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Updated 3-18-2020

Please Note:

  • DO NOT USE MOTRIN, ADVIL, ASPRIN, NAPROSEN IF YOU BELIEVE YOU HAVE THIS VIRUS.
  • AVOID ACE INHIBITORS (LISINOPRIL, BENAZEPRIL, CAPTOPRIL, ENALAPRIL ETC) IF YOU HAVE THIS VIRUS.

Some Facts

  • The number of infected by COVID-19 worldwide is under-reported by the tens to 100’s of millions.  
  • With that said, the number of deaths directly associated with SARS (severe acute respiratory syndrome) is dramatically LESS than is currently suggested by media.

So with under-reporting how many actually have the disease and over-reporting the most severe consequences serve only to drive the panic.

I remain, for the most part dismissive, but I may be wrong.  Again the biggest significance is the ease of transfer – droplets (not airborne).  

So in other words; you cough/sneeze, the droplets that are infected are released, settle, can hang in that spot for up to 5 days.  You then must touch that spot then touch your mouth or eyes (mucosal membranes) to get infected.

WHY NO NSAIDS OR ACE INHIBITORS??

The Current Situation:

Other information came to my attention yesterday (thanks to the amazing pharmacist @ Mariners Debbie Barrows). As I stated in the previous blog, the COVID-19 has already spread word-wide. 

We have seen the effects, particularly in Italy, France, and Iran.  Sadly the later, as well as China and South Korea, provide consistently unreliable data.

In contrast, Italy and Paris have been very informative and hats off to many of those physicians for the insightful and well-organized research. 

The most severe cases of respiratory illness in Europe and the States are identified as SARS-CoV (severe acute respiratory syndrome coronavirus).  

The Cases:

Both Italian and Paris doctors noticed a subset of young men and women, less than 36 years old (total of 54) who required life support in order to survive. Sadly, two did not survive.  

What they discovered is that ALL were taking ibuprofen 800 mg to manage their fevers and arthralgia. 

In addition, when looking at why some survived with diabetes or hypertension, and others did not, they discovered those who had worse outcomes were on ACE or ARB inhibitors.  (The ARB inhibitors are still open to debate.)

The Science (in English):

Angiotensin-Renin cascade or system in the body can cause inflammation.  Inhibitors such as the ACE Inhibitors reduce inflammation in several ways, including increasing angiotensin converting Enzyme 2 (ACE2).  

Therefore the use of these ACE inhibitors can help with inflammatory lung disease, cancer, diabetes, and hypertension by increasing ACE2.

Ibuprofen also increases the ACE2.

COVID-19 and SARS-CoV love ACE2.

COVID-19 relies on receptors to bind, particularly those associated with angiotensin-converting enzymes 2 (ACE2).  When ACE2 is accentuated or more stimulated, it becomes expressed by the epithelial cells of the lung, intestine, kidney, and blood vessels.  This is how it is supposed to work. 

Paris docs and later the Italian docs hypothesis (correctly) that the increased risk of SARS-CoV is due to the ACE2 polymorphisms. 

Recommendations:

If you have fever, aches, and cough, use Tylenol to manage your fever.

If you develop symptoms and are on an ACE inhibitor (and maybe an ARB) call your doctor to consider taking you off until the virus subsides.  Sadly the effects the hypertension medication can take 4 days to diminish. 

Informative Links and Info

Great summary: https://www.bmj.com/content/368/bmj.m1086

Link and good abstract regarding above data. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext

Nice general summary from Italian Doc


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