There is some concern among scientists that ibuprofen may worsen the effect of the virus by supressing the immune system.
There is no strong evidence of this. But out of an abundance of caution the World Health Organisation is now encouraging people to take paracetamol rather than ibuprofen if they have COVID-19.
“We recommend using rather paracetamol, and do not use ibuprofen as a self-medication. That’s important,” WHO spokesman Christian Lindmeier said this week.
The advice follows an onslaught of misinformation about coronavirus treatments on social media.
The WHO’s announcement came after Olivier Veran, a qualified doctor and France’s Health Minister, tweeted on Saturday: “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.”
Inflammation is a sign of the body’s immune system fighting back against a virus. As immune cells rush to the site of the infection, the infected tissues heat up and swell.
Dampening that process means you cut the symptoms of an infection, but you also potentially slow down your body’s attempts to kill the virus.
“Instead of putting out the fire quickly by letting the immune system go full-bore, you’re putting a handbrake on it,” says Professor Stuart Tangye, head of immunity and inflammation research at the Garvan Institute in Sydney.
“Potentially, it will take longer to clear the virus – and potentially you’re infectious for a longer period of time.”
Associate Professor Steven Tong, an infectious-disease physician at the Peter Doherty Institute for Infection and Immunity, said that because coronavirus was such a new disease, there was not enough evidence to prove taking ibuprofen was harmful.
“I think where he [Mr Veran] has come from was that if you suppress the immune system that might be a bad thing, so people who are on steroids and things like that. I suspect he’s kind conflated that with non-steroidal anti-inflammatories as well.”
Professor Tong’s advice for patients is to take paracetamol because it is highly effective at lowering elevated temperatures.
“It really provides some symptom relief. Keep up the fluids, take paracetamol and get some rest, that is what I suggest.”
Professor Bill Rawlinson, senior medical virologist at NSW Health Pathology, said that when patients were diagnosed with influenza they were urged not to take non-steroidal anti-inflammatories, like aspirin, due to the risk of Reye’s syndrome, a rare disorder that causes brain and liver damage.
Concerning coronavirus, Professor Rawlinson stressed there was not enough data to prove ibuprofen was dangerous. His advice, however, was to take paracetamol.
“It [paracetamol] is a good one for controlling fever so that’s sensible,” he said.
Those recovering from coronavirus at home are urged to self-isolate, refrain from vigorous exercise, monitor symptoms and avoid unproven remedies such as vitamin or herbal boosters claiming to prevent or cure coronavirus.
Unlike influenza, where patients could take Tamiflu to halt the disease, there is no effective treatment for COVID-19 yet. It is up to the infected person’s immune system to fight the virus.
“If you took paracetamol, or even if you took ibuprofen, it is unlikely to make a difference as to how long you’re sick for or how sick you are going to get,” Professor Tong said.
He is working alongside Brisbane scientists on a series of revolutionary clinical research trials examining the effectiveness of anti-HIV medicine Kaletra and another drug called hydroxychloroquine, commonly used to treat malaria.
Both medications have killed the virus in test tube studies, with the next stage set to be a clinical trial on humans once funding can be secured.
Meanwhile, the Royal Australian College of General Practitioners has warned Australians to be mindful of false or misleading medical advice on social media.
Melissa Cunningham is The Age’s health reporter.
Liam is The Age and Sydney Morning Herald’s science reporter