March 17, 2020

By Jennifer W. Williams

A recent study published in The Lancet hypothesizes that a potential link between severe cases of COVID-19/poor outcomes of the virus and the increased expression of an enzyme called ACE2. This study theorizes that patients treated with ACE2-increasing drugs, commonly used to treat inflammation, are at increased risk of severe coronavirus infection and death.

ACE2-increasing drugs can be both steroidal and non-steroidal anti-inflammatory medications.

As a result of this study, the French Health Minister, Olivier Veran, sent a Tweet urging doctors to stop using ibuprofen to treat fever in COVID-19 patients, and to use Tylenol instead. Veran’s Tweet was met with mixed reviews from the medical community, many of whom called this advice into question because the sample sizes of the studies utilized were so small.

However, COVID-19 is a new virus and all we have right now are studies with small sample sizes. It may be worthwhile to give more credence to these small studies as researchers work with what limited patient sizes and capabilities they have in efforts to save lives.

The World Health Organization recognizes that caution is warranted as the global health community rushes to find answers while simultaneously working to save lives. WHO is now recommending that medical providers treat fevers with Tylenol in COVID-19 patients rather than using anti-inflammatory drugs.

The World Health Organization cautions patients currently prescribed anti-inflammatory drugs not to cease taking their medications without consulting their physicians.

The National Health Service in the UK, which previously recommended both Tylenol and ibuprofen for fever in COVID-19 patients, has also reversed course and now recommends against it while awaiting further evidence to surface.

Footnote: Tylenol is also known as paracetamol and acetaminophen, ibuprofen is also called Motrin and Advil. Aleve/Naproxen is another frequently used NSAID.