News of the fast-moving coronavirus is changing by the moment, but scientific understanding of how it works and what it does takes a little longer to accumulate. Currently, speculation and uncertainty abound, and amid this chaos, some recommendations for how or how not to handle the virus are garnering a lot of attention.

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Among these is whether or not it’s safe to use the common over-the-counter pain reliever ibuprofen (Advil, Motrin) and other non-steroidal anti-inflammatories to treat symptoms associated with COVID-19, such as fever or body aches.

On March 14, the French minister of health, Olivier Véran, issued a statement recommending that people infected with the novel coronavirus, which causes a potentially deadly upper respiratory disease called COVID-19, not use ibuprofen or aspirin to treat symptoms of the disease. Instead, he urged followers to take acetaminophen, noting that use of non-steroidal anti-inflammatories such as ibuprofen could actually worsen the illness caused by the new coronavirus.

But was this recommendation grounded in fact?

What Are NSAIDs?

These medications are widely used to:

Reduce pain.

Decrease fever.

Decrease inflammation.

Anti-inflammatory drugs, which includes steroids such as prednisone and non-steroidal drugs like ibuprofen, “work by decreasing inflammation,” says Dr. Prakash Shrestha, an infectious disease physician and medical director of the antimicrobial stewardship program at Covenant Health in Lubbock, Texas. These drugs are “helpful for symptomatic treatment only and are not a cure. By decreasing inflammation, they can decrease pain, swelling, redness” and other symptoms that may be associated with inflammation.

Widely available over-the-counter, NSAIDs are in a lot of medicine cabinets around the world. But despite their ubiquity, they aren’t risk free. Side effects of NSAIDs can include:

Shrestha says that “some scientists in the past have argued that NSAIDs also dampen the immune response and prolong or increase risk of complications from viral pneumonia. There are some studies which suggest it might be true, but the evidence is not very strong.”

More Evidence Needed

The need for more evidence with regard to using ibuprofen in conjunction with coronavirus infection is a common refrain among experts. Dr. Jeffrey Klausner, professor of medicine and public health at the University of California Los Angeles Fielding School of Public Health, says that currently, “we know very little” about how using ibuprofen may impact a patient’s experience with COVID-19.

One potential connection is that in high doses of NSAIDs can damage the kidneys. COVID-19 can also affect kidney function. “We know that the coronavirus can cause sepsis in severely infected patients and sepsis can be associated with kidney problems,” Klausner says.

But the connection between coronavirus and ibuprofen may not be direct. “Unfortunately, with so many places experiencing patients with COVID-19, almost inevitably we’re going to see some strange associations, and it’s hard to know what’s going to be real and what’s noise,” says Dr. Larry William Chang, associate professor of medicine, epidemiology and international health at the Johns Hopkins Medicine in Baltimore.

Still, “I’m not aware of any specific mechanism that would make it harmful to use NSAIDs in the presence of coronavirus infection,” Klausner says.

Despite the limited data, on March 17, World Health Organization spokesman Christian Lindmeier told reporters in Geneva that the agency’s health experts were “looking into this to give further guidance.” He also said that until more definitive evidence can be amassed, the organization recommends using paracetamol (another name for acetaminophen) to reduce fevers and treat pain associated with the coronavirus.

But on March 18, the organization walked back that statement in a tweet, saying that "based on currently available information, WHO does not recommend against the use of ibuprofen." The organization also reported that it was consulting with physicians who are treating COVID-19 patients and are so far "not aware of reports of any negative effects of ibuprofen, beyond the usual known side effects that limit its use in certain populations."

How to Manage Mild Symptoms of COVID-19

“The first thing that someone should do if they have a fever and are concerned about COVID-19 is call their health care provider and be evaluated and see whether they need to be diagnosed,” Chang says.

According to the CDC, symptoms of COVID-19 typically appear two to 14 days after exposure and include:

Cough.

Fever.

Shortness of breath.

Shrestha says that “80% of patients have mild symptoms,” and if you fall into this category, you should seek “supportive measures” that treat symptoms, such as using acetaminophen to reduce fever. He also recommends drinking plenty of water and eating soup to remain hydrated.

If you have a fever and body aches that may be associated with the coronavirus, Klausner also recommends treating these symptoms with acetaminophen because it’s “a very effective way to reduce fever,” he says.

Because this novel coronavirus is part of the family of viruses that cause the common cold, Klausner adds that “people with mild symptoms can manage this like the common cold with over the-counter cold medications.” The remedies you might use to feel better with a common cold to “reduce muscle aches, fevers, headaches would be appropriate,” he says.

Get Tailored Advice

For otherwise healthy adults with no complicating medical conditions, Chang agrees that acetaminophen might be the better option for treating pain and fever associated with the coronavirus until we know more.

However, he notes that there are some caveats to that recommendation. “Many critically ill patients with COVID-19 do experience significant complications with their kidneys and liver, so that can make choosing the right medication for their fever pretty complicated. So, for example, if you have any damage to your kidneys already, you typically do not want to use NSAIDs as that can make things a lot worse.”

But for folks with liver problems, the opposite might be true, Chang says. “If there’s something wrong with the liver, we generally tell people to avoid using acetaminophen because high doses of that it can harm the liver.”

The bottom line, Chang says, is to get advice that’s specific to you and your health situation. If you’ve been diagnosed with COVID-19, “talk with your healthcare provider about the overall medical situation. For example, if you’re elderly and have chronic kidney disease, then you probably do want to avoid ibuprofen. If you have cirrhosis of the liver for example, you might want to avoid acetaminophen. It needs to be tailored to each individual.”

If you’re currently under doctor’s orders to take ibuprofen regularly for another condition, ask your doctor for guidance.

Severe Cases of COVID-19

If your symptoms are severe, contact your health care provider for guidance on how best to proceed. Those with severe cases may end up hospitalized, at which point your doctor will run blood tests and conduct other examinations to further determine the best course of action, Chang says. The CDC reports that emergency warning signs for COVID-19 include:

Difficulty breathing or shortness of breath.

Persistent pain or pressure in the chest.

New confusion or inability to arouse

Bluish lips or face.

Other symptoms may also be present, so be sure to contact your health care provider for assistance if you develop any of the above symptoms. “Stay hydrated, and if symptoms get worse, seek medical attention – but please call (your) doctor first before visiting clinic/hospital to minimize risk of exposure to others,” Shrestha says.

If you’re hospitalized with severe illness, you may be given anti-malarial medications or other medications that are used in the treatment of HIV. “However, no specific medication has been approved yet” for the treatment of COVID-19, Shrestha says. Care typically centers around keeping the airways open and managing symptoms.

Because there is no cure or vaccine yet for COVID-19, prevention is your best strategy, Shrestha says. Wash your hands frequently. Limit contact with other who may have the virus and practice social distancing. Get vaccines against other illnesses such as the flu.