Primary Care Coronavirus briefing – Coventry and Warwickshire – 18/03/2020

18 March 2020
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Sent on behalf of the COVID-19 Incident Management Team for Coventry and Rugby, South Warwickshire and Warwickshire North CCGs 

Dear Colleagues,As always, medicines are not immune from misinformation in the event of any health emergency, and two of the latest panics involve ACE-inhibitors and ibuprofen. In both cases, potentially rational but purely theoretical concerns have been translated into hard fact, without consideration of the inconvenient lack of evidence beyond the theory. 

ACE-inhibitors

It has been suggested that treatment with ACE-i increases the risk of Covid-19 infection. There is no evidence for this - it has been proposed as a hypothesis, and is one that deserves investigation, but there is currently no scientific evidence to support it. Animal studies actually suggest that treatment with ACE-i may protect against serious lung complications in Covid-19 infection. 

There is a UK-wide position on this from two relevant professional organisations, issued on the 16th March, here: https://www.britishcardiovascularsociety.org/news/ACEi-or-ARB-and-COVID-19. They refer to a statement from the European Society of Cardiology, which is here: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang.

The Science Media Centre has rebuttals from a range of clinical experts here:https://www.sciencemediacentre.org/expert-reaction-to-questions-about-high-blood-pressure-diabetes-and-ace-inhibitor-drugs-and-risk-of-covid-19-infection/

So, the answer at the moment is that this is purely theoretical, and the harms of stopping effective antihypertensive treatment are going to be significantly greater than the potential risks. 

Ibuprofen

There is currently no strong evidence that ibuprofen can make coronavirus (COVID-19) worse. 

But until we have more information, patients are advised to take paracetamol to treat the symptoms of coronavirus, unless the GP has told them paracetamol is not suitable for the patient or their child. 

If the patient or their child are already taking ibuprofen or another non-steroidal anti-inflammatory (NSAID) on the advice of a doctor, they should not stop taking it without checking first. 

Source: https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/
2Many thanks