NHS no longer advises coronavirus patients take ibuprofen

The NHS no longer says coronavirus patients should take ibuprofen for symptoms of the deadly infection amid a row over the cheap painkiller.

Until last night, its official advice website named paracetamol and ibuprofen as two ‘everyday’ painkillers that could fight off a fever and cough.

Its official advice website now only advises Brits suspected of having the deadly illness to take paracetamol.

It comes after doctors yesterday warned ibuprofen – which costs just pennies – can make symptoms of COVID-19 worse.

French health minister Olivier Véran prompted questions over the NHS advice when he said anti-inflammatories could ‘aggravate the infection’.

Other leading medics echoed his concerns, admitting the drug could dampen the immune system and even slow down recovery.

Today. parents of a four-year-old girl with tell-tale coronavirus symptoms claimed that ibuprofen caused her to become seriously ill.

Amelia Milner’s temperature spiked, she began shaking, panting and couldn’t keep her eyes open. She also vomited on herself.

Amelia Milner (pictured), four, who has suspected coronavirus, was given ibuprofen and experienced a raft of problems including a spike in temperature and vomiting

Amelia Milner (pictured), four, who has suspected coronavirus, was given ibuprofen and experienced a raft of problems including a spike in temperature and vomiting

Amelia Milner (pictured), four, who has suspected coronavirus, was given ibuprofen and experienced a raft of problems including a spike in temperature and vomiting

The NHS' official advice website now only says Brits suspected of having the deadly illness should stick to paracetamol to beat the coronavirus

The NHS' official advice website now only says Brits suspected of having the deadly illness should stick to paracetamol to beat the coronavirus

The NHS’ official advice website now only says Brits suspected of having the deadly illness should stick to paracetamol to beat the coronavirus 

Until last night, the NHS' official advice website named paracetamol and ibuprofen as two 'everyday' painkillers that could fight off a fever and cough

Until last night, the NHS' official advice website named paracetamol and ibuprofen as two 'everyday' painkillers that could fight off a fever and cough

Until last night, the NHS’ official advice website named paracetamol and ibuprofen as two ‘everyday’ painkillers that could fight off a fever and cough

Ibuprofen works by reducing swelling – this can indirectly reduce the power of the immune system

Ibuprofen works by reducing swelling – this can indirectly reduce the power of the immune system

Ibuprofen works by reducing swelling – this can indirectly reduce the power of the immune system 

In a moving Facebook post, Amelia’s step-father Dan Collins shared a photo of her and warned: ‘To those of you that have children please read. If your child has symptoms of coronavirus, DO NOT give them ibuprofen.’

Mr Collins said Amelia had been unwell since Tuesday with a cough, fever and cold. Amelia was given ibuprofen as her mother and step-father were unable to get any Calpol.

‘Within an hour of giving it to her, she dropped dramatically,’ Mr Collins told the Manchester Evening News.

‘She was panting while trying to breathe, her heart rate was very rapid, she couldn’t keep her eyes open, couldn’t lift her head up, her body was shaking, she started being sick on herself and her temperature had risen to 39.4.’ 

Paramedics rushed to Amelia and managed to bring her temperature down, before telling her parents not to give her ibuprofen. 

Amelia’s mother, Maddie, also mother to eight-year-old Katie, said she’s ‘never seen her daughter as poorly in her life’ and they are all now self-isolating.

Doctors haven’t tested Amelia for coronavirus because she isn’t in hospital – health chiefs are only swabbing suspected patients who are critically ill.  

It comes after Mr Véran, who is in charge of France’s coronavirus battle, warned that taking ibuprofen may worsen symptoms of the deadly coronavirus

The neurologist tweeted: ‘The taking of anti-inflammatories (ibuprofen, cortisone, …) could be a factor in aggravating the infection.

Olivier Véran, France's health minister, claimed the over-the-counter medication– which the NHS says could help – may aggravate the infection

Olivier Véran, France's health minister, claimed the over-the-counter medication– which the NHS says could help – may aggravate the infection

Olivier Véran, France’s health minister, claimed the over-the-counter medication– which the NHS says could help – may aggravate the infection

French health minister and doctor Olivier Véran claims that the over-the-counter medication may aggravate symptoms of COVID-19 (pictured, his original tweet in French and a translation to English)

French health minister and doctor Olivier Véran claims that the over-the-counter medication may aggravate symptoms of COVID-19 (pictured, his original tweet in French and a translation to English)

French health minister and doctor Olivier Véran claims that the over-the-counter medication may aggravate symptoms of COVID-19 (pictured, his original tweet in French and a translation to English)

WHY COULD IBUPROFEN WORSEN CORONAVIRUS SYMPTOMS?  

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body’s production of certain natural substances that cause inflammation, and is used to decrease pain or a fever.

Experts say paracetamol should be a first choice because:

1. Ibuprofen may dampen the body’s immune response to infection because it is has anti-inflammatory effects. This may slow the recovery process, Professor Ian Jones, a virologist at the University of Reading, said.

2. He added that it is likely the coronavirus acts in a similar way to SARS, in that it reduces an enzyme which regulates salt and water in the blood. This can lead it pneumonia. Ibuprofen may aggravate this, Professor Jones said.

2. NSAIDs can cause stomach irritation and stress on the kidneys if taken over a long period of time. This could be exacerbated in those who already have kidney or stomach problems brought on by severe illness, such as COVID-19, experts said.  

‘In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs or in doubt, ask your doctor for advice.’

The controversial statement went against health chiefs’ advice to use ibuprofen as well as paracetamol to self-medicate for the killer disease.   

Ibuprofen is widely taken to relieve pain as well as reduce a fever and aches caused by common colds and flu.

It is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body’s production of certain natural substances that cause inflammation.

This effect helps to decrease pain or fever, which most COVID-19 patients are known to suffer.

However, some doctors warn the anti-inflammatory effects may dampen the body’s response to infection – inflammation, or swelling, happens when the immune system piles its resources into the site of an injury or infection – slowing recovery. 

They may also fuel a process in the body that leads to pneumonia, a severe result of COVID-19 which can lead to death. 

Public Health England said there is ‘not currently enough information on ibuprofen use and COVID-19’, but that patients should not be put off using it.  

Most patients will have a mild illness and some may need to take medicines to help with raised temperature, headache and other pains. 

Other British experts supported Mr Véran’s advice, saying paracetamol is a preferred choice over NSAIDs.

Professor Ian Jones, virologist at the University of Reading, said: ‘The advice relates to Ibuprofen’s anti-inflammatory properties, that is, it dampens down the immune system, which may slow the recovery process.

‘In addition, it is likely, based on the substantial literature around SARS I and the similarities this new virus (SARS-CoV-2) has to SARS I, that the virus reduces a key enzyme which part-regulates the water and salt concentration in the blood and could be part of the pneumonia seen in extreme cases.

‘Ibuprofen aggravates this while paracetamol does not.’

Dr Rupert Beale, of The Francis Crick Institute, said there is ‘a good reason to avoid ibuprofen as it may exacerbate acute kidney injury brought on by any severe illness, including severe COVID-19 disease’.

Dr Tom Wingfield, from the Liverpool School of Tropical Medicine, added: ‘Side effects associated with NSAIDs such as ibuprofen, especially if taken regularly for a prolonged period, are stomach irritation and stress on the kidneys, which can be more severe in people who already have stomach or kidney issues.’

HOW DO IBUPROFEN AND PARACETAMOL WORK? 

Paracetamol and ibuprofen are two of the most common painkillers.

The two drugs work in different, but complementary ways.

Ibuprofen blocks the production of various chemicals in the body.

These include prostaglandins, which are produced in response to injury or disease and cause inflammation.

Ibuprofen taken as pills or in liquid form numbs the site of pain and reduces inflammation, and is widely used for arthritic pain.

It has a relatively low level of side effects, although it can cause stomach bleeding, kidney damage, allergic reactions.

It should not be taken by people who are allergic to aspirin.

Paracetamol also blocks prostaglandin, but only in the brain and spinal cord.

It reduces temperature by acting on the area of the brain responsible for controlling temperature.

Side effects are rare but can include a rash or swelling.

British doctors have previously suggested to only use paracetamol, or acetaminophen in the US, for the treatment of respiratory illness – including coughs, colds and sore throats.

Researchers from the University of Southampton found in 2013 that a combination of paracetamol and ibuprofen is inadvisable, and ibuprofen may even slow down recovery.

Professor Professor Paul Little, of the University of Southampton, who led the study, said treatment with ibuprofen could contribute to the progression of the illness.

He said: ‘This may have something to do with the fact the ibuprofen is an anti-inflammatory.

‘It is possible that the drug is interfering with an important part of the immune response and leads to prolonged symptoms or the progression of symptoms in some individuals.

‘Although we have to be a bit cautious since these were surprise findings, for the moment I would personally not advise most patients to use ibuprofen for symptom control for coughs, colds and sore throats.’

According to Jean-Louis Montastruc, the head of pharmacology at Toulouse hospital, in France, ibuprofen can ‘complicate’ the virus, The Guardian reports. 

She told RTL radio: ‘Anti-inflammatory drugs increase the risk of complications when there is a fever or infection.’ 

France tightened measures to stem the spread of coronavirus, after it reported 36 new deaths on Sunday, taking the total to 127. More than 5,430 people have tested positive. 

The coronavirus outbreak there has seen schools, cafes and restaurants closed, along with nearby Spain and Italy, which have also been deeply affected by the virus.

Public Health England declined to comment on the change to official advice. 

WHAT DO WE KNOW ABOUT THE CORONAVIRUS?

What is the coronavirus? 

A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.

The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.

Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.

The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.

Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals. 

‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses). 

‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’ 

The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.

By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.

The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000. 

Where does the virus come from?

According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.

The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.

Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat. 

A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.

However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.

Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.

‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’  

So far the fatalities are quite low. Why are health experts so worried about it? 

Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.

It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.

Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.

Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.

‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’

If the death rate is truly two per cent, that means two out of every 100 patients who get it will die. 

‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.

‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’

How does the virus spread?

The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.

It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.

Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person. 

What does the virus do to you? What are the symptoms?

Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.

If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.

In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.

Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why. 

What have genetic tests revealed about the virus? 

Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world. 

This allows others to study them, develop tests and potentially look into treating the illness they cause.   

Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.

However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.

This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.   

More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.

How dangerous is the virus?  

The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.

Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.

However, an investigation into government surveillance in China said it had found no reason to believe this was true.

Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.

Can the virus be cured? 

The COVID-19 virus cannot be cured and it is proving difficult to contain.

Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.

No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.

The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.

Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.

People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.

And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).

However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.

Is this outbreak an epidemic or a pandemic?   

The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’. 

Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.

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