By Assiniboine Pharmacy
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus first recognized in Wuhan, China in December 2019. While most people with COVID-19 develop mild or uncomplicated illness, results in China found that approximately 14% developed severe disease requiring hospitalization and oxygen support and 5% require administration to an intensive care unit (ICU).
Clinical presentation of a mild illness may have non-specific symptoms such as fever, fatigue, cough, muscle pain, sore throat, shortness of breath, nasal congestion or headache. Some patients may also present with diarrhea, abdominal pain, nausea and vomiting. Most patients (about 80%) recover from the disease without needing special treatment. Older patient or patients with pre-existing medical conditions (high blood pressure, heart disease, lung disease, cancer or diabetes) may be more likely to develop serious illness
How does the coronavirus spread?
COVID-19 is primarily spread via coughing, sneezing, or direct contact with a sick person or via surfaces sick patients have recently touched. It is not an airborne illness.
What should I do if I have symptoms and think I have COVID-19?
If you are sick or think you may have been exposed to COVID-19:
• Patients must self-isolate.
• If you have mild disease, you do not require hospitalization, unless there is a concern for rapid deterioration.
• Isolation is necessary to contain virus transmission – return to hospital only if symptoms worsen (onset of difficulty breathing, pressure in the chest, confusion, drowsiness, or weakness).
• Patients with severe symptoms will require an urgent hospital visit.
How can I protect myself and my family from COVID-19?
• Stay home and avoid social and other outings that are not essential.
• If you must leave your home, practice proper physical distancing.
• Wash hands often and well.
• Avoid touching face, nose, or mouth with unwashed hands.
• Avoid close contact with people who are sick.
• Stay at home and away from others if you are feeling ill.
Should I wear gloves outside of my house or in public places?
• Medical gloves are an important component of Personal Protective Equipment (PPE) of healthcare workers, however, gloves do not need to be worn by the general public during their daily activities.
• Gloves are not a substitute for proper hand hygiene.
I am worried about catching COVID-19, should I wear a mask if I have to leave my house?
• Wearing a non-medical mask, such as a homemade cloth mask, has not been proven to protect the person wearing it.
• However, wearing a non-medical mask may be helpful in protecting others around you if you are infected.
NSAID use and COVID-19:
At this time, there is little to no scientific evidence supporting the notion that complications of COVID-19 increase due to the use of NSAIDs. The proposed mechanism by which NSAIDS may increase the risk of complications is based on reduced antibody production, fluid/sodium dysregulation, and others. In addition, NSAIDs have been linked with poorer outcomes for lower respiratory tract infections/pneumonia.
Since acetaminophen (Tylenol) can help reduce some types of pain and lower temperature in fever without NSAID-related adverse effects (bleeding, cardiac events, and kidney dysfunction, particularly in those with other risk factors) it is reasonable to consider it a suitable first-line agent in patients experiencing symptoms due to likely COVID-19 infection. Until the impact of NSAIDs on the course of COVID-19 is known, it appears that the use of acetaminophen may be a safer choice. Keeping in mind, of course, that it is rarely necessary to lower one’s temperature as fever is one of the key vital signs that allow clinicians to recognize whether a sick patient is improving or worsening.
What about low-dose ASA? ASA can prevent strokes/heart attacks and at low doses (81 mg) it does not harm the kidneys/heart function. If patients have been prescribed low dose aspirin, do not discontinue its use during infection.
ACEIs/ARBs and COVID-19:
ACEIs/ARBs are a class of medication used to treat hypertension, these include medications such as Ramipril, Perindopril, Captopril, Enalapril, Lisinopril, Candesartan, Irbesartan, Losartan, Valsartan and others.
Despite initial reports of an association between the rates of COVID-19 infection and/or severe COVID-19 infection with hypertension, diabetes and cardiovascular disease, there exists no recommendations that suggest discontinuation of an ACEI/ARB during this outbreak. Various societies such as the European Society of Hypertension, Hypertension Canada, the Canadian Cardiovascular Society and others all recommend continuing ACEI/ARB due to the lack of evidence to support differential use in COVID-19 patients.
Please speak to your pharmacist or physician if you have any concerns about medication use and COVID-19 infection.