterioration in some patients with COVID-19+.” Is this true and where is the data/source backing this up?

Answer: In short, we do not have good science on the issue and in the absense of strong data, some reputable medical professionals and associations are recommending use of paracetamol (eg. Tylenol) to treat COVID-19. Now for the longer response: I saw a lot of that floating around on social media two weeks ago (which feels like a lifetime ago) too. A lot of it was prompted by France’s Minister of Health, who made the statement on social media on 14 March that “Taking anti-inflammatory drugs (ibuprofen, cortisone . . .) could be an aggravating factor for the infection. If you have a fever, take paracetamol.” The British Medical Journal published a description of the issue on 17 March, “Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists” and a follow-up report on 23 March, “Covid-19: European drugs agency to review safety of ibuprofen.” As to guidance/suggestions from reputable sources:

  • The European Medicines Agency stated on 18 March that “There is currently no scientific evidence establishing a link between ibuprofen and worsening of covid-19. EMA is monitoring the situation closely and will review any new information that becomes available on this issue in the context of the pandemic….”
  • The Society of Critical Care Management offers this guideline — “The use of non-steroidal anti-inflammatory drugs to treat fever in patients with COVID-19 continues to be debated. Until more evidence is available, we suggest using acetaminophen/paracetamol to treat fever.”
  • And a letter in Science offered this suggestion on 27 March, “…should patients with clinically complicated SARS-CoV-2 infections be administered NSAIDs as a treatment? No. There is no evidence of benefit. If such a patient were also to have poor kidney function, maintenance of renal blood flow becomes critically dependent on vasodilator prostaglandins… Such a situation might also predispose the patient to the gastrointestinal and cardiovascular complications of NSAIDs. However, until we have robust evidence, patients in chronic pain should continue to take their NSAIDs rather than turn to opiates. Given that the elderly appear to comprise the predominant at-risk group for severe COVID-19 at this time, an association between NSAIDs and the disease may merely reflect reverse causality — that is, infection makes you more susceptible to adverse effects of NSAIDs on the infection.”
  • Finally, the Center for Evidence Based Medicine (CEBM) reminds patients and providers that fever can be good and does not always need to be treated. Fever is the body’s strategic response to infection and can inhibit viral reproduction. Other potential benefits of fevers are described by the CEBM in the link I shared. So, another thought is, as long as the fever isn’t too distressing, consider avoiding/reducing consumption of fever reducers.