The idea seems to have taken off because of comments from France's Health Minister Olivier Véran, who is himself a physician https://www.theguardian.com/world/2020/mar/14/anti-inflammatory-drugs-may-aggravate-coronavirus-infection … /2
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This bit in particular has been making the rounds. (For what it's worth, “… ask your doctor’s advice” is only helpful if your doctor has been informed about the basis of the concern.) /3pic.twitter.com/EGVjipI9Dx
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It’s conceivable that, via prostaglandin inhibition or some other mechanism, NSAIDs might influence coronavirus replication, infectivity, or the host response. Whether any such effect would be harmful or beneficial I don't know. /4
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But interestingly, with SARS (another coronavirus), there’s evidence indomethacin (an old school NSAID) selectively *inhibits* viral RNA synthesis https://www.intmedpress.com/servefile.cfm?suid=35d8dc5e-70f4-491f-acad-e35f99be9211 … /5pic.twitter.com/KGuQAlALtY
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As for SARS-CoV-2, here’s a recent correspondence in BMJ suggesting naproxen might inhibit viral replication. This too is largely speculative. https://www.bmj.com/content/368/bmj.m406/rr-9 … /6
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My best guess is simply that people take NSAIDs for viral symptoms, and the sickest of these later show up in hospital. Alternatively, maybe NSAIDs are just a marker of pre-existing illness. Not rocket science, but entirely plausible. /7
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Bottom line: At present there doesn't seem to be much evidence that NSAIDs actually worsen coronavirus infection. More details on the French cluster would be welcome. Insights appreciated. Will add to this thread if more comes to light. / end (for now)
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Addendum: Some have speculated that NSAID-induced upregulation of ACE2 might facilitate coronavirus infection. Here's a thread on that.https://twitter.com/angie_rasmussen/status/1238946941758615553?s=20 …
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@DavidJuurlink this is a question I’ve always wondered. Is it better to treat a low grade fever or let it go to possibly fight off the virus?Thanks. Twitter will use this to make your timeline better. UndoUndo
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I agree that we still don’t know much about it but I think it’s worth to at least give warning to pts to use Tylenol for aches and pains now , unless the NSAIDS are the only options left or are essential !
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