Post by Beth on Apr 3, 2020 6:27:34 GMT
An Update on the Link Between Medications and COVID-19:
In a prior message, I wrote about the possibility of a link between certain heart and blood pressure medications, and the risk of more severe symptoms among people infected with COVID-19. I've been sickened, though not truly shocked, to read since that pharmaceutical companies with a profit stake in the medications in question have been attempting to discredit initial scholarship about the link between medications and severe coronavirus symptoms, and to fund publications countering initial studies about the issue.
A Little More Detail About the Proposed Science:
The issue in question involves what are called ACE2-receptors (ACE = angiotensin-converting-enzyme). In over-simplified terms, angiotensin II is a hormone our bodies produce that among other things, can contribute to high blood pressure, by causing blood vessels to tighten or narrow. ACE (the enzyme) is vital in the production of angiotensin II. So one of the ways to treat high blood pressure, is to interrupt the production of angiotensin II, by regulating ACE. Drugs called ACE-inhibitors, and Angiotensin Receptor Blockers, both contribute to our having more of these ACE2-receptors on our cells. The receptors take angiotension II and turn it back into other forms of angiotensin that will not elevate blood pressure.
For people with high blood pressure, and some forms of heart disease, this can be very helpful. Other drugs, called thiazolidinediones, also increase ACE2 receptors on cells, and are used to treat Type 2 diabetes. In addition, to a lesser degree, some over the counter pain relievers, like ibuprofen (advil) and naproxen (aleev), can also increase ACE2 receptors.
Here's the problem: Potentially, the COVID19 virus seems to really like these ACE2 receptors, and can use ACE2 receptors on lung cells to gain entry to the lungs. So if you are a person taking medications that give you a lot more ACE2 receptors on your cells, if the proposed theories are correct -- its sort of like unintentionally putting out the welcome mat for the Coronavirus to move into your lungs -- resulting in an increased likelihood of viral pneumonia and other severe respiratory crises.
It should be noted that ACE2 receptors were linked to the SARS coronavirus in 2002-2003 (which at the time was understood as a global health threat, though it was much better contained than COVID-19). Click here for an example of the relevant science emerging from that past health crisis.
If the hypotheses about medications that increase ACE2 receptors and COVID-19 do turn out to be supported, this would help explain at least in part, why people with diabetes, high blood pressure, and heart disease are so disproportionately dying from COVID-19.
What to Do With This Information:
Again, with the disclaimer that I am not qualified to give any professional medical advice whatsoever --
Keep learning, share concerns with others, and encourage healthcare authorities to make patients aware of the proposed risk, notwithstanding the fact that more research is needed, and the link between medications and COVID-19 are not proven. Given the lives immediately at stake, patients who take the medications in question should at least be aware that there is a possible risk, and get to make decisions based on available information. Currently, organizations like the American Heart Association are saying that people should just keep taking their medications even if they have COVID-19 symptoms (or a diagnosis), since the link is uncertain. As a result, physicians and pharmacists are mostly not raising the issue unless a patient hears about it first and asks. Liability concerns can factor in for healthcare providers -- as if a patient stops taking a heart or blood pressure medication at a physican's advice and has negative outcomes, the healthcare provider or institution may have to worry about a malpractice suit, whereas -- if someone gets sicker or dies from COVID-19: because the virus is so new and the link between medications and COVID-19 is still uncertain, the chances of malpractice liability are very minimal. So institutions that prioritize concerns about liability over patient safety may feel that it's best to just avoid acting on the issue, until the research is more certain one way or another (which may take many more months).
Though, again, a potential link between severe COVID-19 symptoms and over the counter medications like ibuprofen and naproxen is also hypothetical and unproven (and has been the subject of controversy in Europe, and within the World Health Organization, and more recently the U.S. media) -- while we wait for more study, it's important for people to know that there is at least a possible, albeit smaller, risk, since taking over the counter fever reducers is one of the things we may otherwise do to manage COVID-19 symptoms. Acetaminophen (tylenol) does not increase ACE2 receptors, so it is an alternative for people concerned about the proposed risk.
Last, I want to disclaim again that there is no suggestion that just taking the medications in question would increase your risk of contracting COVID-19. The issue is relevant for people who already have the virus, and are therefore at risk of developing severe symptoms. Suddenly stopping use of a diabetes, heart, or blood pressure medication can sometimes be dangerous, and I would reach out to your primary care provider (or cardiologist) first, to discuss alternatives, if you decide you want to avoid medications that increase the presence of ACE2 receptors on your cells, so that you can potentially transition to other medications that don't increase your ACE2 receptors. For anyone who already has COVID-19 symptoms and is taking these medications however -- I think it's very important to reach out immediately and make some rapid decisions. Viral pneumonia and other severe respiratory symptoms are typically showing up in COVID-19 cases about 10-14 days after the person first gets symptoms, so it matters to act quickly.
In a prior message, I wrote about the possibility of a link between certain heart and blood pressure medications, and the risk of more severe symptoms among people infected with COVID-19. I've been sickened, though not truly shocked, to read since that pharmaceutical companies with a profit stake in the medications in question have been attempting to discredit initial scholarship about the link between medications and severe coronavirus symptoms, and to fund publications countering initial studies about the issue.
A Little More Detail About the Proposed Science:
The issue in question involves what are called ACE2-receptors (ACE = angiotensin-converting-enzyme). In over-simplified terms, angiotensin II is a hormone our bodies produce that among other things, can contribute to high blood pressure, by causing blood vessels to tighten or narrow. ACE (the enzyme) is vital in the production of angiotensin II. So one of the ways to treat high blood pressure, is to interrupt the production of angiotensin II, by regulating ACE. Drugs called ACE-inhibitors, and Angiotensin Receptor Blockers, both contribute to our having more of these ACE2-receptors on our cells. The receptors take angiotension II and turn it back into other forms of angiotensin that will not elevate blood pressure.
For people with high blood pressure, and some forms of heart disease, this can be very helpful. Other drugs, called thiazolidinediones, also increase ACE2 receptors on cells, and are used to treat Type 2 diabetes. In addition, to a lesser degree, some over the counter pain relievers, like ibuprofen (advil) and naproxen (aleev), can also increase ACE2 receptors.
Here's the problem: Potentially, the COVID19 virus seems to really like these ACE2 receptors, and can use ACE2 receptors on lung cells to gain entry to the lungs. So if you are a person taking medications that give you a lot more ACE2 receptors on your cells, if the proposed theories are correct -- its sort of like unintentionally putting out the welcome mat for the Coronavirus to move into your lungs -- resulting in an increased likelihood of viral pneumonia and other severe respiratory crises.
It should be noted that ACE2 receptors were linked to the SARS coronavirus in 2002-2003 (which at the time was understood as a global health threat, though it was much better contained than COVID-19). Click here for an example of the relevant science emerging from that past health crisis.
If the hypotheses about medications that increase ACE2 receptors and COVID-19 do turn out to be supported, this would help explain at least in part, why people with diabetes, high blood pressure, and heart disease are so disproportionately dying from COVID-19.
What to Do With This Information:
Again, with the disclaimer that I am not qualified to give any professional medical advice whatsoever --
Keep learning, share concerns with others, and encourage healthcare authorities to make patients aware of the proposed risk, notwithstanding the fact that more research is needed, and the link between medications and COVID-19 are not proven. Given the lives immediately at stake, patients who take the medications in question should at least be aware that there is a possible risk, and get to make decisions based on available information. Currently, organizations like the American Heart Association are saying that people should just keep taking their medications even if they have COVID-19 symptoms (or a diagnosis), since the link is uncertain. As a result, physicians and pharmacists are mostly not raising the issue unless a patient hears about it first and asks. Liability concerns can factor in for healthcare providers -- as if a patient stops taking a heart or blood pressure medication at a physican's advice and has negative outcomes, the healthcare provider or institution may have to worry about a malpractice suit, whereas -- if someone gets sicker or dies from COVID-19: because the virus is so new and the link between medications and COVID-19 is still uncertain, the chances of malpractice liability are very minimal. So institutions that prioritize concerns about liability over patient safety may feel that it's best to just avoid acting on the issue, until the research is more certain one way or another (which may take many more months).
Though, again, a potential link between severe COVID-19 symptoms and over the counter medications like ibuprofen and naproxen is also hypothetical and unproven (and has been the subject of controversy in Europe, and within the World Health Organization, and more recently the U.S. media) -- while we wait for more study, it's important for people to know that there is at least a possible, albeit smaller, risk, since taking over the counter fever reducers is one of the things we may otherwise do to manage COVID-19 symptoms. Acetaminophen (tylenol) does not increase ACE2 receptors, so it is an alternative for people concerned about the proposed risk.
Last, I want to disclaim again that there is no suggestion that just taking the medications in question would increase your risk of contracting COVID-19. The issue is relevant for people who already have the virus, and are therefore at risk of developing severe symptoms. Suddenly stopping use of a diabetes, heart, or blood pressure medication can sometimes be dangerous, and I would reach out to your primary care provider (or cardiologist) first, to discuss alternatives, if you decide you want to avoid medications that increase the presence of ACE2 receptors on your cells, so that you can potentially transition to other medications that don't increase your ACE2 receptors. For anyone who already has COVID-19 symptoms and is taking these medications however -- I think it's very important to reach out immediately and make some rapid decisions. Viral pneumonia and other severe respiratory symptoms are typically showing up in COVID-19 cases about 10-14 days after the person first gets symptoms, so it matters to act quickly.