ANTI-INFLAMMATORIES AND COVID

DEXAMETHASONE vs NSAIDS vs HYDROXYCHLOROQUINE

At the start of the pandemic, the term “cytokine storm” was bantered about describing the over exaggerated inflammatory response the body had to being infected with SARS Cov-2. By the way, there is an article floating around describing the “bradykinin theory” of how Covid 19 affects us. I am editorializing the article and will post later this week. 

The cytokine storm is not common but complications from this reaction are the most common reasons for hospital admissions and deaths. Also early on in the pandemic, the combination of Zithromax, an antibiotic, and hydroxychloroquine, an anti-malarial, were touted as the definitive combination treatment for Covid. Since SARS Cov-2 is a virus, why would there be any notable benefit at all from these drugs since neither are antivirals? Well, first of all, they do not work that well regardless of what our fearless leader and even some in the medical community contend. Secondly, they both have anti-inflammatory effects, which is the likely mechanism of what little benefit they may provide.

Many medications have anti-inflammatory effects in the body. This includes many antibiotics, over-the-counter medications and even foods.

Corticosteroids (also known as glucocorticosteroids, glucocorticoids or just steroids) are among the most widely used drugs in the world and are effective in many inflammatory and immune diseases. The most common use of corticosteroids is in the treatment of asthma. I use them all the time to help decrease inflammation in acute infections.  Corticosteroids mimic the effects of hormones your body produces naturally in your adrenal glands, which sit on top of your kidneys. An example is cortisol, our “stress” hormone. Corticosteroids are completely different from the steroids you hear about which make your muscles big or we inject into animals to make them grow bigger and faster. Those are anabolic steroids.

The predominant effect of corticosteroids is to switch off multiple inflammatory genes which encode cytokines, chemokines, adhesion molecules, inflammatory enzymes, receptors and proteins, that have been activated during the chronic or acute inflammatory process. In higher concentrations they have additional effects on the production of anti-inflammatory proteins. They help to reduce swelling by shifting fluids from the tissues back into the intravascular space. The steroid which has been shown to be of benefit in Covid-19 is DEXAMETHASONE, or decadron. There is NO role in prevention of infection and in fact taking steroids regularly actually suppress your healthy immune system making it MORE likely to catch Covid-19 and have a worse outcome. To be clear, steroids dampen the immune response but in doing so, they also increase the risk of catching an infection since they also lower our ability to defend ourselves. This includes defending ourselves against cancerous cells which develop every day in everyone’s bodies. 

NSAIDs (Non-Steroidal Anti-inflammatory Drugs) work by reducing the production of prostaglandins. Prostaglandins are chemicals that promote inflammation, pain, and fever. Examples of NSAIDs are Aspirin (ASA or acetylsalicylic acid), Motrin and Advil (ibuprofen) and Aleve and Naprosyn (naproxen). Although they do decrease inflammation and may help with the symptoms of Covid like fever, headaches and aches and pains, they have no role in the more severe cases treated in hospital.

Hydroxychloroquine, again an anti-parasitic drug first developed to treat malaria, is thought to interfere with the metabolic communication between the body’s immune system cells. If the cells can’t effectively communicate with each other, then the excessive immune response of RA is reduced. The same may occur with Covid-19. It has many side effects however, just like any other drug, including arrhythmias and cardiac death. I have also heard from ICU docs that it actually impairs the beneficial effects of Remdesivir, an antiviral which has also been shown to be effective in some patients when administered early on.

Zithromax, an antibiotic, also has anti-inflammatory effects. It causes increased production of  Interleukin-10 (IL-10), one of the proinflammatory cytokine compounds produced. From personal experience, I see many patients who were placed on this antibiotic for questionable reasons. When I ask patients, they often say that someone prescribed it “just in case” there was an infection. Makes me want to pull my hair out. The anti-inflammatory effect may be the actual cause for improvement in symptoms rather than treating an actual infection and in the meanwhile, you’re destroying up to 1/3rd of your healthy gut microbiome and it can take months to recover. Not a good thing.

When you have an injury, regardless of the kind, there is a normal inflammatory response. Cuts get red. Insect bites swell. Lung infections result in coughing which is a nerve irritation… Too much inflammation in the body is not good. ALL chronic diseases produce additional inflammation we do not need. Extra weight is inflammatory. Foods we eat. Toxins we are exposed to. The air we breathe. The water we drink. Psychological and physical stress. The less inflammation in your body as a baseline, the better off you will be. 

The overwhelming reactions from Covid-19 are to some degree predictable but in some cases, why people who apparently are “healthy” die or get really sick is still unclear. Why some people, like CNNs Chris Cuomo, are having long-term and delayed effects like depression, brain fog and fatigue is equally unclear. 

What is clear is that you don’t want to get sick if you can avoid it.

What is clear is that there are some very basic strategies you can follow which will minimize your chances of getting sick. You’ve read it before and I’ll spell it out again:

WEAR A MASK. Wear and handle it properly.

DISTANCE. Remember, physical, not social distancing. We NEED each other.

WASH YOUR HANDS.

DON’T TOUCH YOUR FACE.

WORK ON YOUR HEALTH. At least drink more water and eat more fruit and vegetables.

VENTILATE. More airflow = more viral dilution.

VACCINATE against the flu.

Stay safe and be well. 

AC 😎✌️🌱❤🐖🏃🏻🧘🏻‍♂️🌎😷