Jacob Schor, ND, FABNO

March 17, 2020

Sorting fact from fiction has not been easy in recent years.  A significant segment of our populace now mirrors a habit of discrediting factual information by calling it fake news replacing it with whatever beliefs they prefer.  Ignorance is dangerous these days and so it is important to track ideas back to their source from time to time.

So, it is with the idea that ibuprofen will aggravate Covid-19 infections and make them more lethal.  This idea took off when France’s Health Minister Olivier Veran, tweeted on Saturday that “taking anti-inflammatory drugs (ibuprofen, cortisone…) could be an aggravating factor of the infection. If you have a fever, take paracetamol. If you are already on anti-inflammatory drugs or in doubt, ask your doctor for advice.” [i]

France sent out an official alert that same day saying much the same thing, saying that there are reports of:   “grave adverse effects” linked to the use of non-steroidal anti-inflammatory drugs (NSAID) — the family of drugs that includes ibuprofen — have “been identified with patients affected by Covid-19, in potential or confirmed cases.”  “We repeat that the treatment of a fever or of pain linked to Covid-19 or to any other respiratory viral disease should be paracetamol,” (That’s what we call Tylenol).  [ii]

This French warning has gone international or shall we say, it’s gone viral.  Even as I write this a Turkish news agency reports that the World Health Organization has repeated this cautionary warning.[iii]

This concern about NSAIDS may trace back to a more valid concern about ACE inhibitors:

A letter to the editor of Lancet from Lei Fang, George Karakiulakis, and Michael Roth, that raised this ACE issue was published March 11, 2020.  These authors questioned whether ACE inhibitor drugs used to control high blood pressure could worsen patient outcomes from this virus.  The letter’s authors put forth an interesting hypothesis after looking at the comorbidities of Covid-19 patients most likely to die from the infection that have been reported to date by several Chinese studies.  Covid-19 patients who also have diabetes, high blood pressure and or cardiovascular disease are much more likely to die, than patients without these conditions.  Fang and colleagues point out that these patients, “… are often treated with angiotensin converting enzyme (ACE) inhibitors.”

Covid-19 binds onto angiotensin-converting enzyme 2 (ACE2) located on its target cells.    Patients with diabetes make more of this ACE2 than people without diabetes.  Treating their blood pressure with ACE inhibitor drugs increases ACE2 levels even further.  Thus, there is a concern that taking ACE inhibitor drugs may increase risk, severity and mortality from infection by these viruses. 

The possibility that NSAIDS may worsen Covid-19 infection is extrapolated from this unconfirmed hypothesis.

Take it a step further:  ibuprofen, the NSAID, also increases ACE2 expression.  Thus, there is an element of fact behind the French warnings. If at some point we see evidence that these drugs really do worsen Covid-19 infections, then this might be the reason why. [iv] [v]

At this point we haven’t seen any publication based on human clinical evidence to support these ideas.  

But seriously, would it hurt to take Tylenol (Acetominphen)?  

[i] https://www.cnn.com/2020/03/16/health/coronavirus-ibuprofen-french-health-minister-scn-intl-scli/index.html

[ii] https://dgs-urgent.sante.gouv.fr/dgsurgent/inter/detailsMessageBuilder.do?id=30500&cmd=visualiserMessage

[iii] https://www.dailysabah.com/life/health/who-reiterates-call-for-coronavirus-patients-not-to-take-ibuprofen

[iv] https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf

[v] https://www.nature.com/articles/s41569-020-0360-5?fbclid=IwAR3HoFrfs6ePbGvNFTex6jz3dc0yA7Xfw3uwzwKcCLDmZn9nIYjejAuCM88