Taking ibuprofen and other over-the-counter anti-inflammatories may worsen coronavirus, French health minister warns
- France health minister Olivier Véran claims ibuprofen aggravates symptoms
- However, health officials widely recommend it for relieving aches and a fever
- Some doctors warn the anti-inflammatory effects dampen the body’s response
- Do you have a coronavirus story? Email [email protected]
- Coronavirus symptoms: what are they and should you see a doctor?
Taking ibuprofen may worsen symptoms of the deadly coronavirus, France’s health minister has warned.
Olivier Véran claimed the over-the-counter medication – which the NHS says could help tackle symptoms – may aggravate the infection.
The controversial statement goes against health chiefs’ advice to use ibuprofen as well as paracetamol to self-medicate for the killer disease.
Ibuprofen is widely taken to relieve pain as well as reduce a fever and aches caused by common colds and flu.
However, some doctors are warning the anti-inflammatory effects may dampen the body’s response to infection, slowing recovery.
They may also fuel a process in the body that leads to pneumonia, a severe result of COVID-19 which can lead to death.
The coronavirus has infected at least 170,000 worldwide, and the death toll today surpassed 6,600.
Olivier Véran, France’s health minister, claimed the over-the-counter medication– which the NHS says could help – may aggravate the infection
French health minister and doctor Olivier Véran claims that the over-the-counter medication may aggravate symptoms of COVID-19 (pictured, his original tweet in French and a translation to English)
Ibuprofen is widely taken to relieve pain as well as reduce a fever and aches caused by common colds and flu. It is recommended by the NHS for self-medication of COVID-19
Mr Véran, who is a qualified doctor and neurologist, tweeted: ‘The taking of anti-inflammatories (ibuprofen, cortisone, …) could be a factor in aggravating the infection’
Mr Véran, who is a qualified doctor and neurologist, tweeted: ‘The taking of anti-inflammatories (ibuprofen, cortisone, …) could be a factor in aggravating the infection.
‘In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs or in doubt, ask your doctor for advice.’
WHY COULD IBUPROFEN WORSEN CORONAVIRUS SYMPTOMS?
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body’s production of certain natural substances that cause inflammation, and is used to decrease pain or a fever.
Experts say paracetamol should be a first choice because:
1. Ibuprofen may dampen the body’s immune response to infection because it is has anti-inflammatory effects. This may slow the recovery process, Professor Ian Jones, a virologist at the University of Reading, said.
2. He added that it is likely the coronavirus acts in a similar way to SARS, in that it reduces an enzyme which regulates salt and water in the blood. This can lead it pneumonia. Ibuprofen may aggravate this, Professor Jones said.
2. NSAIDs can cause stomach irritation and stress on the kidneys if taken over a long period of time. This could be exacerbated in those who already have kidney or stomach problems brought on by severe illness, such as COVID-19, experts said.
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body’s production of certain natural substances that cause inflammation.
This effect helps to decrease pain or fever, which most COVID-19 patients are known to suffer.
Mr Veran’s message is important as many people across Europe – the new epicentre of the outbreak – are told to self-medicate for the symptoms with over-the-counter pills.
In the UK, the public has been urged to stay at home and self isolate if they have a cough or a fever, and not to bother ringing the NHS helpline unless their symptoms worsen.
While remaining indoors to avoid spreading the virus to others, the NHS website lists taking ibuprofen, and paracetamol, to alleviate symptoms.
British experts reacted to Mr Veran’s advice, saying paracetamol is a preferred choice over NSAIDs.
Professor Ian Jones, virologist at the University of Reading, said: ‘The advice relates to Ibuprofen’s anti-inflammatory properties, that is, it dampens down the immune system, which may slow the recovery process.
‘In addition, it is likely, based on the substantial literature around SARS I and the similarities this new virus (SARS-CoV-2) has to SARS I, that the virus reduces a key enzyme which part-regulates the water and salt concentration in the blood and could be part of the pneumonia seen in extreme cases.
‘Ibuprofen aggravates this while paracetamol does not.’
Dr Rupert Beale, Cell Biology of Infection at The Francis Crick Institute said there is ‘a good reason to avoid ibuprofen as it may exacerbate acute kidney injury brought on by any severe illness, including severe COVID-19 disease’.
Dr Tom Wingfield, Liverpool School of Tropical Medicine, added: ‘Side effects associated with NSAIDs such as ibuprofen, especially if taken regularly for a prolonged period, are stomach irritation and stress on the kidneys, which can be more severe in people who already have stomach or kidney issues.’
The French authorities’ message is important as many people across Europe – the new epicentre of COVID-19 – are told to self-medicate for the symptoms with over-the-counter pills. There are now 57,147 reported cases across Europe, and 2,345 deaths
British doctors have previously suggested to only use paracetamol, or acetaminophen in the US, for the treatment of respiratory illness – including coughs, colds and sore throats.
Researchers from the University of Southampton found in 2013 that a combination of paracetamol and ibuprofen is inadvisable, and ibuprofen may even slow down recovery.
Professor Professor Paul Little, of the University of Southampton, who led the study, said treatment with ibuprofen could contribute to the progression of the illness.
He said: ‘This may have something to do with the fact the ibuprofen is an anti-inflammatory.
‘It is possible that the drug is interfering with an important part of the immune response and leads to prolonged symptoms or the progression of symptoms in some individuals.
HOW DO IBUPROFEN AND PARACETAMOL WORK?
Paracetamol and ibuprofen are two of the most common painkillers.
The two drugs work in different, but complementary ways.
Ibuprofen blocks the production of various chemicals in the body.
These include prostaglandins, which are produced in response to injury or disease and cause inflammation.
Ibuprofen taken as pills or in liquid form numbs the site of pain and reduces inflammation, and is widely used for arthritic pain.
It has a relatively low level of side effects, although it can cause stomach bleeding, kidney damage, allergic reactions.
It should not be taken by people who are allergic to aspirin.
Paracetamol also blocks prostaglandin, but only in the brain and spinal cord.
It reduces temperature by acting on the area of the brain responsible for controlling temperature.
Side effects are rare but can include a rash or swelling.
‘Although we have to be a bit cautious since these were surprise findings, for the moment I would personally not advise most patients to use ibuprofen for symptom control for coughs, colds and sore throats.’
According to Jean-Louis Montastruc, the head of pharmacology at Toulouse hospital, in France, ibuprofen can ‘complicate’ the virus, The Guardian reports.
She told RTL radio: ‘Anti-inflammatory drugs increase the risk of complications when there is a fever or infection.’
France tightened measures to stem the spread of coronavirus, after it reported 36 new deaths on Sunday, taking the total to 127. More than 5,430 people have tested positive.
The coronavirus outbreak there has seen schools, cafes and restaurants closed, along with nearby Spain and Italy, which have also been deeply affected by the virus.
The Eiffel Tower, Château de Versailles, Louvre, Musée d’Orsay and Centre Pompidou are among the hugely popular tourist attractions that are now eerily quiet after closure.
If French residents need medication, they must seek advice from pharmacies which should remain open. Similar measures have come into affect across Europe.
President Emmanuel Macron will tonight address an anxious French nation in a televised appearance after holding a meeting with ministers.
Meanwhile, Boris Johnson will hold emergency meetings today to assess the UK’s situation, after deaths reached 35.
The weekend saw supermarket shelves swipes of essential products nationwide, including stocks of medication.
As news broke of a coronavirus outbreak in the UK, with 1,395 cases now reported, shop customers have been queuing down the aisles with trolleys stacked high.
Experts say stockpiling isn’t necessary, and it has also been deemed selfish because the country should be trying to protect vulnerable members of society that are most at risk of serious illness.
WHAT DO WE KNOW ABOUT THE CORONAVIRUS?
What is the coronavirus?
A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.
The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.
Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.
The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.
Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals.
‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses).
‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’
The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.
By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.
The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000.
Where does the virus come from?
According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.
The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.
Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat.
A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.
However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.
Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.
‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’
So far the fatalities are quite low. Why are health experts so worried about it?
Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.
It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.
Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.
Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.
‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’
If the death rate is truly two per cent, that means two out of every 100 patients who get it will die.
‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.
‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’
How does the virus spread?
The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.
It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.
Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person.
What does the virus do to you? What are the symptoms?
Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.
If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.
In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.
Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why.
What have genetic tests revealed about the virus?
Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world.
This allows others to study them, develop tests and potentially look into treating the illness they cause.
Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.
However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.
This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.
More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.
How dangerous is the virus?
The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.
Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.
However, an investigation into government surveillance in China said it had found no reason to believe this was true.
Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.
Can the virus be cured?
The COVID-19 virus cannot be cured and it is proving difficult to contain.
Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.
No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.
The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.
Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.
People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.
And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).
However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.
Is this outbreak an epidemic or a pandemic?
The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’.
Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.
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