Are patients with hypertension and diabetes at increased risk for COVID-19? | Hacker News Reader

Are patients with hypertension and diabetes at increased risk for COVID-19?

thelancet.com

130 pointssgroppino89 comments

French sources specifically mention severe cases of covid-19 in "young and healthy" patients (eg. see https://lefigaro.fr/sciences/coronavirus-alerte-sur-l-ibupro... ) but this important piece of information has NOT been relayed by international medias.

Jean Paul Hamon, medical doctor and president of the Federation of French Doctors said on TV to NOT take NSAIDs (anti-inflammatory drugs) if #covid19 is suspected. The ONLY common point among young covid-19 patients they have witnessed in critical care centers in France was that they all took NSAIDs.

Translation from French: paracetamol is preferred over nonsteroidal anti-inflammatory drugs (NSAID). Dose of paracetamol should not exceed 3g/day and doses should be spaced throughout the day.

"Paracetamol" a.k.a. "acetaminophen", common brand: Tylenol.

Which is itself the leading cause of acute liver failure in the US. The active dose is very close to the lethal dose, much more so than naproxen or ibuprofen.

The active dose is nowhere near the lethal dose. It is however close to the dose where you could see some minor damage to the liver. It causes problems because people are addicted to opioid drugs that are typically combined with acetaminophen, not because they are loading up on acetaminophen itself.

Paracetamol is dangerous in overdose, and the therapeutic dose is pretty close to the overdose amount. The therapeutic index is approx 10.

Compare that to morphine, which has a therapeutic index of about 70.

(although the therapeutic index is tricky to use because of dose response curves)

We know that paracetamol is commonly used in both accidental and deliberate overdose. And this is true in countries that don't have the opioid crisis, and it was true in the US before the opioid crisis.

> It causes problems because people are addicted to opioid drugs that are typically combined with acetaminophen,

This is part of the problem, yes. But it's incomplete. We know that paracetamol alone causes problems for the liver even with small overdosing. https://britishlivertrust.org.uk/researchers-shed-new-light-...

This isn't really a debate:

- "Liver toxicity from acetaminophen poisoning is by far the most common cause of acute liver failure in the United States, researchers reported" [1] in 2005. It was also true before the opioid epidemic really began.

- "The recommended dose of acetaminophen in adults is 650 to 1,000 mg every 4 to 6 hours, not to exceed 4,000 mg in a 24-hour period." [2]

- "Single doses of more than 150 mg/kg or 7.5 g in adults have been considered potentially toxic." [2]

- "The minimal dose associated with liver injury can range anywhere from 4 to 10 g" [2]

The active dose is very close to the dose at which liver damage occurs (4X single dose or 1X daily dose) and also a fatal dose (10X single dose or 2.5X daily dose). Further, it's exacerbated by alcohol use, which is why you should never drink and then take Tylenol.

Wheres, ibuprofen the safety margin is 120X a single dose and 40X a daily dose. For naproxen, it's 63X a single dose or 21X a daily dose [3].

[1] https://www.medpagetoday.org/psychiatry/depression/2233?vpas...

[2] https://www.uspharmacist.com/article/acetaminophen-toxicity-...

[3] https://www.advilaide.com/safety/overdose

Ibuprofen is OTOH much riskier and disadvised for many groups of patients, like those with gastric problems (Ulcertativ Colitis, Crohn's etc.)

The problem is often due to people overdosing, often due to mixing different pills that each contain paracetamol. Each cure becomes poison after a threshold.

> Each cure becomes poison after a threshold.

Right, and I'm saying that threshold is much lower for Tylenol than other NSAIDs, separate of whether it's disadvised for certain demographics. That's fact.

Maybe there are different recommendations where you live, but here in Sweden and most of the hits on a web search suggest max dosage of paracetamol is 4g/day spread out.

Upper tolerable dosage isn't as simple as one number for everyone. How much someone can take depends on how long someone takes it, their relative health and their mass dosage (mg/kg). I could take 2g c.i. (6g/day) for weeks (114 kg, large healthy liver, younger) but a little grandmother (40 kg) couldn't.

Ibuprofen already is known to lead to GI perforation and mental decline in the elderly, so there's rarely a compelling reason to administer it. Paracetamol is much safer over short durations for analgesic and antipyretic properties generally unless acute or chronic liver injury is suspected.

Why would young and healthy patients be taking "massive amounts of NSAIDs" if they didn't have co-morbidities? This doesn't really make any sense.

Normally when you see young people taking large doses of NSAIDs, it's because they're either elite athletes or have an autoimmune disease or something.

> Why would young and healthy patients be taking "massive amounts of NSAIDs" if they didn't have co-morbidities? This doesn't really make any sense.

There are enough people who have no idea that hang-over + pop-2-advil is a deadly combination in this situation.

Also a lot of the "new year, new body" resolution folks start too hard at the gym & then push through with NSAIDs.

Young people, particularly the fit, do go through a lot of NSAIDs out of OTC convenience.

"Massive amounts" to me sounds like at least the max dose for at least a week.

Taking 2 ibuprofen in a day against a flu like headache is what your doctor recommends, probably. Not exactly a massive amount even if repeated for a week.

I don't know about for the flu, but for other types of injuries doctors will often recommend taking double or triple the recommended dose on the bottle.

There is 2 standard EU OTC Ibuprofen which is 400 mg and 2 South Korean Ibuprofen which is 2000 mg. Indian formulations also come extra strong.

Lots of people take Ibuprofen when they have a fever.

Or even an minor ache

In the mountain sports community Ibuprofen is jokingly referred to as "Vitamin I". I know a lot of people who take it regularly to push through the soreness of multiple days of physical activity.

Interesting for sure. When I've first heard reports of ibuprofen + CoV-19, I went to check out what Harvard Health was recommending [0].

Under "What treatments are available to treat coronavirus?":

Currently there is no specific antiviral treatment for COVID-19. However, similar to treatment of any viral infection, these measures can help... ... Take acetaminophen, ibuprofen, or naproxen to reduce fever and ease aches and pains. Be sure to follow directions. If you are taking any combination cold or flu medicine, keep track of all the ingredients and the doses. For acetaminophen, the total daily dose from all products should not exceed 3,000 milligrams.

So it seems there is no widespread consensus on the matter for now. North American professionals, from what I've seen on social media, tend to disagree with their European colleagues on the matter.

Personally, I remain somewhat skeptical until there's more data available.

[0] https://www.health.harvard.edu/diseases-and-conditions/coron...

Although it's important to note here that French people take just a completely silly amount of painkillers, so there may be overuse problems being conflated into the recommendations. If your local health authorities say using painkillers is appropriate, I wouldn't rule that out.

https://link.springer.com/article/10.1007/s10194-008-0046-6

It seems like Switzerland is also recommending this and referring to a study done on mice. I don’t have links since they most likely in French/German.

Edit: link to recommendation https://www.bag.admin.ch/bag/de/home/das-bag/aktuell/news/ne...

The actual title of this article is, "Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?"

The relevant portion about ibuprofen, lightly edited to make it more readable, is:

> Coronaviruses bind to their target cells through ACE2. The expression of ACE2 is substantially increased in patients with diabetes, who are treated with ACE inhibitors and ARBs. Hypertension is also treated with ACE inhibitors and ARBs, which results in an upregulation of ACE2. ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.

More broadly, they're saying that many of the medical notes of patients who died mentioned that the patients also had diabetes or hypertension, and they're wondering if the correlation is about the treatment for those conditions and not about the conditions themselves.

It's not clear to me whether they're implying that anyone who takes ibuprofen (e.g. for a headache or even for a COVID-19 fever) will have more ACE2 and therefore be more susceptible to severe and fatal COVID-19, or if that effect only happens in the context of treatment for diabetes and hypertension. I can see how you can read it in the first way, but it feels like they would have titled it clearer if that were what they were actually saying.

In particular, there is plenty of advice for people with mild COVID-19 cases to do the normal things they'd do to take care of a flu at home, including take ibuprofen. If that's a bad idea, I feel like they would have said that more loudly.

(For instance - does it matter whether you've got more ACE2 if you're already infected and trying to keep the symptoms under control?)

EDIT: Thanks to 'FeteCommuniste in another comment for linking this Twitter thread https://twitter.com/angie_rasmussen/status/12389469379166822... which points out that this is an un-peer-reviewed hypothesis.

it's worth watching this lecture from last week to understand the role of ACE2 in SARS-CoV-1 and SARS-CoV-2 - very informative

https://www.youtube.com/watch?v=jAW6VBWTiAA

These sorts of things are exactly the reason to try to slow the spread down.

Ibuprofen /might/ be a bad idea. We currently have the time to notice that, and hopefully find out whether it's true by looking at hundreds of cases instead of tens of thousands.

Generally taking Ibuprofen chronically might be a bad idea.

We don't know how chronic the chronic is through. So to stay on the safe side, use as little as needed to control bigger fever and pain.

This unlike antibiotics (not for viral infections) where you are supposed to take exactly the recommended amount for recommended time, preventing resistance.

After a couple of asthmatic attacks after taking aspirin and ibuprofen I went to an allergist and she told me that I have an allergic reaction to all NSAIDs.

The syndrome is called 'NSAIDs-Exacerbated Respiratory Disease'.

I felt equally proud and ashamed that the medical establishment officially diagnosed me as a NERD

https://en.wikipedia.org/wiki/NSAID_hypersensitivity_reactio...

Sadly NERD doesn't refer to you, but to the disease ;P

Could argue diseased as a noun works (to refer to them, as “the diseased”)

I'm wondering if some of the downside of anti-inflammatories is that they often lower fevers. A fever is the body's natural response to infection, to raise the rate of chemical reactions and make more immune cells:

https://www.sciencedaily.com/releases/2011/11/111101130200.h...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869589/

I also think that this is part of the mechanism that makes zinc effective against viruses as a catalyst.

Generally, I think that it's good to keep fevers down for non-lethal infections like the common cold, especially for children. Just beware that aspirin may cause Reye's syndrome in the young:

https://www.healthline.com/health/headache-reyes-syndrome

But for serious infections like Covid-19, maybe it would be better to maintain a relatively safe temperature of say 101-102 F (38-39 C)? I'm honestly curious to know what doctors think of this.

That is probably completely dependent on the infection you are treating. Sometimes it may be better to reduce stress on the patient, sometimes higher temperatures help stop the infection. After all, someone got a Nobel prize for infecting people with malaria to cure them of syphilis https://en.m.wikipedia.org/wiki/Pyrotherapy

Good summary, althoughI would be more forceful about aspirin- don't use it for children under 12 without a medical professional recommending it. While Reyes syndrome is rare, acetaminophen and ibuprofen are equally effective, available, and do not carry the risk.

Taking too much acetaminophen (Paracetomol) is the most common cause of acute liver failure in the United States.

There has been a huge PR push (in advertising etc) against Aspirin and for other NSAIDs.

Of course, take care, but don’t be sucked in by marketing.

To add to that:

1. High dose aspirin might have been implicated in causing higher death rates from 1918 influenza: https://academic.oup.com/cid/article/49/9/1405/301441 (daily doses of 8 to 31.2 grams, are above the maximum safe dose)

2. But low dose aspirin has been studied and effects are not apparent e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737981/

From the article: "ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19."

Considering that lisinopril (Prinivil, Zestrel, etc, an ACE inhibitor) is, according to any list I could find, easily in the top 10 meds prescribed in the US (and by some top three or number one), this is something that should definitely be more publicly known.

I’m not saying anyone should just stop taking their hypertension drugs, that’s a horrible idea. But if you do suspect that you might have COVID-19, you should probably call your doctor - there’s no shortage of other options.

One of those lists: https://www.medicinenet.com/top_drugs_prescribed_in_the_us/v...

A virologist gives a different view in this thread:

https://twitter.com/angie_rasmussen/status/12389469408820060...

Btw, ACE2 expression is decreased in unmedicated diabetics and HTN patients and the elderly which would imply that those groups should have some degree of protection from the virus (ceteris paribus, obviously). In fact that seems to be exactly the opposite of what we see. Some research even indicates that ACE2 could help prevent ARDS-induced lung injury:

https://www.nature.com/articles/srep27911

But in that article the injury wasn't induced by COVID-19 so really we don't know enough yet.

(Ref. for decreased ACE2 expression in diabetes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992757/)

It is widely known (to some extent) that preexisting conditions severely contribute to the harm of covid-19.

ACE != ACE2.

ACE inhibitors have no effect on ACE2.

https://www.nrcresearchpress.com/doi/10.1139/y02-021

https://www.researchgate.net/publication/26859747_Upregulati...

"Upregulation of angiotensin-converting enzyme (ACE) 2 in hepatic fibrosis by ACE inhibitors"

are those ACE inhibitors also prescribed in China? I really doubt that

Why do you doubt they are prescribed in China?

any reason to doubt it? I mean they are made of flesh and blood as well.

hypertension is a western disease

https://www.theguardian.com/world/2020/mar/14/anti-inflammat...

Was about to say this.

They advise is to use acetaminophen.

It really comes down how covid-19 kills people, whether it is by directly attacking the body, or by triggering cytokine release syndrome (CRS).

In later case, medication that suppresses the immune system would be better, but in former case it could make things worse.

> It really comes down how covid-19 kills people, whether it is by directly attacking the body, or by triggering cytokine release syndrome (CRS).

It seems to be both. Plausibly at least, CRS may be often involved in damage to the respiratory system, but COVID-19 is not unlike SARS in that severe forms can directly attack other parts of the body. So any treatment based on lowering inflammation or any other part of the immune response will have to be carefully tuned.

They think the virus enters the cell via Ace2 receptors. The hypothesis is these drugs increase ace2 receptor expression which makes the cells more likely to get infected. Your lung, heart and kidney cells express this receptor.

Ibuprofen, along with paracetamol, is generally considered very safe. All over the world they are prescribed for any kind of pain, fever, inflammation or discomfort. Of course, there are some known side effects, but they are generally considered minor.

Does it make sense that a virus would evolve to favour these conditions? Or is it just an unfortunate coincidence? I guess it depends on whether the virus being "worse" means it helps spread faster, or just compromises the host faster - after all, the virus doesn't gain from killing its host. Also, animals don't get treated with NSAIDs to the same degree, so if nCovid-19 came from a non-human host that's another argument for it being coincidence.

Ibuprofen is an anti-inflammation drug, which means it weakens somewhat your immune system (which is responsible for the inflammation in the first place). It makes sort of sense that taking such medication while infected with a virus for which there is no treatment can be dangerous.

In related news, there have been cases of "severe" forms of Covid-19 among young people with no antecedents, all of them having taken ibuprofen.

Please don't take ibuprofen.

Why are you putting severe in quotation marks?

What makes you feel qualified to give medical advice on an Internet forum?

There might be negatives to taking ibuprofen in relation to COVID-19, but so far no official guidelines exist. Only internet stories. Responsible institutes have not handed out such advice, nowhere.

> Why are you putting severe in quotation marks?

Because I don't know the official terminology.

>What makes you feel qualified to give medical advice on an Internet forum?

Because of where I work I have been given "primary sources", but of course you are free to not believe me. This is my own sentiment, feel free to look things up yourself.

> no official guidelines exist. Only internet stories.

Not in the US, maybe, but such guidelines definitely exist where I live. Again, you do you

If any official source, regardless of country, recommends to abstain from ibuprofen I would simply like to know. I neither live in the US nor think that scientists and medical personnel in other country are less educated or trained.

I think it's about distinguishing important information from stuff people randomly write online because a non-peer reviewed study made a hypothesis.

The goal is for everyone around the globe to be as safe as possible and misinformation in the context of medical advice is not helpful.

Of course it's better not to take ibuprofen, in any case. But some people may rely on it or other NSAIDs.

> If any official source, regardless of country, recommends to abstain from ibuprofen I would simply like to know.

It's headline news at the moment. You could just check. https://www.theguardian.com/world/2020/mar/14/anti-inflammat...

The reason it's headline news at the moment is because some minister tweeted about the lancet letter this thread is talking about. It's a letter that's not gone through peer review which definitely shouldn't be taken as an official source! Numerous doctors on Twitter have come out and said we shouldn't listen to it too.

Examples: https://twitter.com/notdred/status/1238806682458882049 https://twitter.com/angie_rasmussen/status/12389469379166822...

That the advice of an official is unfounded doesn't mean there wasn't official advice which was what was in question not its veracity.

I'd strongly argue a minister tweeting, even when it is the health minister, isn't official advice in the sense of national guidelines.

I actually think he was incredibly stupid for tweeting that - he should know better than to write what would obviously cause a media stir based on an open non-reviewed letter.

If you're a medical professional and you've seen numerous papers or reports coming in that ibuprofen is a factor in the severity of Covid-19, why do you need to use a throw away account? Why can't you say where this information has come from?

I've seen this topic shot down by doctors on Twitter - a throw away account quoting "primary sources" is unlikely to convince many of us! Can you expand with something a bit more concrete? For example, where are these guidelines that are saying not to us ibuprofen?

It's unclear if English is your first language or not, but in case there is confusion resulting from this, quotation marks around a word is sometimes used to indicate sarcasm.

In this context, it could be read that you don't believe that Covid-19 is at all serious - that the effects are "no worse than the flu".

I don't know if you believe that, or if that is your intention, but there are some that are claiming this pandemic is a 'media hoax'. As you can imagine, that is a very emotionally expensive viewpoint to have to fight, especially when it's an at-risk loved one who is making that claim.

It's already considered unsafe to take NSAIDs when suffering from influenza. In fact it's even been hypothesized that the Spanish flu pandemic was so bad because of widespread use of (the new) aspirin.

> In related news, there have been cases of "severe" forms of Covid-19 among young people with no antecedents, all of them having taken ibuprofen.

I'm not sure what you're trying to say here - are you claiming that all young people with severe cases of COVID-19 (including, for instance, 33-year-old Wenliang Li) took ibuprofen?

Or simply that there exists a small group of people such that all people in that group took ibuprofen, and there are also other young people with severe cases who did not?

Given that standard advice for young people (who are expected not to have severe cases) is to take fever-reducing medication like ibuprofen, I feel like we need a lot more information here before we can turn this correlation into causation.

I don't know what happened to Wenliang Li. What I know is that there have been reports of severe cases among young people without antecedents or pre-existing pathologies where I live and the common thread was that they took ibuprofen. In parallel, there are papers/preprints popping left and right suggesting that ibuprofen's side effects may worsen the symptoms of covid-19. Just google things, it's not hard to find.

>Given that standard advice for young people (who are expected not to have severe cases) is to take fever-reducing medication like ibuprofen, I feel like we need a lot more information here before we can turn this correlation into causation.

There's other fever-reducing medication that doesn't involve anti-inflammation action. Paracetamol is fine.

This is precisely the sort of comment that not only makes social networking a medium with nearly no real value, but actually dangerous.

The commentator comes here with some assumptions, perhaps some hearsay, and an emotional attachment to their position and make the statement as though it's fact.

In this comment, you know what's missing? Actual knowledge, actual reasoning, and actual facts to back up the his/her claims. Perhaps worse, there are some facts (Ibuprofen suppresses some immune system responses to infection) which are used to draw unsubstantiated conclusions about the commentator's opinions (Ibuprofen can cause severe forms of Covid-19 in young people).

From where did this "related news" come from? On what rational basis do you draw the conclusion that an across-the-board recommendation not to take Ibuprofen is warranted? How does that trump other factors that may be at play?

What I really worry about though is how many people will read the comment I'm responding to and go on to post elsewhere, "in related news...", with a similar air of self-certainly and casting of opinions as facts. In other contexts of high emotion, people get lynched because of this sort of social media posting, people may cause themselves harm because of this kind of posting.

By the way, the commentator may actually be right... but there is nothing in the comment to make me believe that his/her being right would be anything more than coincidence.

I'll leave with the personal observation that this community is suppose to be made up of "the smart ones"; which we ourselves so often confidently believe to be true that we all too frequently think we should be able to engineer society and solve all its ills. If there is any one ponder-able to take away from reading Hacker News on regular basis, it's how decidedly average even "the smart ones" can be on any given topic.

tylonol is safer than ibuprofen if you have covid19. But you don't have to believe me as I read and don't make bibliographies in all of my posts.

But I will make an exception for you. https://amp.theguardian.com/world/2020/mar/14/anti-inflammat...

> But you don't have to believe me as I read and don't make bibliographies in all of my posts.

We certainly don't have to make them in all posts, but I think it's reasonable to request that we make them in what are hopefully a small number of posts wherein we offer medical advice.

No one should be accepting anything online as medical advice. It's like high finance, if you base every purchase on what you read on Yahoo finance you are going to lose your shirt. If you take health advice online you might die. Nobody is giving advice here. We are having a discussion.

Read not to contradict and confute; nor to believe and take for granted; nor to find talk and discourse; but to weigh and consider.

- Bacon

your link does not support what you wrote. You wrote

> "Ibuprofen is an anti-inflammation drug, which means it weakens somewhat your immune system"

The article says

> anti-inflammatory drugs are known to be a risk for those with infectious illnesses because they tend to diminish the response of the body’s immune system.

weakens the immune system != weakens the response of the immune system

As for ibuprofen vs tylonol there's this

https://www.thisamericanlife.org/505/use-only-as-directed

ibuprofen may or may not be worse for you if you catch covid-19 but tylonol has never worked for me personally.

The taking of anti-inflammatories [ibuprofen, cortisone … ] could be a factor in aggravating the infection. In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.”

Ok I'm done in this thread now

Inflammatory response is not the immune system. Both are intertwined but this should not be misread to say they are the same thing. Although I don’t disagree with your statement. There is possible reason against and no evidence that it (or paracetamol for that matter) improves outcomes.

Paracetamol (acetaminophen) isn't all that safe. Too high a dose can quickly and irreversibly damage your liver. Many people have died this way.

If you're intending to take paracetamol long term, you can do worse than to reduce the stated maximum daily dose on the bottle by 1/4 or 1/2. You'll be less comfortable, sure. But it's called a "liver" because you need one to live. So it's worth a little extra discomfort to avoid the risk of breaking yours.

Disclaimer: I'm not a doctor.

Paracetamol is probably as safe as it gets when it comes to drugs in its class. Overdosing is not all that simple and the numbers are high because of the availability and popularity of Paracetamol as a pain-killer and its silent use as a side ingredient in many products. Paracetamol is not as good as Ibuprofen when it comes to killing pain (IMHO), so maybe this causes a tendency to overdose in people who have built a tolerance to the drug.

To get liver damage, you have to exceed the daily recommended maximum of 4g of Paracetamol. Wiki says paracetomol toxicity is likely if your consumption exceeds 7g in a day [1]. Assuming you are a consuming Paracetamol in the form of OTC pills, say the super strength ones which are 500mg, you have to consume like 15 pills in a day. Overdosing from a combination of drugs containing paracetamol is much more likely. Most people don't realize the presence of the other ingredient.

For short term use, Ibuprofen is said to have a similar safety profile to Paracetamol, though its classification as an NSAID lends to its perception as a slightly less safe drug. Long term, it causes stomach and kidney damage.[2]

Anecdotally, Ibuprofen is much better at killing my pain, but I also have some negative reactions like increased reflux. Technically, Paracetamol also increases acidity but I tolerate it much better. I've mostly stopped using NSAIDs but I realize this is not possible for a lot of people.

[1]: https://en.wikipedia.org/wiki/Paracetamol_poisoning#Cause

[2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5306275/

Also not a doctor, but one of mine recommended a max daily dose of 3g, so that's what I'm working from.

I have GERD (Gastroesophageal reflux disease) along with mild asthma, and NSAIDs are a big no-no for me. When I was in the Army, the docs handed out bottles of 800mg Ibuprofen tablets like candy for virtually any complaint - I took them because I was young and invincible back then.

These days, I rarely take anything for headaches. If it's bad enough, I'll take the occasional Tylenol (usually after my wife orders me to take something because the pain is making me cranky). Body aches get ice and/or bengay.

I too suffer from allergic asthma and GERD.

If you want to manage your GERD, diet is a big driver. Ever since I lost weight and changed my eating habits, I haven't had a single GERD episode and it's been two years.

In my weight loss journey I went through keto, then paleo, now I'm doing 40 days of high carb vegan (for lent) — macro composition doesn't matter that much, what I think mattered was the weight loss itself and eating whole foods.

It's interesting because I used to get GERD episodes from kidney beans or bananas and nowadays I eat impressive amounts with no GERD in sight. I figured that if I am to survive this month on veganism, I have to eat a lot of beans, lentils, etc. I am no longer drinking carbonated beverages, no beer or sodas, so that might have something to do with it. The general idea being that some trigger foods might not be a problem in the context of a healthy diet and a body weight that's close to normal.

---

I have allergic asthma and while it's been under control for years, with me requiring no treatment, when I was in my twenties I went through really rough periods, with me ending up in ICUs with difficulty breathing.

I also heard that extensive use of Ibuprofen can worsen asthma episodes and this is what happened in my twenties, however my asthma is nowadays under control, my immune system seems to be working normally and even when catching a cold, I seem to tolerate Ibuprofen quite well.

Just so we are clear, I'm now 37 and my tolerance of Ibuprofen and similar improved a lot since my twenties, so it can go in the other direction.

---

For many people giving up on painkillers isn't an option. My wife gets migraines that are so bad it makes her puke.

I'm writing this to say that GERD and allergic asthma are many times manageable with the proper treatment and a lifestyle change.

> Does it make sense that a virus would evolve to favour these conditions?

I strongly doubt that COVID-19 has been exposed to NSAIDs long enough to result in evolution of any type. The paper suggests that NSAIDs make us more biocompatible, so it really is just a coincidence. Lots of medications have contra-indications.

> Ibuprofen, along with paracetamol, is generally considered very safe

NSAIDs are considerably more harmful than might be assumed from their availability and public perception. Over the past half decade, I've heard doctors recommending with increasing frequency against cessation of OTC NSAID use. Research available on Pubmed and NCBI seems to agree.

I'm also in a common but at-risk group for Covid-19 that should never use NSAIDs, but I think qualifications of their safety shouldn't be accepted outside of any but a very loose definition of 'generally'.

why is this keep popping up???

https://news.ycombinator.com/item?id=22582568

https://news.ycombinator.com/item?id=22576721

stop spamming this

Those other ones got flagged, but this is from the lancet which is a credible source.

Any information on cough suppressants? Whether they're a good or bad for people with COVID-19?

I've had my doctor recommend against cough suppressants in the past. But I've had trouble sleeping with a bad cough, and so if cough suppressants make sleep possible, it seems like a net-win. Is there any data yet?

I've looked and haven't found any. My gut says it sounds like a bad idea. Usually they want pneumonia patients to cough, and use their incentive spirometer frequently.

Are you asking about dextromethorphan or some other cough suppressant? I don't think there's any real evidence one way or the other yet.

Yes, dextromethorphan. Thanks.

Ibuprofen is also used among people with arthritis and gout, gout is strongly linked with diabetes.

Curious. Melatonin is anti-inflammatory. Would this pose a similar (hypothetical) danger as NSAIDs?

Bettridge's law may be wrong here... sounds like the answer is "maybe"

But this isn't even the real headline. The real headline is "Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?" And it's not even a headline, it's a title of a medical note to other researchers to advance a hypothesis. This isn't a news source, this is work in progress in the early stages of the scientific method.

How do you follow up one these “articles”. I understand that it is a hypothesis, but unfortunately these articles do create some nasty rumors, where these tend to be treated as facts instead of just a hypothesis.

Morbidity aside, this must be an exciting time to be an epidemiologist.

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