NSAIDs & Paracetamol: Why Are Younger People Getting Sicker in The US and Europe?

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What is the explanation for the remarkable uptick in young people getting very sick as Covid-19 sweeps through Europe and the United States? There are a number of possibilities. It could be genetic, or it could have something to do with lifestyle choices such as smoking or vaping. The virus was recently reported to have mutated. However, there is a different option. A lifestyle-related option. This option is currently part of an intense political debate, and I’ve personally come under fire in the recent past for saying things very much like I will be saying in this piece. The question is too important to let go, though. Here is the question: What is the role of COX-2 inhibitors in the European and North American Covid-19 epidemic?

First, the high-level evidence: in China, where traditional medicine is typically a point of contention for Western scientists and even Chinese scientists to pick at when dealing with the sometimes strange ways of a civilization that has lasted millennia, NSAID usage is limited (I’ve looked and looked for sources here, but the paywalls are keeping me out. Please drop a line if you’ve got access to numbers on this). In Europe and the United States, NSAIDs are used to treat everything from pre-workout aches and pains to things such as the flu.

Picture this: young people (20–40) get sick for a few days, treat their symptoms with NSAIDs and paracetamol, and get better. Days later, they relapse, end up in the hospital, and their chest x-rays look worse than anything the doctors could be expected to really be prepared for. Now, this could be due to genetics, or to culture, or to some other unseen commonality. But if we entertain the possibility that COX-2 inhibition is relatively unique to the West, and we look at some of the evidence that suggests that pulmonary health can be adversely impacted (through unknown mechanism) by paracetamol use, a tenuous connection becomes evident.

I am not a doctor, and I do not claim to be certain about this. I am both unqualified and unwilling to recommend choices to anyone regarding healthcare. If you are a member of the general public and you’re reading this, please, discuss any questions you have with your doctor before changing your approach.

That said, I will not be taking paracetamol or NSAIDs. My reasoning runs thus: the benefit I get from taking these drugs is extremely limited, and I believe that they could put me at risk of a severe Covid-19 infection. There is a potential small benefit, and a potential great harm. If I assume I am likely to contract Covid-19, it seems obvious to me that I should avoid the potential harm because it is far more severe than the small amount of pain I may have been able to avoid by taking NSAIDs or paracetamol. I am willing to accept slightly more pain should I become infected to even slightly reduce the risk of being put on a ventilator in an ICU.

Notice that this is a philosopher’s argument. We’re talking about things that may or may not happen, and we’re making assumptions which we’re then identifying and recognizing. We can move these things around and play with them without the need to accept any of the arguments as truth because we are recognizing first and foremost that what we’re doing is a thought experiment.

That said, I believe there is some physiology that needs to be looked at here as well. The highlights are that ACE2 and COX-2 seem to be related. Downregulating COX-2 may directly or indirectly upregulate ACE2, which would make it easier for the virus that causes Covid-19 to replicate and spread. Understandably, the medical establishment is already quite busy, but if you read this, know that I’ve been able to find tenuous support (COX-2 is downstream of ACE2; breaking the feedback loop is thus likely to upregulate ACE2) for a physiological mechanism which could plausibly be causal in the debacle facing Europe and the United States.

It would be ideal to be able to do a randomized study, but if you’re into stats and have some data we could also look at the association between NSAID/paracetamol use (by nation) and Covid-19 cases (by age). This would tell us a bit more specifically who was getting the sickest and where NSAID/paracetamol use was the heaviest. I am unfortunately unable to be of much assistance at the present, having more or less reached the end of my resources, but again I’m happy to be of service if you’re looking for help doing some of the legwork that will need to be done to reach a definitive answer on this thing.

Good luck out there.

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