French health authorities recently rocked the world by announcing that anti-inflammatory drugs like ibuprofen could exacerbate COVID-19, the infection caused by coronavirus. The proclamation made headlines in prominent news outlets and social media alike. Even the World Health Organization first supported the claim and then flip-flopped 24 hours later.
Which is true?
Q. Can ibuprofen aggravate symptoms for COVID-19 or any infectious illness?
A. There is no scientific evidence that ibuprofen causes worsening of COVID-19.
Q. So why have French health authorities claimed that anti-inflammatory drugs increase the risk of complications during fever or infection?
A. This is mostly theoretical. The thinking is that inflammation, which contributes to symptoms like fever and muscle aches, is part of the body’s immune response against infection -- and if you reduce inflammation, you might reduce your immune response, too. Whether this is a significant effect or not in patients is debated.
Doctors’ observations in small numbers of patients suggest that ibuprofen could slow recovery from bacterial pneumonia -- or increase the severity of some viral infections like chickenpox -- but these aren't careful prospective scientific studies.
Consider this counterargument: Patients experiencing worse symptoms are more likely to take ibuprofen; so their worse conditions have nothing to do with the ibuprofen itself. Other studies have argued that ibuprofen can actually help combat lung infections by reducing inflammation, which may damage the lung.
Q. How does this theory apply to COVID-19?
A. Some laboratory experiments in cells show that ibuprofen may increase the amount of a receptor used by the coronavirus to infect cells, and this could make the virus spread faster. Again, this has not been supported by clinical evidence in patients.
Whether this type of experimental finding translates to impact in the clinic is usually unclear. For example, it may be true that ibuprofen increases cells’ receptor level, but that may prove meaningless in people if the increase is small, or there is already so much receptor that adding more doesn't matter.
Q. If someone is diagnosed with COVID-19, what should they know about choosing a pain medicine?
It depends on the individual. A person can certainly take acetaminophen, but the case against ibuprofen is entirely theoretical and not backed by evidence. So if someone has chronic liver disease or another reason to avoid acetaminophen, it is still reasonable to take ibuprofen or a similar medication. Check with your doctor if you have questions.